1st London Metabolic Teleconference Tel: [phone] code: 71545314 then

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1st London Metabolic TeleconferenceTel
0808 1005145 code 71545314 then Tuesday 8th
April 2008 1 - 2pm

• Dr.Senan Devendra
• Consultant Endocrinologist
• Imperial College School of Medicine, Brent tPCT
• Clementine Churchill Hospital
• Slides available on www.riverside-endocrine.com

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Intro

• Given our busy working lives, we all find
  attending educational meetings sometimes
  difficult to do.
• This monthly Pan London teleconference covers the
  primary care management of the cardio-metabolic
  syndrome, including
• diabetes
• lipids
• hypertension
• chronic kidney disease
• non-alcoholic fatty liver disease

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Objectives

• Dissecting pertinent issues in LTCs
• Discuss evidence based approach for care
• Review cost-effectiveness of care provided (eg.
  HTA,NICE)
• Tailoring an individualized care plan for your
  patient empowerment,
  engagement sustaining an effect durability

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Case history

• 62 yr old man with Type 2DM for 9 yrs
• Fasting Blood glucose 6.5-7.2, BMI 30
• Metformin 1g bd, HbA1c 8.4, background
  retinopathy
• Hypertensive Ramipril 10mgod, Amlodipine 10mg
  od
• Patient claims BP at home fine but office BP
  always gt130/80
• Patient does not want to take anymore tablets
• What should I do next?

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Major Underlying Factors causing Death - Worldwide
Raised Blood Pressure
7 million
Tobacco
High cholesterol
Underweight
Unsafe sex
Low fruit vegetables intake
High BMI
Developed region
Physical inactivity
Developing region
Alcohol
Unsafe water, sani hygiene
0
1
2
3
4
5
6
7
Millions of Deaths
Ezzati et al. Lancet 20023601347-60.
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Systolic BP and Risk of Death
Heart Deaths
Stroke Deaths
16
32
8
16
8
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Risk
Risk
2
4
1
2
120
125
135
148
168
120
125
135
148
168
Systolic Blood Pressure (mmHg)
The risk starts at systolic 115 mmHg (83 UK
adults)
MacMahon et al. Lancet 1990335765-74
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Reasons for Poor control

• Raised BP not measured
• Raised BP not treated or treatment stopped
• Wrong drugs or too few
• Bad or no lifestyle advice
• Side effects / poor compliance
• Resistant hypertension

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Event peak timings
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OvA study

• CV events greater in older, male, Diabetic
  patients and patients with hypercholesterolaemia
  and previous history of CV disease

Prognostic value of Ambulatory Blood-Pressure
Recordings in Patients with Treated Hypertension.
Clement et al. NEJM 2003 348 2407-2415
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Feedback

• Please email me your opinion thoughts on how to
  improve this service
• d.devendra_at_ic.ac.uk
• Please email me any cases that you wish to
  discuss prior to next teleconference

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Prevention better than cure?

• White gt40yrs, Ethnicgt 25yrs
• Close family member DM
• Obesity
• Hypertension, CVD
• Polycystic ovary obesity
• Gestational diabetes
• Severe Mental Health Problems

http//www.diabetes.org.uk/infocentre/state/downlo
ads/earlyid.doc
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Progressive Hyperglycaemia with MET, SU, or
Conventional Diet Alone
Conventional Diet Glyburide Metformin
HbA1c ()
Years from randomisation
Adapted from UKPDS 34. Lancet 1998 352 854-865
Turner RC, et al. JAMA. 19992812005-2012
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Current Treatment Options for Type 2 Diabetes
their Effect on Beta-Cells, and Weight
Diminished Beta-Cell Response (Insulin
Deficiency)
Increased Beta-Cell Workload(Insulin
Resistance)
Biguanides hepatic glucose
output TZDs insulin sensitivity
weight
weight
Mazze, Strock, Simonson, Bergenstal Staged
Diabetes Management A Systematic Approach 2nd
edition 200651-54. A.H Barnett et all.,
Clinical Therapeutics, 200729216
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www.riverside-endocrine.com
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www.riverside-endocrine.com
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www.riverside-endocrine.com
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www.riverside-endocrine.com