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- August 20, 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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"Lowering blood glucose - Walking the tightrope between good and evil"Prof. Richard O'Brien (biography)
English - 2008-05-17 - 44 minutes
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Summary :
Glucose control in type 1 and type 2 diabetic patients has been shown to reduce microvascular complications, as seen in the DCCT and UKPDS trials, however there is some controversy about the relationship between intensive glycaemic control and cardiovascular (CV) risk.
There is clinical trial data suggesting that intensive glucose control in type 2 patients is not effective in...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
Lowering blood glucose in the context of:
- Microvascular effects
- Macrovascular effects
- Possible harm
- Mechanisms for possible harm
- Glitazones, glucose control and CVD
Bibliographic references :
1. Philip D. Home, D.M., D.Phil., Stuart J. Pocock, Ph.D., Henning Beck-Nielsen, D.M.S.C., Ramón Gomis, M.D., Ph.D., Markolf Hanefeld, M.D., Ph.D., Nigel P. Jones, M.A., Michel Komajda, M.D., John J.V. McMurray, M.D., for the RECORD Study Group Rosiglitazone Evaluated for Cardiovascular Outcomes — An Interim Analysis NEJM 2007. Volume 357:28-38.
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"Lifestyle modification - What does it achieve?"Prof. John Prins (biography)
English - 2008-05-17 - 39 minutes
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Summary :
Does lifestyle modification have proven benefits?
Obesity is associated with increased risk for diabetes and coronary heart disease, and even a ten percent weight loss is associated with decreased mortality, diabetes risk, blood pressure and lipids. These improvements have been summarized in a publication by Jung et al. (1).
In diabetic patients, lifestyle...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Obesity-associated health risks
- Clinical benefits of weight loss
- Effects of lifestyle intervention in diabetic patients
- Weight loss and cancer risk (Women's Health Study)
- Exercise and osteoporosis risk
- Proatherogenic mechanisms in obesity
Bibliographic references :
1. Roland T Jung. Obesity as a disease British Medical Bulletin 53:307-321 (1997).
2. Chinmay Patel, Husam Ghanim, Shreyas Ravishankar, Chang Ling Sia, Prabhakar Viswanathan, Priya Mohanty and Paresh Dandona. Prolonged Reactive Oxygen Species Generation and Nuclear Factor-{kappa}B Activation after a High-Fat, High-Carbohydrate Meal in the Obese J Clin Endocrinol Metab. 2007 Nov;92(11):4476-9.
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"Lowering blood glucose - Walking the tightrope between good and evil"Prof. Richard O'Brien (biography)
English - 2008-05-17 - 45 minutes
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| (50 slides) |
Summary :
Glucose control in type 1 and type 2 diabetic patients has been shown to reduce microvascular complications, as seen in the DCCT and UKPDS trials, however there is some controversy about the relationship between intensive glycaemic control and cardiovascular (CV) risk.
There is clinical trial data suggesting that intensive glucose control in type 2 patients is not effective in...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
Lowering blood glucose in the context of:
- Microvascular effects
- Macrovascular effects
- Possible harm
- Mechanisms for possible harm
- Glitazones, glucose control and CVD
Bibliographic references :
1. Philip D. Home, D.M., D.Phil., Stuart J. Pocock, Ph.D., Henning Beck-Nielsen, D.M.S.C., Ramón Gomis, M.D., Ph.D., Markolf Hanefeld, M.D., Ph.D., Nigel P. Jones, M.A., Michel Komajda, M.D., John J.V. McMurray, M.D., for the RECORD Study Group Rosiglitazone Evaluated for Cardiovascular Outcomes — An Interim Analysis NEJM 2007. Volume 357:28-38.
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"Oral anti-diabetic action on the beta cell"Dr. Sof Andrikopoulos (biography)
English - 2008-04-17 - 39 minutes
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Summary :
Dr. Andrikopoulos first explains that type-2 diabetes results from the failure of beta cells to secrete amounts of insulin sufficient to compensate for the impact of muscle insulin resistance, obesity, and a glucose-rich diet. He then goes on to describe some of the main oral anti-diabetic agents used today.
The first of these is sulfonylurea, which acts on the pancreas to...
