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- November 19, 2008 |
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Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists.
CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"Pre-diabetes: Definition"Dr. Sir George Alberti (biography)
English - 2005-04-14 - 34 minutes
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Summary :
Prediabetes is an old term first used officially by WHO as a retrospective diagnosis to describe the state of a person which preceded the diagnosis of diabetes in that person. A radical new definition was introduced in the United States recently to describe collectively people found to have IGT and/or IFG. In other words it describes those with a high risk of developing diabetes in the future and...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The changing definition of "prediabetes" according to a historical perspective
- Limitations of the current definition of “prediabetes”
Bibliographic references :
JACKSON WP;That expression, "prediabetes". Diabetes. 1962 Jul-Aug;11:334.
Keen H, Jarrett RJ, McCartney P.; The ten-year follow-up of the Bedford survey (1962-1972): glucose tolerance and diabetes. Diabetologia. 1982 Feb;22(2):73-8.
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""Prediabetes" - A Global Snapshot"Prof. Paul Zimmet (biography)
English - 2005-04-14 - 28 minutes
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Summary :
The dramatic increase in the prevalence of diabetes (mainly type 2) world-wide is a matter of enormous concern to public health authorities in both developed and developing nations and international agencies such as WHO. Perhaps of even greater concern is the simultaneous dramatic increase in numbers with IFG and IGT (prediabetes). This is occurring not only in adults but, in so far poorly...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence rates of prediabetes in different populations around the world
- Gender differences in abnormal glucose tolerance
- IGT and IFG as CVD risk factors
- Progression to diabetes
Bibliographic references :
Davies MJ, Raymond NT, Day JL, Hales CN, Burden AC. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics.Diabet Med. 2000 Jun;17(6):433-40.
F de Vegt, JM Dekker, CD Stehouwer, G Nijpels, LM Bouter and RJ Heine. Similar 9-year mortality risks and reproducibility for the World Health Organization and American Diabetes Association glucose tolerance categories: the Hoorn StudyDiabetes Care. 2000;23(1):40-44.
SB Harris, J Gittelsohn, A Hanley, A Barnie, TM Wolever, J Gao, A Logan and B Zinman. The prevalence of NIDDM and associated risk factors in native CanadiansDiabetes Care. 1997; 20(2):185-187.
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(6):920-924.
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"IDF Consensus on the Metabolic Syndrome: Definition and Treatment"Dr. Sir George Alberti (biography)
English - 2005-04-14 - 38 minutes
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Summary :
The modern era of the "metabolic syndrome" began with the seminal work of Reaven and his Banting Lecture in 1988. He described the association of glucose intolerance, hypertension, dyslipidaemia and obesity and termed it Syndrome X with insulin resistance suggested as the unifying underlying aetiological factor. An explosion of studies and publications followed with the syndrome given a variety...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Different names and criteria used to describe the metabolic syndrome
- Conclusions from the 2004 IDF Consensus Meeting on the Metabolic Syndrome
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"Origin and Development of the Metabolic Syndrome"Prof. Gaetano Crepaldi (biography)
English - 2005-04-14 - 32 minutes
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Summary :
The metabolic syndrome, as a conceptual entity, is a relatively young one. However, the first descriptions of the syndrome and its associated pathology reach as far back as the 17th century. Prof. Gaetano Crepaldi of the University of Padua leads us through the history of the metabolic syndrome, from the first observations of Turp and Morgagni to the accelerated understanding of this “peculiar...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The history of the metabolic syndrome
• The different definitions of the metabolic syndrome
• The new consensus on the definitions of the components of the metabolic syndrome
• Recent scientific achievements in the study of the components of the metabolic syndrome
• The results of the Italian Longitudinal Study of Aging (ILSA)
• Future challenges in the study the metabolic syndrome
Bibliographic references :
P. Avogaro, G. Crepaldi, G. Enzi, A. Tiengo. Association of hyperlipemia, diabetes mellitus and mild obesity. Acta Diabetologica Latina, Vol IV, 1967
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.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356-9.
Superko HR. Beyond LDL cholesterol reduction. Circulation. 1996 Nov 15;94(10):2351-4.
Austin MA, Edwards KL. Small, dense low density lipoproteins, the insulin resistance syndrome and noninsulin-dependent diabetes. Curr Opin Lipidol. 1996 Jun;7(3):167-71.
Thompson SG, Kienast J, Pyke SD, Haverkate F, van de Loo JC. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med. 1995 Mar 9;332(10):635-41.
Faggin E, Zambon A, Puato M, Deeb SS, Bertocco S, Sartore S, Crepaldi G, Pessina AC, Pauletto P. Association between the --514 C-->T polymorphism of the hepatic lipase gene promoter and unstable carotid plaque in patients with severe carotid artery stenosis. J Am Coll Cardiol. 2002 Sep 18;40(6):1059-66.
