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Diabetes Update

Diabetes Update. Part 1 of 3. Division of Endocrinology Department of Medicine Wayne State University Medical School Detroit, Michigan. Type 2 Diabetes Associated with Serious Complications. Stroke. Diabetic Retinopathy. CV Disease & Stroke account for ~65% of deaths in T2D patients.

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Diabetes Update

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  1. Diabetes Update Part 1 of 3 Division of Endocrinology Department of Medicine Wayne State University Medical School Detroit, Michigan

  2. Type 2 Diabetes Associated with Serious Complications Stroke DiabeticRetinopathy CV Disease & Stroke account for ~65% of deaths in T2D patients Leading cause of blindness in adults CardiovascularDisease Diabetic Nephropathy DiabeticNeuropathy Major cause of kidney failure Major cause of lower extremity amputations CV = cardiovascular. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institute of Health, 2005.

  3. 42% Of Diabetes Costs Related To Hospitalization And Long-Term Care 2010 US Total Healthcare Costs Attributable To Diabetes 50 $200 Billion Total! 40 Oral Antidiabetics Insulin and Supplies Outpatient Medication* Outpatient Services† Physician Office Visits Nursing Home Care (11%) Inpatient Care (31%) 30 20 10 0 Direct Costs Indirect Costs‡

  4. ADA and AACE/ACE Guidelines:Treatment Goals for A1C, FPG, and PPG aThe goal for an individual patient is to achieve an A1C as close to normal (<6%) as possible without significant hypoglycemia. FPG=fasting plasma glucose; PPG=postprandial glucose; ADA=American Diabetes Association; AACE=American Association of Clinical Endocrinologists; ACE=American College of Endocrinology. 1. Adapted from Buse J et al. In: Williams Textbook of Endocrinology. 10th ed. 2003. Permission requested. 2. AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Endocr Pract. 2007;13:(suppl 1)3–68. 3. ADA. Diabetes Care. 2007;30:S4–S41.

  5. Components of HbA1c HbA1c = FBS + PPBS

  6. Both Fasting and Postprandial Hyperglycemia Contribute to A1C Postprandial Hyperglycemia Fasting Hyperglycemia Uncontrolled DiabetesWith A1C ~8% 300 200 Plasma Glucose (mg/dL) 100 Normal glycemic exposure A1C ~5% 0 6 AM 12 PM 6 PM 12 AM 6 AM Time of Day Adapted from Riddle MC. Diabetes Care. 1990;13:676-686

  7. SUPPLY DEMAND Beta-Cell Workload and Beta-Cell Response Normally Balanced to Maintain Euglycemia Normal Physiology

  8. The Pathogenesis of Type 2 DiabetesAn Imbalance of Beta-Cell Workload and Beta-Cell Response Hyperglycemia

  9. Type 2 Diabetes Is a Complex and Progressive Metabolic Disorder History and Progression of Type 2 Diabetes1-3 By the time of diabetes onset, up to 80% of beta-cell function may be lost2,3 Diagnosis Adapted from Kendall DM, Bergenstal RM. 1. Kendall DM, et al. International Diabetes Center. 2005. 2. DeFronzo DA. Diabetes. 2009. 3. Fehse F, et al. J Clin Endocrinol Metab. 2005. 9

  10. Unmet Needs for Type 2 DM Treatment Durable HbA1ccontrol (i.e. help improve Beta-cell function). Addressing islet dysfunction (i.e., addressing both insulin and glucagon secretion. Addressing both fasting and postprandial sugars Minimum risk of treatment-limiting adverse events: -Minimum risk of hypoglycemia -Minimum risk of weight gain -No increased risk of edema -No increased risk of heart failure

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