1 / 8

Reducing the Risk of Developing Diabetes

Canadian Diabetes Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes. Chapter 5 Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki , Ally PH Prebtani , Zubin Punthakee. Key Points. 2013.

rhys
Download Presentation

Reducing the Risk of Developing Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Canadian Diabetes Association 2013 Clinical Practice Guidelines Reducing the Risk of Developing Diabetes Chapter 5 Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally PH Prebtani, ZubinPunthakee

  2. Key Points 2013 • At this time, there are no safe and effective strategies to prevent T1DM • Intensive lifestyle modification with weight loss can reduce the risk of progression from pre-diabetes to T2DM by almost 60% • Progression from pre-diabetes to T2DM can be reduced by Metformin or Acarbose by approximately 30%

  3. No Safe and Effective Strategies to Prevent T1DM at this Time • T1DM is a chronic autoimmune condition with destruction of pancreatic beta cells • Ongoing or completed trials • ENDIT: High-dose nicotinamide – Not effective • DPT-1: Low-dose insulin in high risk relatives – Not effective overall • TRIGR: Exclusion of cow’s milk protein to infants until 6-8 months of age – Trial ongoing • Alternate strategy to use immunosuppression / modulation at the time of diagnosis but significant side effects and ethical considerations

  4. Benefit of diet and exercise or Metformin on diabetes prevention in at-risk patients • N = 3234 with IFG and IGT, without diabetes 40 Placebo P* < 0.001 Metformin 30 Cumulative incidence of diabetes (%) 31% 20 Lifestyle < 0.001 58% 10 *vs placebo IFG = impaired fasting glucose, IGT = impaired glucose tolerance 0 0 1.0 2.0 3.0 4.0 Years Diabetes Prevention Program (DPP) Diabetes Prevention Program (DPP) Research Group. N Engl J Med 2002;346:393-403.

  5. 1.00 Acarbose Placebo 0.95 0.90 0.85 0.80 0.75 0.70 Cumulative probability 0.65 0.60 0.55 0.50 0.45 P = 0.0022 0.40 0 100 200 300 400 500 600 800 900 700 1000 1100 1200 1300 Days after randomization STOP-NIDDM StudyEffects of Acarbose on the risk of T2DM N = 1429 people with IGT, BMI 25-40, 40-70 yrs, 3.3 years follow up Acarbose 25% Chiasson JL, et al. Lancet 2002;359:2072-77.

  6. Pharmacology to Reduce Progression to T2DM • Metformin has been shown to reduce the incidence of T2DM by approximately 30% in the Diabetes Prevention Program (DPP) • Acarbose has been shown to reduce the risk of progression to diabetes by approximately 30% in the Study to Prevent Non-Insulin Dependent Diabetes (STOP-NIDDM) study

  7. Recommendation 1 and 2 2013 • A structured program of lifestyle modification that includes moderate weight loss and regular physical activity should be implemented to reduce risk of T2DM in individuals with IGT[Grade A, Level 1A] or IFG[Grade B, Level 2]or A1C 6.0-6.4% [Grade D, consensus]. • In individuals with IGT, pharmacologic therapy with Metformin[Grade A, Level 1A]or Acarbose[Grade A, level 1A] may be used to reduce the risk of T2DM.

  8. CDA Clinical Practice Guidelines http://guidelines.diabetes.ca – for professionals 1-800-BANTING (226-8464) http://diabetes.ca – for patients

More Related