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"Management of the Metabolic Syndrome: The Evidence Base"Prof. Philip Barter (biography)
English - 2005-04-14 - 27 minutes
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Summary :
Features of the metabolic syndrome include central adiposity, insulin resistance, dyslipidaemia and mild hypertension. Each of these features contributes to an increased CV risk. Management includes lifestyle measures to promote weight reduction, anti-hypertensive therapy and the use of statins, fibrates and niacin to treat the dyslipidaemia. Insulin sensitizers such as PPAR-gamma agonists may...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• Which factors predict benefit (reduced cardiovascular risk) from fibrate therapy (Helsinki Heart Study, BIP Study, VA-HIT study)
• Which factors predict benefit from statin therapy (Heart Protection Study)
• What the evidence for fibrate therapy tells us about the metabolic syndrome as a disease entity
Bibliographic references :
Tenkanen L, Manttari M, Manninen V. Some coronary risk factors related to the insulin resistance syndrome and treatment with gemfibrozil. Experience from the Helsinki Heart Study. Circulation. 1995 Oct 1;92(7):1779-85.
Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP, Frick MH. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992 Jan;85(1):37-45.
BIP Study Group. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the Bezafibrate Infarction Prevention (BIP) study. Circulation. 2000 Jul 4;102(1):21-7.
Rubins HB, Robins SJ, Collins D, Nelson DB, Elam MB, Schaefer EJ, Faas FH, Anderson JW. Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT). Arch Intern Med. 2002 Dec 9-23;162(22):2597-604.
Collins R, Armitage J, Parish S, Sleigh P, Peto R; 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. Lancet. 2003 Jun 14;361(9374):2005-16.
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"Australia and the Obesity Epidemic - Past and Future"Dr. Senator Guy Barnett (biography)
English - 2005-04-14 - 20 minutes
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Summary :
Australians are getting fatter, asserts Australian Senator Guy Barnett of Tasmania. What is to be done about it?
Senator Barnett presents here a synopsis of the state of the obesity epidemic in Australia, highlighting both the health and economic costs and addressing some of the societal issues that may be at the root of this growing problem.
Most interestingly,...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The state of the obesity epidemic in Australia
• The initiatives that the Australian Government has instituted in the community
• The initiatives that the Australian Government has instituted with key stakeholders
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"The Metabolic Syndrome -The Clinicians' Point of View"Prof. Gerard Slama (biography)
English - 2005-04-14 - 29 minutes
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Summary :
The concept of metabolic syndrome was suspected in the 1950's by a clinician, Jean Vague, in Marseille, France. This remarkable physician noticed that women exhibiting abdominal obesity were more frequently suffering from diabetes, hypertension, and cardiovascular complications. With the thousand of epidemiological and observational studies witch have appeared since, the clinician can only be...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The partners in the Metabolic Syndrome Polylogue
• The regulatory oriented/legalistic approach to the management of patients with the metabolic syndrome
• The academic (prudent) approach to the management of patients with the metabolic syndrome
• The activist approach to the management of patients with the metabolic syndrome
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"The Metabolic Syndrome - Payers / Insurers Perspective"Prof. Avi Porath (biography)
English - 2005-04-14 - 27 minutes
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Summary :
Payers and insurers are increasingly recognizing the importance of the metabolic syndrome as a risk factor for cardiovascular (CV) events. Due to limited resources, modern health systems must develop a managerial approach to the condition of metabolic system in the framework of their global CV management priorities. Only recently payers have expanded their management programs to include primary...
Learning objectives :
Managerial formal considerations:
- Magnitude of the problem
- Effectiveness of interventions
- Cost-effectiveness
- Affordability
- Priority setting
Additional considerations
Conclusions
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"IFG and IGT - State of the Art"Dr. Nigel Unwin (biography)
English - 2005-04-14 - 32 minutes
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Summary :
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) represent higher than normal blood glucose levels, based on post glucose challenge and fasting blood measurement respectively, and are associated with a markedly increased risk of developing diabetes and an increased risk of cardiovascular disease. Interest in these categories has grown with the clear demonstration that...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Epidemiology of IFG and IGT
- Metabolic characteristics and CV risk factors associated with IFG and IGT
- Risk of diabetes and CVD mortality associated with IFG and IGT
- ADA proposal to lower the cut point for IFG
Bibliographic references :
M Coutinho, HC Gerstein, Y Wang and S Yusuf. 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 yearsDiabetes Care. 1999;22(2):233-240.
Andreas Festa, Ralph D’Agostino, Jr., Anthony J.G. Hanley, Andrew J. Karter, Mohammed F. Saad, and Steven M. Haffner. Differences in Insulin Resistance in Nondiabetic Subjects With Isolated Impaired Glucose Tolerance or Isolated Impaired Fasting Glucose Diabetes 53:1549-1555, 2004.
