The Diabetes TideJohn Doig
228,004
268,154
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-S80Copyright © 2014 American Diabetes Association, Inc.
Lim EL Diabetologia [0012-186X] Lim, E L yr:2011 vol:54 iss:10 pg:2506 -14
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/m2, or between 35 kg/m2 and 40 kg/m2 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
HbA1c (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
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