Learning objectives :
Learning objectives
After viewing this presentation the participant will be able to discuss the role the beta cell in type-2 diabetes and the effect of the following oral anti-diabetic agents on the beta cell:
-Sulfonylureas
-GLP-1
-Metformin
-TZDs
Bibliographic references :
Kahn SE, Hull RL, Utzschneider KM Mechanisms linking obesity to insulin resistance and type 2 diabetes Nature. 2006 Dec 14;444(7121):840-6.
Aston-Mourney K, Proietto J, Morahan G, Andrikopoulos S Too much of a good thing: why it is bad to stimulate the beta cell to secrete insulin Diabetologia 2008 Apr;51(4):540-5. Epub 2008 Feb 2.
Lupi R, Mancarella R, Del Guerra S, Bugliani M, Del Prato S, Boggi U, Mosca F, Filipponi F, Marchetti P S Effects of exendin-4 on islets from type 2 diabetes patients Diabetes Obes Metab. 2008 Jun;10(6):515-9. Epub 2008 Jan 14.
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"Antipsychotics and Diabetes"Prof. John Prins (biography)
English - 2007-11-21 - 25 minutes
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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.
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"The Edmonton protocol - Where to from now?"Dr. Philip O'Connell (biography)
English - 2007-11-17 - 43 minutes
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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.
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"Management of Type 2 Diabetes: A GP's Perspective"Dr. Nestor Fuertes (biography)
English - 2007-11-15 - 31 minutes
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Summary :
The burden of diabetes in Australians is significant, and most patients are being managed in primary care.
Dr. Fuertes talks about the diagnosis and treatment of type 2 diabetic patients, and strategies to reduce complications.
Copyright © 2008 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Incidence of T2DM in Australia
- Diagnosis and treatment of T2DM
- Aims to reduce risk of complications
- Targets for HbA1c, BP and lipids
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"Glycaemic Efficacy of TZDs"Prof. Don Chisholm (biography)
English - 2007-11-10 - 22 minutes
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Summary :
The pathophysiology of type 2 diabetes involves both insulin resistance and β-cell dysfunction.
As the United Kingdom Prospective Diabetes Study showed, in all arms of the study there was a progressive loss of glycaemic control, and a separate analysis showed there was a progressive failure of β-cell function after the first year.
HOMA estimates of ß-cell...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Data on HOMA estimates of ß-cell function and insulin resistance in rosiglitazone-treated patients with type 2 diabetes (Lebovitz et al. JCEM 2001)
- Reduction in the incidence of type 2 diabetes with rosiglitazone in prediabetic subjects (DREAM trial)
- Glycaemic efficacy and durability data for rosiglitazone compared to sulfonylurea or metformin (ADOPT trial)
Bibliographic references :
1. Rosiglitazone Monotherapy Is Effective in Patients with Type 2 Diabetes The Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 1 280-288.
2. The DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial The Lancet Volume 368, Issue 9541, 23 September 2006-29 September 2006, Pages 1096-1105.
3. Steven E. Kahn, M.B., Ch.B., Steven M. Haffner, M.D., Mark A. Heise, Ph.D., William H. Herman, M.D., M.P.H., Rury R. Holman, F.R.C.P., Nigel P. Jones, M.A., Barbara G. Kravitz, M.S., John M. Lachin, Sc.D., M. Colleen O'Neill, B.Sc., Bernard Zinman, M.D., F.R.C.P.C., Giancarlo Viberti, M.D., F.R.C.P., for the ADOPT Study GroupGlycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy NEJM 2006 Volume 355:2427-2443.
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"Thiazolidinediones and bone biology"Prof. John Prins (biography)
English - 2007-11-10 - 29 minutes
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Summary :
In this presentation Dr. Prins discusses the effects of TZDs on bone formation/resorption. Interestingly, these effects are partly caused by a TZD-induced increase in adipogenesis (1); the endocrinology of this phenomenon is discussed as well.
TZDs have an effect on many hormones including adiponectin, osteocalcin and TNF alpha. They were also shown to modulate the ratio of OPG and...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Regulation of progenitor cell determination (osteoblasts and adipocytes)
- Endocrinology of bone, fat and pancreas
- Effects of TZDs on bone formation/resorption
- Preclinical and genetic studies
Bibliographic references :
1. M Adams, C T Montague, J B Prins, J C Holder, S A Smith, L Sanders, J E Digby, C P Sewter, M A Lazar, V K Chatterjee and S O'Rahilly Activators of peroxisome proliferator-activated receptor gamma have depot-specific effects on human preadipocyte differentiation J. Clin. Invest. 100(12): 3149-3153 (1997).