The DECODE Study Group Age- and Sex-Specific Prevalences of Diabetes and Impaired Glucose Regulation in 13 European CohortsDiabetes Care 26:61-69, 2003.
N. Unwin, J. Shaw, P. Zimmet and K. G. M. M. Alberti. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention Diabetic Medicine. Volume 19 Issue 9 Page 708 - September 2002.
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"Impaired Glucose Tolerance versus Impaired Fasting Glucose: Is the Risk the Same?"Prof. Markolf Hanefeld (biography)
English - 2005-04-14 - 29 minutes
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Summary :
IGT and IFG are two risk categories for type 2 diabetes. According to the NCEPIII definition fasting hyperglycemia but not postchallenge hyperglycemia is considered as a single trait of the metabolic syndrome. As consistently shown IFG and IGT bear a similar risk for subsequent conversion to type 2 diabetes. They are, however, different in underlying pathophysiology: IFG is more related to...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Differences in demographic epidemiology between IFG and IGT
- Differences in underlying pathophysiology between IFG and IGT
- IFG- and IGT-associated risk for diabetes
- Differences in the risk of CVD with IFG or IGT
Bibliographic references :
Markolf Hanefeld, MD, PHD, Carsta Koehler, PHD, Katja Fuecker, DIPL CHEM, Elena Henkel, MD, Frank Schaper, MD and Theodora Temelkova-Kurktschiev, MD, PHD. Insulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose - The Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes Study Diabetes Care 26:868-874, 2003.
Kohler C, Temelkova-Kurktschiev T, Schaper F, Fucker K, Hanefeld M.
[Prevalence of newly diagnosed type 2 diabetes, impaired glucose tolerance and abnormal fasting glucose in a high risk population. Data from the RIAD study using new diagnostic criteria for diabetes]Dtsch Med Wochenschr. 1999 Sep 17;124(37):1057-61.
TS Temelkova-Kurktschiev, C Koehler, E Henkel, W Leonhardt, K Fuecker and M Hanefeld. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c levelDiabetes Care. 2000;23(12):1830-1834.
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"Control of Adipocyte Function by Nuclear Receptors of the PPAR and REV-ERBalpha Family"Prof. Bart Staels (biography)
English - 2005-04-14 - 34 minutes
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Summary :
Lipid and carbohydrate homeostasis is controlled by integrated systems that allow higher organisms to respond to metabolic changes. Numerous signals reciprocally convey information about body fat status from the periphery to the central nervous system in an attempt to maintain body weight stable throughout life. The role of the adipocyte in energy homeostasis goes beyond its function as a simple...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Rev-erbα- and PPARγ-mediated effects in vivo
- The effects of Rev-erbα deficiency in vivo
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"Insulin Resistance and Glucose Allostasis"Prof. Michael Stumvoll (biography)
English - 2005-04-14 - 34 minutes
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Summary :
Maintance of glycemia is of vital importance. Regulation of glycemia is accomplished by the balanced interplay between insulin action and insulin secretion. It is common belief that in healthy humans plasma glucose concentration is regulated by a homeostatic system, i.e. a system designed to maintain plasma glucose concentration constant. Here we review evidence that in response to a chronic...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The variation of serum glucose levels with different degrees of insulin resistance (IR)
• The signals that may be responsible for the increase beta cell response to IR
• The definition of the Disposition Index (DI)
• The definition of the Beta Cell Demand Index (BCDI)
• The relationship of both the DI and the BCDI to serum glucose levels
Bibliographic references :
Michael Stumvoll, P. Antonio Tataranni, Norbert Stefan, Barbora Vozarova, and Clifton Bogardus Glucose Allostasis Diabetes 52:903-909, 2003
Stumvoll M, Tataranni PA, Bogardus C. The hyperbolic law--a 25-year perspective. Diabetologia. 2005 Feb;48(2):207-9.
Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet. 2005 Apr;365(9467):1333-46.
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.
Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001 Nov;50(11):2444-50
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"Genetics of Type 2 Diabetes and the Metabolic Syndrome?"Prof. Leif C Groop (biography)
English - 2005-04-14 - 27 minutes
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Summary :
Whereas diabetes can be diagnosed by measuring blood glucose, there are few laboratory tests for diagnosing diabetic subgroups like type 1 and type 2 diabetes (T2D). In general, everything which is not type 1 diabetes has been considered as type 2 diabetes. Therefore, T2D has accounted between 85-99% of all cases with diabetes around the world. This certainly represents an oversimplification of...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Metabolic disturbances leading to type 2 diabetes
- Some important susceptibility genes for type 2 diabetes
Bibliographic references :
Charlotte Ling, Pernille Poulsen, Emma Carlsson, Martin Ridderstråle, Peter Almgren, Jørgen Wojtaszewski, Henning Beck-Nielsen, Leif Groop and Allan VaagMultiple environmental and genetic factors influence skeletal muscle PGC-1(alpha) and PGC-1ß gene expression in twins
J. Clin. Invest. 114:1518-1526 (2004).
Valeriya Lyssenko, Peter Almgren, Dragi Anevski, Roland Perfekt, Kaj Lahti, Michael Nissén, Bo Isomaa, Björn Forsen, Nils Homström, Carola Saloranta, Marja-Riitta Taskinen, Leif Groop, and Tiinamaija Tuomi for the Botnia Study Group Predictors of and Longitudinal Changes in Insulin Sensitivity and Secretion Preceding Onset of Type 2 Diabetes
Diabetes 54:166-174, 2005.
