Diabetes Mellitus 101 for Cardiologists (and Alike): 2015 Stan Schwartz MD,FACP Affiliate, Main Line Health System Emeritus, Clinical Associate Professor.

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Definitions Body Mass Index (BMI) describes relative weight for height: weight (kg)/height (m 2 ) Overweight = 25–29.9 BMI Obesity = >30 BMI.

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Presentation transcript:

Diabetes Mellitus 101 for Cardiologists (and Alike): 2015 Stan Schwartz MD,FACP Affiliate, Main Line Health System Emeritus, Clinical Associate Professor of Medicine, U of Pa An Aggressive Pathophysiologic Approach to Therapy of Type 2 Diabetes in Cardiometabolic Patients: Looking at Diabetes Medications with a Cardiologists Eye Part 3

Early Treatment Decreases Micro and Macro Vascular RISK

Impact of Intensive Therapy in Type 2 Diabetes Summary of Major Clinical Trials: BUT Subset Evaluations Show Reduced CV Outcomes if shorter duration of DM, without significant pre-existing complications StudyMicrovascularMacrovascularMortality UGDP ↔↔↔ UKPDS ↓↓↔↓↔↓ DCCT/EDIC* ↓↓↔↓↔ ↔ ACCORD ↓↔ ↑ (unadj.), ↔ (adj.) ADVANCE ↓↔↔ VADT ↔↔↔ Initial Trial Long Term Follow-up ↑- likely due to hypoglycemia and weight gain

WEIGHT GAIN IN ACCORD TRIAL Avg ~6 lb, 10% >20 lbs

Overweight Overweight and Obesity Increase the Risk of CV Disease Mortality Data are from 1 million men and women (average age, 57 years) followed for 16 years who never smoked and had no history of disease at enrollment. Calle EE, et al. N Engl J Med. 1999;341: Normal weightObese Relative Risk of Cardiovascular Disease Mortality > >40 BMI, kg/m 2 Women Men

Weight Loss Reduces Cardiometabolic Risk Factors in Patients With Type 2 Diabetes Δ A1C (%) * Δ HDL Cholesterol (mg/dL) * Intensified Lifestyle Intervention, 8.6% Weight Loss Diabetes Support and Education, 0.7% Weight Loss Randomized, controlled trial; n = 5145; Patients with type 2 diabetes, age >18 y; Mean ± SE Intensified lifestyle intervention (n = 2496) vs diabetes support and education (n = 2463) therapy; *P<0.001 between groups Look AHEAD Research Group. Diabetes Care. 2007;30: Δ Triglycerides (mg/dL) * Δ Blood Pressure (mm Hg) * * SystolicDiastolic

Consequences of Hypoglycemia Prolonged QT- intervals- Diabetologia 52:42,2009 –Can be of pronged duration IJCP Sup 129, 7/02 –Greater with higher catecholamine levels Europace 10,860 Associated with Angina Diabetes Care 26, 1485, 2003 / Ischemic EKG changes Porcellati, ADA2010 Associated with Arrhythmias Associated with Sudden Death Endocrine Practice 16,¾ 2010 Increased Variabilty- explains highest mortality in intensive group had highest HgA1c in ACCORD ( i ncreases inflammation, ICU mortality Hirsch ADA2010)

Cardiovascular effects of Hypoglycemia Clin. Cardiol. (in press) 3 V. Sanon et al: Cardiovascular effects of hypoglycemia Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: /clc © 2014 Wiley Periodicals, Inc.