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  Français - August 16, 2011
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  Topic  

Treatment therapies

Diabetes is a chronic disease that weakens the capacity of the body to produce or use insulin adequately. Type 2 diabetes leads to hyperglycemia (excessive levels of sugar in the blood) and can cause complications such as kidney or heart disease, stroke, blindness and impotence. To fight the deterioration of the quality of life of diabetic patients, many possibilities are available to help them live with the disease. Pharmacological treatment is an aspect that is studied, as well as alternative methods such as nutrition, the use of natural products...

Presentations listing

Medication Matters - Dr. Pat Phillips
Therapeutic Inertia - Dr. Pat Phillips
Hypoglycaemia - Dr. Pat Phillips
Hypoglycaemia - Dr. Pat Phillips
Post Prandial BGL – As simple as 1, 2, 3 - Dr. Pat Phillips
Glycemic intervention studies in type 2 DM: implications... - Dr. Lawrence A. Leiter
Lung function and inhaled insulin in diabetes - Prof. Timothy Davis
Pros and cons of newer diabetes strategies - DPP-4... - Prof. John Prins
Starting insulin in Type 2 Diabetes - Dr. Pat Phillips
Insulin Pump Therapy in Children and Adolescents - A.Prof. Timothy W. Jones
Antipsychotics and Diabetes - Prof. John Prins
The Edmonton protocol - Where to from now? - Dr. Philip O'Connell
Practical diabesity intervention: Strategies borrowed from... - Dr. Soji Swaraj
Is self-monitoring of blood glucose (SMBG) worthwhile in... - Prof. Timothy Davis
Adding PS to the ABCss of Diabetes Care – An Australian... - Dr. Pat Phillips
The Progressive Nature of Type 2 Diabetes - Update on... - Prof. Giancarlo Viberti
Are We Making Progress With Slowing Disease Progression? - Prof. Peter J. Grant
Complementary Therapies - An Overview - Prof. Trisha Dunning
UKPDS - Unanswered Questions? - Prof. Rury Holman
Pharmacotherapy for Obesity - Dr. David Lau
Oral Hypoglycemic Agents and Cardiac Events: The Good the... - Dr. David S.H. Bell
Prevention and Treatment of Diabetic Nephropathy:... - Dr. Richard E. Gilbert
Treating Obesity in Type 2 DM: What's New? - Dr. Jeannette Goguen
Thiazolidinediones and the Heart: A Tale of Two Organs? - Dr. Robin Buckingham
Diabetes In Canada Evaluation (The DICE Study): Impact on... - Dr. Stewart Harris
The FIELD Study - Prof. Timothy Davis
Dual PPAR alpha/gamma Agonists - Promise and Problems - Prof. John Prins
Update on Dietary and Drug Management of Atherogenic... - Dr. Ronald M. Krauss
Differential Effects of Rosiglitazone and Metformin on... - Prof. Allen J. Taylor
The VICTORY Study: Assessing the efficacy of rosiglitazone... -
TZDs and Atherosclerosis: Can They Make a Difference? - Dr. Lawrence A. Leiter
The Link Between Diet, Exercise, and Insulin Resistance... - Dr. Stuart A Ross
The PROACTIVE Study: What are Its Implications for the... - Dr. Lawrence A. Leiter
Anti-atherogenic Effects of PPAR gamma Activators – From... - Prof. Nikolaus Marx
Effect of Troglitazone on Pre-Clinical Carotid... - Prof. Thomas A. Buchanan
Evidence Versus Reality: Gaps in Cardiovascular Risk Factor... - Dr. Baiju R. Shah
Managing Diabetes and Insulin Resistance in Patients with... - Dr. Vivian A. Fonseca
The ORIGIN Study - Prof. Hertzel Gerstein
New drugs for 'Prediabetes', Metabolic Syndrome and their... - Prof. Michael A. Nauck
Should We Measure hsCRP After Starting Statin Therapy?... - Dr. Paul M. Ridker
Pitfalls in DKA - Dr. Jeannette Goguen
Advanced Insulin Pump Strategies: Exercise and the Athlete - Dr. Bruce Perkins
The Heart in Type 2 Diabetes Mellitus - Hyperglycemia: A... - Dr. Richard W. Nesto
Treatment of Painful Diabetic Neuropathy - Dr. Gyl Midroni
ACE-I and ARB Combination Therapy Should Be a Standard... - Dr. Alice Cheng
ACEI + ARB Therapy Should Be A Standard Treatment in People... - Dr. Phil McFarlane
Long-Acting Insulin Analogues - Dr. Amir Hanna
Identifying Metabolic Syndrome as a Risk Factor for Type 2... - Dr. Barry Goldstein
Canadian Diabetes Association 2003 Clinical Practice... - Prof. Bernard Zinman
TZDs and Cardiac Function - Dr. Peter Liu
Diabetes Treatments and Inflammatory Markers - Dr. Vivian A. Fonseca
Treatment with insulin detemir provides improved glycaemic... - Dr. A. J. Garber
Markers of endothelial dysfunction and insulin resistance.... - Prof. Paul Valensi
Diabetes/Lipids - Dr. Ehud Ur
Evolving Therapies in Type 2 Diabetes - Prof. John Prins
Based on these mechanisms, are beta-cells a therapeutic... - Dr. Julio Rosenstock
What clinical guidelines are available to support the need... - Dr. Steven V. Edelman
Should insulin resistance be considered a therapeutic... - Dr. Steven V. Edelman
Good Morning Diabetes: Building a New Framework for... - Dr. James R. Gavin
Could you please comment on recent clinical trials of... - Dr. Andrew P. Selwyn
What clinical evidence is available to support... - Dr. Andrew P. Selwyn
What is the rationale for earlier use of oral antidiabetic... - Dr. Steven V. Edelman
What is the evidence for combination therapy with a TZD... - Dr. Julio Rosenstock
What are some of the clinical management issues with TZDs... - Dr. Andrew P. Selwyn
What is the increasing evidence that supports TZDs and... - Dr. Julio Rosenstock
What clinical data is there regarding inflammatory markers... - Dr. Steven V. Edelman
Are there any outcome measures that suggest a favorable... - Dr. Julio Rosenstock
How can we make a difference in clinical practice to... - Dr. Andrew P. Selwyn
Dr. Rosenstock Summary - Dr. Julio Rosenstock
Dr. Edelman Summary - Dr. Steven V. Edelman
Dr. Selwyn Summary - Dr. Andrew P. Selwyn
Dr. Gavin Concludes - Dr. James R. Gavin
Use of Thiazolidinediones in Type 2 Diabetes: Advantages - Dr. David Kendall
Type 2 Diabetes Mellitus and Heart Failure: Implications... - Dr. Richard W. Nesto
2003 CDA Clinical Practice Guidelines for the prevention... - Dr. Amir Hanna
Hypoglycemic Disorders: Investigation and Treatment - Dr. Amir Hanna
Treating Dyslipidemia in Diabetes - Dr. Jeannette Goguen
Novel Dietary Therapies in the Treatment of Diabetes and... - Dana Whitham
Targets for Glucose Control: A Review of Recent Evidence - Dr. Gillian Booth
Perioperative Glycemic Control - Dr. Alice Cheng
The Value of Combination Therapy in Type 2 Diabetes - Prof. Bernard Zinman
Sustaining Long-Term Glycemic Control: Are we ready for... - Dr. Stuart A Ross
Thiazolidinediones to Preserve B-Cell Function and Prevent... - Prof. Thomas A. Buchanan
Shifting the paradigm: from stepwise to early combination... - Prof. Rury Holman
The case for rosiglitazone therapy : putting theory into... - Dr. Kathleen Wyne
What are the optimal combination strategies in order to... - Dr. Lawrence A. Leiter
Early combination therapy in type 2 diabetes: targeting... - Prof. John Nolan
Scientific Update: Rosiglitazone in Perspective - Dr. Robin Buckingham
Multifactorial Intervention and Cardiovascular Disease in... - Dr. Oluf Pedersen
Looking at New Evidence: Immediate Solutions to a Long-Term... - Dr. Steven V. Edelman
Type 2 diabetes-Early : Aggressive Treatment Strategies - Dr. Amir Hanna
Canadian Diabetes Association Guidelines - Update - Dr. Stewart Harris
Targeting Glycemia in Type 2 Diabetes - Prof. Bernard Zinman
Sustaining Long-Term Glycemic Control - Dr. Stuart A Ross
Hypoglycemia in Type 2 Diabetes: Impact and Management - Dr. Amir Hanna
Type 2 Diabetes: A Multifactorial Syndrome - Dr. Stuart A Ross
Treating Type 2 Diabetes Patients to Target - Dr. Lawrence A. Leiter
Alternative Therapies in the Glycemic Control of Type 2... - Dr. Jeannette Goguen
Use of Combination Therapy in the Treatment of Type 2... - Dr. Amir Hanna
The Treatment of Obesity in Type 2 Diabetes - Dr. Lawrence A. Leiter
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 Presentation 

"Medication Matters"

Dr. Pat Phillips (biography)
English - 2009-11-24 - 43 minutes
(38 slides)

Summary :
Type 2 diabetic patients can take numerous types of medications both prescribed and complementary, and it is important to know which of these should be encouraged, stopped or better managed, according to their role in the context of diabetes management.

Ideally, the “type 2 tablet” would exist and include metformin, an ACE inhibitor, aspirin, and a statin, which would be...

Learning objectives :
After viewing this presentation the participant will be able to discuss:
- What the ideal “type 2 tablet” would contain and why
- Side effects of commonly used hypoglycaemic and other types of drugs
- Medications to consider stopping in type 2 diabetic patients
- How to address the issue of adherence with the patient
- Which drugs should be taken at a certain time/under certain conditions

   


 Presentation 

"Therapeutic Inertia"

Dr. Pat Phillips (biography)
English - 2009-11-24 - 14 minutes
(35 slides)

Summary :
The problem of therapeutic inertia in diabetes management has been long acknowledged. How should the problem be addressed? Studies in patients and healthcare providers give some indication that a different approach makes the difference.

Keeping the HbA1c below 7 percent has been recommended by the ADA and EASD (1). There are however different reasons for patients or physicians to...

Learning objectives :
After viewing this presentation, the participant will be able to:
- Review the progressive natural history of type 2 diabetes
- Identify patient and physician factors that impede good glycaemic control
- Describe randomized evidence on the effects on risk factors and risk of complications, due to having active physicians and active patients

Bibliographic references :
1) Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B.Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy - A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care. 2006 Aug;29(8):1963-72.

2) R. Rachmani, Z. Levi, I. Slavachevski, M. Avin and M. Ravid Teaching patients to monitor their risk factors retards the progression of vascular complications in high-risk patients with Type 2 diabetes mellitus—a randomized prospective study Diabetic Medicine 2002; Volume 19 Issue 5, Pages 385 - 392.

3) Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes NEJM 2003;348:383-393.

   


 Presentation 

"Hypoglycaemia"

Dr. Pat Phillips (biography)
English - 2009-10-17 - 36 minutes
(26 slides)

Summary :
Hypoglycaemia risk per thousand patient years is higher in Type 1 patients compared to Type 2, according to a comparison of the data from the DCCT and UKPDS studies. Type 1 patients have no intrinsic compensatory mechanism, and hence are more sensitive to increases in the insulin dose.

Type 2 patients with longstanding diabetes may have a similar risk of hypoglycaemia as Type 1...

Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Hypoglycaemia risk in Type 1 vs Type 2 diabetes
- The ‘5,4,3,2,1’ rule for physiological responses to hypoglycaemia; loss of hypoglycaemic awareness
- Circumstances leading to hypoglycaemia in Type 1 and Type 2
- Hypoglycaemia and drugs
- Protocols for hypoglycaemia treatment

   


 Presentation 

"Hypoglycaemia"

Dr. Pat Phillips (biography)
English - 2009-10-17 - 36 minutes
(26 slides)

Summary :
Hypoglycaemia risk per thousand patient years is higher in Type 1 patients compared to Type 2, according to a comparison of the data from the DCCT and UKPDS studies. Type 1 patients have no intrinsic compensatory mechanism, and hence are more sensitive to increases in the insulin dose.

Type 2 patients with longstanding diabetes may have a similar risk of hypoglycaemia as Type 1...

Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Hypoglycaemia risk in Type 1 vs Type 2 diabetes
- The ‘5,4,3,2,1’ rule for physiological responses to hypoglycaemia; loss of hypoglycaemic awareness
- Circumstances leading to hypoglycaemia in Type 1 and Type 2
- Hypoglycaemia and drugs
- Protocols for hypoglycaemia treatment

   


 Presentation 

"Post Prandial BGL – As simple as 1, 2, 3"

Dr. Pat Phillips (biography)
English - 2009-08-24 - 32 minutes
(46 slides)

Summary :
Dr. Phillips discusses issues to consider when trying to control post prandial blood glucose. The three components of controlling post prandial blood glucose are: to count the carbohydrates (carbs) to be consumed in the meal, to check the blood glucose level, and to take the required amount of insulin. If the 2-hour blood glucose level is too high or too low, the carbs component or the blood...

Learning objectives :
After viewing this presentation the participant will be able to:
- Establish with the patient a system of carbohydrate counting, blood glucose monitoring, and insulin dosing for controlling post prandial blood glucose
- Explain to the patient the impact of basal glycaemia on the effectiveness of this system

   


 Presentation 

"Glycemic intervention studies in type 2 DM: implications for patient care"

Dr. Lawrence A. Leiter (biography)
English - 2009-08-14 - 40 minutes
(31 slides)

Summary :
In this presentation Dr. Leiter reviews updated evidence from trials looking at the role of glycemic control in reducing the risk of diabetic complications.

There is evidence to support the concept of “earlier is better” for glycemic control in the prevention of cardiovascular (CV) complications, in type 1 and type 2 diabetic patients. In type 1 patients, the 10-year EDIC...

Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Long-term reductions in cardiovascular outcomes associated with earlier glycemic control in type 1 and type 2 diabetic patients
- Evidence for “earlier is better” regarding glycemic control in type 2 patients
- Data suggesting harm from intensive treatment in some patients
- Current Canadian glycemic targets
- Treatment in patients with coronary artery disease

Bibliographic references :
The Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Effect of Intensive Therapy on the Microvascular Complications of Type 1 Diabetes Mellitus JAMA Vol. 287 No. 19, May 15, 2002.

The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes NEJM Volume 353:2643-2653.

Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Effect of a Multifactorial Intervention on Mortality in Type 2 DiabetesNEJM Volume 358:580-591.

Rury R. Holman, F.R.C.P., Sanjoy K. Paul, Ph.D., M. Angelyn Bethel, M.D., David R. Matthews, F.R.C.P., and H. Andrew W. Neil, F.R.C.P. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes NEJM Volume 359:1577-1589.

The Action to Control Cardiovascular Risk in Diabetes Study GroupEffects of Intensive Glucose Lowering in Type 2 Diabetes N Engl J Med. 2008 Jun 12;358(24):2545-59.

   


 Presentation 

"Lung function and inhaled insulin in diabetes"

Prof. Timothy Davis (biography)
English - 2009-07-24 - 36 minutes
(26 slides)

Summary :
Pulmonary involvement in diabetes was first reported about thirty years ago, and in 1989 a cross-sectional study from Denmark was published showing slightly impaired lung function among diabetic patients, which was more apparent in those taking insulin (1).

More recently, cross-sectional and prospective data from the Fremantle Diabetes Study shed further light on the topic. In this...

Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The effect of diabetes on the lung
- The rationale for inhaled insulin
- The status of inhaled insulin

Bibliographic references :
1. Lange P, Groth S, Kastrup J, Mortensen J, Appleyard M, Nyboe J, Jensen G, Schnohr P. Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study. Eur Respir J. 1989 Jan;2(1):14-9.

2. Timothy M.E Davis, Matthew Knuiman, Peter Kendall, Hien Vu, Wendy A Davis Reduced pulmonary function and its associations in type 2 diabetes: the Fremantle Diabetes Study Diabetes Research and Clinical Practice - 1 October 2000 (Vol. 50, Issue 2, Pages 153-159)

3. Davis WA, Knuiman M, Kendall P, Grange V, Davis TM; Fremantle Diabetes Study.Glycemic Exposure Is Associated With Reduced Pulmonary Function in Type 2 Diabetes: The Fremantle Diabetes Study Diabetes Care. 2004 Mar;27(3):752-7.

   


 Presentation 

"Pros and cons of newer diabetes strategies - DPP-4 inhibitors and incretins"

Prof. John Prins (biography)
English - 2009-05-27 - 40 minutes
(58 slides)

Summary :
After glucose, the incretin hormones are the most important stimulator of insulin secretion, says Prof. Prins.

The incretin effect is reduced in type 2 diabetes. Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are the two major incretin hormones. They can be increased by using oral dipeptidyl peptidase-4 (DPP-4) inhibitors which stop the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Contributors to hyperglycaemia in T2DM
- Regulation of glucose homeostasis by incretins
- Similarities and differences between effects of DPP-4 inhibitors and GLP-1 analogues
- Efficacy and safety of these agents

Bibliographic references :
M. Nauck et al. Reduced incretin effect in Type 2 (non-insulin-dependent) diabetes Diabetologia. Volume 29, Number 1 / January, 1986

   


 Presentation 

"Starting insulin in Type 2 Diabetes"

Dr. Pat Phillips (biography)
English - 2009-03-23 - 48 minutes
(35 slides)

Summary :
Dr Phillips talks about initiation of insulin therapy in type 2 diabetic patients using the KISS (Keep Insulin Safe and Simple) principle.

The use of insulin sooner rather than later in type 2 diabetes is supported by findings from the United Kingdom Prospective Diabetes Study (UKPDS). As the study showed, there was an increasing loss of glycaemic control with time regardless of...

Learning objectives :
After viewing this presentation the participant will be able to:
- Explain the progressive nature of type 2 diabetes
- Demonstrate the rationale for and safety of earlier use of insulin in type 2 diabetes
- Implement the KISS (Keep Insulin Safe and Simple) method for commencement of insulin therapy in type 2 patients

Bibliographic references :
Robert C. Turner, FRCP; Carole A. Cull, PhD; Valeria Frighi, MD; Rury R. Holman, FRCP; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49) JAMA. 1999;281:2005-2012.

Brown JB, Nichols GA, Perry A.The Burden of Treatment Failure in Type 2 Diabetes
Diabetes Care 27:1535-1540, 2004.

UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet 352; 837-53.1998

Irl B. Hirsch, MD, Richard M. Bergenstal, MD, Christopher G. Parkin, MS, Eugene Wright, Jr., MD and John B. Buse, MD, PhD A Real-World Approach to Insulin Therapy in Primary Care Practice Clinical Diabetes 23:78-86, 2005.

   


 Presentation 

"Insulin Pump Therapy in Children and Adolescents"

A.Prof. Timothy W. Jones (biography)
English - 2008-02-04 - 27 minutes
(50 slides)

Summary :
In this presentation A.Prof. Jones talks about the rationale for, and clinical experience with insulin pump therapy in children and adolescents.

The maintenance of good glycaemic control is difficult in children and adolescents with type 1 diabetes, due to a number of factors. Severe hypoglycemia remains a major problem, however insulin pump treatment was associated with reduced...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Obstacles to good glycaemic control in children and adolescents with T1DM
- Safety and efficacy of insulin pump therapy in children and adolescents
- Importance of a patient and family centred team approach for insulin pump therapy to be successful

Bibliographic references :
1. Bulsara MK, Holman CD, Davis EA, Jones TW.The Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children With Type 1 Diabetes Diabetes Care 27:2293-2298, 2004.

2. Battelino T.Risk and benefits of continuous subcutaneous insulin infusion (CSII) treatment in school children and adolescents Pediatr Diabetes. 2006 Aug;7 Suppl 4:20-4.

   


 Presentation 

"Antipsychotics and Diabetes"

Prof. John Prins (biography)
English - 2007-11-21 - 25 minutes
(19 slides)

Summary :
In this presentation Prof. Prins talks about the relationship between the use of therapies for major psychiatric disorders and the increase in the incidence of metabolic dysfunction.

Different types of studies have suggested a trend toward worsening metabolic dysfunction with antipsychotic therapies (1). An important effect of these therapies is weight gain, and related to the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Metabolic dysfunction in schizophrenia
- Metabolic effects of antipsychotic therapies
- Data to suggest within-class differences in metabolic effects of antipsychotics
- Management of patients taking atypical antipsychotics

Bibliographic references :
1. Holt RIG and Peveler RC Association between antipsychotic drugs and diabetes Diabetes, Obesity and Metabolism 8 (2) , 125–135.

2. Haupt DW, Kane JM.
Metabolic risks and effects of atypical antipsychotic treatment. J Clin Psychiatry. 2007 Oct;68(10):e24.


3. STEPHEN H. SCHULTZ, MD, STEPHEN W. NORTH, MD, mph, and CLEVELAND G. SHIELDS, PhD. Schizophrenia: A Review Am Fam Physician. 2007 Jun 15;75(12):1821-9.

   


 Presentation 

"The Edmonton protocol - Where to from now?"

Dr. Philip O'Connell (biography)
English - 2007-11-17 - 43 minutes
(40 slides)

Summary :
In patients with type 1 diabetes, increasing hypoglycaemia with improving glycaemic control is a problem in patients on intensive insulin treatment. Although the DCCT study showed intensive insulin treatment to result in less complications, the accompanying risk of severe hypoglycaemia makes it harder to maintain long-term.

Islet transplantation aims to achieve normal HbA1c using...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The rationale of the Edmonton protocol for islet transplantation
- Results from the Edmonton group and the International Multicenter Trial of Islet Transplantation Using the Edmonton Protocol in Patients with Type 1 Diabetes
- Benefits of and problems with the Edmonton protocol
- Future directions for research

Bibliographic references :
A.M. James Shapiro, M.B., B.S., Jonathan R.T. Lakey, Ph.D., Edmond A. Ryan, M.D., Gregory S. Korbutt, Ph.D., Ellen Toth, M.D., Garth L. Warnock, M.D., Norman M. Kneteman, M.D., and Ray V. Rajotte, Ph.D.Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen N Engl J Med. 2000 Jul 27;343(4):230-8.

2.Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JR, Shapiro AM. Five-Year Follow-Up After Clinical Islet Transplantation Diabetes 54:2060-2069, 2005.

