DRUG THERAPY OF OBESITY METFORMIN (UKPDS)二甲双胍治疗肥胖的药物（UKPDS）.pptVIP

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DRUG THERAPY OF OBESITY METFORMIN (UKPDS)二甲双胍治疗肥胖的药物（UKPDS）.ppt

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DRUG THERAPY OF OBESITY METFORMIN (UKPDS)二甲双胍治疗肥胖的药物（UKPDS）.ppt

DIABETES MANAGEMENT 2006:INTEGRATING NEW MEDICINES AND NEW DEVICES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Diabetes Mellitus in the US: Health Impact of the Disease Diabetes Mellitus: U.S. Impact Screening for Diabetes ADA: 45, especially if BMI 25. 45 if overweight and have risk factor for DM (inactive, FH, high risk ethnicity, baby 9 lb, HTN, low HDL or high TG, PCOS, vascular disease). Screen with FPG or 2-h OGTT Diabetes Care, 2006 USPSTF: Insufficient evidence to recommend for or against. However, recommend screening in adults with hypertension and lipid disorders Ann Intern Med, 2003 Diagnosis of Diabetes Two measures of any of the following: Random glucose: 200 mg/dl with symptoms (poly’s, weight loss) Fasting glucose: 126 mg/dl 2-hr glucose: 200 mg/dl during OGTT Diabetes Care 2006 HbA1C for Screening ? HbA1c 2SD above mean has sensitivity of 66 % and specificity of 98 % and compares favorably to FPG Different nondiabetic reference ranges due to different glycated hemoglobin fractions Precision and accuracy may not be sufficient in all labs Affected by hemoglobinopathies, anemia, transfusions, uremia, pregnancy Diagnosis of Pre-Diabetes Two measures of any of the following: Fasting glucose 100 - 125 mg/dl 2-hr glucose 140 - 199 mg/dl during OGTT DPP: % Developing DM After 3 Years Prevention of Type 2 DM: RCTs Trial Description Results (RR) Da Qing1 Diet /or exercise 31 to 46% Finnish Prevention Study (FPS)2 Intensive lifestyle 58 % Diabetes Prevention Meformin 31 % Program (DPP)3 Lifestyle 58 % STOP- NIDDM4 Acarbose 25 % TRIPOD5 Troglitazone 55 % Recommendations for Adults Glycemic Control A1C: 7.0 Preprandial: 90-130 mg/dl Postprandial: 180 mg/dl Blood Pressure: