Epidemiology and Diagnosis A Practical Guide to Therapy Monotherapy Combination Therapy Add ons.

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Presentation transcript:

Epidemiology and Diagnosis A Practical Guide to Therapy Monotherapy Combination Therapy Add ons

Impaired Glucose Tolerance - IGT Impaired Fasting Glucose - IFG

Evaluation of Major Risk Factors in Diabetics Cigarette Smoking Blood Pressure Serum Lipids & Lipoproteins Albuminuria Glycemic Status Body Weight BMI (Kgs/M2& W/H Ratio Physical activity Family History

Detection of Clinical & Subclinical Cardiovascular Disease in the Diabetics Stress testing (BP & HR response blunted) Painless ST depression, lowered specificity Echo : diastolic dysfunction Tc 99 perfusion Scintigraphy Autonomic dysfunction (50% mort. In 5yrs) LVH in ECG is strong predictor of CHD Coronary calcium scoring - CT based

Predictors of Worsening of GT Insulin resistance Insulin Secretory dysfunction These can be assessed by –Insulin stimulated glucose disposal (M) –Acute insulin Secretory response (AIR) –Hydrodensitometry (body composition)

Beta cell mechanism Insulin secretion and Glucose regulation Effects of hyper glycemia Biphasic Insulin response Insulin secretagogues Glycaemic goals & Pregnancy Diabetic retinopathy Glitazones Hyperglycemia

Etiologic classification of diabetes mellitus Glucose tolerance categories Diagnosis of Diabetes Diagnosis of Diabetes II

Management Goals Metabolic Targets Deterioration in Median Antihyperglycemic Agents Antihyperglycemic Agents(Sites) Antihyperglycemic Agents(Mechanism) The  -Glucosidase inhibitors The  -Glucosidase inhibitors(Effect) Acarbose Effect on HbA1c The Biguanides(Characteristics) Metformin (Mechanism)

Metformin Effect(Glucose) Metformin Effect(HbA1c) Dose Response(Metformin) Insulin Secretagogues Repaglinide Effect(HbA1c) Repaglinide after Sulfonylurea Sulfonylurea Effect(Glucose) Dose Response(Sulfonylurea) Once vs Twice daily(Sulfonylurea) Placebo subtracted dose Selected insulin secretagogues  -Glucosidase Dosing Hypoglycemic episodes Sulfonylureas Insulin Secretagogues Initial treatment Secondary Failures Metformin  -Glucosidase Inhibitors

Glycemic Improvements Sulfonylurea+Metformin Sulfonylurea+Acarbose Combinations of Oral agents Secondary Failure Metformin+Repaglinide Metformin+Acarbose Glimepride+Insulin(FPG) Glimepride+Insulin(HbA1c) Oral Agents+Insulin Sulfonyurea+Insulin Insulin+Metformin(HbA1c) Insulin+Metformin(Effect)