3. A.M. James Shapiro, M.D., Ph.D., Camillo Ricordi, M.D., Bernhard J. Hering, M.D., Hugh Auchincloss, M.D., Robert Lindblad, M.D., R. Paul Robertson, M.D., Antonio Secchi, M.D., Mathias D. Brendel, M.D., Thierry Berney, M.D., Daniel C. Brennan, M.D., Enrico Cagliero, M.D., Rodolfo Alejandro, M.D., Edmond A. Ryan, M.D., Barbara DiMercurio, R.N., Philippe Morel, M.D., Kenneth S. Polonsky, M.D., Jo-Anna Reems, Ph.D., Reinhard G. Bretzel, M.D., Federico Bertuzzi, M.D., Tatiana Froud, M.D., Raja Kandaswamy, M.D., David E.R. Sutherland, M.D., Ph.D., George Eisenbarth, M.D., Ph.D., Miriam Segal, Ph.D., Jutta Preiksaitis, M.D., Gregory S. Korbutt, Ph.D., Franca B. Barton, M.S., Lisa Viviano, R.N., Vicki Seyfert-Margolis, Ph.D., Jeffrey Bluestone, Ph.D., and Jonathan R.T. Lakey, Ph.D.International Trial of the Edmonton Protocol for Islet Transplantation N Engl J Med. 2006 Sep 28;355(13):1318-30.

   


 Presentation 

"Practical diabesity intervention: Strategies borrowed from the marketing and economics world"

Dr. Soji Swaraj (biography)
English - 2007-08-17 - 12 minutes
(37 slides)

Summary :
In this presentation Dr. Swaraj talks about how disciplines outside of medicine, such as economics and marketing, can help in understanding the diabesity epidemic and motivating diabetic patients to adhere to therapy and lifestyle change.

How can the current diabesity epidemic be explained? According to economic theory, human lifestyles have been 'optimised' to minimise energy...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Why bother with aggressive diabesity intervention?
- Failure in achieving targets: economic and marketing hypotheses
- Are standard approaches counterproductive?
- Solutions: A patient-centric 'marketing' approach

   


 Presentation 

"Is self-monitoring of blood glucose (SMBG) worthwhile in type 2 diabetes? Findings from the Fremantle Diabetes Study"

Prof. Timothy Davis (biography)
English - 2007-05-31 - 37 minutes
(32 slides)

Summary :
Although self-monitoring of blood glucose (SMBG) is unanimously recommended for type 2 diabetic patients treated with insulin, there is no international consensus on whether SMBG is required in those on diet or oral antihyperglycaemic treatment (1).

Here Prof. Davis presents recently published data from the prospective, observational Fremantle Diabetes Study (FDS). These analyses...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The value of self-monitoring of blood glucose in type 2 diabetes

Bibliographic references :
1. Burgers JS, Bailey JV, Klazinga NS, Van Der Bij AK, Grol R, Feder G; AGREE COLLABORATION.Comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries Diabetes Care 25:1933-1939, 2002.

2. Wendy A. Davis, PHD, David G. Bruce, MD and Timothy M.E. Davis, DPHILIs Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients? Diabetes Care 29:1764-1770, 2006.

3. W. A. Davis, D. G. Bruce1 and T. M. E. Davis. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study Diabetologia 2007;50:510-515.

4. S. Martin, B. Schneider, L. Heinemann, V. Lodwig, H.-J. Kurth, H. Kolb, W. A. Scherbaum and for the ROSSO Study Group.Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study Diabetologia 2006;49:271-278.

   


 Presentation 

"Adding PS to the ABCss of Diabetes Care – An Australian Perspective"

Dr. Pat Phillips (biography)
English - 2006-12-07 - 29 minutes
(35 slides)

Summary :
In this presentation, Dr. Phillips talks about the importance of adding psychosocial (PS) issues to the "ABCss" of diabetes care or working to achieve the targets for A1c, blood pressure, cholesterol, salicylate use and smoking cessation.

Psychosocial issues can impact on diabetes control/care and vice versa. In addition, depression has been found to be an independent risk factor...

Learning objectives :
After viewing this presentation, the participant will be able to discuss:

- Why diabetes is commonly associated with psychosocial issues.
- The importance of psychosocial issues affecting and being affected by diabetes control and care.
- The risk of diabetes complications associated with psychosocial issues, particularly depression.
- Ways to incorporate assessment and intervention into the routine cycle of diabetes care.

Bibliographic references :
1. Stephen J Bunker, David M Colquhoun, Murray D Esler, Ian B Hickie, David Hunt, V Michael Jelinek, Brian F Oldenburg, Hedley G Peach, Denise Ruth, Christopher C Tennant and Andrew M Tonkin"Stress" and coronary heart disease: psychosocial risk factors - National Heart Foundation of Australia position statement update MJA 2003 178 (6): 272-276.

   


 Presentation 

"The Progressive Nature of Type 2 Diabetes - Update on Clinical Management: Results of the ADOPT Trial"

Prof. Giancarlo Viberti (biography)
English - 2006-12-04 - 43 minutes
(31 slides)

Summary :
Clinical management of type 2 diabetes has conventionally relied on a stepwise approach, in which therapy is intensified, from diet and exercise, through monotherapy and then on to combination therapy, in response to steadily worsening glycaemic control. As such, the stepwise approach implicitly acknowledges type 2 diabetes as an inevitably progressive disorder and principally aims to respond to...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

Newly-released results from the ADOPT trial - Effects of rosiglitazone versus metformin or glyburide as initial therapy in recently diagnosed type 2 diabetic patients:

- Primary outcome: Time to monotherapy failure - FPG > 180 mg/dl (> 10 mmol/L)
- Secondary outcomes: FPG > 140 mg/dl (> 7.8 mmol/L); Changes in FPG, HbA1c, insulin sensitivity and beta-cell function
- Adverse events
- Clinical implications

Bibliographic references :
Steven E. Kahn, Steven M. Haffner, Mark A. Heise, William H. Herman, Rury R. Holman, Nigel P. Jones, Barbara G. Kravitz, John M. Lachin, M. Colleen O'Neill, Bernard Zinman, Giancarlo Viberti, for the ADOPT Study Group Glycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy NEJM. 2006 Dec;(23) 355:2427-2443

   


 Presentation 

"Are We Making Progress With Slowing Disease Progression?"

Prof. Peter J. Grant (biography)
English - 2006-12-04 - 17 minutes
(9 slides)

Summary :
Our understanding of the pathophysiological relationship between diabetes and cardiovascular disease has been markedly increased over the last 15 years. The seminal ADA lecture by Reaven in 1989, which described the existence of cardiovascular risk clustering in the presence of underlying insulin resistance, has been followed by a wave of publications linking changes in classical and novel...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Diabetes and cardiovascular disease: the "common soil" hypothesis
- Targeting of beta-cell dysfunction and increasing insulin resistance
- The DREAM trial: summary and conclusions
- The ADOPT trial: summary of glycaemic efficacy; outstanding questions
- Clinical trials across the diabetes continuum

   


 Presentation 

"Complementary Therapies - An Overview"

Prof. Trisha Dunning (biography)
English - 2006-10-28 - 59 minutes
(46 slides)

Summary :
What are complementary therapies? According to the British Medical Association, they are therapies which can work alongside and in conjunction with orthodox medical treatment.

People with diabetes have been found to be more likely to use complementary therapies than non-diabetics (1). What do people with diabetes use? Among the range of therapies used are glucose-lowering and...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The philosophical basis of complementary therapies
- Frequency of complementary therapy use in diabetic patients
- Types of herbs and supplements used by diabetic patients
- Safety issues associated with complementary therapy use
- Potential interactions between herbal and conventional medicines

Bibliographic references :
1. Leonard E. Egede, MD, MS, Xiaobou Ye, MD, MS, Deyi Zheng, MB, PHD and Marc D. Silverstein, MDThe Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals With Diabetes Diabetes Care 25:324-329, 2002

   


 Presentation 

"UKPDS - Unanswered Questions?"

Prof. Rury Holman (biography)
English - 2006-09-13 - 31 minutes
(33 slides)

Summary :
The UKPDS was a landmark 20-year trial which showed that the complications of type 2 diabetes could be reduced by more intensive management of glycaemia and blood pressure. In 5, 102 patients recruited with newly-diagnosed type 2 diabetes, the study demonstrated that maintaining improved blood glucose control with sulphonylurea or insulin monotherapy over median 10.3 years reduced the risk of the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Additive effects of glucose and blood pressure control in T2DM
- Ongoing studies on glucose control and macrovascular risk
- Macrovascular benefits of metformin
- T2DM, metabolic syndrome and CVD mortality
- CHD case fatality with and without SU therapy in the UKPDS
- The progressive nature of T2DM

   


 Presentation 

"Pharmacotherapy for Obesity"

Dr. David Lau (biography)
English - 2006-05-26 - 82 minutes
(40 slides)
(55 slides)

Summary :
According to data from Statistics Canada the majority of adults in Canada are overweight or obese, and not only that but as a study reported in the Canadian Medical Association Journal in 2000 indicated, the childhood obesity rates have been climbing as well (1).

Obesity is known to be associated with a number of medical complications, and with respect to the metabolic...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The emerging dual epidemics of obesity and type 2 diabetes
- The role of abdominal adiposity in metabolic co-morbidities
- Current and future pharmacotherapy for obesity
- Implications of CPGs in the treatment and prevention of obesity

Bibliographic references :
1. Mark S. Tremblay and J. Douglas Willms Secular trends in the body mass index of Canadian children CMAJ. 2000 Nov 28;163(11):1429-33

2. Lau DC, Yan H, Dhillon B. Metabolic syndrome: A marker of patients at high cardiovascular risk Can J Cardiol. 2006 Feb;22 Suppl B:85B-90B.

Further reading:

Alison E. Field, ScD; Eugenie H. Coakley; Aviva Must, PhD; Jennifer L. Spadano, MA; Nan Laird, PhD; William H. Dietz, MD, PhD; Eric Rimm, ScD; Graham A. Colditz, MD, DrPH Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period Arch Intern Med. 2001;161:1581-1586

Yong-Woo Park, MD, PhD; Shankuan Zhu, MD, PhD; Latha Palaniappan, MD; Stanley Heshka, PhD; Mercedes R. Carnethon, PhD; Steven B. Heymsfield, MD The Metabolic Syndrome: Prevalence and Associated Risk Factor Findings in the US Population From the Third National Health and Nutrition Examination Survey, 1988-1994 Arch Intern Med. 2003;163:427-436

Vincent J. Carey, Ellen E. Walters, Graham A. Colditz, Caren G. Solomon, Walter C. Willet, Bernard A. Rosner, Frank E. Speizer and JoAnn E. Manson Body Fat Distribution and Risk of Non-Insulin-dependent Diabetes Mellitus in Women: The Nurses' Health Study American Journal of Epidemiology Vol. 145, No. 7: 614-619

Lau DC, Dhillon B, Yan H, Szmitko PE, Verma S. Adipokines: molecular links between obesity and atheroslcerosis Am J Physiol Heart Circ Physiol 288: H2031-H2041, 2005

Jean-Pierre Després, professor, Isabelle Lemieux, PhD student, Denis Prud'homme, professor Treatment of obesity: need to focus on high risk abdominally obese patients BMJ 2001;322:716-720

Sjostrom L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HP, Krempf M. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients Lancet. 1998 Jul 18;352(9123):167-72


Hollander PA, Elbein SC, Hirsch IB, Kelley D, McGill J, Taylor T, Weiss SR, Crockett SE, Kaplan RA, Comstock J, Lucas CP, Lodewick PA, Canovatchel W, Chung J, Hauptman J. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study Diabetes Care. 1998 Aug;21(8):1288-94

James WP, Astrup A, Finer N, Hilsted J, Kopelman P, Rossner S, Saris WH, Van Gaal LF. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance Lancet. 2000 Dec 23-30;356(9248):2119-25

Thomas A. Wadden, Ph.D., Robert I. Berkowitz, M.D., Leslie G. Womble, Ph.D., David B. Sarwer, Ph.D., Suzanne Phelan, Ph.D., Robert K. Cato, M.D., Louise A. Hesson, M.S.N., Suzette Y. Osei, M.D., Ph.D., Rosalind Kaplan, M.D., and Albert J. Stunkard, M.D. Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity N Engl J Med. 2005 Nov 17;353(20):2111-20

Zhaoping Li, MD, PhD; Margaret Maglione, MPP; Wenli Tu, MS; Walter Mojica, MD; David Arterburn, MD, MPH; Lisa R. Shugarman, PhD; Lara Hilton, BA; Marika Suttorp, MS; Vanessa Solomon, MA; Paul G. Shekelle, MD, PhD; and Sally C. Morton, PhD Meta-Analysis: Pharmacologic Treatment of Obesity Ann Intern Med 2005; 532-546

Diabetes Prevention Program Research Group Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin N Engl J Med. 2002 Feb 7;346(6):393-403

Steven B. Heymsfield, MD; Andrew S. Greenberg, MD; Ken Fujioka, MD; Russell M. Dixon, MD; Robert Kushner, MD; Thomas Hunt, MD; John A. Lubina, PhD; Janet Patane, MPH; Barbara Self, MPH; Pam Hunt, PhD; Mark McCamish, PhD, MD Recombinant Leptin for Weight Loss in Obese and Lean Adults : A Randomized, Controlled, Dose-Escalation Trial JAMA. 1999;282:1568-1575


David E. Cummings, M.D., David S. Weigle, M.D., R. Scott Frayo, B.S., Patricia A. Breen, B.S.N., Marina K. Ma, E. Patchen Dellinger, M.D., and Jonathan Q. Purnell, M.D. Plasma Ghrelin Levels after Diet-Induced Weight Loss or Gastric Bypass Surgery N Engl J Med. 2002 May 23;346(21):1623-30

   


 Presentation 

"Oral Hypoglycemic Agents and Cardiac Events: The Good the Bad and the Ugly"

Dr. David S.H. Bell (biography)
English - 2006-04-28 - 62 minutes
(30 slides)
(44 slides)

Summary :
In this presentation Dr. Bell talks about different classes of antidiabetic agents, their effects, tolerability and impact on cardiac risk.

Do sulfonylureas increase the risk of cardiac events? Sulfonylureas work by closing the ATP-sensitive K+ channels in the wall of the pancreatic beta cell, leading to depolarization, an influx of calcium and an increased release of insulin....

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Ischemic preconditioning in the heart: effects of SUs and diabetes
- Studies on SU treatment and mortality in type 2 diabetes
- Decreased cardiac events associated with α-glucosidase inhibitor and metformin use
- Effects of TZDs in lowering cardiac risk factors and surrogate markers of atherosclerosis
- Evidence for possible benefit of lowering insulin resistance in heart failure

Bibliographic references :
1. Bell, DSH. Do sulfonylurea drugs increase the risk of cardiac events? CMAJ. 2006 Jan 17;174(2):185-6.

2. Garratt KN, Brady PA, Hassinger NL, Grill DE, Terzic A, Holmes DR Jr.
Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction J Am Coll Cardiol. 1999 Jan;33(1):119-24.

3. UGDP.Diabetes (1970);19:789-826.

4. Jeffrey A. Johnson, PHD, Sumit R. Majumdar, MD, MPH, FRCPC, Scot H. Simpson, PHARMD and Ellen L. Toth, MD, FRCPCDecreased Mortality Associated With the Use of Metformin Compared With Sulfonylurea Monotherapy in Type 2 Diabetes Diabetes Care 25:2244-2248, 2002.

5. Scot H. Simpson, Sumit R. Majumdar, Ross T. Tsuyuki, Dean T. Eurich and Jeffrey A. Johnson Dose–response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study CMAJ. 2006 Jan 17;174(2):169-74.

6. Matteo Monami, Chiara Luzzi, Caterina Lamanna, Veronica Chiasserini, Filomena Addante, Carla Maria Desideri, Giulio Masotti, Niccolò Marchionni, Edoardo MannucciThree-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin Diabetes Metab Res Rev. 2006 Apr 24.

7. Ceriello A, Hanefeld M, Leiter L, Monnier L, Moses A, Owens D, Tajima N, Tuomilehto J.Postprandial glucose regulation and diabetic complications. Arch Intern Med. 2004 Oct 25;164(19):2090-5.

   


 Presentation 

"Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?"

Dr. Richard E. Gilbert (biography)
English - 2006-04-28 - 26 minutes
(44 slides)

Summary :
In this presentation Dr. Gilbert talks about anti-hypertensive therapy in the prevention and treatment of diabetic nephropathy, recent advances in understanding and remaining questions.

Are ACE inhibitors and ARBs equally good at slowing the progression of diabetic nephropathy? Studies such as IDNT and RENAAL have demonstrated renal benefits with ARBs in type 2 diabetic patients...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Prevalence of diabetic nephropathy and associated cardiovascular risk
- Effects of ARBs and ACE inhibitors on progression of diabetic nephropathy: current knowledge and remaining questions
- Evidence for decreased incidence of microalbuminuria with anti-hypertensive therapy in diabetic patients
- Approach to anti-hypertensive therapy in diabetes

Bibliographic references :
1. Anthony H. Barnett, M.D., Stephen C. Bain, M.D., Paul Bouter, Ph.D., Bengt Karlberg, M.D., Sten Madsbad, M.D., Jak Jervell, Ph.D., Jukka Mustonen, Ph.D., for the Diabetics Exposed to Telmisartan and Enalapril Study GroupAngiotensin-Receptor Blockade versus Converting–Enzyme Inhibition in Type 2 Diabetes and Nephropathy N Engl J Med. 2004 Nov 4;351(19):1952-61.

2. Piero Ruggenenti, M.D., Anna Fassi, M.D., Anelja Parvanova Ilieva, M.D., Simona Bruno, M.D., Ilian Petrov Iliev, M.D., Varusca Brusegan, M.D., Nadia Rubis, R.N., Giulia Gherardi, R.N., Federica Arnoldi, R.N., Maria Ganeva, Stat.Sci.D., Bogdan Ene-Iordache, Eng.D., Flavio Gaspari, Ph.D., Annalisa Perna, Stat.Sci.D., Antonio Bossi, M.D., Roberto Trevisan, M.D., Alessandro R. Dodesini, M.D., Giuseppe Remuzzi, M.D., for the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) InvestigatorsPreventing Microalbuminuria in Type 2 Diabetes N Engl J Med. 2004 Nov 4;351(19):1941-51.

   


 Presentation 

"Treating Obesity in Type 2 DM: What's New?"

Dr. Jeannette Goguen (biography)
English - 2006-04-28 - 30 minutes
(39 slides)

Summary :
Diabetes and obesity are intimately linked, says Dr. Goguen. Not only does visceral obesity lead to insulin resistance and diabetes but some antidiabetic agents also cause weight gain. Would stopping weight gain or promoting weight loss reduce the risk of cardiovascular disease in these patients?

Of the several components of weight loss programs, Dr. Goguen focuses on...

Learning objectives :
1. To know the benefits and risks for the use of each of the following medications to treat obesity in diabetes:
a. Sibutramine
b. Orlistat
c. Rimonabant

2. To understand limitations of drug studies in obesity

Bibliographic references :
J. Bruce Redmon, MD, Kristell P. Reck, RD, Susan K. Raatz, PHD, Joyce E. Swanson, RD, Christine A. Kwong, RD, Hong Ji, MS, William Thomas, PHD and John P. Bantle, MDTwo-Year Outcome of a Combination of Weight Loss Therapies for Type 2 Diabetes Diabetes Care 28:1311-1315, 2005.

NEW DRUG TREATS MULTIPLE PROBLEMS OF PEOPLE WITH TYPE 2 DIABETES: Rimonabant Lowers Blood Glucose and Reduces Weight, Waist Size, and Lipid Problems American Diabetes Association.

   


 Presentation 

"Thiazolidinediones and the Heart: A Tale of Two Organs?"

Dr. Robin Buckingham (biography)
English - 2006-03-27 - 58 minutes
(26 slides)
(37 slides)

Summary :
In this presentation Dr. Buckingham talks about congestive heart failure (CHF) and diabetes in general and in the context of thiazolidinedione treatment.

Are the perceived cardiovascular benefits of thiazolidinediones negated by an increased incidence of CHF? First looking at some background data, in a 6-year cohort study from Kaiser Permanente, risk factors for incident CHF were...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Risk factors for incident CHF
- Thiazolidinediones and other treatments in relation to CHF incidence
- Effects of thiazolidinediones on cardiac energy metabolism in type 2 diabetes
- Risk factors for heart failure in patients treated with thiazolidinediones
- Clinical practice recommendations

Bibliographic references :
1. Gregory A. Nichols, PHD, Christina M. Gullion, PHD, Carol E. Koro, PHD, Sara A. Ephross, PHD and Jonathan B. Brown, PHD, MPP The Incidence of Congestive Heart Failure in Type 2 Diabetes: An update Diabetes Care 27:1879-1884, 2004.

2. Ingelsson E, Sundstrom J, Arnlov J, Zethelius B, Lind L.Insulin resistance and risk of congestive heart failure. JAMA. 2005 Jul 20;294(3):334-41.

3. Varela-Roman A, Grigorian Shamagian L, Barge Caballero E, Mazon Ramos P, Rigueiro Veloso P, Gonzalez-Juanatey JR.Influence of diabetes on the survival of patients hospitalized with heart failure: A 12-year study Eur J Heart Fail. 2005 Aug;7(5):859-64.

4. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, Skene AM, Tan MH, Lefebvre PJ, Murray GD, Standl E, Wilcox RG, Wilhelmsen L, Betteridge J, Birkeland K, Golay A, Heine RJ, Koranyi L, Laakso M, Mokan M, Norkus A, Pirags V, Podar T, Scheen A, Scherbaum W, Schernthaner G, Schmitz O, Skrha J, Smith U, Taton J; PROactive investigators.Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial Lancet. 2005 Oct 8;366(9493):1279-89.

5. Delea TE, Edelsberg JS, Hagiwara M, Oster G, Phillips LS.Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes Diabetes Care 26:2983-2989, 2003.

6. Rajagopalan R, Rosenson RS, Fernandes AW, Khan M, Murray FT.Association between congestive heart failure and hospitalization in patients with type 2 diabetes mellitus receiving treatment with insulin or pioglitazone: a retrospective data analysis Clin Ther. 2004 Sep;26(9):1400-10.

7. A. J. Karter, A. T. Ahmed, J. Liu, H. H. Moffet and M. M. ParkerPioglitazone initiation and subsequent hospitalization for congestive heart failure Diabet Med. 2005 Aug;22(8):986-93.

8. Frederick A. Masoudi, MD, MSPH; Silvio E. Inzucchi, MD; Yongfei Wang, MS; Edward P. Havranek, MD; JoAnne M. Foody, MD; Harlan M. Krumholz, MDThiazolidinediones, Metformin, and Outcomes in Older Patients With Diabetes and Heart Failure: An Observational Study Circulation. 2005;111:583-590.

9. Inzucchi SE, Masoudi FA, Wang Y, Kosiborod M, Foody JM, Setaro JF, Havranek EP, Krumholz HM.Insulin-Sensitizing Antihyperglycemic Drugs and Mortality After Acute Myocardial Infarction: Insights from the National Heart Care Project Diabetes Care 28:1680-1689, 2005.

