Cardiovasculaire Geneeskunde.nl

WCN 2010 - Diabetes update: huidige stand van zaken behandeling en medicatie

Slides (presentatie) - Dec. 15, 2010

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Content

Diabetes ~ equivalent to MI

Dia 3

Blood pressure and vascular risk in diabetes Best evidence: 2000

Blood pressure: best evidence 2009

All-cause mortality

Dia 7

Population in ACCORD

Intensive BP lowering (<120) versus standard BP treatment (<140)

Intensive BP lowering (<120) is not better than standard BP (<140)

Intensive BP lowering (<120) is not better than standard BP (<140)

Aspirin in diabetes

Belch J et al. BMJ 2008; 337:1030-44.

Role of glucose in CV-disease

Dia 15

Glucose control in ACCORD

Effect of intensive glucose regulation on major cardiovascular events

UK General Practice Research Base 1986 –2008 Twee cohorten: intensivering van orale medicatie Intensivering naar insuline Sterfte versus HbA1c decilen

Survival versus HbA1c (oral treatment)

Survival versus HbA1c (insulin treatment)

Atherosclerosis Risk in Communities (ARIC) study Populatie-based sample 11,092 persons No history of diabetes or cardiovascular disease HbA1c measured in whole blood samples 1990-1992

Higher HbA1c more CV-disease

Higher HbA1c more stroke

Holman R ea. N Engl J Med 2008;359:1577-89.

Holman R ea. N Engl J Med 2008;359:1577-89.

Interpretation

Dia 27

galega officinalis

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

Metformin: evidence and pitfalls

SU-derivatives

Pioglitazone versus gliclazide added to metformin

Time to treatment failure

Thiazolidine-diones

Dia 35

Fracture risk in ADOPT

Thiazolidine-diones

Alpha-glucosidase inhibitors

Diabetes Market Forecast to 2013

The incretin concept

Nauck MA ea. JCEM 1986; 63:492

Nauck MA ea. JCEM 1986; 63:492

Incretin effect

The incretin effect

“The incretins”

Incretins (GLP-1 and GIP) Regulate Glucose Homeostasis Through Effects on Islet Cell Function

After release incretins are rapidly inactivated

GLP-1 is Rapidly Degraded by the DPP-4 enzyme

Degradation of incretins can be decreased by inhibition of the DPP-4 enzyme

Effect of sitagliptin on top of metformin

Vildagliptin Add-on to Metformin

Dia 52

DPP-4 remmers

When to use incretins?

Dia 55

Effects of GLP-1

General Prescribing Considerations: How It Is Supplied

Effect of Exenatide on HbA1c (30 Weeks)

Effect of Exenatide on Body Weight

Adverse Events

Insulin compared to GLP-1 analogue Change in HbA1c compared to baseline

Insulin compared to GLP-1 analogue Effect on weight

Samenvatting GLP-1 analogen

Approach after combination therapy

Dia 65

Shah ND, et al. NEJM 2010; 363:2081-4.

DeSouza C ea. Nat Rev Drug Discov 2009; 8:361-7.

FDA guidance on CV outcome trials

MACE analysis: Major Adverse Cardiovascular Events

Best JH et al. Diabetes Care 2010; on line

CV outcome trials investigating incretin based therapies

Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy

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