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The multiple challenges of Type 2 diabetes management

The multiple challenges of Type 2 diabetes management. Type 2 diabetes – a majority of patients worldwide fail to reach HbA 1c goals.

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The multiple challenges of Type 2 diabetes management

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  1. The multiple challenges of Type 2 diabetes management

  2. Type 2 diabetes – a majority of patients worldwide fail to reach HbA1c goals 1. De Pablo-Velasco, P et al. Poster presented at: 46th EASD Meeting; September 20–24, 2010; Stockholm, Sweden.;2. Wong ND, et al. Presented at: American Diabetes Association 70th Scientific Sessions; June 25–29, 2010; Orlando, FL; 3. Harris SB, et al. Diab Res ClinPract 2005;70:90–7: 4. Díaz-Apodaca BA, et al. Rev Panam SaludPublica 2010;28:207–13.

  3. Type 2 diabetes – increasingly challenging to control over time OAD =oral antidiabetic. UK Prospective Diabetes Study (UKPDS) Group. Lancet.1998;352:854–65; Campbell W. Br J Cardiol 2000;7:625–31; KhatibOMN, ed. EMRO Technical Publications Series 32. World Health Organization; 2006.

  4. Type 2 diabetes – most EU patients are overweight, have hypertension, or have dyslipidaemia1–3 1. European Public Health Alliance Web site. Obesity and diabetes. National Obesity Forum Annual Conference (last modified 2009). http://www.epha.org/a/3671. Accessed December 13, 2010; 2. Mancia G. ActaDiabetol2005;42(suppl 1):S17–S25; 3. Isomaa B, et al. Diabetes Care 2001;24:683–9.

  5. Type 2 diabetes – insulin and some oral antidiabetic therapies are associated with weight gain over time These trials have shown weight gain over time: • UKPDS, where there was a significant mean increase of 3.1 kg in weight in the intensive treatment (sulphonylurea or insulin) group compared with the conventional treatment (diet and exercise) group1 • Patients gained an average of 1.7 kg over 10 years of intensive treatment with glibenclamide1 • Patients gained up to 8 kg after 12 years of insulin therapy2 • Action to Control Cardiovascular Risk in Diabetes (ACCORD), where patients receiving intensive therapy (targeting an HbA1c <6%, often through the useof insulin and multiple agents) gained an average of 3.5 kg, with nearly 30% gaining >10 kg3 • In A Diabetes Outcome Progression Trial (ADOPT), patients receiving glibenclamide gained an average of 1.6 kg over a median treatment duration of3.3 years4 1. UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837–53; 2. UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:854–65;3. Members of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group. N Engl J Med 2008;358:2545–59; 4. Kahn SE, Haffner SM, Heise MA, et al.for the ADOPT Study Group. N Engl J Med 2006;355:2427–43.

  6. Type 2 diabetes – visceral adipose tissue (VAT) is a major cardiovascular risk factor 1. Carr DB, et al. Diabetes. 2004;53:2087–94; 2. Eeg-Olofsson K, et al. Diabetologia. 2009;52:65–73; 3. De Koning L, et al.Eur Heart J 2007;28:850–6.

  7. Type 2 diabetes can lead to severe consequences1–7 1. International Diabetes Federation. IDF Diabetes Atlas, 4th ed. Brussels, Belgium: International Diabetes Federation, 2009. 2. Hirsch LJ. Ask Dr. Hirsch: Cardiac autonomic neuropathy. http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=19101. Accessed December 29, 2010; 3. Luchsinger JA, et al. Am J Epidemiol. 2001;154:635–41; 4. National Diabetes Information Clearing House (NDIC) Web site. Prevent diabetes problems: keep your feet and skin healthy. http://diabetes.niddk.nih.gov/dm/ pubs/complications_feet. Accessed December 9, 2010; 5. NDIC Web site. Sexual and urologic problems of diabetes. http://diabetes.niddk.nih.gov/dm/pubs/sup. Accessed December 9, 2010; 6. Wolosin JD, et al. Clin Diabetes. 2000;18:148. http://journal.diabetes.org/clinicaldiabetes/ v18n42000/pg148.htm. Accessed December 9, 2010; 7. NDIC Web site. Diabetes, heart disease and stroke. http://diabetes.niddk.nih.gov/dm/pubs/stroke/index.htm. Accessed December 9, 2010.

  8. Type 2 diabetes – a CVD risk equivalent Adapted frpm: Haffner SM, et al. N Engl J Med 1998;339:229–34.

  9. Summary • The majority of patients with Type 2 diabetes worldwide fail to control HbA1c • HbA1c becomes increasingly difficult to control with time • Type 2 diabetes is also associated with comorbidities such as hypertension, obesity and dyslipidaemia and these can lead to severe consequences

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