10. Lautamaki R, Airaksinen KE, Seppanen M, Toikka J, Luotolahti M, Ball E, Borra R, Harkonen R, Iozzo P, Stewart M, Knuuti J, Nuutila P.Rosiglitazone Improves Myocardial Glucose Uptake in Patients With Type 2 Diabetes and Coronary Artery Disease Diabetes 54:2787-2794, 2005.

11. Scheuermann-Freestone et al, Circulation 108 Suppl IV: IV-60, abstract 277, 2003.

12. Richard W. Nesto, MD; David Bell, MD; Robert O. Bonow, MD; Vivian Fonseca, MD; Scott M. Grundy, MD, PhD; Edward S. Horton, MD; Martin Le Winter, MD; Daniel Porte, MD; Clay F. Semenkovich, MD; Sidney Smith, MD; Lawrence H. Young, MD; Richard Kahn, PhD. Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Circulation. 2003;108:2941.

   


 Presentation 

"Diabetes In Canada Evaluation (The DICE Study): Impact on Family Practice"

Dr. Stewart Harris (biography)
English - 2006-03-08 - 60 minutes
(36 slides)
(26 slides)

Summary :
In this presentation Dr. Harris talks about the Canadian diabetes epidemic and clinical practice guidelines, and findings from the Diabetes In Canada Evaluation (DICE) study on the management of type 2 diabetes in the family practice setting.

Along with the growing burden of type 2 diabetes in Canada a major challenge remains the translation of clinical practice guidelines into...

Learning objectives :
Overview:

- Epidemiology of diabetes
- Revisiting the CDA guidelines
- How are FPs doing?
- Review of the DICE study findings
- Conclusions

   


 Presentation 

"The FIELD Study"

Prof. Timothy Davis (biography)
English - 2005-12-07 - 34 minutes
(43 slides)

Summary :
The results of the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study were presented at the AHA meeting held in Dallas in November 2005. This was a randomised trial of the effects of fenofibrate on coronary morbidity and mortality in people with diabetes, and in this talk Prof. Davis presents the data and discusses its implications.

Fenofibrate reduces...

Learning objectives :
After viewing this presentation the participant will be able to discuss randomised evidence from the prospective FIELD study:

- Effects of fenofibrate on the risk of major coronary disease events in patients with type 2 diabetes
- Secondary and tertiary outcomes including total CVD events, stroke, progression of renal disease and others
- Safety
- Implications of the data

Bibliographic references :
The FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial Lancet. 2005 Nov 26;366(9500):1849-61.

   


 Presentation 

"Dual PPAR alpha/gamma Agonists - Promise and Problems"

Prof. John Prins (biography)
English - 2005-12-07 - 22 minutes
(22 slides)

Summary :
In this presentation Prof. Prins talks about a newer class of compounds, the dual PPAR alpha/gamma agonists, collectively known as the glitazars.

The Peroxisome Proliferator-Activated Receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. PPAR α ligands include the fibrate drugs which are used in patients with...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- PPAR isoforms, their effects and ligands
- Dual PPAR alpha/gamma agonists (glitazars): development and recent clinical data
- Safety issues related to glitazar treatment in type 2 diabetic patients

Bibliographic references :
1. Buse JB, Rubin CJ, Frederich R, Viraswami-Appanna K, Lin KC, Montoro R, Shockey G, Davidson JA.Muraglitazar, a dual (α/γ) PPAR activator: A randomized, double-blind, placebo-controlled, 24-week monotherapy trial in adult patients with type 2 diabetes Clin Ther. 2005 Aug;27(8):1181-95.

2. Nissen SE, Wolski K, Topol EJ.Effect of muraglitazar on death and major adverse cardiovascular events in patients with type 2 diabetes mellitus. JAMA. 2005 Nov 23;294(20):2581-6.

   


 Presentation 

"Update on Dietary and Drug Management of Atherogenic Dyslipidemia of the Insulin Resistance Syndrome"

Dr. Ronald M. Krauss (biography)
English - 2005-11-13 - 61 minutes
(38 slides)

Summary :
In this presentation Dr. Krauss talks about treatment options that are available for the management of the atherogenic dyslipidemia associated with insulin resistance.

This atherogenic dyslipidemia is characterised by high triglycerides, low HDL cholesterol and an increase in small dense LDL particles. Although pharmacological treatments are available to address these...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The nature of atherogenic dyslipidemia associated with insulin resistance
- Effects of diet and exercise on dyslipidemia
- Effects on triglycerides, HDL cholesterol and LDL particle size due to treatment with statins, niacin, fibrates and glitazones

Bibliographic references :
1. Michael L. Dansinger, MD; Joi Augustin Gleason, MS, RD; John L. Griffith, PhD; Harry P. Selker, MD, MSPH; Ernst J. Schaefer, MD. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: A Randomized Trial JAMA. 2005;293:43-53.

2. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S; Diabetes Prevention Program Research Group. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005 Apr 19;142(8):611-9.

   


 Presentation 

"Differential Effects of Rosiglitazone and Metformin on Inflammation and Subclinical Atherosclerosis in Patients with Type 2 Diabetes - The CHD Study"

Prof. Allen J. Taylor (biography)
English - 2005-11-13 - 22 minutes
(21 slides)

Summary :
In this talk Prof. Taylor presents the results of the CHD (Coronary Health in Diabetics) study, a randomized clinical trial on rosiglitazone vs. metformin in type 2 diabetic patients.

The insulin-sensitising antidiabetic agent metformin was shown to reduce cardiovascular outcomes in the UKPD Study, and it remains to be seen what are the effects on cardiovascular risk of the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Effects of rosiglitazone vs. metformin in type 2 diabetic patients:
- -> Glycemic control
- -> Changes in CRP
- -> Changes in CIMT
- Implications of the CHD study

   


 Presentation 

"The VICTORY Study: Assessing the efficacy of rosiglitazone in inhibiting the progression of atherosclerosis in CABG surgery"

(biography)
English - 2005-10-25 - 29 minutes
(23 slides)

Summary :
In this talk Dr. Bertrand gives an overview of the design and objectives of the VICTORY (VeIn-Coronary ATherOsclerosis and Rosiglitazone after Bypass surgerY) trial.

Research conducted at the Montreal Heart Institute on bypass patients has shown that the majority of vein grafts show atherosclerotic changes after 10 years. The overall objectives of VICTORY are to assess the efficacy...

Learning objectives :
Key learning points:

1. Presentation of the VICTORY trial protocol, the first cardio-metabolic trial in type 2 diabetes patients to assess atherosclerosis progression and its detailed interrelations with metabolic abnormalities.
2. Understand the combinations of intravascular ultrasound, angiography, DEXA, abdominal CT-scan, exercise test, holter monitoring and biological markers to assess cardio-metabolic abnormalities in type 2 diabetes patients.
3. Understand the use of saphenous vein graft as a clinical model of accelerated atherosclerosis.
4. Understand the use of DEXA and abdominal CT-scan to assess morphology abnormalities in type 2 diabetes patients.

   


 Presentation 

"TZDs and Atherosclerosis: Can They Make a Difference?"

Dr. Lawrence A. Leiter (biography)
English - 2005-10-25 - 36 minutes
(65 slides)

Summary :
Vascular disease is a leading cause of death in diabetes, and cardiovascular risk is increased even before the diagnosis of diabetes, as seen in the Nurses' Health Study (1). How well is glycemia being controlled in type 2 diabetic patients in Canada? The cross-sectional DICE (Diabetes in Canada Evaluation) study showed that half of the patients are not at target. Although physicians seem to be...

Learning objectives :
Key learning points:

1. TZDs can decrease multiple traditional and non-traditional CV risk factors.
2. There are now a number of trials using surrogate endpoints suggesting decreased CV risk in TZD-treated patients.
3. The results of the PROACTIVE study, although not definitive, are consistent with the anti-atherosclerotic effects of TZDs.
4. Ongoing clinical trials will hopefully definitively reveal if TZDs reduce CV risk.

Bibliographic references :
1. Haffner SJ, Cassells H. Hyperglycemia as a cardiovascular risk factor. The American Journal of Medicine. 115(8), 6-11.

2. Hanley AJ, Williams K, Stern MP, Haffner SM. Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease. Diabetes Care. 2002 Vol. 25, 1177-1184.

3. Enzo Bonora, Gianni Formentini, Francesco Calcaterra, Simonetta Lombardi, Franco Marini, Luciano Zenari, Francesca Saggiani, Maurizio Poli, Sandro Perbellini, Andrea Raffaelli, Vittorio Cacciatori, Lorenza Santi, Giovanni Targher, Riccardo Bonadonna, and Michele Muggeo. HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects - Prospective data from the Verona Diabetes Complications Study. Diabetes Care. 2002 Vol. 25, 1135-1141.

4. Jagdip S. Sidhu; Zoltan Kaposzta; Hugh S. Markus; Juan Carlos Kaski. Effect of Rosiglitazone on Common Carotid Intima-Media Thickness Progression in Coronary Artery Disease Patients Without Diabetes Mellitus. Arteriosclerosis, Thrombosis, and Vascular Biology. May 2004; 24 930 – 934.

5. Hiroyuki Koshiyama, Dai Shimono, Naomitsu Kuwamura, Jun Minamikawa, and Yoshio Nakamura. RAPID COMMUNICATION: Inhibitory Effect of Pioglitazone on Carotid Arterial Wall Thickness in Type 2 Diabetes. The Journal of Clinical Endocrinology and Metabolism. July 2001; 86, 3452-6.

6. Choi SH et al. Diabetes. 2003;52 (suppl 1):A18. Oral presentation 82-0R.

7. Masoudi F.A. et al. Diabetes 2004; 53(Suppl.2);A29.

8. The official PROactive results website

   


 Presentation 

"The Link Between Diet, Exercise, and Insulin Resistance Reduction"

Dr. Stuart A Ross (biography)
English - 2005-10-21 - 36 minutes
(20 slides)

Summary :
In this presentation Dr. Ross talks about the importance of understanding the pathophysiology of type 2 diabetes, identifying the needs of the individual patient and tailoring their treatment accordingly to achieve optimal diabetes management.

Type 2 diabetes is characterised by impaired insulin secretion, as well as insulin resistance which can promote the development of...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The pathophysiology of type 2 diabetes
- The progressive nature of type 2 diabetes
- Recent treatment guidelines from the Canadian Diabetes Association
- The state of glycaemic control in type 2 diabetic patients in Canada
- Action points for the management of diabetic patients

Bibliographic references :
1. UK Prospective Diabetes Study (UKPDS) GroupIntensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)Lancet. 1998 Sep 12;352(9131):837-53.

   


 Presentation 

"The PROACTIVE Study: What are Its Implications for the Management of Diabetes in Canada?"

Dr. Lawrence A. Leiter (biography)
English - 2005-09-14 - 35 minutes
(50 slides)

Summary :
In this presentation Dr. Leiter reviews the major results of the PROactive (PROspective PioglitAzone Clinical Trial In MacroVascular Events) study presented at the recent European Association for the Study of Diabetes (EASD) meeting in Athens.

Taking into account findings from the UK Prospective Diabetes Study (UKPDS), the 2003 Canadian Diabetes Association clinical practice...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Current Canadian treatment guidelines for overweight type 2 diabetic patients with mild to moderate hyperglycemia
- Findings from the PROactive study presented at the 2005 EASD meeting

Bibliographic references :
1. CDA Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes. Dec,2003;27(Suppl 2): S39.

2. proactive-results.com The official PROactive results website

   


 Presentation 

"Anti-atherogenic Effects of PPAR gamma Activators – From Bench to Bedside"

Prof. Nikolaus Marx (biography)
English - 2005-09-14 - 32 minutes
(47 slides)

Summary :
During this presentation Prof. Marx talks about the role of peroxisome proliferator-activated receptor gamma (PPARγ) activators in vascular disease.

PPARγ activators are regulators of gene expression in adipocytes and in muscle, increasing insulin sensitivity and modulating glucose homeostasis (1). PPARγ which is activated by thiazolidinediones (TZDs/glitazones), has...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

PPARγ activators – background
PPARγ activators – anti-atherogenic effects
-- in vitro
-- in vivo

Bibliographic references :
1. Nikolaus Marx, Hélène Duez, Jean-Charles Fruchart, Bart Staels Peroxisome Proliferator-Activated Receptors and Atherogenesis: Regulators of Gene Expression in Vascular Cells Circulation Research. 2004;94:1168.

2. Nikolaus Marx, Galina Sukhova, Curran Murphy, Peter Libby and Jorge Plutzky Macrophages in Human Atheroma Contain PPAR{gamma}: Differentiation-Dependent Peroxisomal Proliferator-ActivatedReceptor {gamma} (PPAR{gamma}) Expression and Reduction of MMP-9 Activity through PPAR{gamma} Activation in Mononuclear Phagocytes inVitro American Journal of Pathology. 1998;153:17-23.

3. Nikolaus Marx; Todd Bourcier; Galina K. Sukhova; Peter Libby; Jorge PlutzkyPPAR{gamma} Activation in Human Endothelial Cells Increases Plasminogen Activator Inhibitor Type-1 Expression: PPAR{gamma} as a Potential Mediator in Vascular Disease Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:546-551.

4. Nikolaus Marx, Bettina Kehrle, Klaus Kohlhammer, Miriam Grüb, Wolfgang Koenig, Vinzenz Hombach, Peter Libby, Jorge Plutzky PPAR Activators as Antiinflammatory Mediators in Human T Lymphocytes: Implications for Atherosclerosis and Transplantation-Associated Arteriosclerosis Circulation Research. 2002;90:703.

5. Nikolaus Marx, Daniel Walcher, Nina Ivanova, Kirstin Rautzenberg, Annelie Jung, Reinhard Friedl, Vinzenz Hombach, Raffaele de Caterina, Giuseppina Basta, Marie-Paule Wautier, and Jean-Luc Wautiers Thiazolidinediones Reduce Endothelial Expression of Receptors for Advanced Glycation End Products Diabetes 53:2662-2668, 2004.

6. Nikolaus Marx, Uwe Schönbeck, Mitchell A. Lazar, Peter Libby, , Jorge PlutzkyPeroxisome Proliferator-Activated Receptor Gamma Activators Inhibit Gene Expression and Migration in Human Vascular Smooth Muscle Cells Circulation Research. 1998;83:1097-1103.

7. Pfutzner A, Marx N, Lubben G, Langenfeld M, Walcher D, Konrad T, Forst T.Improvement of Cardiovascular Risk Markers by Pioglitazone Is Independent From Glycemic Control: Results From the Pioneer Study Journal of the American College of Cardiology.Volume 45, Issue 12 , 21 June 2005, Pages 1925-1931.

8. Nikolaus Marx; Johannes Froehlich; Laila Siam; Jochen Ittner; Gerhard Wierse; Arnold Schmidt; Hubert Scharnagl; Vinzenz Hombach; Wolfgang KoenigAntidiabetic PPAR{gamma}-Activator Rosiglitazone Reduces MMP-9 Serum Levels in Type 2 Diabetic Patients With Coronary Artery Disease Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:283.

9. Nikolaus Marx, MD; Armin Imhof, MD; Johannes Froehlich, MS; Laila Siam, MS; Jochen Ittner, MD; Gerhard Wierse, MD; Arnold Schmidt, MD; Winfried Maerz, MD; Vinzenz Hombach, MD; Wolfgang Koenig, MDEffect of Rosiglitazone Treatment on Soluble CD40L in Patients With Type 2 Diabetes and Coronary Artery Disease Circulation. 2003;107:1954.

10. Dandona P. Diabetologia 2001; 44 (Suppl 1): A36, Abs 136.

11. Donghoon Choi, MD, PHD, Soo-Kyung Kim, MD, Sung-Hee Choi, MD, Young-Guk Ko, MD, Chul-Woo Ahn, MD, PHD, Yangsoo Jang, MD, PHD, Sung-Kil Lim, MD, PHD, Hyun-Chul Lee, MD, PHD1, and Bong-Soo Cha, MD, PHD. Preventative Effects of Rosiglitazone on Restenosis After Coronary Stent Implantation in Patients With Type 2 Diabetes Diabetes Care 27:2654-2660, 2004.

   


 Presentation 

"Effect of Troglitazone on Pre-Clinical Carotid Atherosclerosis in Women with Recent Gestational Diabetes"

Prof. Thomas A. Buchanan (biography)
English - 2005-06-10 - 26 minutes
(18 slides)

Summary :
In this presentation Prof. Buchanan discusses data from the TRIPOD (Troglitazone in the Prevention of Diabetes) study on the impact of troglitazone treatment on the progression of pre-clinical atherosclerosis in high-risk Hispanic women with recent gestational diabetes, and mechanisms by which troglitazone may slow this progression.

Carotid intima media thickness (IMT) serves as a...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Data from the IMT analysis of the TRIPOD Study, showing the effect of troglitazone on IMT progression in Hispanic women at high risk for type 2 diabetes.

Bibliographic references :
Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Cesar Ochoa, Aura Marroquin, Jose Goico, Sylvia Tan, Chengwei Wang, Stanley P. Azen, Chao-ran Liu, Ci-hua Liu, Howard N. Hodis and Thomas A. Buchanan. Effect of Thiazolidinedione Treatment on Progression of Subclinical Atherosclerosis in Premenopausal Women at High Risk for Type 2 Diabetes J Clin Endocrinol Metab. 2005 Apr;90(4):1986-91.

   


 Presentation 

"Evidence Versus Reality: Gaps in Cardiovascular Risk Factor Intervention for Diabetic Patients"

Dr. Baiju R. Shah (biography)
English - 2005-05-06 - 27 minutes
(18 slides)

Summary :
In this presentation Dr. Shah presents evidence for cardiovascular (CV) risk factor intervention in diabetic patients and discusses the current state of underutilization of medications to lower CV risk.

In terms of evidence for CV risk factor intervention in diabetic patients, large randomized trials have shown the benefits of tight blood pressure control (1-3), and lipid control...

Learning objectives :
- To examine the gap in cardiovascular risk intervention for diabetic patients between evidence and actual clinical practice;
- To understand why this gap may occur;
- To counter the glucose-focused approach to diabetes management in clinical practice.

Bibliographic references :
1. UK Prospective Diabetes Study Group.
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
BMJ 1998;317:703-13.

2. J. D. Curb, S. L. Pressel, J. A. Cutler, P. J. Savage, W. B. Applegate, H. Black, G. Camel, B. R. Davis, P. H. Frost, N. Gonzalez, G. Guthrie, A. Oberman, G. H. Rutan and J. Stamler. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group JAMA. Vol. 276 No. 23, December 18, 1996.

3. ProfLennart Hansson MD, Alberto Zanchetti MD, S George Carruthers MD, Björn Dahlöf MD, Dag Elmfeldt MD, Stevo Julius MD, Joël Ménard MD, Karl Heinz Rahn MD, Hans Wedel PhD, Sten Westerling Msc and for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial The Lancet. Volume 351, Issue 9118 , 13 June 1998, Pages 1755-1762.

4.K Pyorala, TR Pedersen, J Kjekshus, O Faergeman, AG Olsson and G Thorgeirsson. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)Diabetes Care. 1997; Vol 20, Issue 4: 614-620.

5. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial The Lancet. Volume 361, Issue 9374 , 14 June 2003, Pages 2005-2016.

6. Prof Helen M Colhoun, MD, Prof D John Betteridge, PhD, Prof Paul N Durrington, MD, Prof Graham A Hitman, MD, H Andrew W Neil, DSc, Shona J Livingstone, MSc, Margaret J Thomason, PhD, Michael I Mackness, PhD, Valentine Charlton-Menys, PhD and Prof John H Fuller, MRCP. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial The Lancet. Volume 364, Issue 9435 , 21 August 2004, Pages 685-696.

7. Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes NEJM. Volume 348:383-393 January 30, 2003.

8. Can J Diabetes. 2003;27(suppl 2).

9. Diabetes Care. 2005;28(suppl 1).

10. Jinan B. Saaddine, MD; Michael M. Engelgau, MD; Gloria L. Beckles, MD; Edward W. Gregg, PhD; Theodore J. Thompson, MS; and K.M. Venkat Narayan, MD. A Diabetes Report Card for the United States: Quality of Care in the 1990s Ann Int Med.16 April 2002;Volume 136 Issue 8: 565-574.

11. Lauren C. Brown, Jeffrey A. Johnson, Sumit R. Majumdar, Ross T. Tsuyuki and Finlay A. McAlister. Evidence of suboptimal management of cardiovascular risk in patients with type 2 diabetes mellitus and symptomatic atherosclerosis CMAJ. November 9, 2004; 171 (10).

   


 Presentation 

"Managing Diabetes and Insulin Resistance in Patients with CVD"

Dr. Vivian A. Fonseca (biography)
English - 2005-05-02 - 56 minutes
(37 slides)
(48 slides)

Summary :
In this presentation Dr. Fonseca talks about the interaction between diabetes and cardiovascular disease, the effects of different diabetes therapies and their possible impact on CVD.

Insulin resistance is recognized as a core underlying defect in type 2 diabetes. Patients with diabetes or IGT are frequently encountered in cardiology practices, and many of these patients are...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The role of insulin resistance in promoting CVD
- The effects of diabetes therapies on insulin-resistance related risk factors
- Combination therapies utilising insulin sensitizers
- Factors involved in diabetic cardiomyopathy
- Management of diabetic patients with CHF

   


 Presentation 

"The ORIGIN Study"

Prof. Hertzel Gerstein (biography)
English - 2005-04-16 - 27 minutes
(22 slides)

Summary :
In this presentation Prof. Gerstein describes the rationale and design of the ORIGIN (Outcome Reduction with an Initial Glargine INtervention) trial.

ORIGIN is a large, international, multicentre trial investigating in high risk people with IFG, IGT or early diabetes, whether insulin replacement therapy targeting fasting normoglycaemia with insulin glargine reduces the risk of CV...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The rationale and design of the ORIGIN trial

   


 Presentation 

"New drugs for 'Prediabetes', Metabolic Syndrome and their CVD consequences: GLP-1"

Prof. Michael A. Nauck (biography)
English - 2005-04-15 - 23 minutes
(21 slides)

Summary :
Glucagon-like Peptide 1 (GLP-1) is a gut hormone with incretin and "ileal brake" activity. There are many facets of its action that add up to antidiabetic effects: (a) glucose-dependent stimulation of insulin secretion, (b) a glucagonostatic activity, (c) a deceleration of gastric emptying, (d) a suppression of appetite (and reduction in food intake), and effects on islet B cells demonstrated in...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Antidiabetic effects of GLP-1
- Incretin mimetics: GLP-1 receptor antagonists with prolonged pharmacokinetic profiles
- Efficacy of GLP-1 in subjects with IGT
- Antiapoptotic effect of GLP-1

   


 Presentation 

"Should We Measure hsCRP After Starting Statin Therapy? Update 2005"

Dr. Paul M. Ridker (biography)
English - 2005-01-31 - 33 minutes
(28 slides)

Summary :
With regards to assessment of cardiovascular risk, hsCRP levels add prognostic information to that obtained from the Framingham risk score (1).

Statin drugs are cholesterol-lowering agents that also lower CRP levels (2), and the Cholesterol and Recurrent Events (CARE) trial showed that statin therapy reduced the risk of recurrent coronary events, with a more pronounced...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Recent trials demonstrating the lowering of cardiovascular risk with statin therapy (primary and secondary prevention)
- New results from the PROVE IT-TIMI 22 trial on the effects of LDL-C- and CRP-lowering on the risk of recurrent MI/ coronary death
- New evidence from the REVERSAL study on the role of LDL-C- and CRP-lowering in slowing the rate of atherosclerosis progression

Bibliographic references :
1. Paul M Ridker, MD; Peter W.F. Wilson, MD; Scott M. Grundy, MD.Should C-Reactive Protein Be Added to Metabolic Syndrome and to Assessment of Global Cardiovascular Risk? Circulation. 2004;109:2818-2825.

2. Paul M. Ridker, MD; Nader Rifai, PhD; Marc A. Pfeffer, MD; Frank Sacks, MD; Eugene Braunwald, MD; for the Cholesterol and Recurrent Events (CARE) Investigators.Long-Term Effects of Pravastatin on Plasma Concentration of C-reactive Protein Circulation. 1999;100:230-235.

3. Paul M. Ridker, MD; Nader Rifai, PhD; Marc A. Pfeffer, MD; Frank M. Sacks, MD; Lemuel A. Moye, MD, PhD; Steven Goldman, MD; Greg C. Flaker, MD; Eugene Braunwald, MD; ; for the Cholesterol and Recurrent Events (CARE) Investigators.Inflammation, Pravastatin, and the Risk of Coronary Events After Myocardial Infarction in Patients With Average Cholesterol Levels Circulation. 1998;98:839-844.


4. Paul M. Ridker, M.D., M.P.H., Nader Rifai, Ph.D., Michael Clearfield, D.O., John R. Downs, M.D., Stephen E. Weis, D.O., J. Shawn Miles, M.D., Antonio M. Gotto, Jr., M.D., D.Phil., for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators.Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events
NEJM.2001;344:1959-1965.

5. Christopher P. Cannon, M.D., Eugene Braunwald, M.D., Carolyn H. McCabe, B.S., Daniel J. Rader, M.D., Jean L. Rouleau, M.D., Rene Belder, M.D., Steven V. Joyal, M.D., Karen A. Hill, B.A., Marc A. Pfeffer, M.D., Ph.D., Allan M. Skene, Ph.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators.Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary SyndromesNEJM.2004;350:1495-1504.

6. Paul M Ridker, M.D., Christopher P. Cannon, M.D., David Morrow, M.D., Nader Rifai, Ph.D., Lynda M. Rose, M.S., Carolyn H. McCabe, B.S., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) Investigators.C-Reactive Protein Levels and Outcomes after Statin TherapyNEJM.2005;352:20-28.

7. Steven E. Nissen, M.D., E. Murat Tuzcu, M.D., Paul Schoenhagen, M.D., Tim Crowe, B.S., William J. Sasiela, Ph.D., John Tsai, M.D., John Orazem, Ph.D., Raymond D. Magorien, M.D., Charles O'Shaughnessy, M.D., Peter Ganz, M.D., for the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Investigators.Statin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery DiseaseNEJM.2005;352:29-38.

   


 Presentation 

"Pitfalls in DKA"

Dr. Jeannette Goguen (biography)
English - 2005-01-21 - 31 minutes
(35 slides)
(4 questions)

Summary :
In this presentation Dr. Goguen uses case studies to illustrate some potential pitfalls in diagnosing or managing diabetic ketoacidosis (DKA).

Important considerations in DKA management are ECF volume contraction/ water balance, acidosis, K+ depletion, hyperglycaemia and the precipitating cause.

A diagnosis of DKA can be missed if the pH is normal due to a...

Learning objectives :
- To recognize how to avoid four potential “pitfalls” in the diagnosis or management of DKA

   


 Presentation 

"Advanced Insulin Pump Strategies: Exercise and the Athlete"

Dr. Bruce Perkins (biography)
English - 2005-01-21 - 40 minutes
(29 slides)
(6 questions)

Summary :
Advanced insulin pump strategies can provide certain advantages to the diabetic athlete.

Adjustment of (pre-meal and basal) insulin doses and carbohydrate consumption according to the intensity and duration of physical activity are important considerations in diabetic people who exercise, in particular those who practice exercise of higher intensity and/or long duration.

Learning objectives :
After viewing this presentation the participant will be able to:

- State the main physiological influences on blood sugar during and after exercise;
- Describe to patients the main risks associated with exercise;
- Explain to patients at least two pump strategies that permit safe athletic training;
- Problem solve issues that limit athletic performance in people with diabetes.

   


 Presentation 

"The Heart in Type 2 Diabetes Mellitus - Hyperglycemia: A Target for Treatment in Acute Coronary Syndromes"

Dr. Richard W. Nesto (biography)
English - 2005-01-21 - 71 minutes
(48 slides)
(26 slides)
(6 questions)

Summary :
Despite the recent improvements in cardiac care resulting in reduced risk of early mortality from acute MI (1), diabetes still confers an increased risk of poor outcome after MI although appropriate use of medications has been shown to reduce nonfatal events (2). In this presentation Dr. Nesto describes structural and metabolic abnormalities occurring in the diabetic heart, and implications for...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Structural and metabolic changes in the heart associated with diabetes and insulin resistance;
- The effect of glycemic control on the risk of heart failure in diabetes;
- The importance of admission blood glucose level in predicting long-term survival post-MI;
- The usefulness of some metabolic modulators as pharmacotherapy for AMI.

Bibliographic references :
1. Eugene Braunwald, M.D. Cardiovascular Medicine at the Turn of the Millennium: Triumphs, Concerns, and OpportunitiesNEJM. 1997;337:1360-1369.

2. Hitinder S. Gurm MD, A. Michael Lincoff MD, David Lee MD, W. H. Wilson Tang MD, Gang Jia MS, Joan E. Booth RN, Robert M. Califf MD, E. M. Ohman MD, Frans Van de Werf MD, PhD, Paul W. Armstrong MD, Victor Guetta MD, Robert Wilcox MD and Eric J. Topol MD. Outcome of acute ST-segment elevation myocardial infarction in diabetics treated with fibrinolytic or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibitionJournal of the American College of Cardiology. Volume 43, Issue 4 , 18 February 2004, Pages 542-548.

3. Gregory A. Nichols, PHD, Christina M. Gullion, PHD, Carol E. Koro, PHD, Sara A. Ephross, PHD and Jonathan B. Brown, PHD, MPP. The Incidence of Congestive Heart Failure in Type 2 Diabetes: An update.Diabetes Care 27:1879-1884, 2004.

4. Anna Norhammar, Klas Malmberg, Erik Diderholm, Bo Lagerqvist, Bertil Lindahl, Lars Rydén and Lars Wallentin. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularizationJACC. 18 February 2004, Volume 43, Issue 4 Pages 585-591.

5. Martin K. Rutter, MB, ChB; Helen Parise, ScD; Emelia J. Benjamin, MD, ScM; Daniel Levy, MD; Martin G. Larson, ScD; James B. Meigs, MD, MPH; Richard W. Nesto, MD; Peter W.F. Wilson, MD; Ramachandran S. Vasan, MD Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function: Sex-Related Differences in the Framingham Heart Study Circulation. 2003;107:448.

6. Oliver MF, Opie LH.Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias.Lancet. 1994 Jan 15;343(8890):155-158.

7. Carlos Iribarren, MD, MPH, PhD; Andrew J. Karter, PhD; Alan S. Go, MD; Assiamira Ferrara, MD, PhD; Jennifer Y. Liu, MPH; Stephen Sidney, MD, MPH; Joseph V. Selby, MD, MPH. Glycemic Control and Heart Failure Among Adult Patients With Diabetes Circulation. 2001;103:2668.

8. Ischa Stranders, MD; Michaela Diamant, MD, PhD; Rogier E. van Gelder, MD; Hugo J. Spruijt, MSEE; Jos W. R. Twisk, PhD; Robert J. Heine, MD, PhD, FRCP; Frans C. Visser, MD, PhD. Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med. 2004;164:982-988.

9. Insulin therapy as an adjunct toreperfusion after acute coronary ischemia: A proposed direct myocardial cell survival effect independent of metabolic modulation JACC. 16 April 2003, Volume 41, Issue 8 Pages 1404-1407.

10. Dandona P, Aljada A, Mohanty P. "The anti-inflammatory and potential anti-atherogenic effect of insulin: a new paradigm." Diabetologia. 2002 Jun;45(6):924-30.

11. Tian-li Yue, PhD; Jun Chen, MS; Weike Bao, MD; Padma K. Narayanan, PhD; Antoine Bril, PhD; Wen Jiang, MD; Paul G. Lysko, PhD; Juan-Li Gu, MD; Rogely Boyce, PhD; Dawn M. Zimmerman, MS; Timothy K. Hart, PhD; Robin E. Buckingham, PhD; Eliot H. Ohlstein, PhD In Vivo Myocardial Protection From Ischemia/Reperfusion Injury by the Peroxisome Proliferator–Activated Receptor-(gamma) Agonist Rosiglitazone Circulation. 2001;104:2588.

12. Tetsuya Shiomi, MD; Hiroyuki Tsutsui, MD; Shunji Hayashidani, MD; Nobuhiro Suematsu, MD; Masaki Ikeuchi, MD; Jing Wen, MD; Minako Ishibashi, MD; Toru Kubota, MD; Kensuke Egashira, MD; Akira Takeshita, MD Pioglitazone, a Peroxisome Proliferator–Activated Receptor-(gamma) Agonist, Attenuates Left Ventricular Remodeling and Failure After Experimental Myocardial Infarction Circulation. 2002;106:3126.

   


 Presentation 

"Treatment of Painful Diabetic Neuropathy"

Dr. Gyl Midroni (biography)
English - 2005-01-21 - 36 minutes
(45 slides)
(3 questions)

Summary :
In this presentation Dr. Midroni describes the clinical features of painful diabetic polyneuropathy, reviews the currently available medications for treatment of neuropathic pain and suggests an approach to treatment.

The approach to management of neuropathic pain starts with eliminating other potential causes of pain such as cramps, musculoskeletal or ischemic causes.

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The clinical features of painful diabetic polyneuropathy;
- The medications available for treatment of neuropathic pain;
- An approach to treatment.

   


 Presentation 

"ACE-I and ARB Combination Therapy Should Be a Standard Treatment for People with Diabetes"

Dr. Alice Cheng (biography)
English - 2005-01-21 - 27 minutes
(34 slides)

Summary :
In this presentation Dr. Cheng presents evidence for the use of angiotensin converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) combination therapy in patients with type 2 diabetes.

Combination therapy with ACE-I/ARB provides more complete inhibition of the renin-angiotensin system than either agent alone, and additive and compensatory benefits based on their...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Mechanism of action of ACE inhibitors and ARBs
- Effects of ACE-I/ARB combination therapy on blood pressure control and ACR in type 2 diabetic patients with renal disease
- Effects of ACE-I/ARB combination therapy in patients with and without diabetes, with congestive heart failure
- Safety of ACE-I/ARB combination therapy

Bibliographic references :
1. Carl Erik Mogensen, Steen Neldam, Ilkka Tikkanen, Shmuel Oren, Reuven Viskoper, Richard W Watts, Mark E Cooper. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study BMJ 2000;321:1440-1444.

2. Jay N. Cohn, M.D., Gianni Tognoni, M.D., for the Valsartan Heart Failure Trial Investigators. A Randomized Trial of the Angiotensin-Receptor Blocker Valsartan in Chronic Heart Failure NEJM. 2001;345:1667-1675.

3. McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA; CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial.
Lancet. 2003 Sep 6;362(9386):767-71.

   


 Presentation 

"ACEI + ARB Therapy Should Be A Standard Treatment in People with Diabetes - Arguments Against"

Dr. Phil McFarlane (biography)
English - 2005-01-21 - 25 minutes
(55 slides)
(3 questions)

Summary :
In this presentation Dr. McFarlane gives an overview of the framework of cardiorenal priorities in the 2003 CDA Guidelines (1) and evidence for the use of ACE inhibitor plus angiotensin receptor blocker (ARB) combination therapy, followed by a discussion of its suitability as a standard treatment for people with diabetes.

In terms of the available evidence for combination therapy...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The cardiorenal priorities set forth in the 2003 CDA Guidelines
- Available evidence for ACEI/ARB combination therapy in diabetic patients
- Whether ACEI/ARB combination therapy should be a standard treatment for diabetic patients

Bibliographic references :
1. CDA Guidelines 2003, CJD 2003;27 (Sup 2):S58-S65.

2. Jacobsen P, Parving HH. Beneficial impact on cardiovascular risk factors by dual blockade of the renin-angiotensin system in diabetic nephropathy.Kidney Intl.2004;66(S92):S108-S110.

3. Carl Erik Mogensen, professor of medicine a, Steen Neldam, general practitioner b, Ilkka Tikkanen, associate professor of medicine (nephrology) c, Shmuel Oren, physician d, Reuven Viskoper, physician d, Richard W Watts, physician e, Mark E Cooper, professor of medicine f, for the CALM study group. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study BMJ 2000;321:1440-1444 (9 December).

4. Ballard DJ et al.DM. 1988;37(4):405-412.

5. McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, Olofsson B, Yusuf S, Pfeffer MA; CHARM Investigators and Committees. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial.Lancet. 2003 Sep 6;362(9386):767-71.

   


 Presentation 

"Long-Acting Insulin Analogues"

Dr. Amir Hanna (biography)
English - 2005-01-21 - 34 minutes
(50 slides)
(9 questions)

Summary :
In this presentation Dr. Hanna reviews studies on the efficacy and safety of insulin glargine and insulin detemir compared to NPH insulin in patients with type 1 and type 2 diabetes.

Insulin glargine and insulin detemir provide some advantages over NPH insulin, for example, less within-subject pharmacodynamic variability as seen in a study of type 1 diabetics (1), and Dr. Hanna...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The characteristics and mechanisms of prolonged action of insulin detemir and insulin glargine
- Pharmacokinetics and pharmacodynamics of insulin glargine, insulin detemir and NPH insulin in T1DM patients
- Studies on the efficacy and safety of insulin glargine and insulin detemir compared to NPH insulin in T1DM and T2DM patients

Bibliographic references :
1. Tim Heise, Leszek Nosek, Birgitte Biilmann Rønn, Lars Endahl, Lutz Heinemann, Christoph Kapitza, and Eberhard DraegerLower Within-Subject Variability of Insulin Detemir in Comparison to NPH Insulin and Insulin Glargine in People With Type 1 Diabetes
Diabetes 53:1614-1620, 2004

2. Yogish C. Kudva, MD, MBBS, Ananda Basu, MD, Gregory D. Jenkins, MS, Guillermo M. Pons, MD, Lori L. Quandt, RN, Julie A. Gebel, RN, Debra A. Vogelsang, NP, Steven A. Smith, MD, Robert A. Rizza, MD and William L. Isley, MD.Randomized Controlled Clinical Trial of Glargine Versus Ultralente Insulin in the Treatment of Type 1 Diabetes Diabetes Care 28:10-14, 2005.

3. RE Ratner, IB Hirsch, JL Neifing, SK Garg, TE Mecca and CA Wilson.
Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. U.S. Study Group of Insulin Glargine in Type 1 Diabetes
Diabetes Care. 2000; Vol 23, Issue 5: 639-643.

4. Philip Home, DM, DPHIL, Paul Bartley, MB, BS, FRACP, FACE, David Russell-Jones, MD, Hélène Hanaire-Broutin, MD, Jan-Evert Heeg, MD, Pascale Abrams, MD, Mona Landin-Olsson, MD, Birgitte Hylleberg, MSC, Hanne Lang, MSC, PHARM and Eberhard Draeger, PHD on behalf of the Study to Evaluate the Administration of Detemir Insulin Efficacy, Safety and Suitability (Steadiness) Study Group Insulin Detemir Offers Improved Glycemic Control Compared With NPH Insulin in People With Type 1 Diabetes Diabetes Care 27:1081-1087, 2004.

5. De Leeuw I, Vague P, Selam JL, Skeie S, Lang H, Draeger E, Elte JW.
Insulin detemir used in basal-bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin
Diabetes, Obesity and Metabolism Volume 7 Issue 1 Page 73  - January 2005.

6. H Yki-Jarvinen, A Dressler and M Ziemen
Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. HOE 901/3002 Study GroupDiabetes Care. 2000; Vol 23, Issue 8 1130-1136.

7. Julio Rosenstock, MD, Sherwyn L. Schwartz, MD, Charles M. Clark, Jr., MD, Glen D. Park, PharmD, David W. Donley, PHD and Mike B. Edwards, RPH Basal Insulin Therapy in Type 2 Diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin Diabetes Care 24:631-636, 2001.

8. Matthew C. Riddle, MD, Julio Rosenstock, MD and John Gerich, MD on behalf of the Insulin Glargine 4002 Study InvestigatorsThe Treat-to-Target Trial: Randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients Diabetes Care 26:3080-3086, 2003.

9. Raslova K, Bogoev M, Raz I, Leth G, Gall MA, Hancu N.
Insulin detemir and insulin aspart: a promising basal-bolus regimen for type 2 diabetes.Diabetes Res Clin Pract. 2004 Nov;66(2):193-201.

   


 Presentation 

"Identifying Metabolic Syndrome as a Risk Factor for Type 2 Diabetes: Implications for Cardiologists"

Dr. Barry Goldstein (biography)
English - 2004-11-08 - 44 minutes
(39 slides)

Summary :
Diabetes is known to increase the risk of cardiovascular disease, and it is important for cardiologists to know how to optimally manage diabetic patients in order to reduce their risk of adverse cardiovascular outcomes.

Hyperglycaemia is a key risk factor for cardiovascular disease. HbA1c values were correlated with the risk of myocardial infarction in the UKPD study (1), however...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The contribution of hyperglycemia towards the risk of cardiovascular disease
- Identifying patients at risk for conversion to type 2 diabetes
- Studies on diabetes prevention using lifestyle intervention and/or insulin-sensitizing oral agents (DPP, TRIPOD)
- Treatment strategies for improving cardiovascular risk factors in type 2 diabetes

Bibliographic references :
1. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR.Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study BMJ 2000;321:405-412.

2. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, Day N. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk)BMJ 2001;322:15.

3. The DECODE study group on behalf of the European Diabetes Epidemiology Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe.Lancet. 1999 Aug 21;354(9179):617-21.

4. Barry J. Goldstein MD, PhDInsulin resistance as the core defect in type 2 diabetes mellitus The American Journal of Cardiology. Volume 90, Issue 5, Supplement 1 , 5 September 2002, Pages 3-10.

5. Steven M. Haffner, MD; Leena Mykkänen, MD; Andreas Festa, MD; James P. Burke, PhD; Michael P. Stern, MD Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Factors Than Insulin-Sensitive Prediabetic Subjects: Implications for Preventing Coronary Heart Disease During the Prediabetic State Circulation. 2000;101:975.

6.Diabetes Prevention Program Research Group Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or MetforminNEJM. 2002; Volume 346:393-403.

7. Thomas A. Buchanan, Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Aura Marroquin, Jose Goico, Cesar Ochoa, Sylvia Tan, Kathleen Berkowitz, Howard N. Hodis, and Stanley P. AzenPreservation of Pancreatic ß-Cell Function and Prevention of Type 2 Diabetes by Pharmacological Treatment of Insulin Resistance in High-Risk Hispanic Women Diabetes 51:2796-2803, 2002.

8. Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Cesar Ochoa, Aura Marroquin, Jose Goico, Sylvia Tan, Chengwei Wang, Stanley P. Azen, Chao-ran Liu, Ci-hua Liu, Howard N. Hodis, and Thomas A. Buchanan. Effect of Thiazolidinedione Treatment on Progression of Subclinical Atherosclerosis in Premenopausal Women at High Risk for Type 2 Diabetes Journal of Clinical Endocrinology & Metabolism 2004. Dec 28; [Epub ahead of print].

   


 Presentation 

"Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Glycemic and Cardiovascular Implications"

Prof. Bernard Zinman (biography)
English - 2004-10-25 - 42 minutes
(34 slides)

   


 Presentation 

"TZDs and Cardiac Function"

Dr. Peter Liu (biography)
English - 2004-10-25 - 37 minutes
(31 slides)

   


 Presentation 

"Diabetes Treatments and Inflammatory Markers"

Dr. Vivian A. Fonseca (biography)
English - 2004-09-30 - 46 minutes
(56 slides)

Summary :
It is by now well recognized that atherosclerosis is an inflammatory disease and diabetics appear to be disproportionately affected by both cardiovascular disease and inflammation. What is the effect of chronic inflammation on the pathophysiology of diabetes? What is the effect of diabetes on inflammatory processes?

Dr. Fonseca examines the evidence for the inter-relatedness of...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The role of inflammation in diabetes
- The role of diabetes in inflammation
- The effect of insulin sensitizers on CRP and other markers of inflammation
- The effect of insulin on CRP and other markers of inflammation
- The effect of statins other cholesterol lowering medications on CRP and other markers of inflammation
- How ACE-inhibitors and ARBs impact on serum levels of markers of inflammation
- The role of anti-inflammatory medications, such as ASA, in diabetes

Bibliographic references :
Peter Libby, Paul M. Ridker, and Attilio Maseri Inflammation and Atherosclerosis Circulation 2002 105: 1135 - 1143

Grimble, Robert F.Inflammatory status and insulin resistance. Current Opinion in Clinical Nutrition & Metabolic Care. 5(5):551-559, September 2002.

Kaplan, Robert C. PhD; Frishman, William H. MDSystemic Inflammation as a Cardiovascular Disease Risk Factor and as a Potential Target for Drug Therapy. Heart Disease. 3(5):326-332, September/October 2001.