2. Simonet WS, Lacey DL, Dunstan CR, Kelley M, Chang MS, Lüthy R, Nguyen HQ, Wooden S, Bennett L, Boone T, Shimamoto G, DeRose M, Elliott R, Colombero A, Tan HL, Trail G, Sullivan J, Davy E, Bucay N, Renshaw-Gegg L, Hughes TM, Hill D, Pattison W, Campbell P, Sander S, Van G, Tarpley J, Derby P, Lee R, Boyle WJ.Osteoprotegerin: A Novel Secreted Protein Involved in the Regulation of Bone Density Cell. 1997 Apr 18;89(2):309-19.
3. Cock TA, Back J, Elefteriou F, Karsenty G, Kastner P, Chan S, Auwerx J.Enhanced bone formation in lipodystrophic PPARgamma(hyp/hyp) mice relocates haematopoiesis to the spleen. EMBO Rep. 2004 Oct;5(10):1007-12.
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"Where Do Glitazones Fit In in clinical practice?"Dr. Soji Swaraj (biography)
English - 2007-11-10 - 39 minutes
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Summary :
In this presentation Dr. Swaraj discusses the use of glitazones in diabetes treatment. Many treatment options are available and it is important to understand the place of each one in the general scheme. According to Dr. Swaraj, the traditional management of type 2 diabetes should be revised.
Regarding therapies, he comments that they all have limitations, for example: the ceiling...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The objectives of type 2 diabetes therapy
- The importance of changes in lifestyle as a treatment option
- Case studies and the use of combination therapy
Bibliographic references :
1- Garber AJ, Duncan TG, Goodman AM, Mills DJ, Rohlf JL.Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose-response trial. Am J Med. 1997 Dec;103(6):491-7.
2- Nesto RW, Bell D, Bonow RO, Fonseca V, Grundy SM, Horton ES, Le Winter M, Porte D, Semenkovich CF, Smith S, Young LH, Kahn R.Thiazolidinedione use, fluid retention, and congestive heart failure: a consensus statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2004 Jan;27(1):256-63. Review.
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"Practical diabesity intervention: Strategies borrowed from the marketing and economics world"Dr. Soji Swaraj (biography)
English - 2007-08-16 - 32 minutes
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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
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"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
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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.
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"Treat to target"Prof. Richard O'Brien (biography)
English - 2007-04-21 - 37 minutes
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Summary :
With the current management of type 2 diabetes, a large proportion of patients are not achieving the glycaemic target. How can this be improved?
Early combination treatment may help in keeping the HbA1c down longer, says Dr. O'Brien. As seen in the United Kingdom Prospective Diabetes Study, most type 2 diabetic patients require polypharmacy to achieve long-term glycaemic control...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Why there is a need for an early and intensive approach to type 2 diabetes management
- Potential advantages of early combination therapy
- Studies illustrating greater benefit with combination therapy versus monotherapy
- Practical management considerations
Bibliographic references :
1. 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.
2. Del Prato S, Felton AM, Munro N, Nesto R, Zimmet P, Zinman B; Global Partnership for Effective Diabetes Management. Improving glucose management: Ten steps to get more patients with type 2 diabetes to glycaemic goal: Recommendations from the Global Partnership for Effective Diabetes Management International Journal of Clinical Practice. Volume 59 Issue 11 Page 1345-1355, November 2005.
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"Introduction"Dr. Matthew Cohen (biography)
English - 2007-04-21 - 9 minutes
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"Current treatments in type 2 diabetes"Dr. Neale Cohen (biography)
English - 2007-04-21 - 29 minutes
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Summary :
Type 2 diabetes develops due to insulin resistance as well as beta-cell dysfunction. There are various barriers to achieving good glycemic control in these patients, and one of them is inadequate targeting of the underlying pathophysiology.
Different factors are recognised to drive beta-cell failure, such as oversecretion of insulin to compensate for insulin resistance,...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Core defects of type 2 diabetes: insulin resistance and beta-cell dysfunction
- The progressive nature of type 2 diabetes
- The link between insulin resistance and cardiovascular disease
- Evidence for decreased risk of macrovascular complications with decreasing insulin resistance
- Drawbacks of the traditional stepwise approach to management of glycaemia
- Antidiabetic medications: mechanisms of action, efficacy, tolerability and safety
Bibliographic references :
1. UK Prospective Diabetes Study (UKPDS) GroupEffect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) 1: Lancet. 1998 Sep 12;352(9131):854-65.
