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02/10/2019

New ESC/EASD Guidelines on diabetes no longer regard metformin as first-line therapy
NEWS - SEP. 3, 2019
Among the five new ESC guidelines presented at this year’s ESC congress, was the 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Since the publication of the previous version in 2013, a lot of new evidence has become available that has implications for daily clinical practice. The most important novel insights are the result of a number of CV safety trials for type 2 diabetes (T2DM) therapies. All have reported CV safety, but several have also demonstrated, for the first time in the diabetes field, clear evidence of CV benefit. This regards SGLT2 inhibitors and GLP-1 receptor agonists (GLP-1RAs).

In other ways, and on a global scale, little has changed. The prevalence of DM worldwide continues to increase, rising to 10% of the population in countries such as China and India, which are now embracing western lifestyles. Combining the increasing prevalence with the novel treatment opportunities, shows the relevance of an update to the earlier guidelines.

Here, we highlight some of the new recommendations in the 2019 ESC/EASD Guidelines on diabetes, pre-diabetes and CV diseases.

Prevention of CVD: Lifestyle intervention is recommended to delay/prevent conversion from pre-DM to T2DM and to prevent CV complications of diabetes.
Lipid targets: In line with the 2019 ESC/EAS Dyslipidaemia Guidelines, recommendations on lipid targets have been altered to LDL-c

11/09/2018

Recently researchers proposed the term ‘Type-3-Diabetes’ for Alzheimer's disease (ad) because of the shared molecular and cellular features among Type-1-Diabetes, Type-2-Diabetes and insulin resistance associated with memory deficits and cognitive decline in elderly individuals. Recent clinical and basic studies on patients with diabetes and AD revealed previously unreported cellular and pathological among diabetes, insulin resistance and AD. These studies are also strengthened by various basic biological studies that decipher the effects of insulin in the pathology of AD through cellular and molecular mechanisms. For instance, insulin is involved in the activation of glycogen synthase kinase 3β, which in turn causes phosphorylation of tau, which involved in the formation of neurofibrillary tangles. Interestingly, insulin also plays a crucial role in the formation amyloid plaques. In this review, we discussed significant shared mechanisms between AD and diabetes and we also provided therapeutic avenues for diabetes and AD. This article is part of a Special Issue entitled: Oxidative Stress and Mitochondrial Quality in Diabetes/Obesity and Critical Illness Spectrum of Diseases - edited by P. Hemachandra Reddy.

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15/02/2018

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DIABETIC FOOT: FACTS AND FIGURES
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Diabetes affects 30 million people in the US and more than 415 million people worldwide.

Diabetesatlas.org/American Diabetes Association



The big picture: Diabetes, Diabetic Foot Ulcers, Peripheral Artery Disease and Limb Loss Visualized



The top 10 diabetes nations
International Diabetes Federation / Diabetesatlas.org



Worldwide trends in diabetes from 1980 to today



Diabetes kills more people annually than breast cancer and AIDS combined.

American Diabetes Association, 2009



Two thirds of all new cases of type 2 diabetes are diagnosed in low- and middle-income countries, such as Mexico, India, China and Egypt.

Pharmacoeconomics, 2015



Diabetes reduces a woman’s chances of employment by 50%

Pharmacoeconomics, 2015



If diabetes were a country, it would be the 3rd largest in the world

International Diabetes Federation / Diabetesatlas.org



80% of people with diabetes are from low and middle income nations

International Diabetes Federation, 2012



The number of people with diabetes is increasing in every single nation

International Diabetes Federation/World Health Org 2012



Half of people with diabetes don’t know they have it.

American Diabetes Association / International Diabetes Federation, 2012



Quiet. Slow. Deadly. Expensive: Chronic Diseases Account for 75% of our Healthcare Costs.

CDC



25% of all medical care is consumed by 1% of the population and nearly 50% is consumed by 5%.
AHRQ, 2013

__

1 Day with in USA: 5000 diagnosed, $670M, 280 lives, 200 limbs. We can do better. Today.
American Diabetes Association, 2014



Seconds Count: Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated.

International Diabetes Federation / Diabetesatlas.org

Armstrong, et al, Diabetes Care 2013



The cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer

Barshes, et al, Diab Foot Ankle 2013



The cost to heal a complex diabetic foot ulcer is between 3 months and 6 years’ salary depending on nationality

Cavanagh, et al, Diabetes Metab Res Rev, 2012



Diabetic Foot Ulcer patients are twice as costly to US Medicare as those with diabetes alone

Rice, et al, Diabetes Care, 2014



Inpatient care constitutes nearly two thirds of insurance costs for diabetic foot ulcers
Rice, et al, Diabetes Care, 2014



The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion
Rice, et al, Diabetes Care, 2014



By 2030, at least 550 million people will have diabetes- approximately 10% of the world’s adult population.

International Diabetes Federation (IWGDF), 2011



There are now approximately 86M people with pre-diabetes in the USA
That’s the total population of 30 states.
American Diabetes Association, 2014
2010 United States Census



The population of diabetes in the USA is greater than the population of the nation’s 10 largest cities.
American Diabetes Association, 2012
2010 United States Census



Today with Diabetes In America: 200 Lives, 200 Limbs, 86 million at risk.
American Diabetes Association 2014



The population of Diabetes in Arizona (home of SALSA) would make it the fourth largest city in the state.
American Diabetes Association, 2012
2010 United States Census



60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.