Steven M. Haffner, Andrew S. Greenberg, Wayde M. Weston, Hongzi Chen, Ken Williams, and Martin I. Freed Effect of Rosiglitazone Treatment on Nontraditional Markers of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus Circulation 2002 106: 679 - 684;

Neelima V. Chu, Alice P. S. Kong, Dennis D. Kim, Debra Armstrong, Sunita Baxi, Reena Deutsch, Michael Caulfield, Sunder R. Mudaliar, Richard Reitz, Robert R. Henry, and Peter D. ReavenDifferential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes Diabetes Care 25: 542-549

Burton E. Sobel, Janet Woodcock-Mitchell, David J. Schneider, Robert E. Holt, Kousuke Marutsuka, and Herman Gold Increased Plasminogen Activator Inhibitor Type 1 in Coronary Artery Atherectomy Specimens From Type 2 Diabetic Compared With Nondiabetic Patients : A Potential Factor Predisposing to Thrombosis and Its Persistence Circulation 1998 97: 2213 – 2221

Nakamura, Tsukasa; Ushiyama, Chifuyu; Shimada, Noriaki; Hayashi, Kayo; Ebihara, Isao; Koide, Hikaru Comparative effects of pioglitazone, glibenclamide, and voglibose on urinary endothelin-1 and albumin excretion in diabetes patients J Diabetes Complications Vol: 14, Issue: 5, September - October, 2000

Stefan Engeli, Mareike Feldpausch, Kerstin Gorzelniak, Frauke Hartwig, Ute Heintze, Jürgen Janke, Matthias Möhlig, Andreas F.H. Pfeiffer, Friedrich C. Luft, and Arya M. Sharma Association Between Adiponectin and Mediators of Inflammation in Obese Women Diabetes 2003; 52: 942-947

Paresh Dandona, Ahmad Aljada, Priya Mohanty, Husam Ghanim, Wael Hamouda, Ezzat Assian, and Shakeel AhmadInsulin Inhibits Intranuclear Nuclear Factor B and Stimulates I B in Mononuclear Cells in Obese Subjects: Evidence for an Anti-inflammatory Effect? J. Clin. Endocrinol. Metab., Jul 2001; 86: 3257 - 3265.

Troels Krarup Hansen, Steffen Thiel, Pieter Jozef Wouters, Jens Sandahl Christiansen, and Greet Van den BergheIntensive Insulin Therapy Exerts Antiinflammatory Effects in Critically Ill Patients and Counteracts the Adverse Effect of Low Mannose-Binding Lectin Levels J. Clin. Endocrinol. Metab., Mar 2003; 88: 1082 - 1088.

Van den Berghe G., Wouters P., Weekers F., Verwaest C., Bruyninckx F., Schetz M., Vlasselaers D., Ferdinande P., Lauwers P., Bouillon R.Intensive Insulin Therapy in Critically Ill Patients N Engl J Med 2001; 345:1359-1367, Nov 8, 2001.

Ajay Chaudhuri, David Janicke, Michael F. Wilson, Devjit Tripathy, Rajesh Garg, Arindam Bandyopadhyay, Janeen Calieri, Debbie Hoffmeyer, Tufail Syed, Husam Ghanim, Ahmad Aljada, and Paresh DandonaAnti-Inflammatory and Profibrinolytic Effect of Insulin in Acute ST-Segment–Elevation Myocardial Infarction Circulation 2004 109: 849 – 854

Hannes Gaenzer, Günther Neumayr, Peter Marschang, Wolfgang Sturm, Monika Lechleitner, Bernhard Föger, Rudolf Kirchmair and Josef PatschEffect of insulin therapy on endothelium-dependent dilation in type 2 diabetes mellitus The American Journal of Cardiology Volume 89, Issue 4 , 15 February 2002, Pages 431-434

JP Albertini, P Valensi, B Lormeau, MH Aurousseau, F Ferriere, JR Attali, and L GattegnoElevated concentrations of soluble E-selectin and vascular cell adhesion molecule-1 in NIDDM. Effect of intensive insulin treatment Diabetes Care 21: 1008-1013.

I. Jialal, D. Stein, D. Balis, S. M. Grundy, B. Adams-Huet, and S. Devaraj Effect of Hydroxymethyl Glutaryl Coenzyme A Reductase Inhibitor Therapy on High Sensitive C-Reactive Protein Levels Circulation 2001 103: 1933 - 1935

Steven E. Nissen; E. Murat Tuzcu; Paul Schoenhagen; B. Greg Brown; Peter Ganz; Robert A. Vogel; Tim Crowe; Gail Howard; Christopher J. Cooper; Bruce Brodie; Cindy L. Grines; Anthony N. DeMariaEffect of Intensive Compared With Moderate Lipid-Lowering Therapy on Progression of Coronary Atherosclerosis: A Randomized Controlled Trial JAMA. 2004;291:1071-1080

Christie M. Ballantyne, John Houri, Alberto Notarbartolo, Lorenzo Melani, Leslie J. Lipka, Ramachandran Suresh, Steven Sun, Alexandre P. LeBeaut, Philip T. Sager, and Enrico P. VeltriEffect of Ezetimibe Coadministered With Atorvastatin in 628 Patients With Primary Hypercholesterolemia: A Prospective, Randomized, Double-Blind Trial Circulation 2003 107: 2409 - 2415

Philip T. Sager, Lorenzo Melani, Leslie Lipka, John Strony, Bo Yang, Ramachandran Suresh, Enrico Veltri and Ezetimibe Study GroupEffect of coadministration of ezetimibe and simvastatin on high-sensitivity C-reactive protein The American Journal of Cardiology Volume 92, Issue 12 , 15 December 2003, Pages 1414-1418

Sushant Navalkar, Sampath Parthasarathy, Nalini Santanam and Bobby V. KhanIrbesartan, an angiotensin type 1 receptor inhibitor, regulates markers of inflammation in patients with premature atherosclerosis Journal of the American College of Cardiology Volume 37, Issue 2 , February 2001, Pages 440-444

Paul M. Ridker, M.D., Mary Cushman, M.D., Meir J. Stampfer, M.D., Russell P. Tracy, Ph.D., and Charles H. Hennekens, M.D. Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men NEJM 1997; Volume 336:973-979

Ripudaman S. Hundal, Kitt F. Petersen, Adam B. Mayerson, Pritpal S. Randhawa, Silvio Inzucchi, Steven E. Shoelson, and Gerald I. ShulmanMechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes J. Clin. Invest. 2002 109:1321-1326

   


 Presentation 

"Treatment with insulin detemir provides improved glycaemic control and less weight gain compared to NPH insulin in people with diabetes"

Dr. A. J. Garber (biography)
English - 2004-09-09 - 23 minutes
(16 slides)

Summary :
In this presentation Dr. Garber discusses the advantages of treatment with insulin detemir compared to NPH insulin.

Insulin detemir is a new basal insulin analogue containing a myristic acid fatty acid chain, and having three modes of protracted action. In the results of a meta-analysis of six randomised, prospective trials done in type1 and type 2 diabetic patients, detemir was...

Learning objectives :
After viewing this presentation, the participant will be able to discuss:

- The characteristics and modes of protracted action of insulin detemir
- The effects of insulin detemir compared to NPH insulin in terms of:
Glycaemic control
Day-to-day variation in fasting blood glucose levels
Change in body weight
Risk of minor hypoglycaemia

   


 Presentation 

"Markers of endothelial dysfunction and insulin resistance. Beneficial effects of rosiglitazone in type 2 diabetes"

Prof. Paul Valensi (biography)
English - 2004-09-08 - 22 minutes
(21 slides)

Summary :
In this presentation Prof. Valensi discusses the association between endothelial dysfunction and insulin resistance in patients with type 2 diabetes, and presents new data on the effects of rosiglitazone treatment on markers of endothelial dysfunction.

Type 2 diabetes (1) and insulin resistance (2) are associated with endothelial dysfunction, which is in turn an early step in the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The associations between type 2 diabetes and insulin resistance, and endothelial dysfunction
- Data from the 2004 EASD meeting supporting the beneficial impact of rosiglitazone on endothelial function in type 2 diabetes

Bibliographic references :
1. Russell Ross, Ph.D. Atherosclerosis — An Inflammatory DiseaseNEJM 1999;340:115.


2. AE Caballero, S Arora, R Saouaf, SC Lim, P Smakowski, JY Park, GL King, FW LoGerfo, ES Horton and A Veves Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetesDiabetes. 1999;48(9):1856.

3. Mark A. Creager, MD; Thomas F. Lüscher, MD, FRCP; and prepared with the assistance of Francesco Cosentino, MD, PhD; Joshua A. Beckman, MD Diabetes and Vascular Disease: Pathophysiology, Clinical Consequences, and Medical Therapy: Part ICirculation. 2003;108:1527.

4. Andreas Festa, MD; Ralph D’Agostino, Jr, PhD; George Howard, DrPH; Leena Mykkänen, MD, PhD; Russell P. Tracy, PhD; Steven M. Haffner, MD Chronic Subclinical Inflammation as Part of the Insulin Resistance Syndrome: The Insulin Resistance Atherosclerosis Study (IRAS) Circulation. 2000;102:42.

5. Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition Annu Rev Med. 1993;44:121-31.

   


 Presentation 

"Diabetes/Lipids"

Dr. Ehud Ur (biography)
English - 2004-08-06 - 68 minutes
(51 slides)

Summary :
In this presentation Dr. Ur reviews several topics of current interest in diabetes management.

Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) provide information about different aspects of pathopyhsiology. IGT is known to increase cardiovascular risk, and several diabetes prevention studies have used IGT as an entry criterion. It is therefore important to...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Prediabetes and Diabetes Prevention
- Differentiation between type 1 and type 2 diabetes
- Benefits of Multifactorial Management in Diabetes: The Steno-2 Study
- New Lipid Lowering Evidence in Diabetes: CARDS
- New Lipid Lowering Evidence: PROVE-IT
- The Metabolic Syndrome
- Cholesterol Absorption Inhibitors
- CRP: Uses and Abuses
- Rimonobant: New Treatment for Obesity

Bibliographic references :
1. M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato and A Sekikawa.Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care.1999;22:920-924.

2. Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetesnejm.2003;348:383-393.

3. Christopher P. Cannon, M.D., Eugene Braunwald, M.D., Carolyn H. McCabe, B.S., Daniel J. Rader, M.D., Jean L. Rouleau, M.D., Rene Belder, M.D., Steven V. Joyal, M.D., Karen A. Hill, B.A., Marc A. Pfeffer, M.D., Ph.D., Allan M. Skene, Ph.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators.Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary SyndromesNEJM.2004;350:1495-1504.

4. Earl S. Ford, MD,MPH; Wayne H. Giles, MD,MSc; William H. Dietz, MD,PhD.Prevalence of the Metabolic Syndrome Among US Adults:
Findings From the Third National Health and Nutrition Examination Survey
JAMA. 2002;287:356-359.

5. Hanna-Maaria Lakka, MD, PhD; David E. Laaksonen, MD, MPH; Timo A. Lakka, MD, PhD; Leo K. Niskanen, MD, PhD; Esko Kumpusalo, MD, PhD; Jaakko Tuomilehto, MD, PhD; Jukka T. Salonen, MD, PhD. The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men JAMA. 2002;288:2709-2716.

6. Christie M. Ballantyne, MD; John Houri, MD; Alberto Notarbartolo, MD; Lorenzo Melani, MD; Leslie J. Lipka, MD, PhD; Ramachandran Suresh, PhD; Steven Sun, PhD; Alexandre P. LeBeaut, MD; Philip T. Sager, MD; Enrico P. Veltri, MD, for the Ezetimibe Study Group.Effect of Ezetimibe Coadministered With Atorvastatin in 628 Patients With Primary Hypercholesterolemia: A Prospective, Randomized, Double-Blind TrialCirculation. 2003;107:2409.

7. Paul M. Ridker, MD, MPH.Evaluating Novel Cardiovascular Risk Factors:
Can We Better Predict Heart Attacks?
Ann Int Med.1999;130:933-937.

8. Paul M. Ridker, M.D., M.P.H., Nader Rifai, Ph.D., Michael Clearfield, D.O., John R. Downs, M.D., Stephen E. Weis, D.O., J. Shawn Miles, M.D., Antonio M. Gotto, Jr., M.D., D.Phil., for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators. Measurement of C-Reactive Protein for the Targeting of Statin Therapy in the Primary Prevention of Acute Coronary Events
NEJM.2001;344:1959-1965.

9. I. Jialal, MD, PhD; D. Stein, MD; D. Balis, MD; S. M. Grundy, MD, PhD; B. Adams-Huet, MS; S. Devaraj, PhD.Effect of Hydroxymethyl Glutaryl Coenzyme A Reductase Inhibitor Therapy on High Sensitive C-Reactive Protein Levels Circulation. 2001;103:1933.

10. Steven M. Haffner, MD; Andrew S. Greenberg, MD; Wayde M. Weston, PhD; Hongzi Chen, PhD; Ken Williams, MS; Martin I. Freed, MD.Effect of Rosiglitazone Treatment on Nontraditional Markers of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus Circulation. 2002;106:679.

   


 Presentation 

"Evolving Therapies in Type 2 Diabetes"

Prof. John Prins (biography)
English - 2004-06-04 - 24 minutes
(22 slides)

Summary :
The AusDiab Study showed a steadily rising prevalence of type 2 diabetes in the Australian population, with over 1 million people estimated to have the disease by 2010. In this presentation Dr. Prins reviews the natural history of type 2 diabetes and describes how treatment strategies can be adapted to prevent conversion from IGT to diabetes, lower insulin resistance and preserve beta cell...

Learning objectives :
The participant will learn about:

- The natural history of type 2 diabetes
- Treatment strategies to prevent diabetes, lower insulin resistance and preserve beta cell function

   


 Presentation 

"Based on these mechanisms, are beta-cells a therapeutic target for slowing or possibly preventing disease progression?"

Dr. Julio Rosenstock (biography)
English - 2004-06-04 - 17 minutes
(12 slides)

Summary :
The UKPDS showed that conventional monotherapy does not affect the progressive decline in beta cell function. Different factors drive this process, such as hyperglycemia, lipotoxicity (elevated free fatty acids and triglycerides) and protein glycation. Autopsy studies have demonstrated that diabetic patients also have a reduced beta cell volume. This in turn is a result of increased beta cell...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- Factors driving the progressive decline in beta cell function in type 2 diabetes
- Pharmacologic options which may preserve beta cell function

Bibliographic references :
Thomas A. Buchanan, Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Aura Marroquin, Jose Goico, Cesar Ochoa, Sylvia Tan, Kathleen Berkowitz, Howard N. Hodis, and Stanley P. Azen. Preservation of Pancreatic ß-Cell Function and Prevention of Type 2 Diabetes by Pharmacological Treatment of Insulin Resistance in High-Risk Hispanic Women
Diabetes 2002;51:2796-2803.

Alexandra E. Butler, Juliette Janson, Susan Bonner-Weir, Robert Ritzel, Robert A. Rizza, and Peter C. Butler. ß-Cell Deficit and Increased ß-Cell Apoptosis in Humans With Type 2 Diabetes Diabetes 2003;52:102-110.

Diane T. Finegood, M. Dawn McArthur, David Kojwang, Marion J. Thomas, Brian G. Topp, Thomas Leonard, and Robin E. Buckingham.ß-Cell Mass Dynamics in Zucker Diabetic Fatty Rats Rosiglitazone Prevents the Rise in Net Cell Death Diabetes 2001;50:1021-1029.

UKPDS Group (UKPDS 16).U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group Diabetes 1995;44(11):1249-1258.

Giancarlo Viberti, MD, Steven E. Kahn, MB, CHB, Douglas A. Greene, MD, William H. Herman, MD, Bernard Zinman, MD, Rury R. Holman, MD, Steven M. Haffner, MD, Daniel Levy, MD, John M. Lachin, SCD, Rhona A. Berry, BSC, Mark A. Heise, PHD, Nigel P. Jones, MA and Martin I. Freed, MD.A Diabetes Outcome Progression Trial (ADOPT)An international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes Diabetes Care 2002;25:1737-1743.

   


 Presentation 

"What clinical guidelines are available to support the need for aggressive HbA1c, blood pressure, and lipid control?"

Dr. Steven V. Edelman (biography)
English - 2004-06-04 - 16 minutes
(6 slides)

Summary :
A discussion of the goals of therapy for diabetic patients from the American Diabetes Association (ADA) and the American College of Endocrinology (ACE), Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC 7) blood pressure classification and management, and lipid targets in diabetic patients (ADA, NCEP ATP III).

Copyright © 2004
Learning objectives :
After viewing these slides the participant will be able to discuss:

- Targets for diabetes treatment (ADA vs ACE)
- JNC7 blood pressure classification and management
- The effect of diastolic blood pressure control on cardiovascular mortality in diabetic patients (HOT Trial)
- Lipid goals in patients with type 2 diabetes

Bibliographic references :
ADA. Standards of Medical Care in Diabetes Diabetes Care. 2004;27:S15-S35.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA. 2001;285:2486-2497.

Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S.Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998 Jun 13;351(9118):1755-62.

JNC7 Express. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC 7 Express. 2003

Vincenza Snow, MD; Mark D. Aronson, MD; E. Rodney Hornbake, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians The Lancet. 2004;140:644-649.

   


 Presentation 

"Should insulin resistance be considered a therapeutic target to slow or prevent macrovascular complications?"

Dr. Steven V. Edelman (biography)
English - 2004-06-04 - 12 minutes
(7 slides)

Summary :
Numerous cardiovascular risk factors are associated with insulin resistance, which can be improved with the thiazolidinedione class of drugs. Also, impaired glucose tolerance has been shown to increase CHD mortality risk, therefore the identification of these patients is important.

Copyright © 2004 MULTIWEBCAST "State-of-the-Art Webcast...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The cardiovascular risk factors associated with insulin resistance
- Metabolic effects of oral antidiabetic agents
- Atherosclerosis therapy in type 2 diabetes
- The relationship between CHD risk factors and glucose tolerance

Bibliographic references :
Joshua A. Beckman, MD,MS; Mark A. Creager, MD; Peter Libby, MD. Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management JAMA. 2002;287:2570-2581.

Eschwege E, Richard JL, Thibult N, Ducimetiere P, Warnet JM, Claude JR, Rosselin GE.Coronary heart disease mortality in relation with diabetes, blood glucose and plasma insulin levels. The Paris Prospective Study, ten years later. Horm Metab Res Suppl. 1985;15:41-6.

Samy I. McFarlane, Maryann Banerji and James R. Sowers. Insulin Resistance and Cardiovascular Disease The Journal of Clinical Endocrinology & Metabolism 2001;82(2):713-718.

   


 Presentation 

"Good Morning Diabetes: Building a New Framework for Combination Therapy"

Dr. James R. Gavin (biography)
English - 2004-06-04 - 14 minutes
(5 slides)

Summary :
Dr. Gavin begins the symposium with a call to action. Current treatment practices for type 2 diabetes are suboptimal, and it is important to understand why they are failing, and what improvements can be made.

Copyright © 2004 MULTIWEBCAST "State-of-the-Art Webcast Services"

Learning objectives :
After viewing these slides the participant will be able to discuss:

- Data from NHANES 1999-2000 on the proportion of diabetics actually reaching the targets for glucose control, blood pressure and total cholesterol.

Bibliographic references :
Sharon H. Saydah, PhD; Judith Fradkin, MD; Catherine C. Cowie, PhD. Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes JAMA. 2004;291:335-342.

   


 Presentation 

"Could you please comment on recent clinical trials of cardiovascular events in patients with type 2 diabetes?"

Dr. Andrew P. Selwyn (biography)
English - 2004-06-04 - 16 minutes
(9 slides)

Summary :
Recent studies of prevention of cardiovascular events with lipid-lowering therapy include the PROVE-IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy) trial and the CARDS (Collaborative AtoRvastatin Diabetes Study).

The PROVE-IT trial was conducted in over 4000 patients over 30 months of follow up, and showed the superiority of an intensive lipid-lowering therapy...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The benefit of intensive lipid-lowering therapy in subjects having undergone an acute coronary syndrome (PROVE-IT study)
- The benefit of lipid-lowering therapy for the primary prevention of CVD in type 2 diabetic patients having at least one other CVD risk factor (CARDS study).

Bibliographic references :
Christopher P. Cannon, M.D., Eugene Braunwald, M.D., Carolyn H. McCabe, B.S., Daniel J. Rader, M.D., Jean L. Rouleau, M.D., Rene Belder, M.D., Steven V. Joyal, M.D., Karen A. Hill, B.A., Marc A. Pfeffer, M.D., Ph.D., Allan M. Skene, Ph.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes NEJM.2004;350:1495-1504.

H. M. Colhoun, M. J. Thomason, M. I. Mackness*, S. M. Maton, D. J. Betteridge, P. N. Durrington*, G. A. Hitman§, H. A. W. Neil¶, J. H. Fuller andthe CARDS Investigators.Design of the Collaborative AtoRvastatin Diabetes Study (CARDS) in patients with Type 2 diabetesDiabetic Medicine. 2002;19(3):201.

   


 Presentation 

"What clinical evidence is available to support multifactorial intervention?"

Dr. Andrew P. Selwyn (biography)
English - 2004-06-04 - 12 minutes
(3 slides)

Summary :
The Steno-2 was a small study that randomized type 2 diabetic patients with microalbuminuria to either a conventional or intensive treatment regimen. The study aimed to achieve not only glycemic control but also blood pressure and lipid control. It was found that a target-driven intensive treatment approach lowered cardiovascular and microvascular events by about fifty percent.

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The results of the STENO-2 study which looked at the efficacy of a multifactorial treatment intervention in patients with type 2 diabetes and microalbuminuria.

Bibliographic references :
Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes NEJM 2003;348:383-393.

   


 Presentation 

"What is the rationale for earlier use of oral antidiabetic combination therapy?"

Dr. Steven V. Edelman (biography)
English - 2004-06-04 - 19 minutes
(9 slides)

Summary :
Dr. Edelman reviews the mechanism of action of various oral antidiabetic agents and discusses their relative significance in the prevention of type 2 diabetes as shown in clinical trials.

Data from DeFronzo et al. published in 1995 showed the superior glucose-lowering efficacy of adding metformin to glyburide compared to using glyburide alone or metformin alone. A more recent study...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The mechanism of action of different oral antidiabetic agents
- Data relating to the benefit of combination therapy versus uptitration or switching of agents in monotherapy

Bibliographic references :
ADA.Standards of Medical Care for Patients With Diabetes Mellitus Diabetes Care 2002;25:S33-S49.

Ralph A. DeFronzo, M.D., Anita M. Goodman, M.D., for The Multicenter Metformin Study Group. Efficacy of Metformin in Patients with Non-Insulin-Dependent Diabetes MellitusNEJM. 1995;333:541-549.

Alan J. Garber, Daniel S. Donovan, Jr., Paresh Dandona, Simon Bruce and Jong-Soon Park.Efficacy of Glyburide/Metformin Tablets Compared with Initial Monotherapy in Type 2 Diabetes JCEM 2003;Vol. 88, No. 8 3598-3604.

UK Prospective Diabetes Study (UKPDS) Group.Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) The Lancet 1998;352(9131):854-865.

   


 Presentation 

"What is the evidence for combination therapy with a TZD added to metformin or a sulfonylurea?"