2.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, Vol 44, Issue 11 1249-1258.
3. Strutton DR, Stang PE, Erbey JR, Lydick E.
Estimated coronary heart disease attributable to insulin resistance in
populations with and without type 2 diabetes mellitus. Am J Manag Care. 2001 Aug;7(8):765-73.
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"Summary and Close"Dr. Matthew Cohen (biography)
English - 2007-04-21 - 12 minutes
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"Case Study Presentation"Dr. Andrew Marangou (biography)
English - 2007-04-21 - 31 minutes
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Summary :
In this presentation Dr. Marangou talks about the management of type 2 diabetes, taking into account the guidelines and the latest clinical trial data. A case study is introduced in two modules, focusing on challenges likely to be encountered when facing newly diagnosed patients, initial management, and longer term treatment strategies.
Copyright © 2007 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Challenges likely to be encountered when facing newly diagnosed type 2 diabetic patients
- Initial management and subsequent treatment options
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"‘Algorithm(s)’ for Glycaemic Control - Preceding ADOPT"Dr. Stephen Twigg (biography)
English - 2007-03-03 - 37 minutes
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Summary :
In this presentation Dr. Twigg focuses on a recently published consensus algorithm from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), discussing lifestyle intervention and medication use in type 2 diabetes and how to go about choosing between different antihyperglycemic agents.
Last year the ADA/EASD published a consensus...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The ADA/EASD consensus algorithm for the initiation and adjustment of therapy in type 2 diabetes (Nathan DM et al. 2006)
- Issues in glycemic control in type 2 diabetes: Lifestyle intervention, medications
- Deciding amongst the options in therapy
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 29:1963-1972, 2006.
2. Timothy M E Davis, Wendy A Davis and David G BruceGlycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study MJA 2006; 184 (7): 325-328.
3. National Association of Diabetes Centres ANDIAB 2006. Australian National Diabetes Information Audit & Benchmarking. March 2007.
4. Hocking S et al. ADS Abs., 2004.
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"Effects of Thiazolidinediones on Insulin Secretion in Glucose Intolerant States"Prof. Kenneth Polonsky (biography)
English - 2007-03-03 - 45 minutes
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| (47 slides) |
Summary :
What is the role of the beta-cell in type 2 diabetes? Abnormal insulin secretion is an essential component of the pathophysiology of type 2 diabetes and is present at each stage in the natural history of the disease, says Prof. Polonsky. As an autopsy study published by Butler et al. concluded, beta-cell mass is decreased in type 2 diabetes and the mechanism underlying this is increased beta-cell...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The role of the beta-cell in type 2 diabetes
- The scientific evidence for beneficial effects of TZDs on insulin secretion
- The mechanisms behind these effects
Bibliographic references :
1. Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC.ß-Cell Deficit and Increased ß-Cell Apoptosis in Humans With Type 2 Diabetes Diabetes 52:102-110, 2003.
2. Melissa K. Cavaghan, David A. Ehrmann, Maria M. Byrne, and Kenneth S. PolonskyTreatment with the Oral Antidiabetic Agent Troglitazone Improves beta Cell Responses to Glucose in Subjects with Impaired Glucose Tolerance J Clin Invest. 1997 Aug 1;100(3):530-7.
3. Claus B. Juhl, Malene Hollingdal, Niels Pørksen, Åge Prange, Frederik Lönnqvist and Ole SchmitzInfluence of Rosiglitazone Treatment on ß-Cell Function in Type 2 Diabetes: Evidence of an Increased Ability of Glucose to Entrain High-Frequency Insulin Pulsatility The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 8 3794-3800.
4. 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 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.
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"A (brief) review of the UKPDS"Prof. Timothy Davis (biography)
English - 2007-03-03 - 34 minutes
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Summary :
In this presentation Prof. Davis talks about the justification for the United Kingdom Prospective Diabetes Study (UKPDS), characteristics of the patients, therapy-specific results, post-study monitoring data, and current-day relevance.
