The Diabetes Tide John Doig

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Number of drugs increasing Metformin Sulphonylureas (Clopropamide, Tolbutamide, Gluiquidone, Glibenclamide,Glipizide, Gliclazide, Glimepiride) Alpha 1 Gliclasidase inhibitors (Acarbose) Thiazolidinediones (Troglitazone,Rosiglitazone, Pioglitazone) GLP1 Analogues (Exenatide, Liraglutide, Albiglutide) DDP4 Inhibitors (Sitagliptin, Saxagliptin, Linagliptin, Alogliptin, Vildagliptin) SGLT2 Inhibitors (Ddapagliflozine, Canagliflozine, Empagliflozine) ?Amylin analogues (Pramlintide)

Antihyperglycemic therapy in type 2 diabetes: general recommendations. American Diabetes Association Dia Care 2014;37:S14-S80 Copyright © 2014 American Diabetes Association, Inc.

Lim EL Diabetologia [ X] Lim, E L yr:2011 vol:54 iss:10 pg:

Prof Roy Taylor twin cycle hypothesis for T2 DM

Bariatric Interventions

Bariatric surgery is recommended as a treatment option for people with obesity if all of the following criteria are fulfilled: BMI > 40 kg/m 2, or between 35 kg/m 2 and 40 kg/m 2 and other significant disease (e.g, type 2 diabetes or HBP) (=25% Dibetic population in Scotland) all appropriate non-surgical measures have been tried the person will receive intensive management in a specialist obesity service fit for anaesthesia and surgery the person commits to long-term follow-up

HbA1c Changes after bariatric surgical intervention in Type 2 diabetes mellitus

Islet cell transplantation typically receive two infusions with an average of 400,000 to 500,000

HbA 1c (mean ± SE), time post-transplantation in subjects who lost all graft function (— ● ),subjects whose graft function remained but had to resume insulin (— ○ ), and those subjects who remained insulin independent (—♦).

Islet cell transplantation Criteria Strict Type 1 DM only Severe hypoglycaemia Wt <85kg Insulin < 0.7U/Kg Normal renal function Long Term Immunosuppression Availability Multiple procedures Graft rejection Only 19 % insulin independent Marked improvement in hypoglycaemia QOL Improved glycaemic control

Beating the immune system

1.Glucose sensor under skin 2.Wireless transmission 3.Monitor picks up data Outcomes  Better glucose control, which reduces the risk of complications  Glucose levels monitored continuously  Risk of overnight hypos reduced  Improved quality of life and peace of mind I Artificial Pancreas

No short term let up in diabetes tide 2030 likely to be 0.5 million patients in Scotland Public/government attitudes to high calorific foods Radical dietetic measures Possible scope for new meds (betatropin) Technology Increased access to bariatric surgery ?Stem cell treatments Retinal screening job is for life