Vamsi K Mootha, Cecilia M Lindgren, Karl-Fredrik Eriksson, Aravind Subramanian, Smita Sihag, Joseph Lehar, Pere Puigserver, Emma Carlsson, Martin Ridderstråle, Esa Laurila, Nicholas Houstis, Mark J Daly, Nick Patterson, Jill P Mesirov, Todd R Golub, Pablo Tamayo, Bruce Spiegelman, Eric S Lander, Joel N Hirschhorn, David Altshuler & Leif C GroopPGC-1-(alpha) responsive genes involved in oxidative phosphorylation are coordinately downregulated in human diabetes
Nature Genetics 34, 267 - 273 (2003).
David Altshuler, Joel N. Hirschhorn, Mia Klannemark, Cecilia M. Lindgren, Marie-Claude Vohl, James Nemesh, Charles R. Lane, Stephen F. Schaffner, Stacey Bolk, Carl Brewer, Tiinamaija Tuomi, Daniel Gaudet, Thomas J. Hudson, Mark Daly, Leif Groop & Eric S. LanderThe common PPAR(gamma) Pro12Ala polymorphism is associated with decreased risk of type 2 diabetesNature Genetics.2000;volume 26 no. 1 pp 76 - 80.
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"Comparison of the Observed Prevalence of the Metabolic Syndrome with that Expected According to the Random Clustering of its Components. The MGSD Study in Five Mediterranean Countries"Prof. Basil Karamanos (biography)
English - 2005-04-14 - 16 minutes
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Summary :
AIM: To investigate the prevalence of the Metabolic Syndrome (MS, NCEP criteria) and the various combinations of its components in comparison to the expected frequencies of by chance clustering of these components.
SUBJECTS AND METHODS: We studied 1833 subjects, 20-74 years, in 5 Mediterranean Countries. Blood pressure, waist circumference, fasting glucose and lipids were measured....
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The goals of the Mediterranean Group for the Study of Diabetes (MGSD) Nutrition Study
• The design of the MGSD Nutrition Study
• The prevalence of the metabolic syndrome (ATP-III definition) and its components among the study population
• How this prevalence compares to the chance clustering of the components
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"Prevalence of the Metabolic Syndrome, and the Ability of 3 Definitions to Identify Incident Cases of Diabetes in Australia"Prof. Jonathan Shaw (biography)
English - 2005-04-14 - 24 minutes
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Summary :
The World Health Organisation (WHO), the (American) National Cholesterol Education Program (NCEP) and the European Group for the study of Insulin Resistance (EGIR) have recently developed independent definitions of the metabolic syndrome (MS). Data from the Australian AusDiab study (1999), and the 5 year follow-up, have been used to calculate the national prevalence of the MS and the ability of...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The prevalence of the metabolic syndrome in Australia, using 3 commonly used definitions (WHO, EGIR, ATP-III) as found in the AusDiab Study
• The capacity of the metabolic syndrome to predict incident diabetes
• The degree of insulin resistance associated with each of the 3 definitions
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"Prevalence of the Metabolic Syndrome in Spanish Population"Dr. M.T. Martinez-Larrad (biography)
English - 2005-04-14 - 19 minutes
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Summary :
The MS is a cluster of metabolic abnormalties conferring an increased risk for DM2 and high cardiovascular morbimortality. We investigate the prevalence of the MS in a sample of the Spanish population. A cross-sectional survey in 809 individuals (males 46%), aged 35 - 74 years. A OGTT was performed in all participants. MS was diagnosed according to the criteria issued by NCEP-ATPIII, 3 or more of...
Learning objectives :
- To review data from a cross-sectional population based study to estimate the prevalence of metabolic syndrome in the Spanish population.