Dr. Julio Rosenstock (biography)
English - 2004-06-04 - 21 minutes
(12 slides)

Summary :
Combination therapy for type 2 diabetes should achieve a durable effect as well as targeting the dual defects of insulin resistance and beta cell dysfunction.

The insulin-sensitizing effects of glitazones result in less strain on the pancreatic beta cell. When combined with submaximal doses of metformin or sulfonylurea (SU), combination therapy with TZDs has been shown to provide a...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The advantages of adding a TZD to metformin or SU monotherapy

Bibliographic references :
Daniel Einhorn MD, Marc Rendell MD, James Rosenzweig MD, John W. Egand, Annette L. Mathisen PhD, Roberta L. Schneider MD and The Pioglitazone 027 Study Group. Pioglitazone hydrochloride in combination with metformin in the treatment of type 2 diabetes mellitus: A randomized, placebo-controlled study Clinical Therapeutics.2000;22(12):1395-1409.

   


 Presentation 

"What are some of the clinical management issues with TZDs in regard to associated weight gain, fluid retention, and CHF?"

Dr. Andrew P. Selwyn (biography)
English - 2004-06-04 - 14 minutes
(10 slides)

Summary :
Edema is most likely to occur when combining a TZD with insulin. Edema is however not unique to TZDs and the glycaemic and potential cardiovascular benefits of TZDs may outweigh the risk of weight gain and fluid retention.

Combination therapy of rosiglitazone added to glipizide showed an increase in the incidence of peripheral edema and modest weight gain. Weight gain is however...

Learning objectives :
After viewing these slides the participant will be able to discuss:

-The incidence of edema and weight gain in patients on TZD monotherapy versus combination therapy
-The AHA/ADA Consensus Statement for TZDs
-Liver function with the use of newer generation TZDs

Bibliographic references :
Vivian Fonseca MD.Effect of thiazolidinediones on body weight in patients with diabetes mellitus Am J of Med.2003;115(8)suppl1:42-48.

Norman K. Hollenberg MD, PhD.Considerations for management of fluid dynamic issues associated with thiazolidinediones The American Journal of Medicine.2003;115(8)suppl 1:111-115.

Harold E. Lebovitz.Differentiating members of the thiazolidinedione class: a focus on safety Diabetes Metab Rev.2003;18(S2):S23 - S29.

Richard W. Nesto, MD, David Bell, MD, Robert O. Bonow, MD, Vivian Fonseca, MD, Scott M. Grundy, MD, PHD, Edward S. Horton, MD, Martin Le Winter, MD, Daniel Porte, MD, Clay F. Semenkovich, MD, Sidney Smith, MD, Lawrence H. Young, MD and Richard Kahn, PHD.Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Diabetes Care. 2004;27:256-263.

Van Gaal LF, De Leeuw IH.Rationale and options for combination therapy in the treatment of Type 2 diabetes. Diabetologia 2003;46 Suppl 1:M44-50.

   


 Presentation 

"What is the increasing evidence that supports TZDs and their extraglycemic benefits?"

Dr. Julio Rosenstock (biography)
English - 2004-06-04 - 10 minutes
(3 slides)

Summary :
Thiazolidinediones have been shown to cause improvements in dyslipidemia, microalbuminuria, blood pressure, vascular smooth muscle cell prolferation/migration in the arterial wall, and Plasminogen Activator Inhibitor-1 (PAI-1) and C-reactive protein (CRP) levels.

More information is available about C-Reactive Protein.

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The improvement of cardiovascular risk factors with thiazolidinediones
- Inflammation as a link between diabetes and atherosclerosis

Bibliographic references :
Neelima V. Chu, MD, Alice P. S. Kong, MRCP, Dennis D. Kim, MD, Debra Armstrong, RN, Sunita Baxi, MD, Reena Deutsch, PHD, Michael Caulfield, PHD, Sunder R. Mudaliar, MD, MRCP, Richard Reitz, MD, Robert R. Henry, MD, FRCP and Peter D. Reaven, MD. Differential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes Diabetes Care.2002;25:542-549.

Peter Libby, MD; Paul M. Ridker, MD; Attilio Maseri, MD.Inflammation and Atherosclerosis Circulation. 2002;105:1135.

Suwattee, Pitiporn M.D.; DeSouza, Cyrus M.D.; Asnani, Sunil M.D.; Gilling, Lucia M.D.; Fonseca, Vivian A. M.D.Cardiovascular Effects of Thiazolidinediones. The Endocrinologist 2002;12(2):126-134.

   


 Presentation 

"What clinical data is there regarding inflammatory markers and antidiabetic agents ?"

Dr. Steven V. Edelman (biography)
English - 2004-06-04 - 12 minutes
(7 slides)

Summary :
Dr. Edelman presents data showing the reduction in inflammatory markers with metformin and thiazolidinediones (TZDs).

The Diabetes Prevention Program (DPP) showed the lowering of C-reactive protein (CRP) with metformin. A study by Satoh et al. showed the lowering of CRP with pioglitazone not only in responders but non-responders as well, suggesting an anti-inflammatory effect of...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- The effects of lifestyle intervention and metformin on CRP (DPP Study)
- The effect of pioglitazone on plasma CRP levels in responders and non-responders
- The reduction of inflammatory markers with early addition of rosiglitazone to 1g metformin

Bibliographic references :
Neelima V. Chu, MD, Alice P. S. Kong, MRCP, Dennis D. Kim, MD, Debra Armstrong, RN, Sunita Baxi, MD, Reena Deutsch, PHD, Michael Caulfield, PHD, Sunder R. Mudaliar, MD, MRCP, Richard Reitz, MD, Robert R. Henry, MD, FRCP and Peter D. Reaven, MD.Differential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes Diabetes Care.2002; 25:542-549.

Dmitri Kirpichnikov, MD; Samy I. McFarlane, MD; and James R. Sowers, MD.Metformin: An Update Ann Int Med.2002;137(1):25-33.

Noriko Satoh, MD, PHD, Yoshihiro Ogawa, MD, PHD, Takeshi Usui, MD, PHD, Tetsuya Tagami, MD, PHD, Shigeo Kono, MD, PHD, Hiroko Uesugi, MD, PHD, Hiroyuki Sugiyama, MD, PHD, Akira Sugawara, MD, PHD, Kazunori Yamada, MD, PHD, Akira Shimatsu, MD, PHD, Hideshi Kuzuya, MD, PHD and Kazuwa Nakao, MD, PHD.Antiatherogenic Effect of Pioglitazone in Type 2 Diabetic Patients Irrespective of the Responsiveness to Its Antidiabetic Effect Diabetes Care.2003; 26:2493-2499.

PETER N. WEISSMAN, BARRY J. GOLDSTEIN, JOHN C. CAMPBELL, ERROL M. GOULD, BRIAN R. WATERHOUSE, LEANNE J. STROW, ALEXANDER R. COBITZ.Rosiglitazone Plus Metformin Combination Effects on CV Risk Markers Suggest Potential CV Benefits in Type 2 Diabetic Patients ADA 64th Scientific Sessions Abstract 121-OR.

   


 Presentation 

"Are there any outcome measures that suggest a favorable vascular effect with TZDs?"

Dr. Julio Rosenstock (biography)
English - 2004-06-04 - 15 minutes
(4 slides)

Summary :
Numerous outcome studies are ongoing to test the durability of TZD treatment and their effects on cardiovascular risk and diabetes prevention. Dr. Rosenstock provides a recap of these studies stating their main objectives and the medications being tested.

Copyright © 2004 MULTIWEBCAST "State-of-the-Art Webcast Services"

Learning objectives :
After viewing these slides the participant will be able to discuss:

- Outcome studies with TZDs testing their durability, cardiovascular effects and ability to prevent diabetes:
--->ADOPT
--->DREAM
--->RECORD
--->BARI 2D
--->PROactive
--->PERISCOPE
--->CHICAGO

   


 Presentation 

"How can we make a difference in clinical practice to improve outcomes?"

Dr. Andrew P. Selwyn (biography)
English - 2004-06-04 - 11 minutes
(3 slides)

Summary :
Dr. Selwyn points out the rising incidence of cardiovascular disease and diabetes in the last few years, and the problem of lack of compliance observed in patients with known cardiovascular disease who receive no medication for secondary prevention of CVD events. To address this problem a Cardiac Hospital Atherosclerosis Management Program (CHAMP) was carried out and this resulted in a...

Learning objectives :
After viewing these slides the participant will be able to discuss:

- the underutilization of medications for secondary prevention of cardiovascular events
- the efficacy of a comprehensive diabetes management program including risk stratification

Bibliographic references :
Charles M. Clark, Jr., MD, James W. Snyder, MD, Robert L. Meek, MS, Linda M. Stutz, RN, MBA and Christopher G. Parkin, MS.A Systematic Approach to Risk Stratification and Intervention Within a Managed Care Environment Improves Diabetes Outcomes and Patient Satisfaction Diabetes Care 2001;24:1079-1086.

Gregg C. Fonarow MD, Anna Gawlinski DNSc, Samira Moughrabi MN and Jan H. Tillisch MD.Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP) Am J Cardiol 2001;87(7):819-822.

   


 Presentation 

"Dr. Rosenstock Summary"

Dr. Julio Rosenstock (biography)
English - 2004-06-04 - 6 minutes
(3 slides)

Summary :
Dr. Rosenstock highlights the need for early combination therapy to preserve beta cell function and achieve durable glycemic control. The goal should be to maximize the treatment intervention so as to reach glycemic targets without unacceptable side effects and hypoglycemia.

Copyright © 2004 MULTIWEBCAST "State-of-the-Art Webcast Services"

   


 Presentation 

"Dr. Edelman Summary"

Dr. Steven V. Edelman (biography)
English - 2004-06-04 - 7 minutes
(3 slides)

Summary :
It is important to identify and treat patients early, according to Dr. Edelman. Furthermore it is important to educate and motivate patients to take control of their diabetes.

Copyright © 2004 MULTIWEBCAST "State-of-the-Art Webcast Services"

   


 Presentation 

"Dr. Selwyn Summary"

Dr. Andrew P. Selwyn (biography)
English - 2004-06-04 - 6 minutes
(3 slides)

Summary :
Dr. Selwyn stresses the importance of health-promoting behaviours.

Glycemic control is important in the management of type 2 diabetes, but so is blood pressure and lipid control, as cardiovascular disease is a major cause of mortality in these patients.

Copyright © 2004 MULTIWEBCAST "State-of-the-Art Webcast Services"

   


 Presentation 

"Dr. Gavin Concludes"

Dr. James R. Gavin (biography)
English - 2004-06-04 - 8 minutes
(2 slides)

Summary :
Diabetes is now understood to be a complex metabolic disease involving the accelerated development of vascular abnormalities and atherosclerosis.

The treatment strategy would now maintain aggressive lifestyle interventions for promoting insulin sensitivity, and focus on earlier use of combination therapy in lieu of uptitration in monotherapy. It is now thought that early...

   


 Presentation 

"Use of Thiazolidinediones in Type 2 Diabetes: Advantages"

Dr. David Kendall (biography)
English - 2004-06-04 - 48 minutes
(46 slides)

Summary :
In this presentation Dr. Kendall discusses the advantages of using thiazolidinedione therapy in type 2 diabetes, with regards to various aspects of management.

The development of type 2 diabetes is dependent on insulin resistance and beta cell dysfunction. TZDs are known to reduce insulin resistance and lower glucose, and studies done in Zucker diabetic fatty rats showed that TZDs...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Glycemic control with TZD therapy:
---- Targeting the metabolic defects of type 2 diabetes
---- Preserving beta cell function
- The role of TZD therapy in diabetes prevention:
---- DPP and TRIPOD studies
- Insulin resistance and CVD risk:
---- Targeting insulin resistance in the metabolic syndrome
- The safety and tolerability of TZDs
- The cost of comprehensive diabetes care

Bibliographic references :
1. Diane T. Finegood, M. Dawn McArthur, David Kojwang, Marion J. Thomas, Brian G. Topp, Thomas Leonard, and Robin E. Buckingham. ß-Cell Mass Dynamics in Zucker Diabetic Fatty Rats: Rosiglitazone Prevents the Rise in Net Cell Death Diabetes 50:1021-1029, 2001.

2. Melissa K. Cavaghan, David A. Ehrmann, Maria M. Byrne, and Kenneth S. Polonsky.Treatment with the Oral Antidiabetic Agent Troglitazone Improves Cell Responses to Glucose in Subjects with Impaired Glucose Tolerance JCI.1997;100(3):530-537.

3. Jeannie Yip, Francesco S. Facchini and Gerald M. Reaven.Resistance to Insulin-Mediated Glucose Disposal as a Predictor of Cardiovascular Disease JCEM.1998;83(8):2773-2776.

   


 Presentation 

"Type 2 Diabetes Mellitus and Heart Failure: Implications for the Use of TZDs"

Dr. Richard W. Nesto (biography)
English - 2004-04-30 - 51 minutes
(42 slides)

Summary :
In this One on One presentation Dr. Nesto answers the following question posed by CMEonDiabetes editorial board member Dr. Lawrence Leiter: "What is the latest data on the risk/benefit ratio of using thiazolidinediones in patients with heart disease?"

Dr. Nesto gives a cardiologist's perspective on heart disease in the setting of diabetes mellitus, the effects of thiazolidinediones...

Learning objectives :
The participant will learn about the following:

- heart disease in diabetes mellitus
- use of TZDs in diabetic patients with CHD

Bibliographic references :
Thomas E. Delea, MBA, John S. Edelsberg, MD, MPH, May Hagiwara, PHD, Gerry Oster, PHD and Lawrence S. Phillips, MD. Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes Diabetes Care 26:2983-2989, 2003.

Richard B. Devereux, MD; Mary J. Roman, MD; Mary Paranicas, BA; Michael J. O’Grady, BA; Elisa T. Lee, PhD; Thomas K. Welty, MD, MPH; Richard R. Fabsitz, MA; David Robbins, MD; Everett R. Rhoades, MD; Barbara V. Howard, PhD. Impact of Diabetes on Cardiac Structure and Function Circulation. 2000;101:2271.

Nassirah Khandoudi, Philippe Delerive, Isabelle Berrebi-Bertrand, Robin E. Buckingham, Bart Staels, and Antoine Bril. Rosiglitazone, a Peroxisome Proliferator-Activated Receptor-, Inhibits the Jun NH2-Terminal Kinase/Activating Protein 1 Pathway and Protects the Heart From Ischemia/Reperfusion Injury Diabetes 51:1507-1514, 2002.

Klas Malmberg, MD, PhD; Salim Yusuf, MBBS, DPhil; Hertzel C. Gerstein, MD, MSc; Joanne Brown, BSc; Feng Zhao, MSc; David Hunt, MD; Leopoldo Piegas, MD; James Calvin, MD; Matyas Keltai, MD; Andrzej Budaj, MD; for the OASIS Registry Investigators. Impact of Diabetes on Long-Term Prognosis in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction Circulation. 2000;102:1014.

Frederick A. Masoudi, MD, MSPH; Yongfei Wang, MS; Silvio E. Inzucchi, MD; John F. Setaro, MD; Edward P. Havranek, MD; JoAnne M. Foody, MD; Harlan M. Krumholz, MD, SM. Metformin and Thiazolidinedione Use in Medicare Patients With Heart Failure JAMA. 2003;290:81-85.

Richard W. Nesto, MD; David Bell, MD; Robert O. Bonow, MD; Vivian Fonseca, MD; Scott M. Grundy, MD, PhD; Edward S. Horton, MD; Martin Le Winter, MD; Daniel Porte, MD; Clay F. Semenkovich, MD; Sidney Smith, MD; Lawrence H. Young, MD; Richard Kahn, PhD.Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Circulation. 2003;108:2941.

Gregory A. Nichols PHD, Teresa A. Hillier, MD, MS, John R. Erbey, PHD and Jonathan B. Brown, PHD, MPP. Congestive Heart Failure in Type 2 Diabetes Diabetes Care 24:1614-1619, 2001

Anna Norhammar, Klas Malmberg, Erik Diderholm, Bo Lagerqvist, Bertil Lindahl, Lars Rydén and Lars Wallentin. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization JACC 2004; 43(4):585-91.

Susumu Ogawa, Kazuhisa Takeuchi and Sadayoshi Ito. Plasma BNP Levels in the Treatment of Type 2 Diabetes with Pioglitazone JCEM 2003; 88(8):3993-3996.

Martin K. Rutter, MB, ChB; Helen Parise, ScD; Emelia J. Benjamin, MD, ScM; Daniel Levy, MD; Martin G. Larson, ScD; James B. Meigs, MD, MPH; Richard W. Nesto, MD; Peter W.F. Wilson, MD; Ramachandran S. Vasan, MD. Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function Circulation. 2003;107:448.

Tetsuya Shiomi, MD; Hiroyuki Tsutsui, MD; Shunji Hayashidani, MD; Nobuhiro Suematsu, MD; Masaki Ikeuchi, MD; Jing Wen, MD; Minako Ishibashi, MD; Toru Kubota, MD; Kensuke Egashira, MD; Akira Takeshita, MD. Pioglitazone, a Peroxisome Proliferator–Activated Receptor- Agonist, Attenuates Left Ventricular Remodeling and Failure After Experimental Myocardial Infarction Circulation. 2002;106:3126.

ROGER H. UNGER, and LELIO ORCI. Diseases of liporegulation: new perspective on obesity and related disorders The FASEB Journal. 2001;15:312-321.

NICOLE S. WAYMAN, YOSHIYUKI HATTORI, MICHELLE C. MCDONALD, HELDER MOTA-FILIPE, SALVATORE CUZZOCREA, BARBARA PISANO, PRABAL K. CHATTERJEE and CHRISTOPH THIEMERMANN. Ligands of the peroxisome proliferator-activated receptors (PPAR-gamma and PPAR-alpha) reduce myocardial infarct size The FASEB Journal. 2002;16:1027-1040.

Tian-li Yue, PhD; Jun Chen, MS; Weike Bao, MD; Padma K. Narayanan, PhD; Antoine Bril, PhD; Wen Jiang, MD; Paul G. Lysko, PhD; Juan-Li Gu, MD; Rogely Boyce, PhD; Dawn M. Zimmerman, MS; Timothy K. Hart, PhD; Robin E. Buckingham, PhD; Eliot H. Ohlstein, PhD. In Vivo Myocardial Protection From Ischemia/Reperfusion Injury by the Peroxisome Proliferator–Activated Receptor- Agonist Rosiglitazone Circulation. 2001;104:2588.

   


 Presentation 

"2003 CDA Clinical Practice Guidelines for the prevention and management of diabetes mellitus, what is new?"

Dr. Amir Hanna (biography)
English - 2004-02-14 - 71 minutes
(59 slides)
(13 questions)

Summary :
In this presentation Dr Hanna talks about new features apparent in the Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, which were published in December 2003.

Screening for type 2 diabetes must now be done every 3 years starting at age 40, and sooner and more frequently in the presence of risk factors, which in the...

Learning objectives :
The participant will review new features of the 2003 CDA Guidelines, in the following aspects:

- Screening for diabetes
- Prevention of diabetes
- New targets for control of glucose, BP, lipids
- Vascular and renal protection

Bibliographic references :
1. Harris MI. ''Impaired glucose tolerance--prevalence and conversion to NIDDM.'' Diabet Med. 1996;13(3 Suppl 2):S9-11.


2. Saydah SH, Loria CM, Eberhardt MS, Brancati FL. ''Subclinical states of glucose intolerance and risk of death in the U.S.'' Diabetes Care. 2001 Mar;24(3):447-53.


3. DECODE Study Group, the European Diabetes Epidemiology Group. ”Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria.” Arch Intern Med. 2001 Feb 12;161(3):397-405.


4. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. ''XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.'' Diabetes Care. 2004 Jan;27(1):155-61.


5. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. ''Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.'' N Engl J Med. 2003 Jan 30;348(5):383-93.

   


 Presentation 

"Hypoglycemic Disorders: Investigation and Treatment"

Dr. Amir Hanna (biography)
English - 2003-10-31 - 20 minutes
(26 slides)

Summary :
Fasting hypoglycemia can have a variety of underlying causes and so once the hypoglycemia has been clinically confirmed, the next step is to use the process of elimination to rule out different causes one by one, starting with the most obvious, for example drugs or critical illness.

In some cases, endogenous hyperinsulinemia is indicated based on plasma glucose response to...

Learning objectives :
The participant will learn how to detect the underlying cause of fasting hypoglycemia and how to detect and treat endogenous hyperinsulinemia.

Summary:

Hypoglycemia is a symptom
Look for an underlying cause
Fulfill Whipple's triad (atypical symptoms)
Rule out:
- Drugs
- Critical illness
- Hormonal deficiency
- Non-beta cell tumor
72-hour fast: to clarify different causes of hyperinsulinemia
Localize insulinoma when suspected
Surgery: treatment of choice for insulinoma
De-bulking surgery in malignant insulinoma
Medical treatment:
- Preparation for surgery
- Failed surgery
- Malignant insulinoma

Bibliographic references :
1. O'Brien T, O'Brien PC, Service FJ. “Insulin surrogates in insulinoma.”

J Clin Endocrinol Metab. 1993 Aug;77(2):448-51.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8345050&dopt=Abstract

   


 Presentation 

"Treating Dyslipidemia in Diabetes"

Dr. Jeannette Goguen (biography)
English - 2003-10-31 - 50 minutes
(44 slides)

Summary :
This presentation will review the new CDA 2003 lipid guidelines, their scientific basis, and the use of combination therapy to achieve target lipid levels.

As it is not always possible for the diabetic patient to achieve target or optimal levels of triglycerides, HDL and LDL on hypolipidemic monotherapy, various studies have been looking at the safety and efficacy of different...

Learning objectives :
After viewing this presentation the participant will be familiar with:

- The 2003 CDA lipid guidelines
- The evidence that the guidelines are based upon
- How to safely achieve lipid targets

Bibliographic references :
1. Brown BG, Zhao XQ, Chait A, Fisher LD, Cheung MC, Morse JS, Dowdy AA, Marino EK, Bolson EL, Alaupovic P, Frohlich J, Albers JJ. “Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.” N Engl J Med. 2001 Nov 29;345(22):1583-92.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11757504&dopt=Abstract

2. Alan Marcus, M.D. “Current Lipid-lowering Strategies for the Treatment of Diabetic Dyslipidemia: An Integrated Approach to Therapy.” The Endocrinologist 2001;11:368-383.
http://ipsapp006.lwwonline.com/content/getfile/3320/2/5/abstract.htm

3. Athyros VG, Papageorgiou AA, Athyrou VV, Demitriadis DS, Kontopoulos AG.
“Atorvastatin and micronized fenofibrate alone and in combination in type 2 diabetes with combined hyperlipidemia.” Diabetes Care. 2002 Jul;25(7):1198-202.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12087019&dopt=Abstract

   


 Presentation 

"Novel Dietary Therapies in the Treatment of Diabetes and Cardiovascular Disease"

Dana Whitham (biography)
English - 2003-10-31 - 22 minutes
(40 slides)

Summary :
Nutritional therapy for the type 2 diabetic patient is important, and should be chosen with the aim of reducing not only obesity but CVD risk. Many popular diets have emerged in recent years, including the low carbohydrate Atkin's diet, but how good are they for the diabetic patient?

