Physicians' Academy for Cardiovascular Education

Achieving optimal glycemic control: What are the current options in management?

Slides (presentation) - Oct. 18, 2011

Achieving optimal glycemic control: What are the current options in management?
The aim of treatment : To prevent the complications of diabetes
The 5 main large outcome studies for blood glucose lowering strategies in type 2 diabetes
Lessons from the main cardio-vascular outcome studies
Lessons from the main cardio-vascular outcome studies
ACCORD design (±similar for ADVANCE and VADT)
Large outcome studies: méta-analyses
Large outcome studies: méta-analyses
Large outcome studies: méta-analyses
Mortality
Mortality
Severe hypoglycemias
What’s new in the scientific world in 2011?
Is the increased total mortality and sudden death risk associated with the intensive glycemic treatment strategy (ACCORD – VADT) linked to hypoglycemia ?
Is the increased total mortality and sudden death risk associated with the intensive glycemic treatment strategy (ACCORD – VADT) linked to hypoglycemia ?
Severe hypoglycaemia predicted adverse CV outcomes in ACCORD…
…and also non-cardiovascular adverse outcomes
No temporal relationship between severe hypoglycaemia and adverse outcomes in ACCORD
Hypoglycemia : a risk marker for the risk of death, rather the cause of death
Hypoglycemia : a risk marker for the risk of death, rather the cause of death
High HbA1c is a predictor of severe hypoglycemia in ACCORD (and in VADT)
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Why an excess deaths on intensive treatment in ACCORD ?
Available medications used to get the HbA1c target (in 2011)
Type 2 Diabetes Treatment step 1 (at diagnosis)
Type 2 Diabetes Treatment step 1 (at diagnosis)
Step 2 : early intensification on the top of metformin Which oral agent ?
Step 2 : early intensification on the top of metformin
Pioglitazone Which benefits/risks balance ?
Step 2 : early intensification (on the top of metformin) Which place for pioglitazone?
Step 2 : early intensification (on the top of metformin) Which place for pioglitazone?
Treatment intensification : further steps What to add on to a dual oral therapy
The best indications for GLP1-agonists
Treatment intensification : further steps What to add on to a dual oral therapy
Treatment intensification : further steps What to add on to a dual oral therapy
Type 2 Diabetes Treatment Algorithm Last step : insulin
Management of insulin treatment in type 2
Management of insulin treatment in type 2
Insulin + pioglitazone
Insulin + pioglitazone
Conclusions

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