Dyck et al. Diabetic Neuropathy 1999



More than 90% of people with diabetic peripheral neuropathy are unaware they have it.

Bongaerts, et al, Diabetes Care, 2013



Up to 25% of those with diabetes will develop a foot ulcer.

Singh, Armstrong, Lipsky. J Amer Med Assoc 2005



The yearly incidence of diabetic foot ulcers ranges from 2% to 32%, depending on ADA risk classification
Boulton, Armstrong, et al, Diabetes Care 2008
Lavery , et al, Diabetes Care 2008
Sibbald, et al, Adv Skin Wound Care, 2012



More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation.

Lavery, Armstrong, et al. Diabetes Care 2006



Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.

Armstrong et al. Amer Fam Phys 1998



“Every 20 seconds, somewhere in the world, a limb is lost as a consequence of diabetes”

DFCon11, Bakker (after Boulton), DFCon.com

Boulton, The Lancet (cover), Nov. 2005



After a major amputation, 50% of people will have their other limb amputated within 2 years.

Goldner. Diabetes 1960

Armstrong, et al, J Amer Podiatr Med Assn, 1997



More than half of people with osteomyelitis of the heel will undergo high level amputation

Faglia, et al, Foot Ankle Int, 2013



The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%). (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%)

Armstrong, et al, International Wound Journal, 2007



Median time to healing for diabetic foot wounds: 147,188, and 237 days for toe, midfoot and heel ulcers.

Pickwell, et al, Diabetes Metab Res Rev, 2013



People with a history of a diabetic foot ulcer have a 40% greater 10 year mortality than people with diabetes alone.

Iversen, et al, Diabetes Care, 2009



Every 30 minutes a limb is lost due to a landmine, Every 20 seconds, a limb is lost due to diabetes.

Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009



Having a wound immediately doubles one’s chances of dying at 10 years compared with someone without diabetes

Iversen, et al, Diabetes Care 2009



One third of patients seeking care for ischemic wounds die unhealed
Elgzyri, et al, Eur J Vasc Endovasc Surg, 2013



For people on dialysis receiving an amputation, 2 year mortality is 74%

Ndip, et al, 2012, Diabetes



Diabetic foot ulcers double mortality and heart attack risk while increasing risk for stroke by 40%
Brownrigg, et al, Diabetologia, 2012



Chronic wounds affect some 8 million Americans each year. That’s one wound every 3.8 seconds in the USA, alone.
Harsha , 2008 and Tomic-Canic 2010



Each $1 invested in care by a podiatrist for people with diabetes results in $27 to $51 of healthcare savings.

JAPMA, 101(2), 2011



Podiatry care not only reduces amputation risk, but also dramatically impacts rate of hospitalization and reulceration
Gibson, et al, Int Wound Journal, 2013



Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80%
Gibson, et al, Int Wound Journal, 2013



Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality
Weck, et al, Cardiovascular Diabetology, 2013



When footcare is removed from a population with diabetes, there is a 37% increase in hospital admissions for limb threatening wounds and 45% increase in individual patient charges.

Skrepnek, Mills, Armstrong, Diabetes Care, 2014

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27/04/2017
27/03/2017

SGLT2 inhibitor dapagliflozin simlarly reduces cardiovascular risk factors regardless of renal function

27/03/2017

DPP4 inhibitor sitagliptin did not increase the risk of serious hypoglycaemia and was neutral with respect to CV outcomes compared to placebo in older diabetes patients

17/07/2016

لو انت طبيب ومقيم فى المنصورة أو الزقازيق أو شبين الكوم أو المحلة الكبرى ومهتم انك تحضر المؤتمرالسنوي الاول لجمعية الدلتا والقنال للسكر والميتابوليزم
" 1st Delta Canal Diabetes & Metabolism Conference "
والذي يضم كوكبة من القامات العلمية الكبيرة بمصر بالاضافة لمجموعة من المتحدثين الأجانب المميزين .

نحيطكم علما بوجود باصات لنقل السادة الأطباء من وإلى المنصورة والزقازيق وشبين الكوم والمحلة الكبرى يوميا
بمقر انعقاد المؤتمر بفندق فيرمونت هليوبوليس بالقاهرة وذلك من 20-22 يوليوا الجاري وذلك تيسيرا من اللجنتين العلمية والمنظمة للمؤتمر لإتاحة الفرصة لأكبر عدد ممكن من السادة الأطباء لحضور المؤتمر والاستفادة من المادة العلمية والعمل على زيادة الوعى بأحدث الطرق والأساليب العلاجية المتعلقة بمرض السكر وتعقيداته والتعامل مع المرضى وفقا لآخر الأبحاث العالمية.
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SGLT2 inhibition: What are the potential mechanisms for clinical benefit?
18/05/2016

SGLT2 inhibition: What are the potential mechanisms for clinical benefit?

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