A review of low carb diets by Bravata et al found that weight lost while on these diets was...

Learning objectives :
The participant will review evidence on various diets, to determine which kind is appropriate for type 2 diabetics:

- Calories in versus calories out is the biggest determinant of weight
- Low fat diet results in the best metabolic parameters
- All dieters need support

Bibliographic references :
1. Bravata DM, Sanders L, Huang J, Krumholz HM, Olkin I, Gardner CD, Bravata DM. “Efficacy and safety of low-carbohydrate diets: a systematic review.”JAMA. 2003 Apr 9;289(14):1837-50.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12684364&dopt=Abstract

2. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. “A low-carbohydrate as compared with a low-fat diet in severe obesity.” N Engl J Med. 2003 May 22;348(21):2074-81.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12761364&dopt=Abstract

3. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S. "A randomized trial of a low-carbohydrate diet for obesity."
N Engl J Med. 2003 May 22;348(21):2082-90.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12761365&dopt=Abstract

   


 Presentation 

"Targets for Glucose Control: A Review of Recent Evidence"

Dr. Gillian Booth (biography)
English - 2003-10-31 - 29 minutes
(44 slides)

Summary :
The UKPDS and DCCT studies showed the need for good glycemic control in terms of HbA1c, to reduce the risk of microvascular complications (1, 2). However some studies have also looked at the relationship between fasting blood glucose and post prandial glycemia, and the risk of complications. For example, the Kumamoto study looked at FBG (3) and 2-hour postprandial glycemia (4) and risk of...

Learning objectives :
The participant will learn about:

- Evidence relating FBG, HbA1c, and postprandial glycemia to complications of DM
- Targets for glycemic control recommended in the 2003 CDA Guidelines
- Recent studies of Intensive therapy – STENO-2
- Upcoming studies of Intensive therapy – ACCORD

Bibliographic references :
1. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR. “UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis”. Diabetologia. 2001 Feb;44(2):156-63.


2. The Diabetes Control and Complications Trial Research Group: “The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. (1995).” Diabetes, 44, 968-983.


3. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. “Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study.” Diabetes Res Clin Pract. 1995 May;28(2):103-17.


4.Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000 Apr;23 Suppl 2:B21-9.


5. Coutinho M, Gerstein HC, Wang Y, Yusuf S.“The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years.” Diabetes Care. 1999 Feb;22(2):233-40.


6.Louis Monnier, MD, Hélène Lapinski, MD and Claude Colette, PHD. “Contributions of Fasting and Postprandial Plasma Glucose Increments to the Overall Diurnal Hyperglycemia of Type 2 Diabetic Patients.” Diabetes Care 26:881-885, 2003.

   


 Presentation 

"Perioperative Glycemic Control"

Dr. Alice Cheng (biography)
English - 2003-10-31 - 6 minutes
(30 slides)

Summary :
This presentation will discuss the 2003 CDA Guidelines for perioperative glycemic control, with a review of studies on hyperglycemia and surgical outcomes and supporting evidence for blood glucose targets in perioperative glycemic control.

The need for optimal perioperative glycemic control is becoming evident with information from studies looking at perioperative glycemia in...

Learning objectives :
The participant will be able to:

- Describe the short- and long-term effects of hyperglycemia on surgical outcomes
- Outline the evidence for perioperative glycemic control and appropriate targets
- Discuss the 2003 CDA Clinical Practice Guidelines recommendations for perioperative glycemic control

Bibliographic references :
1. McAlister FA, Man J, Bistritz L, Amad H, Tandon P. “Diabetes and Coronary Artery Bypass Surgery: An examination of perioperative glycemic control and outcomes.” Diabetes Care. 2003 May;26(5):1518-24.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12716815&dopt=Abstract

2. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. “Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.” Ann Thorac Surg. 1999 Feb;67(2):352-60; discussion 360-2.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10197653&dopt=Abstract

3. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R.Intensive insulin therapy in the critically ill patients.N Engl J Med. 2001 Nov 8;345(19):1359-67.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11794168&dopt=Abstract

   


 Presentation 

"The Value of Combination Therapy in Type 2 Diabetes"

Prof. Bernard Zinman (biography)
English - 2003-10-18 - 31 minutes
(28 slides)
(4 questions)

Summary :
The pathophysiology of type 2 diabetes is complex. In addition to insulin resistance and beta cell dysfunction, there is increased hepatic glucose production, and also adipocytokines that affect beta cell function and insulin action. It therefore makes sense to target more than one aspect of pathophysiology in the management of type 2 diabetes.

The UKPDS showed the inability of...

Learning objectives :
The participant will learn about the rationale behind using combination therapy early in type 2 diabetes treatment, and about the characteristics of Avandamet, a combination of rosiglitazone and metformin:

-Targets pathophysiology at two complimentary pathways: improved insulin sensitivity and reduced hepatic glucose output
-Robust effect on lowering HbA1c
-Low incidence of hypoglycemia
-Less weight gain
-Well tolerated
-Potential added value on beta cell function and cardiovascular risk

Bibliographic references :
1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) ". UK Prospective Diabetes Study (UKPDS) Group." Lancet. 1998; 352(9131):837-53.


2. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. "" Diabetes. 2002 Sep;51(9):2796-803.

   


 Presentation 

"Sustaining Long-Term Glycemic Control: Are we ready for change?"

Dr. Stuart A Ross (biography)
English - 2003-10-17 - 34 minutes
(30 slides)

Summary :
The challenge to effectively manage type 2 diabetes has perhaps never been so critical. We are now aware of the increasing number of people who will develop diabetes over the coming years. There is also the recognition that diabetes is a complex disorder with major disturbances in glucose control and blood pressure and lipid abnormalities leading to not only the microvascular complications of...

Learning objectives :
The participant will review how traditional type 2 diabetes therapy has failed, and learn about promising new concepts in therapy.

Bibliographic references :
Festa A, D'Agostino R Jr, Howard G, Mykkanen L, Tracy RP, Haffner SM. “Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).” Circulation. 2000 Jul 4;102(1):42-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Reaven GM. “Role of insulin resistance in human disease (syndrome X): an expanded definition.” Annu Rev Med. 1993;44:121-31.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi


   


 Presentation 

"Thiazolidinediones to Preserve B-Cell Function and Prevent Type 2 Diabetes"

Prof. Thomas A. Buchanan (biography)
English - 2003-08-28 - 39 minutes
(32 slides)
(1 question)

Summary :
Recorded during the 18th IDF Meeting, Paris: Type 2 diabetes is not just a disease of hyperglycemia but indeed one of progressive beta cell failure. This beta cell failure begins long before the diagnosis of diabetes, and this presentation will deal with how to intervene in such a way to preserve beta cell function and preclude the development of diabetes.

Fat accumulation in the...

Learning objectives :
The participant will review the results of the TRIPOD (Troglitazone in the Prevention of Diabetes) Study and learn about first year’s results of the PIPOD (Pioglitazone in the Prevention of Diabetes) Study being conducted with women who finished from TRIPOD:

TRIPOD Summary:

•Troglitazone reduced the incidence of diabetes by 55% in high-risk Hispanic women.
•Protection from diabetes:
orequired an increase in insulin sensitivity
owas greatest in women who had the largest reduction in insulin requirements (“ß-cell rest”)

•Women who were protected during the trial:
oremained protected 8 months later
ohad stable ß-cell function over a 54-month period

PIPOD Year 1 Summary:

•The low incidence of diabetes and the beta cell rest observed at 1 year in women who entered PIPOD without diabetes suggests a protective effect similar to TRIPOD
•Treatment of insulin resistance with TZDs may have different effects at different stages in the evolution of diabetes:
oEarly intervention in patients without diabetes resulted in lowered insulin levels with a minimal effect on glucose
oLater intervention resulted in lowered glucose and insulin concentrations
This suggests a loss of beta cell autoregulation with disease progression.

Bibliographic references :
Bergman RN, Phillips LS, Cobelli C. Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. J Clin Invest. 1981 Dec;68(6):1456-67.

Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999 Sep;104(6):787-94.


Homko C, Sivan E, Chen X, Reece EA, Boden G. Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. J Clin Endocrinol Metab. 2001 Feb;86(2):568-73.


Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. Diabetes. 2002 Sep;51(9):2796-803.

   


 Presentation 

"Shifting the paradigm: from stepwise to early combination therapy?"

Prof. Rury Holman (biography)
English - 2003-08-26 - 27 minutes
(24 slides)

Summary :
The number of people worldwide with diabetes is predicted to exceed 300 million by the year 2025, more than all of the people living currently in North America. Despite major efforts to improve the management of diabetes, it remains in the 21st century the leading cause of blindness, end stage renal disease and lower extremity amputations in industrialized nations. The U.K. Prospective Diabetes...

Learning objectives :
The participant will review evidence supporting the need for early combination therapy:

Treating progressive hyperglycemia:
- Existing hypoglycaemic therapies can be given in combination at a much earlier stage, whenever therapeutic targets are not met
- Combination therapy is required to address the multiple risk factors in T2DM
- Thiazolidinediones offer additional therapeutic possibilities

Summary:
- Early combination therapy is essential if glycaemic targets are to be achieved and maintained in T2DM
- Therapies with different modes of action can be combined to address:
o Both fasting and postprandial hyperglycemia
o Insulin resistance and loss of B-cell function
- Outcome trials are evaluating potential benefits of new therapeutic options and combinations

Bibliographic references :
Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57). Wright A, Burden AC, Paisey RB, Cull CA, Holman RR; U.K. Prospective Diabetes Study Group.
Diabetes Care. 2002 Feb;25(2):330-6.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Stevens RJ, Kothari V, Adler AI, Stratton IM; United Kingdom Prospective Diabetes Study (UKPDS) Group. Clin Sci (Lond). 2001 Dec;101(6):671-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

A randomized double-blind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U.K. Prospective Diabetes Study 44). Holman RR, Cull CA, Turner RC. Diabetes Care. 1999 Jun;22(6):960-4.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

   


 Presentation 

"The case for rosiglitazone therapy : putting theory into practice"

Dr. Kathleen Wyne (biography)
English - 2003-08-26 - 30 minutes
(32 slides)
(5 questions)

Summary :
Historically, the aim of physicians treating type 2 diabetes has been to reduce hyperglycaemia through diet and exercise supplemented with oral anti-diabetic agents and/or insulin. Even with intensive use of these therapies, however, many of our patients fail to reduce HbA1c to the ADA target level of < 7%, and we are seeing increasing numbers of individuals with cardiovascular disease (CVD)....

Learning objectives :
The participant will review data supporting the use of rosiglitazone.

Conclusions:

- A1c target is now below 6.5%
- Most patients will require combination therapy to attain this target A1c
- Combination therapy needs to be oriented toward the disease process
- It’s not just about sugar which is the end result of the process


Bibliographic references :
Wyne KL, Drexler AJ, Miller JL, Bell DS, Braunstein S, Nuckolls JG. Constructing an algorithm for managing type 2 diabetes. Focus on role of the thiazolidinediones. Postgrad Med. 2003 May;Spec No:63-72.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi


   


 Presentation 

"What are the optimal combination strategies in order to achieve glycaemic control?"

Dr. Lawrence A. Leiter (biography)
English - 2003-08-26 - 27 minutes
(39 slides)
(4 questions)

Summary :
Current guidelines for the management of type 2 diabetes emphasize the importance of optimal glycaemia in an attempt to reduce the risk of complications. Given the inadequacy of conventional monotherapies in maintaining blood glucose targets in the long term, new approaches to treating type 2 diabetes are required. In particular, earlier introduction of combination therapy is being increasingly...

Learning objectives :
The participant will review new evidence about optimal combination strategies for achieving optimal glucose control.

Conclusions:

- Despite increasingly aggressive glycaemic targets, many persons with DM are still are still not achieving target.
- Although the cause of this is multifactorial, rigid adherence to a stepwise approach has led to significant delays in reaching targets.
- Combination therapy has been shown to improve glycaemic control and increase the proportion of patients achieving goals.
- Outcome studies with combination therapy are underway.

Bibliographic references :
Kipnes MS, Krosnick A, Rendell MS, Egan JW, Mathisen AL, Schneider RL. Pioglitazone hydrochloride in combination with sulfonylurea therapy improves glycemic control in patients with type 2 diabetes mellitus: a randomized, placebo-controlled study. Am J Med. 2001 Jul;111(1):10-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Fonseca V, Rosenstock J, Patwardhan R, Salzman A. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA. 2000 Apr 5;283(13):1695-702.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

   


 Presentation 

"Early combination therapy in type 2 diabetes: targeting insulin resistance and beta-cell dysfunction"

Prof. John Nolan (biography)
English - 2003-08-26 - 25 minutes
(25 slides)

Summary :
Type 2 diabetes is a complex metabolic disease with major cardiovascular complications. The rapid increase in the prevalence of obesity and type 2 diabetes, with their complications, is a global health problem in terms of health expenditure and human cost. 'Diabesity' is increasingly used to describe the syndrome of diabetes and its associated complications that typically present as the...

Learning objectives :
The participant will review the pathophysiology and evolution of type 2 diabetes and learn about treating the patient at different stages of the disease.

Bibliographic references :
Bergman RN, Phillips LS, Cobelli C. "Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose."
J Clin Invest. 1981 Dec;68(6):1456-67.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7033284&dopt=Abstract

Bonadonna RC, De Fronzo RA. "Glucose metabolism in obesity and type 2 diabetes." Diab Metab. 1991 May;17(1 Pt 2):112-35.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1936466&dopt=Abstract

Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. "Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women."
Diabetes. 2002 Sep;51(9):2796-803.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12196473&dopt=Abstract

   


 Presentation 

"Scientific Update: Rosiglitazone in Perspective"

Dr. Robin Buckingham (biography)
English - 2003-07-02 - 64 minutes
(55 slides)
(20 slides)
(8 questions)

Summary :
We now understand the major pathophysiological defects of type 2 diabetes to be insulin resistance and beta cell failure. Epidemiological data suggest that inflammatory factors predict the future development of type 2 diabetes. What is the link between these inflammatory factors and the underlying pathophysiology of the disease?

One hypothesis is that insulin resistance and...

Learning objectives :
The participant will review data supporting the properties of thiazolidinediones as being consistent with those of agents most likely to reduce the rate of beta cell apoptosis, and thereby, the rate of deterioration of glycaemic control:

- Epidemiological data suggest that the pre-diabetic insulin resistant state, and Type 2 diabetes itself, are characterized by chronic, low-grade systemic inflammation.

- Insulin resistance and compensatory hyperinsulinemia, in tandem with chronic systemic inflammation, might explain the elevated rate of beta cell apoptosis in Type 2 Diabetes.

- To test this hypothesis, reducing insulin resistance and plasma insulin, together with reducing systemic inflammation, should reduce the rate of beta cell apoptosis and the rate of deterioration of glycaemic control.

- The ADOPT and DREAM studies are 2 long-term studies currently underway to test this hypothesis using rosiglitazone, an insulin-sensitizing, insulin-sparing AND anti-inflammatory drug:

o It reduced serum CRP levels in type 2 diabetic patients (Haffner et al, Circulation 106: 679-684, 2002).

o It reduced serum CD40 ligand (CD40L) concentrations (Marx et al, Circulation 107: 1954-57, 2003). CD40 and CD40L are surface proteins found on activated platelets (Ruggeri, Nature Medicine 8: 1227-34, 2002). They are also found in the activation cascade between T-lymphocytes and macrophages (Libby, Nature 420: 868-874, 2002).

o It inhibited IFN-?-induced expression of chemokines IP-10, Mig and I-TAC (Marx et al. J Immunology 164: 6503-08, 2000), which are involved in the recruitment of T-lymphocytes to the area of inflammation on the vascular wall (Libby, Nature 420: 868-874, 2002).

o It limited the expression of proinflammatory cytokines such as IFN-?, in activated human T-lymphocytes (Marx et al. Circ Res 90: 703-710, 2002).

- The ability of troglitazone to prevent diabetes was seen in the recent DPP data presented at the 63rd ADA Meeting, although the average duration of treatment was only 9 months (Diabetes 52 (Suppl 1): A58, 251-OR, 2003).

- The TRIPOD Study, however, showed over a 4 year follow up period a significant reduction in incidence of diabetes in women who had had gestational diabetes (Buchanan et al Diabetes 51: 2796 – 2803, 2002). The protective action of troglitazone was associated was persistent at 8 months after the medication was stopped, suggesting some kind of re-programming of the destructive mechanism on beta cells.

- We now have the first evidence that rosiglitazone is vascular-protective, as it has been shown to reduce restinosis after coronary stenting in Type 2 diabetics (Choi et al. Diabetes 52 (suppl 1): A19, 82-OR, 2003).

- Data coming out of the 2-year RESULT Study (Rosiglitazone Early vs SULfonylurea Titration) show that the combination of rosiglitazone with glipizide provides better glycaemic control than escalating the dose of glipizide alone.

Bibliographic references :
Sample Publications (of >50)

Buckingham RE, Al-Barazanji KA, Toseland CDN, Slaughter M, Connor SC, West A, Bond B, Turner NC, Clapham JC. The PPARg agonist, rosiglitazone, protects against nephropathy and pancreatic islet abnormalities in Zucker fatty rats. Diabetes 47: 1326-1334, 1998.

Walker AB, Chatington PD, Buckingham RE, Williams G. The thiazolidinedione rosiglitazone (BRL 49653) lowers blood pressure and protects against impairment of endothelial function in Zucker fatty rats. Diabetes 48: 1448-1453, 1999.

Smith SA, Lister CA, Toseland CDN, Buckingham RE. Rosiglitazone prevents the onset of hyperglycemia and proteinuria in the Zucker Diabetic Fatty (ZDF) rat. Diabetes, Obesity & Metabolism 2: 363-372, 2000.

Yue Y-I, Chen J, Bao W, Narayanan PK, Bril A, Jiang W, Lysko PG, Gu J-L, Boyce R, Zimmerman DM, Hart TK, Buckingham RE, Ohlstein EH. In vivo myocardial protection from ischemia/reperfusion injury by the peroxisome proliferator-activated receptor-g agonist rosiglitazone. Circulation 104: 2588-2594, 2001.

Carpentier A, Taghibiglou C, Leung N, Szeto L, Van Iderstine S, Uffelman K, Buckingham R, Adeli K, Lewis GF. Ameliorated hepatic insulin resistance is associated with normalization of microsomal triglyceride transfer protein (MTP) expression and reduction in very low density lipoprotein assembly and secretion in the fructose-fed hamster. J Biol Chem 277: 28795-28802, 2002.

Scheuermann-Freestone M, Madsen PL, Manners D, Blamire AM, Buckingham RE, Styles P, Radda GK, Neubauer S, Clarke K. Abnormal cardiac and skeletal muscle energy metabolism in patients with Type 2 diabetes. Circulation (in press).


   


 Presentation 

"Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes - 'Steno 2'"

Dr. Oluf Pedersen (biography)
English - 2003-06-16 - 49 minutes
(47 slides)

Summary :
The Steno-2 Study was designed in 1990, when there was no evidence base for the treatment of type 2 diabetes, and studies such as the UKPDS were ongoing. Steno-2 was an attempt to validate the efficacy of daily clinical practice, i.e., the multifactorial treatment of type 2 diabetes, in high-risk type 2 diabetes patients. The aim of the study was to investigate the impact on microvascular and...

Learning objectives :
The participant will learn about the objectives and findings of the Steno-2 Study, which took place in Denmark in the 1990s:

- The aim of the study was to investigate the impact on microvascular and cardiovascular disorders, of a target driven behaviour modification and polypharmacy as compared to a conventional multifactorial treatment of high-risk type 2 diabetic patients with the metabolic syndrome including microalbuminuria.

- After 7.8 years duration the study showed an absolute risk reduction of 20% for CVD, and the relative risk reductions for microvascular events were as follows: nephropathy 61%, retinopathy 58% and autonomic neuropathy 63%.

Bibliographic references :
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

   


 Presentation 

"Looking at New Evidence: Immediate Solutions to a Long-Term Problem"

Dr. Steven V. Edelman (biography)
English - 2003-06-16 - 37 minutes
(44 slides)

Summary :
Dr Edelman presents here new data supporting the rationale for treating insulin resistance and preserving beta cell function early in treatment. The RESULT (Rosiglitazone Early vs Sulfonylurea Titration) study was the first 2-year, randomized, double blind, parallel-group study comparing titration to maximum dose of SU versus half the maximum dose of SU plus rosiglitazone. This study showed that...

Learning objectives :
The participant will review data from two new studies: RESULT (Rosiglitazone Early vs Sulfonylurea Titration) and Rosiglitazone Added Early to 1 g Metformin:

- Early addition of rosiglitazone to half the maximum dose of SU is more effective than maximizing monotherapy with SU alone.
- Adding rosiglitazone to low dose metformin is more effective and more tolerable than high dose metformin alone.
- New data strengthens the rationale for targeting insulin resistance and preserving beta cell function early in treatment.
- Early diagnosis and treatment with drugs that improve insulin resistance may alter the natural history of type 2 diabetes.

Bibliographic references :
Ramlo-Halsted BA, Edelman SV. The natural history of type 2 diabetes. Implications for clinical practice. Prim Care. 1999 Dec;26(4):771-89.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

   


 Presentation 

"Type 2 diabetes-Early : Aggressive Treatment Strategies"

Dr. Amir Hanna (biography)
English - 2002-11-23 - 27 minutes
(46 slides)

Summary :
Studies in Type 1 and 2 diabetes clearly show that using intensive regimens in the management of hyperglycemia results in significant reduction in microvascular disease and a trend towards amelioration of macrovascular disease (1-4). Early aggressive glycemic control in Type 1 diabetes resulted in long-term protection against microvascular disease (5).

Treatment paradigms in type 2...

