Figure 1: Global burden of Type 2 Diabetes • In 2015, 415 million across the globe (1 in 11) ─ By 2040, 642 million people will have diabetes (1 in 10) o ~90-95% of cases are Type 2 diabetes 12% of global health costs ($673 billion) Three- quarters of diabetics live in low/middle- income countries 46.5% adults with diabetes are undiagnosed ational Diabetes Federation Atlas (7th edition). Key messages 2015 . ble from: http://www.diabetesatlas.org/key-messages.html .
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Figure 1: Global burden of Type 2 Diabetes
• In 2015, 415 million across the globe (1 in 11)─By 2040, 642 million people will have
diabetes (1 in 10)o~90-95% of cases are Type 2 diabetes
12% of global health costs ($673 billion)
Three-quarters of diabetics live in
low/middle-income countries
46.5% adults with diabetes are undiagnosed
International Diabetes Federation Atlas (7th edition). Key messages 2015 . Available from: http://www.diabetesatlas.org/key-messages.html.
Figure 2: Partial list of sugar substitutes
• Stevia extracts (Pure Via, Truvia)
• Tagatose (Naturlose)• Trehalose
Novel sweeteners
a
• Acesulfame Potassium (Sunett, Sweet One)• Aspartame (Equal, NutraSweet)• Neotame• Saccharin (SugarTwin,Sweet'N Low)• Sucralose (Splenda)
Artificial sweeteners
• Agave nectar• Fruit juice
concentrate• Honey• Maple syrup• Molasses
Natural sweeteners
• Erythritol• Hydrogenated starch
hydrolysate• Lactitol• Maltitol• Mannitol• Sorbitol• Xylitol
Sugar alcohols
Mayo Clinic. Artificial sweeteners and other sugar substitutes. 2015 Available from: http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936.
Figure 3: Shifting treatment paradigm
Key messages
• Individualize glycemic targets & glucose-lowering therapies
• Build plan on foundation of diet,exercise, & education
• Metformin as 1st-line drug, unless contra-indicated
• Consider risks of hypoglycemia/adverse effects
PrespecifiedGlycemic targets
Diet, exercise, education
Metformin
Oral/injectable agents
Insulin therapy alone /withother agents
Center on
patient needs
Factors to Individualize
Diabetes
Card
iova
scul
ar ri
sk
reed
ucat
ion
Glucose-
lowering
therapies
Keller DM. New EASD/ADA Position Paper Shifts DiabetesTreatment Goals. Medscape Medical News 2012. Available from: http://www.medscape.com/viewarticle/771989#vp_1.
Figure 4: Class & mechanism of action of antihyperglycemic agents
-glucosidase inhibitors
≥2 agents
DPP-4 ihibitor
GLP-1 receptor agonist
Insulin
Insu
lin
secr
etat
ogog
s
Type 2 Diabetes
Metfo
rmin
SGLT-2 inhibitors
• Inhibits pancreatic alpha-amylase and intestinal
alphaglucosidase
• Amplifies incretin pathway activation by inhibition of enzymatic breakdown of endogenous GLP-1 and GIP
• Activates incretinpathway by utilizing DPP-4 resistantanalogue to GLP-1
• Activates insulin receptors to regulate metabolism of carbohydrate, fat, and protein
• Activatessulfonylureareceptor on betacell to stimulateendogenous insulinsecretion
• Enhances insulinsensitivity in liver and peripheraltissues by activationof AMP-activatedprotein kinase
• Sodium-glucose linked transporter 2 inhibitor• Enhances urinary glucose excretion by inhibiting glucose reabsorption in the proximal renal tubule
• Combined formulations
Canadian Diabetes Association. Clinical Practice Guidelines (Update July 2015). Available from: http://guidelines.diabetes.ca/CDACPG_resources/Ch13_Table1_Antihyperglycemic_agents_type_2_Jul_30.pdf.
Related Documents