The UKPDS participants were not a "typical" community-based cohort of type 2 diabetic patients. Compared to subjects in the Fremantle Diabetes...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The background to the UK Prospective Diabetes Study
- The progressive loss of beta-cell function in type 2 diabetes
- The issue of metformin's cardiovascular protection independent of glycaemia
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"Adding PS to the ABCss of Diabetes Care – An Australian Perspective"Dr. Pat Phillips (biography)
English - 2006-12-07 - 29 minutes
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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.
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"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
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| (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
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"Are We Making Progress With Slowing Disease Progression?"Prof. Peter J. Grant (biography)
English - 2006-12-04 - 17 minutes
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| (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
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"Complementary Therapies - An Overview"Prof. Trisha Dunning (biography)
English - 2006-10-28 - 59 minutes
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| (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
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"UKPDS - Unanswered Questions?"Prof. Rury Holman (biography)
English - 2006-09-13 - 31 minutes
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| (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
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"Platelets in Diabetes: An Important Therapeutic Target"Prof. Karlheinz Peter (biography)
English - 2006-05-07 - 39 minutes
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| (23 slides) |
Summary :
In this presentation Prof. Peter talks about the role of platelets in diabetes-induced atherosclerosis and its complications, as well as anti-platelet therapy and associated issues in diabetic patients.
Platelets are now thought to play an important role not only in the end stage of atherosclerosis but in the beginning and middle phases as well. In the context of diabetes, in a...
Learning objectives :
After viewing this presentation, the participant will be able to discuss:
- The history of anti-platelet therapy
- The role of platelets in different phases of atherosclerosis
- Platelet activation in diabetic patients
- Targets for platelet inhibition
- Response to and benefit of anti-platelet therapy in diabetic patients
Bibliographic references :
1. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, Ramirez C, Sabate M,
Jimenez-Quevedo P, Hernandez R, Moreno R, Escaned J, Alfonso F, Banuelos C,
Costa MA, Bass TA, Macaya C.Platelet Function Profiles in Patients With Type 2 Diabetes and Coronary Artery Disease on Combined Aspirin and Clopidogrel Treatment Diabetes 54:2430-2435, 2005.
2. Marc S. Sabatine, MD; Eugene Braunwald, MD Will Diabetes Save the Platelet Blockers? Circulation. 2001;104:2759.
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"Insulin Resistance, Diabetes and Vascular Disease: The Emerging Role of Glitazones"Prof. Nikolaus Marx (biography)
English - 2006-05-06 - 41 minutes
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| (56 slides) |
Summary :
Insulin resistance is associated with several cardiovascular risk factors. In this presentation Prof. Marx focuses on inflammation, endothelial dysfunction and arteriosclerosis, and evidence for how they can be improved with glitazone treatment.
The insulin-sensitising glitazones work by activating the nuclear transcription factor PPARγ. They are known to reduce inflammation...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Effects of glitazone treatment on inflammation, endothelial function and arteriosclerosis in type 2 diabetic patients and nondiabetic individuals
Bibliographic references :
1. Franz Meisner; Daniel Walcher; Florence Gizard; Xaver Kapfer; Roman Huber; Anja Noak; Ludger Sunder-Plassmann; Helga Bach; Cornelia Haug; Max Bachem; Tatjana Stojakovic; Winfried März; Vinzenz Hombach; Wolfgang Koenig; Bart Staels; Nikolaus Marx. Effect of Rosiglitazone Treatment on Plaque Inflammation and Collagen Content in Nondiabetic Patients: Data From a Randomized Placebo-Controlled Trial Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:845.
2. Jürgen Hetzel; Bernd Balletshofer; Kilian Rittig; Daniel Walcher; Wolfgang Kratzer; Vinzenz Hombach; Hans-Ulrich Häring; Wolfgang Koenig; Nikolaus Marx Rapid Effects of Rosiglitazone Treatment on Endothelial Function and Inflammatory Biomarkers Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:1804.
3. 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, PHD 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.
4. Nikolaus Marx, MD; Jochen Wöhrle, MD; Thorsten Nusser, MD; Daniel Walcher, MD; Angelika Rinker, MS; Vinzenz Hombach, MD; Wolfgang Koenig, MD; Martin Höher, MD. Pioglitazone Reduces Neointima Volume After Coronary Stent Implantation: A Randomized, Placebo-Controlled, Double-Blind Trial in Nondiabetic Patients Circulation. 2005;112:2792-2798.