Learning objectives :
The participant will learn about the rationale for early combination therapy and the use of different agents in mono- or combination therapy:

- Decreasing HbAIc to 7% reduces microvascular complications
- This target is not achieved in the majority of patients
- Initial combination therapy decreases glucose more than mono-therapy and has less side effects
- Complication prevention for type 2 diabetes should start promptly after diagnosis
- Agents used in combination therapy should be tailored to the individual patient
- The stepwise approach should be left behind in favour of early/initial combination therapy targeting HbA1c < 7%
- Choice of agents should take into account results of clinical studies, rate of secondary failure and non glycemic effects


Bibliographic references :
1. The Diabetes Control and Complications Trial Research Group. The effect of intensive therapy of diabetes on the developpment and progression of long-term complications in insulin-dependent diabtes mellitus. N Engl J Med 1993: 329:977-986
2. Ohkubo Y, Kishikawa H, Araki E et al. Intensive Insulin Therapy prevents the progression of diabetic microvascular complications in Japanese patients with Non-insulin dependent Diabetes Mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28:103-117
3. UKPDS Group. Intensive Blood Glucose control with sulponylurea or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853.
4. Effect of Intesive blood-glucose control with metformin on complications in overweight patients with Type 2 diabetes (UKPDS 34) Lancet 1998; 352 (9131): 854-865
5. Retinopathy and Nephropathy in patients with Type1 Diabetes Four Years after a Trial of Intensive Therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions And Complications Research Group. N Engl J Med 2000; 3452:381-389
6. Meltzer S, Leiter L, Daneman D et al. 1998 Clinical Practice Guidelines for the Management And Complications Research Group. N Engl J Med 2000; 3452:381-389.
7. Nathan DM. N Engl J Med 2002; 347:1342.
8. Riddle M. American J Med 2000; 106 (6A): 165-22S.
9. UKPDS JAMA 1999; 281:2005.
10. Fonseca V et al. JAMA 2000; 283:1695-1702.
11. Garber AJ, Larsen J, Schneider SH, et al. Diabetes Obes Metab 2002; 4(3) 201-8.


   


 Presentation 

"Canadian Diabetes Association Guidelines - Update"

Dr. Stewart Harris (biography)
English - 2002-11-16 - 41 minutes
(23 slides)
(45 slides)

Summary :
In the late 2003, the CDA Expert Committee of the Canadian Diabetes Association will be publishing a revised set of evidence-based Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Many of the proposed changes reflect new evidence published since the 1998 set of guidelines were presented in a public forum recently at the CDA conference in Vancouver. This...

Learning objectives :
To present and discuss some of the main changes to the Clinical Practice Guidelines of the CDA which are due to take effect in late 2003. The proposed changes include early and aggressive monitoring and treatment of dysglycemia and hypertension, new glycemic targets and management, and simplified screening for nephropathy.

Bibliographic references :
The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus.

Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M.

Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, 100 Collip Circle, London, Ontario N6G 4X8, Canada. jbbrown@uwo.ca

BACKGROUND: Few studies have explored the contextual dimensions and subsequent interactions that contribute to a lack of adherence in the application of guidelines for diabetes management. OBJECTIVE: The purpose of this qualitative study was to explore family physicians' issues and perceptions regarding the barriers to and facilitators of the management of patients with type 2 diabetes mellitus (DM). METHODS: Four focus groups composed of family physicians (n= 30) explored the participants' experiences in the management of patients with type 2 DM. A semi-structured interview guide began with questions on family physicians' experience of providing care and included specific probes to stimulate discussion about the various barriers to and facilitators of the management of type 2 DM in family practice. RESULTS: Participants clearly identified type 2 DM as a chronic disease most often managed by family physicians. The findings revealed distinct barriers and facilitators in managing patients with type 2 DM which fell into three domains: patient factors; physician factors; and systemic factors. There was a dynamic interplay among the three factors. The important role of education was common to each. CONCLUSIONS: The interactions of patient, physician and systemic factors have implications for the implementation of a diabetes management model. The care of patients with type 2 DM exemplifies the ongoing challenges of caring for patients with a chronic disease in family practice. The findings, while specific to the management of type 2 DM, have potential transferability to other chronic illnesses managed by family physicians.

Fam Pract 2002 Aug;19(4):344-9


   


 Presentation 

"Targeting Glycemia in Type 2 Diabetes"

Prof. Bernard Zinman (biography)
English - 2002-11-16 - 27 minutes
(29 slides)

Summary :
The management of type 2 Diabetes Mellitus has some critical issues. We
still need to reach a consensus about adequate screening measures for type
2 diabetes, and traditional therapies reduce hyperglycemia in the short
term, but fail to maintain glycemic control. The Disposition Index shows
the relationship between insulin resistance and beta cell function, and
Learning objectives :
Ojectives:

Learn how to manage Type 2 Diabetes Mellitus by:

- Implementing appropriate screening

- Striving for better metabolic control (glycemic control is still poor in many patients)

- Using therapeutic interventions that target pathophysiology

- Using additive rather than substitutive therapy

Conclusions:

- We still need to reach a consensus about adequate screening measures for type 2 diabetes

- Traditional therapies reduce hyperglycemia in the short term, but fail to maintain glycemic control

- Significant reductions in macrovascular complications have only been seen with metformin in overweight patients

- The Disposition Index shows the relationship between insulin resistance and beta cell function, and how staying on the "euglycemic curve" involves increasing insulin secretion, improving insulin sensitivity, or as is often the case, using more than one strategy. Hence it's important to have treatments which are at least additive, and which target pathophysiology so target glycemia levels can be obtained

- Patients seem to prefer taking one pill containing two medications versus taking two kinds of pills, and (newly released in Canada) Avandamet (rosiglitazone maleate/metformin HCl) offers the advantage of 2 agents in one pill which not only lower blood glucose but do so by targeting pathophysiology

- The rosiglitazone and metformin in Avandamet have complementary mechanisms of action, where metformin primarily reduces hepatic glucose production, and rosiglitazone directly targets insulin resistance increasing peripheral glucose uptake

- The combination of rosiglitazone and metformin mitigates some of the weight gain seen with rosiglitazone use alone

- GI side effects with Avandamet are identical to those seen with metformin alone

- Hypoglycemia rates are very low with the combination of rosiglitazone and metformin

- Precautions and contraindications are the same for Avandamet as for metformin or Avandia alone (renal function, heart failure, liver function)

- Avandamet fixed dose combination is indicted for use as an adjunct to diet and exercise in the treatment of type 2 diabetes when diet, exercise and metformin or rosiglitazone alone do not result in adequate glycemic control

   


 Presentation 

"Sustaining Long-Term Glycemic Control"

Dr. Stuart A Ross (biography)
English - 2002-10-05 - 39 minutes
(32 slides)

Summary :
A lot about diabetes care has changed in recent years. We now have multiple drug therapies, and specific targets and goals to reach as outlined by the CDA. In spite of this, target glucose levels are difficult to achieve. The UKPDS and other studies have shown a deterioration of glucose control after monotherapy with agents such as the sulfonylureas and metformin. Further research has indicated...

Learning objectives :
The participant will learn about the drawbacks of traditional treatments for Type 2 Diabetes, as revealed by studies such as UKPDS. Introduction to different combination therapies and their long-term success rates; and some insights into the treatment of obesity.

Bibliographic references :
A comparative study of insulin lispro and human regular insulin in patients with type 2 diabetes mellitus and secondary failure of oral hypoglycemic agents.

Ross SA, Zinman B, Campos RV, Strack T;

Canadian Lispro Study Group.

University of Calgary, Alta.
saross@cadvision.com

OBJECTIVE:

To compare the effects of insulin lispro (LP) and human regular insulin (HR) when given twice daily with NPH insulin on glycemic control (HbA1c), daily blood glucose profiles and rates of hypoglycemia in patients with type 2 diabetes mellitus after failure to respond to sulfonylurea drugs.

RESEARCH DESIGN AND METHODS:

A 5.5-month randomized, open-label, parallel study of 148 patients receiving either LP (n = 70) or HR (n = 78). Eight-point blood glucose profiles and HbA1c measurements were collected at baseline, 1.5, 3.5 and 5.5 months.

RESULTS:

Two-hour post-breakfast and 2-hour post-supper blood glucose levels (means [and standard errors]) were significantly lower for LP than for HR at the end point (9.5 [0.4] mmol/L v. 10.9 [0.4] mmol/L and 8.4 [0.4] mmol/L v. 9.7 [0.4] mmol/L, respectively, p = 0.02 in both cases). HbA1c improved from 10.5% (0.2%) (LP) and 10.3% (0.2%) (HR) to 8.0% (0.1%). Hypoglycemia rates were similar during the day; however, there was an overnight trend to reduced rates with LP (0.08 [0.03] episodes/30 d v. 0.16 [0.04] episodes/30 d, p = 0.057). Quality-of life assessment showed significant improvement (p < 0.05) in the diabetes-related worry scale for LP subjects whereas HR subjects slightly worsened.

CONCLUSIONS:

With traditional twice-daily insulin administration algorithms, LP improves 2-hour postprandial glucose levels, quality of life and overnight hypoglycemia rates while delivering an equivalent level of glycemic control (HbA1c) compared with HR to insulin-naive patients with type 2 diabetes who require insulin.

Clin Invest Med 2001 Dec;24(6):292-8

   


 Presentation 

"Hypoglycemia in Type 2 Diabetes: Impact and Management"

Dr. Amir Hanna (biography)
English - 2002-10-05 - 17 minutes
(25 slides)

Summary :
One of the major obstacles in attaining euglycemia in type 2 diabetes is the increased risk of hypoglycemia. This concern results in clinicians and patients accepting blood glucose levels below the normal range.
The CDA clinical practice guidelines for the prevention and management of hypoglycemia in diabetes were recently published *.
These guidelines identified factors...

Learning objectives :
The participant will learn which treatment therapies and antihyperglycemic drugs when used cause the patient to be more hypoglycemia prone. Treatment recommendations for hypoglycemia are also outlined.

Bibliographic references :
Prolonged sulfonylurea-induced hypoglycemia in diabetic patients with end-stage renal disease.

Krepinsky J, Ingram AJ, Clase CM.

McMaster University, Hamilton, Ontario, Canada.

Renal impairment is a recognized risk factor for prolonged hypoglycemia, but predisposing characteristics in patients with advanced renal impairment have not been studied. We observed prolonged hypoglycemia in a number of patients with end-stage renal disease (ESRD) and conducted a case-control study at two Canadian centers to identify such risk factors. Through hospital, pharmacy, and dialysis program records, we retrospectively identified 7 case patients and 31 controls with ESRD and type 2 diabetes using oral hypoglycemic monotherapy. Control patients had no history of hospital admission for prolonged hypoglycemia. All case patients and 28 controls were receiving glyburide (glibenclamide in Europe); the remainder were treated with tolbutamide. Duration of intravenous treatment for hypoglycemia ranged from 28 to 256 hours, with 83 g to 2 kg of glucose administered per episode. Preceding treatment with glyburide varied from 2 days to 13 years. Univariate analyses showed a recent decline in oral intake (odds ratio [OR], 81; 95% confidence interval [CI], 3.6 to 1,840), previous hypoglycemic episodes (OR, 15; 95% CI, 0.77 to 297), longer duration of diabetes (22 versus 12 years; P = 0.008), and a history of cerebrovascular disease (OR, 7. 0; 95% CI, 1.0 to 47) to be associated with prolonged hypoglycemia. No association between prolonged hypoglycemia and age, sex, beta blockers, angiotensin-converting enzyme inhibitors, oral hypoglycemic dose, or duration of treatment was identified. This study describes the potentially devastating effect of sulfonylurea-based oral hypoglycemic therapy in ESRD. Patients at greatest risk appear to be those with reduced intake, previous hypoglycemic episodes, and longer duration of diabetes. We describe the mechanisms for observed hypoglycemia and suggest that alternative drugs may be considered in this patient group.

Am J Kidney Dis 2000 Mar;35(3):500-5

   


 Presentation 

"Type 2 Diabetes: A Multifactorial Syndrome"

Dr. Stuart A Ross (biography)
English - 2002-04-24 - 49 minutes
(40 slides)

Summary :
In this presentation Dr Ross addresses the current-day notion of type 2 diabetes as a multifactorial syndrome. No longer is control of glycemia the sole goal of treatment, but we now must control dyslipidemia, hypertension, proteinuria, weight gain, insulin resistance and cardiovascular disease. Early in the talk, Dr Ross defines insulin resistance and it’s mechanisms. He then focuses on the...

Learning objectives :
After viewing this presentation, the participant will be familiar with the mechanisms of insulin resistance and its role in type 2 diabetes. An idea of the treatment goals and strategies targeting all pathological aspects of the disease will also be gained.

Bibliographic references :
Multifactorial insulin resistance and clinical impact in hypertension
and cardiovascular diseases.

Harano Y, Suzuki M, Koyama Y, Kanda M, Yasuda S, Suzuki K, Takamizawa I.

Koshien University College of Nutrition, 10-1, Momijigaoka, Hyogo,
Takarazuka, Japan.

Insulin resistance and hyperinsulinemia have been observed in over 70% of the nonobese, nondiabetic subjects with essential hypertension (HT). Alpha-1 blockers, ACE-antagonists, long-acting Ca blockers including nifedipine CR, some form of beta-blockers, tilisolor, which is reported to increase blood flow, improve insulin sensitivity when blood pressure is better controlled. Decrease of serum potassium during insulin sensitivity test and intraplatelet free Ca2+ concentration is positively and negatively correlated with insulin sensitivity, respectively. Blood pressure is correlated with insulin resistance, which is also observed in secondary HT. The resistance is correlated with salt sensitivity as well as impaired nocturnal fall of blood pressure. These suggest the possible association of insulin resistance with altered intracellular cation metabolism. Insulin resistance and associated hyperinsulinemia have been observed in effort as well as vasospastic angina pectoris(VSAP), atherothrombotic cerebral infarction, and in ASO without obesity, HT, or diabetes, suggesting the resistance resulting from endothelial dysfunction. Insulin resistance has been observed in heart failure and is correlated with angiotensin II. Resistance is also observed in hypertrophic cardiomyopathy and is partially correlated with TNF-alpha. These results indicate that insulin resistance seem to be multifactorial. An effort to normalize insulin sensitivity is crucial to eliminate multiple risk factors as well as to prevent the progression of atherosclerotic vascular lesions.

J Diabetes Complications 2002 Jan-Feb;16(1):19-23


   


 Presentation 

"Treating Type 2 Diabetes Patients to Target"

Dr. Lawrence A. Leiter (biography)
English - 2002-03-07 - 42 minutes
(52 slides)

Summary :
This presentation is an excellent source of information on the guidelines used when treating patients with type 2 diabetes.

Learning objectives :
Upon this presentation, participant should be able to:
-List target glucose, BP and lipid level in patients with type 2 diabetes;
-Review recommended schedule of monitoring;
-Recognize the importance of achieving target level;
-Discuss treatment strategies for glucose, BP and lipids.

Bibliographic references :
Effect of wheat bran on glycemic control and risk factors for
cardiovascular disease in type 2 diabetes.

Jenkins DJ, Kendall CW, Augustin LS, Martini MC, Axelsen M, Faulkner D,
Vidgen E, Parker T, Lau H, Connelly PW, Teitel J, Singer W, Vandenbroucke
AC, Leiter LA, Josse RG.

Clinical Nutrition and Risk Factor Modification Center, St. Michael's
Hospital, Toronto, Ontario, Canada. cyril.kendall@utoronto.ca

OBJECTIVE: Cohort studies indicate that cereal fiber reduces the risk of
diabetes and coronary heart disease (CHD). Therefore, we assessed the
effect of wheat bran on glycemic control and CHD risk factors in type 2
diabetes. RESEARCH DESIGN AND METHODS: A total of 23 subjects with type 2
diabetes (16 men and 7 postmenopausal women) completed two 3-month phases
of a randomized crossover study. In the test phase, bread and breakfast
cereals were provided as products high in cereal fiber (19 g/day
additional cereal fiber). In the control phase, supplements were low in
fiber (4 g/day additional cereal fiber). RESULTS: Between the test and
control treatments, no differences were seen in body weight, fasting blood
glucose, HbA(1c), serum lipids, apolipoproteins, blood pressure, serum
uric acid, clotting factors, homocysteine, C-reactive protein, magnesium,
calcium, iron, or ferritin. LDL oxidation in the test phase was higher
than that seen in the control phase (12.1 +/- 5.4%, P < 0.034). Of the
subjects originally recruited, more dropped out of the study for health
and food preference reasons from the control phase (16 subjects) than the
test phase (11 subjects). CONCLUSIONS: High-fiber cereal foods did not
improve conventional markers of glycemic control or risk factors for CHD
in type 2 diabetes over 3 months. Possibly longer studies are required to
demonstrate the benefits of cereal fiber. Alternatively, cereal fiber in
the diet may be a marker for another component of whole grains that
imparts health advantages or a healthy lifestyle.

Diabetes Care 2002 Sep;25(9):1522-8

   


 Presentation 

"Alternative Therapies in the Glycemic Control of Type 2 Diabetes: An Evidence-Based Approach"

Dr. Jeannette Goguen (biography)
English - 2002-01-19 - 25 minutes
(44 slides)

Summary :
Overview of the most commonly used alternative substances in the treatment of diabetes. Information on different studies regarding substances such as chromium, vanadium, vitamin C and E, ginseng…

Learning objectives :
By the end of the session, participants should have an appreciation for the following:
1.The frequency of use of alternative therapies for hyperglycemia by patients with diabetes mellitus.
2.What actual therapies are being used.
3.What evidence exists

Bibliographic references :
Lipids and diabetes mellitus: a review of therapeutic options.

Goguen JM, Leiter LA.

St. Michael's Hospital and Department of Medicine, University of Toronto, Ontario, Canada.

Diabetes mellitus ia very common disease with a high cardiovascular morbidity and mortality. This articles reviews the types of lipid disorders that can accompany diabetes mellitus and the evidence that treatment of dyslipidaemia improves primary and secondary endpoints, i.e. lipid levels, cardiovascular events, and mortality. Specific lipid-lowering strategies are discussed, including diet and exercise, treatment of hyperglycaemia, and the use of lipid-lowering therapy such as statins, fibric acid derivatives, bile acid sequestrants, nicotinic acid and its derivatives, fish oil and hormone replacement therapy. An approach to the patient with diabetes mellitus and dyslipidaemia is provided.

Curr Med Res Opin 2002;18 Suppl 1:s58-74



   


 Presentation 

"Use of Combination Therapy in the Treatment of Type 2 Diabetes"

Dr. Amir Hanna (biography)
English - 2002-01-19 - 22 minutes
(35 slides)

Summary :
The initiation of intensive treatment at the beginning of the disease provides superior results for the control of glucose levels and the development of complications, contrary to presently accepted guidelines.

Learning objectives :
LEARNING OBJECTIVES:
Upon completion of this presentation, participants should be able to:
1. Review the impact of intensive and early glucose control on the
complications of diabetes.
2. Understand the characteristics of different classes of hypoglycemic
agents.
3. Provide an overview of recent combination therapy studies.

Bibliographic references :
Comparison of insulin monotherapy and combination therapy with insulin and metformin or insulin and troglitazone in type 2 diabetes.

Strowig SM, Aviles-Santa ML, Raskin P.

University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

OBJECTIVE-To evaluate the safety and efficacy of treatment with insulin alone, insulin plus metformin, or insulin plus troglitazone in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 88 type 2 diabetic subjects using insulin monotherapy (baseline HbA(lc) 8.7%) were randomly assigned to insulin alone (n = 31), insulin plus metformin (n = 27), or insulin plus troglitazone (n = 30) for 4 months. The insulin dose was increased only in the insulin group. Metformin was titrated to a maximum dose of 2,000 mg and troglitazone to 600 mg.
RESULTS-HbA(lc) levels decreased in all groups, the lowest level occurring in the insulin plus troglitazone group (insulin alone to 7.0%, insulin plus metformin to 7.1%, and insulin plus troglitazone to 6.4%, P < 0.0001). The dose of insulin increased by 55 units/day in the insulin alone group (P < 0.0001) and decreased by 1.4 units/day in the insulin plus metformin group and 12.8 units/day in the insulin plus troglitazone group (insulin plus metformin versus insulin plus troglitazone, P = 0.004). Body weight increased by 0.5 kg in the insulin plus metformin group, whereas the other two groups gained 4.4 kg (P < 0.0001 vs. baseline). Triglyceride and VLDL triglyceride levels significantly improved only in the insulin plus troglitazone group. Subjects taking metformin experienced significantly more gastrointestinal side effects and less hypoglycemia.
CONCLUSIONS-Aggressive insulin therapy significantly improved glycemic control in type 2 diabetic subjects to levels comparable with those achieved by adding metformin to insulin therapy. Troglitazone was the most effective in lowering HbA(lc), total daily insulin dose, and triglyceride levels. However, treatment with insulin plus metformin was advantageous in avoiding weight gain and hypoglycemia.

Diabetes Care 2002 Oct;25(10):1691-8

   


 Presentation 

"The Treatment of Obesity in Type 2 Diabetes"

Dr. Lawrence A. Leiter (biography)
English - 2002-01-19 - 62 minutes
(55 slides)

Summary :
Presentation that illustrates the association between obesity and the development of Type 2 diabetes. An overview of those treatments and benefits related to weight loss.

Learning objectives :
LEARNING OBJECTIVES:
At the end of the presentation, the participant should be able to:
1. Understand any differences in the response to weight loss interventions
in the diabetic versus the non-diabetic individual.
2. Understand the expected weight and glycemic responses to currently
available weight loss medications in persons with diabetes.

Bibliographic references :
Lifestyle modifications to prevent and control hypertension. 2. Recommendations on obesity and weight loss. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada.

Leiter LA, Abbott D, Campbell NR, Mendelson R, Ogilvie RI, Chockalingam A.

Department of Medicine, University of Toronto, Ont.

OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of weight loss and maintenance of healthy weight on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: The main options are to attain and maintain a healthy body weight (body mass index [BMI] 20-25 kg/m2) or not to do so. For those at risk for hypertension, weight loss and maintenance of healthy weight may prevent the condition. For those who have hypertension, weight loss and maintenance of healthy weight may reduce or obviate the need for antihypertensive medications.
OUTCOMES: The health outcome considered was change in blood pressure. Because of insufficient evidence, no economic outcomes were considered.
EVIDENCE: A MEDLINE search was conducted for the years 1992-1996 with the terms hypertension and obesity in combination and antihypertensive therapy and obesity in combination. Other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence.
VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension.
BENEFITS, HARMS AND COSTS: Weight loss and the maintenance of healthy body weight reduces the blood pressure of both hypertensive and normotensive people. The indirect benefits of a health body weight are well known. The negative effects of weight loss are primarily the frustrations associated with attaining and maintaining a healthy weight. The costs associated with weight loss programs were not measured in the studies reviewed.
RECOMMENDATIONS: (1) It is recommended that health care professionals determine weight (in kilograms), height (in metres) and BMI for all adults. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy BMI (20-25). (3) All overweight hypertensive patients (BMI greater than 25) should be advised to reduce their weight.
VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension, the Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada.

CMAJ 1999 May 4;160(9 Suppl):S7-12

   


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