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"Neural Control of Energy Balance"Prof. Stephen C. Woods (biography)
English - 2005-04-14 - 32 minutes
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Summary :
Knowledge of the hormones, neurotransmitters and neural pathways that regulate energy homeostasis is increasing at a rapid pace. Food intake was historically thought to occur in response to acute energy demands; however, current evidence suggests that meals occur based on habit and convenience rather than on metabolic need. Most individuals maintain stable body weights over long intervals by...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The satiety system of energy balance
• The adiposity system of energy balance
• The central integrators of energy balance
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"Genetics of Obesity"Dr. Claude Bouchard (biography)
English - 2005-04-14 - 39 minutes
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Summary :
Obesity is one of the most pressing public health problems in the industrialized world. Twin, adoption, and family studies have shown that genetic factors play a significant role in the pathogenesis of obesity. Rare mutations in humans and model organisms have provided insights into the pathways involved in body weight regulation. To date, almost 200 human obesity cases have been ascribed to...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The four adiposity phenotypes
• The five genetic hypotheses of obesity
• The evidence for single gene diseases
• The evidence for oligogenic disorders
Bibliographic references :
Pietilainen KH, Rissanen A, Kaprio J, Makimattila S, Hakkinen AM, Westerbacka J, Sutinen J, Vehkavaara S, Yki-Jarvinen H. Acquired obesity is associated with increased liver fat, intra-abdominal fat, and insulin resistance in young adult monozygotic twins. Am J Physiol Endocrinol Metab. 2005 Apr;288(4):E768-74. Epub 2004 Dec 7.
Bouchard C, Tremblay A, Despres JP, Nadeau A, Lupien PJ, Theriault G, Dussault J, Moorjani S, Pinault S, Fournier G. The response to long-term overfeeding in identical twins. N Engl J Med. 1990 May 24;322(21):1477-82.
Perusse L, Rankinen T, Zuberi A, Chagnon YC, Weisnagel SJ, Argyropoulos G, Walts B, Snyder EE, Bouchard C. The human obesity gene map: the 2004 update. Obes Res. 2005 Mar;13(3):381-490.
Human Obesity Gene Map Website
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"Societal Approach to DM Prevention in the Young"Prof. Francine Kaufman (biography)
English - 2005-04-14 - 33 minutes
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Summary :
Rather than contributing to the emerging epidemic of type 2 diabetes in the global pediatric population, schools, communities and governments must play a role in preventing this disorder. There is ample evidence that lifestyle interventions can prevent diabetes in adults, and similar evidence is emerging of the salutatory effect of lifestyle change in youth.
Breast-feeding has...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Measures that can be taken by schools, communities and governments to reduce the incidence of obesity and diabetes in youth.
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"The Metabolic Phenotype of Pre-diabetes in Obese Youth"Dr. Sonia Caprio (biography)
English - 2005-04-14 - 39 minutes
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Summary :
The unabated rise in the prevalence of childhood obesity has been accompanied by the appearance of a new pediatric disease: Type 2 diabetes. In adults, type 2 diabetes develops over a long period. Most, if not all, patients initially have impaired glucose tolerance (IGT), which is highly predictive of diabetes and cardiovascular disease. Little is known about IGT in pediatrics.
We...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The epidemiology of childhood obesity
• The emerging epidemic of type-2 diabetes in the world
• How the metabolic syndrome in adolescents was defined by Weiss et al (NEJM, 2004)
• Prevalence of impaired glucose tolerance and the metabolic syndrome in obese youth
• Mechanisms of insulin resistance in obese adolescents with impaired glucose tolerance
• The natural history of “pre-diabetes” in the young
Bibliographic references :
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002 Mar 14;346(11):802-10.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004 Jun 3;350(23):2362-74.
Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, Caprio S. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care. 2005 Apr;28(4):902-9.
Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, Boselli L, Barbetta G, Allen K, Rife F, Savoye M, Dziura J, Sherwin R, Shulman GI, Caprio S. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet. 2003 Sep 20;362(9388):951-7.
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"Epidemiology of 'Prediabetes' and the MS - Global View"Prof. Jonathan Shaw (biography)
English - 2005-04-14 - 34 minutes
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Summary :
The metabolic syndrome, diabetes and pre-diabetes have become major public health problems in recent decades, and are increasing in prevalence around the world. Declining levels of physical activity, increasing caloric intake and the subsequent rises in obesity rates have been documented in populations from virtually every ethnic and cultural background. Whilst pre-diabetes is more common in most...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence of pre diabetes worldwide
- Prevalence of the metabolic syndrome in consequence of the definition used
- The need to develop a uniform method of determining obesity criteria that is ethnic specific
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"Diabetes and Metabolic Syndrome - An Asian Perspective"Prof. Juliana Chan (biography)
English - 2005-04-14 - 32 minutes
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Summary :
In this presentation Dr. Chan gives an Asian perspective on diabetes and the metabolic syndrome, focusing on studies from China.
About 60 million Chinese adults of age 35-74 years are estimated to have diabetes or impaired fasting glucose, and Dr. Chan shows data from the DECODA study on the prevalence of diagnosed and undiagnosed DM, and IFG/IGT in Chinese and Japanese men and...