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"Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?"Dr. Richard E. Gilbert (biography)
English - 2006-04-28 - 26 minutes
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| (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.
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"Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?"Dr. Richard E. Gilbert (biography)
English - 2006-04-28 - 26 minutes
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| (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.
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"Insulin Stabilisation"Prof. Trisha Dunning (biography)
English - 2006-04-07 - 62 minutes
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| (45 slides) |
Summary :
In this presentation Prof. Dunning discusses insulin action and the types of insulin available, factors concerning insulin use, education issues and commencing insulin in type 2 diabetes.
Insulin stabilisation needs to be maintained over time. In the context of diabetes this refers to replacing endogenous insulin in type 1 diabetes, augmenting endogenous insulin in type 2...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Insulin action and types of insulin
- Insulin regimens and administration
- Factors affecting insulin absorption
- Adjusting insulin doses
- Insulin-related fears
- Patient education about insulin
- Commencing insulin in type 2 diabetes
Bibliographic references :
H Ilkova, B Glaser, A Tunckale, N Bagriacik, and E Cerasi Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care, Vol 20, Issue 9 1353-1356.
Cavaghan, MK. The Beta Cell and First-Phase Insulin Secretion. Medscape Diabetes and Endocrinology, 2004 6(2): 1-5.
Dunning P., Martin M. Beliefs About Diabetes and Diabetic Complications. Professional Nurse, 1998 13(7): 429-434.
Gerich, J. Physiology and Pathophysiology of Postprandial Glucose Regulation. Medscape Diabetes and Endocrinology. 2004 6(2): 1-6.
Nathan, D. Initial Management of Glycemia in Type 2 Diabetes Mellitus New England Journal of Medicine. 2002 347(17): 1342-1349.
Olsson, P., Hans, A., Henning, V. Miscibility of Human Semisynthetic Regular and Lente Insulin and Human Biosynthetic Regular and NPH insulin. Diabetes Care. 1987 10(4): 473-477.
UK Prospective Diabetes Study Group. UK Prospective Diabetes Study (UKPDS) VIII. Study Design, Progress and Performance. Diabetologia. 1991 34(12): 877-890.
Zinman, B. Glucose Control in Type 1 Diabetes: From Conventional to Intensive Therapy. Clinical Cornerstone. 1998 1(3): 29-38.
UK Prospective Diabetes Study 7: Response of Fasting Plasma Glucose to Diet Therapy in Newly Presenting Type II Diabetic Patients Metabolism. 1990 39(9): 905-912
American Diabetes Association. Insulin Administration. Diabetes Care. 2004 27 (Supp): 106S – 107S
Boyages S., When and How to Start Insulin Therapy in Type 2 Diabetes. Medicine Today. September (Supp): 10-16
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003. Clinical Practice Guidelines For the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes. 2003 27(2) (Supp): 128-140.
Rutherford, A., Wright, E., Hussaine, Z., Colagiuri, R. On Behalf of the DAWN Advisory Committee. DAWN: Diabetes Attitudes, Wishes and Needs, the Australian Experience. 2004
Zinman, B. Translating the Diabetes Control and Complications Trial (DCCT) Into Clinical Practice: Overcoming the Barriers. Diabetologia. 1997 40(Supp 2): S88 – S90.
Dunning T., Martin M., 1998 Type 2 Diabetes: Is It Serious? Journal of Diabetes Nursing 2(3): 70-76.
BOOKS:
Colwell, J. Diabetes – Hot Topics. Philadelphia: Hanley & Belfus. 2003. ISBN 1560535628
Davidson, M. Diabetes Mellitus Diagnosis and Treatment. 4th ed. Philadelphia: W.B. Saunders Company. 1998. ISBN 0721664032
Klingensmith, GJ. Intensive Diabetes Management, 3rd ed. Virginia: American Diabetes Association. 2003. ISBN 1580401643
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"Transplantation in Diabetes Management"Dr. Philip O'Connell (biography)
English - 2006-02-20 - 54 minutes
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| (46 slides) |
Summary :
In this presentation Dr. O'Connell talks about the rationale for transplantation in diabetes, which patients are eligible for these procedures, and how this field is likely to progress.
In type 1 diabetic patients, intensive insulin treatment has been associated with reduced complications, however aggressive control with exogenous insulin increases the ri | | | |
