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"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
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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 new guidelines also include South Asian descent, abdominal obesity, polycystic ovary syndrome, acanthosis nigricans and schizophrenia. Detection of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) allows for the use of strategies to prevent diabetes, modify cardiovascular risk factors, and monitor for diabetes progression.
Conversion from IGT to diabetes happens at different rates in different populations (1), and the importance of diagnosing impaired glucose tolerance has been illustrated with studies showing an increased risk of cardiovascular disease with IGT compared to normal glucose tolerance (NGT) (2) and compared to IFG (3).
Several studies on the prevention or delay of progression to type 2 diabetes using lifestyle and/or pharmacologic intervention have been conducted, including the U.S. DPP Study, STOP-NIDDM, TRIPOD, and the newly published XENDOS Study, which looked at intervention with orlistat plus lifestyle modification in obese patients to reduce the risk of type 2 diabetes (4), and Dr Hanna discusses the findings of these studies and their interpretation.
The new targets for control of glucose, blood pressure and lipids are presented along with the evidence-based rationale for choosing those targets. Dr Hanna also explains the new algorithm for treatment of hyperglycemia in type 2 diabetes, outlining different approaches for different patients depending on the presence of mild to moderate versus marked hyperglycemia. The rationale for using biguanide and insulin sensitizers as first and second choice agents respectively, is explained on the basis of their efficacy not only in controlling glycemia but also in terms of additional proven benefits that reduce the risk of diabetes-related complications.
Dr Hanna concludes his talk by showing how to screen for diabetic nephropathy; and discusses the efficacy of an intensive multifactorial treatment approach in reducing the risk of cardiovasular and microvascular events in patients with type 2 diabetes, as was shown in the STENO2 Study (5).
Copyright © 2004 E-MedHosting.com Inc.
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.
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