Learning objectives :
After viewing this presentation the participant will be able to discuss studies from Asian (mainly Chinese) populations on the following:
- The prevalence of obesity, diabetes and metabolic syndrome
- The relationship between metabolic syndrome and CVD
- The effect of weight reduction on components of the metabolic syndrome
Bibliographic references :
Gu D, Reynolds K, Duan X, Xin X, Chen J, Wu X, Mo J, Whelton PK, He J; InterASIA Collaborative Group.Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA).Diabetologia. 2003 Sep;46(9):1190-8. Epub 2003 Jul 15.
The DECODA Study Group Age- and Sex-Specific Prevalence of Diabetes and Impaired Glucose Regulation in 11 Asian Cohorts Diabetes Care 26:1770-1780, 2003
Chee-Eng Tan, Stefan Ma, Daniel Wai, Suok-Kai Chew, and E.-Shyong TaiCan We Apply the National Cholesterol Education Program Adult Treatment Panel Definition of the Metabolic Syndrome to Asians?Diabetes Care 27: 1182-1186.
Jung-Nan Wei; Fung-Chang Sung; Chau-Ching Lin; Ruey-Shiung Lin; Chuan-Chi Chiang; Lee-Ming ChuangNational Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children JAMA, Sep 2003; 290: 1345 - 1350.
Peter C. Y. Tong; Zoe S. K. Lee; Man-Mei Sea; Chun-Chung Chow; Gary T. C. Ko; Wing-Bun Chan; Wing-Yee So; Ronald C. W. Ma; Risa Ozaki; Jean Woo; Clive S. Cockram; Juliana C. N. Chan The Effect of Orlistat-Induced Weight Loss, Without Concomitant Hypocaloric Diet, on Cardiovascular Risk Factors and Insulin Sensitivity in Young Obese Chinese Subjects With or Without Type 2 Diabetes Archives of Internal Medicine, Nov 2002; 162: 2428 - 2435.
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"Epidemiology of Prediabetes and Metabolic Syndrome in Indians"Dr. A. Ramachandran (biography)
English - 2005-04-14 - 25 minutes
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Summary :
Objective: To highlight high prevalence and the peculiarities of prediabetic conditions and the metabolic syndrome in India.
Method: Epidemiological data on the prevalence and risk associations of prediabetic conditions, and occurrence and peculiarities in metabolic syndrome are described.
Results: Both IFG (8.7%) and IGT (8.1%) show high prevalence in India with an...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The prevalence of prediabetes in the Indian population based on IGT and IFG;
• The prevalence of the metabolic syndrome among the Indian population.
Bibliographic references :
Ramachandran A, Snehalatha C, Vijay V.Temporal changes in prevalence of type 2 diabetes and impaired glucose tolerance in urban southern India.Diabetes Res Clin Pract. 2002 Oct;58(1):55-60
Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Nair JD; Diabetes Epidemiology Study Group in India (DESI).High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.Diabetologia. 2001 Sep;44(9):1094-101.
Ramachandran A, Snehalatha C, Baskar AD, Mary S, Kumar CK, Selvam S, Catherine S, Vijay V.Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India.Diabetologia. 2004 May;47(5):860-5. Epub 2004 Apr 28.
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"Genetic Prediction of the Metabolic Syndrome: The Botnia Study"Dr. Valeriya Lyssenko (biography)
English - 2005-04-14 - 13 minutes
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Summary :
Background and aims: The metabolic syndrome is a cluster of risk factors associated with cardiovascular morbidity and mortality. However, underlying genetic susceptibility to the metabolic syndrome has not been extensively studied. The aim of the study was to evaluate the role of common variants in candidate genes for their ability to predict the metabolic syndrome in a large prospective study...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The risk of developing the metabolic syndrome in the BOTNIA population
• Which mutations were associated with the development of the metabolic syndrome
• Which components of the metabolic syndrome (ATP-III) were predictable by the mutations studied
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"Polymorphism -308 G/A of the TNF-(alpha) Gene: Effect on plasma soluble TNF-receptor 2 (sTNFR2) according to Degree of Glucose Tolerance (IGT, DM2), Insulin Resistance (IR), and other Related Parameters. A Population Based Study (The Segovia Study, Spain)"Dr. Jose Luis Gonzalez- Sanchez (biography)
English - 2005-04-14 - 14 minutes
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Summary :
To investigate the relationships between the -308 G/A TNF-(alpha) polymorphism on plasma sTNFR2 levels, IR and other related parameters 436 unrelated subjects (49.1% males; 35-74 years) from a cross-sectional population-based survey in the province of Segovia (Spain) were studied.
Measurements: BMI, waist circumference (WC), sagittal abdominal diameter (SAD), systolic and...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
Data from the population based Segovia study on the relationship between the -308 G/A polymorphism of the TNF-alpha gene, and the following:
- Plasma soluble TNF-alpha receptor 2 in DM2
- Insulin resistance
- Other related parameters
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"Association of Low Testosterone and Insulin-Like Growth Factor-1 but High C-Reactive Protein with Metabolic Syndrome in Chinese Middle-Aged Men with a Family History of Type 2 Diabetes"Dr. Wing Yee So (biography)
English - 2005-04-14 - 23 minutes
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Summary :
Aim: Age-related decline in testosterone and insulin-like growth factor-1 (IGF-1) may interact with familial disposition to increase the association with metabolic syndrome (MES).
Methods: We compared clinical characteristics and prevalence of fMES using the WHO criteria with modified definitions of obesity for Asians (BMI³25kg/m2) between 179 middle aged men with family history...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The incidence of metabolic syndrome in Chinese men with and without a family history of diabetes
• The association of testosterone, IGF-1 and hs-CRP with the metabolic syndrome
• The metabolic profiles of subjects with/without metabolic syndrome, with/without a family history of diabetes.
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"The Diabetes Prevention Program"Dr. William C. Knowler (biography)
English - 2005-04-15 - 28 minutes
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Summary :
The DPP was a randomized clinical trial of type 2 diabetes prevention in high-risk persons conducted in 27 clinics in the U.S.A. From 1996-98, participants were randomly assigned to treatment with placebo, metformin, troglitazone, or intensive lifestyle intervention. Due to concern regarding its liver toxicity, use of troglitazone was discontinued in 1998. Randomization to the other three groups...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The objective of the diabetes prevention program (DPP)
• The medical and lifestyle interventions in subjects enrolled in the DPP
• The DPP study design and changes
• The results of the DPP
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"STOP NIDDM Trial"Prof. Avraham Karasik (biography)
English - 2005-04-15 - 19 minutes
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Summary :
The STOP NIDDM trial was a multicenter, international, placebo-controlled, randomized clinical trial to assess the effect of acarbose in preventing or delaying conversion of impaired glucose tolerance (IGT) to type 2 diabetes. Patients were recruited through screening of high risk population and those with both IGT and IFG (FBG > 5.6 mmol/L) were included in the study. 714 patients were allocated...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The effect of acarbose in preventing or delaying conversion of impaired glucose tolerance (IGT) to type 2 diabetes.
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"TheTRIPOD and PIPOD Studies"Prof. Thomas A. Buchanan (biography)
English - 2005-04-15 - 24 minutes
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Summary :
The Troglitazone in Prevention of Diabetes (TRIPOD) and Pioglitazone in Prevention of Diabetes (PIPOD) studies were conducted in Hispanic-American women with recent gestational diabetes. TRIPOD was a randomized, placebo-controlled trial in which 236 of 266 randomized subjects had at least one follow-up visit and 126 women completed 3.6 years of treatment and 8 months of post-drug washout. The...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The nature of pre-diabetes (type 2)
- The effects of thiazolidinediones on progression to diabetes
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"DREAM Trial"Prof. Hertzel Gerstein (biography)
English - 2005-04-15 - 31 minutes
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Summary :
The objective of the dream trial (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) is to determine the efficacy of ramipril and/or rosiglitazone on prevention of diabetes in non-diabetic individuals with impaired glucose tolerance or impaired fasting glucose.
Prof Gerstein presents the design of the DREAM trial in detail and reviews the key questions which...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The objectives of the DREAM trial;
- The study design of the DREAM trial.
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"The Diabetes Prevention Program: A Randomized Clinical Trial to Prevent Type 2 Diabetes in Persons at High Risk"Prof. Elizabeth Barrett-Connor (biography)
English - 2005-04-15 - 38 minutes
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Summary :
The DPP randomized controlled clinical trial included 3234 participants with impaired glucose tolerance (IGT) who were randomized to ILS, MET, or usual advice. Both ILS and MET significantly reduced the risk of diabetes. A further major benefit of these interventions may be reduction of cardiovascular disease (CVD) risk. Because persons with IGT have a high prevalence of CVD risk factors,...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The objective, design and outcomes of the Diabetes Prevention Program (DPP);
- Adverse events in the DPP;
- Treatment effect of the DPP on hypertension, dyslipidemia, and the metabolic syndrome;
- The effect of age, sex, ethnicity, and body mass index on the incidence of diabetes.
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"Primary Prevention of Type 2 Diabetes - A Matter of Maintaining the New Lifestyle"Dr. Bernt Lindahl (biography)
English - 2005-04-15 - 16 minutes
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Summary :
Object: To study short- and long-term effects of an intensive lifestyle change programme.
Method: Subjects with IGT and obesity (BMI>27) were randomised to two different intervention programmes based on low-fat, high-fibre diet and regular physical exercise. The intensive group (n=100) participated in a one month learning and training session using behavioural modification...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- Compliance-oriented and empowerment-oriented approaches to behaviour modification
- The design of the GT-VIP Study
- The short-term effects of an intensive behavioural intervention in the GT-VIP
- The long-term effects of an intensive behavioural intervention in the GT-VIP
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"Lessons from the UKPDS"Prof. Alastair Gray (biography)
English - 2005-04-15 - 33 minutes
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Summary :
In this presentation Prof. Gray descibes results from UKPDS 61 and 68, which looked at fasting plasma glucose (FPG) levels at diagnosis of diabetes in relation to clinical outcomes, and the UKPDS Outcomes Model, respectively.
UKPDS 61 found that those with lower FPG levels at diagnosis of diabetes had fewer complications but similar rates of deterioration in glycemic control...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The relationship between FPG level at diagnosis of diabetes and clinical outcomes
- The UKPDS Outcomes Model
Bibliographic references :
Stephen Colagiuri, FRACP, Carole A. Cull, PHD and Rury R. Holman, FRCP For the UKPDS Group. Are Lower Fasting Plasma Glucose Levels at Diagnosis of Type 2 Diabetes Associated With Improved Outcomes? - U.K. Prospective Diabetes Study 61 Diabetes Care 25:1410-1417, 2002.
P. M. Clarke, A. M. Gray, A. Briggs, A. J. Farmer, P. Fenn, R. J. Stevens, D. R. Matthews, I. M. Stratton, R. R. Holman and on behalf of the UK Prospective Diabetes Study (UKPDS) Group. A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)Diabetologia. 2004; 47(10):1747 - 1759.
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"Does the Metabolic Syndrome Predict Death in Type 2 Diabetes? The Fremantle Diabetes Study"Prof. Timothy Davis (biography)
English - 2005-04-15 - 20 minutes
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Summary :
The Fremantle Diabetes Study (FDS) was a prospective, observational study of a representative patient cohort recruited from 1993 to 1996 and followed for at least 5 years. The FDS cohort comprised 1426 patients (63% of all diabetic individuals identified in a catchment area of 120,000 people), and 1294 (91%) had type 2 diabetes. Prospective outcome data were obtained through the Western Australia...
Learning objectives :
After viewing this presentation the participant will be able to discuss results from the Fremantle Diabetes Study relating to:
- Prevalence of metabolic syndrome in type 2 diabetic patients
- Metabolic syndrome as a predictor of all-cause and CHD mortality in type 2 diabetic patients
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"Television Viewing Time and Blood Glucose Levels in Australian Adults"Dr. David Dunstan (biography)
English - 2005-04-15 - 24 minutes
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Summary :
Objective:
Sedentary behaviours, as well as physical activity, are important determinants of glycaemic control. We examined the associations of television (TV) time with fasting blood glucose (FBG) and 2-hour blood glucose levels (2-hr BG) in Australian adults.
Materials and Methods:
A population-based cross-sectional study (AusDiab) included 9,966 adults aged...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The sedentary death syndrome
• The different types of sedentary behaviours
• The association between television viewing time and fasting and 2-hour blood glucose levels
Bibliographic references :
David W. Dunstan, PHD, Jo Salmon, PHD, Neville Owen, PHD, Timothy Armstrong, PHD, Paul Z. Zimmet, MD, Timothy A. Welborn, PHD, Adrian J. Cameron, MPH, Terence Dwyer, PHD, Damien Jolley, MSC and Jonathan E. Shaw, MD on behalf of the AusDiab Steering Committee Physical Activity and Television Viewing in Relation to Risk of Undiagnosed Abnormal Glucose Metabolism in Adults Diabetes Care. 2004 Nov;27(11):2603-9.
David W. Dunstan, Paul Z. Zimmet, Timothy A. Welborn, Maximilian P. de Courten, Adrian J. Cameron, Richard A. Sicree, Terry Dwyer, Stephen Colagiuri, Damien Jolley, Matthew Knuiman, Robert Atkins, and Jonathan E. Shaw The Rising Prevalence of Diabetes and Impaired Glucose Tolerance: The Australian Diabetes, Obesity and Lifestyle Study Diabetes Care 25: 829-834.
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"Prevalence of the Metabolic Syndrome in the City of Beijing and Developing a Prediction System for Diabetes in Large Population"Dr. Tiemei Zhang (biography)
English - 2005-04-15 - 24 minutes
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Summary :
The prevalence of the metabolic syndrome in the city of Beijing was defined by the NCEP-ATPIII(2002) among 15387 adults over 20 years old. The unadjusted prevalence of metabolic syndrome was 9.9% and the age-adjusted prevalence of metabolic syndrome was 7.55% respectively. Using 2000 census data, about 90 million Chinese residents had the metabolic syndrome. The syndrome was more common in the...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The prevalence of metabolic syndrome in the city of Beijing
- A prediction system for diabetes based on survey data
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"New drugs for 'Prediabetes', Metabolic Syndrome and their CVD consequences: GLP-1"Prof. Michael A. Nauck (biography)
English - 2005-04-15 - 23 minutes
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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 :
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