Presentation is loading. Please wait.

Presentation is loading. Please wait.

Glycemic control for macrovascular disease in type II diabetes: Evidence and insights from recent trials  Sanjay Rajagopalan  Journal of Indian College.

Published byVirginia Brooks Modified over 5 years ago

Similar presentations

Presentation on theme: "Glycemic control for macrovascular disease in type II diabetes: Evidence and insights from recent trials  Sanjay Rajagopalan  Journal of Indian College."— Presentation transcript:

1 Glycemic control for macrovascular disease in type II diabetes: Evidence and insights from recent trials  Sanjay Rajagopalan  Journal of Indian College of Cardiology  Volume 5, Pages S83-S94 (March 2015) DOI: /j.jicc Copyright © Terms and Conditions

2 Fig. 1 Survival data from 820,900 individuals in 97 prospective studies. Source: Seshasai SR, et al. N Engl J Med. 2011; 364(9):829–841 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

3 Fig. 2 Trends in age-standardized rates of diabetes-related complications in U.S adults. Source: Gregg EW et al. NEJM. April 17, 2014; 370; 1514–1523 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

4 Fig. 3 Annual event rate due to coronary heart disease and MI observed in various diabetes trials. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

5 Fig. 4 Comparison of the BARI 2D and the SYNTAX trials, in terms of CV events. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

6 Fig. 5 Blood glucose levels and vascular risk in diabetes – Best Evidence. (Diabetes Related End-Points: Sudden death, death from hyperglycemia or hypoglycemia, fatal or non-fatal MI, angina, heart failure, stroke, renal failure, amputation [of at least one digit], vitreous hemorrhage, retinal photocoagulation, blindness in one eye, or cataract extraction). Source: UK Prospective Diabetes Study Group. Lancet. 1998; 352(9131):837–853 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

7 Fig. 6 Blood glucose and vascular risk in diabetes best evidence: 2000. Source: Stratton IM, et al. BMJ. 2000; 321(7258):405–412 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

8 Fig. 7 Benefit and risks of blood glucose control coexist: Evidence from UKPDS. The risks of diabetes complications significantly reduced for every 1% reduction of HbA1c. 1: Glycemia trials in perspective. 2: Glycemic targets set by various trials. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

9 Fig. 8 Impact of intensive therapy for diabetes: Legacy and vintage effects for CV events. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

10 Fig. 9 Hypoglycemia in the landmark trials.
Source: Turnbull FM, et al. Diabetologia. 2009;52(11):2288–2298 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

11 Fig. 10 Incident vascular outcomes and death among patients who had severe hypoglycemia in ADVANCE. Source: Zoungas N,et al. Engl J Med Oct 7; 363(15):1410–8 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

12 Fig. 11 10 year follow-up of UKPDS.
Source: Holman R et al. N Engl J Med 2008; 359:1577–89 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

13 Fig. 12 Effect of duration of diabetes (“vintage”) and other pre-specified sub-groups on major cardiovascular events. Source: Turnbull FM, et al. Diabetologia. 2009; 52(11):2288–2298 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

14 Fig. 13 Heart disease prevention with improved glycemic control: Start early and continue long-term. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

15 Fig. 14 Steno-2: Effects of multifactorial intervention on CV outcomes. Source: Gaede P, et al. N Engl J Med. 2008; 358(6):580–591 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

16 Fig. 15 Effect of early intensive therapy on outcomes detected by screening. Source: Griffin SJ, et al. Lancet. 2011;378(9786):156–167 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

17 Fig. 16 Summary of pharmacological incretin action on different target tissues. Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

18 Fig. 17 Macrovascular outcome trials.
Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

19 Fig. 18 SAVOR-TIMI primary outcome measure.
Source: Scirica BM, et al.N Engl J Med Oct 3;369(14):1317–6 and AHA Scientific Session, 2013 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

20 Fig. 19 1: SAVOR-TIMI: Individual Endpoints of Secondary Composite End-Point: Expanded MACE. 2: SAVOR-TIMI: Risk of hospitalization for HF according to baseline NT-proBNP. Source: Scirica BM, et al.N Engl J Med Oct 3;369(14):1317–6 and AHA Scientific Session, 2013 Journal of Indian College of Cardiology 2015 5, S83-S94DOI: ( /j.jicc ) Copyright © Terms and Conditions

Download ppt "Glycemic control for macrovascular disease in type II diabetes: Evidence and insights from recent trials  Sanjay Rajagopalan  Journal of Indian College."

Similar presentations

THE ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES STUDY (ACCORD)

THE ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES STUDY (ACCORD)
Aggressive Hyperglycemia Management. Significant hospital hyperglycemia requires close follow-up Previously diagnosed diabetes and elevated A1C Without.

Aggressive Hyperglycemia Management. Significant hospital hyperglycemia requires close follow-up Previously diagnosed diabetes and elevated A1C Without.
Foos et al, EASD, Lisbon, 13 September 2011 Comparison of ACCORD trial outcomes with outcomes estimated from modelled and meta- analysis studies Volker.

Foos et al, EASD, Lisbon, 13 September 2011 Comparison of ACCORD trial outcomes with outcomes estimated from modelled and meta- analysis studies Volker.
UKPDS Paper 36 Slides © University of Oxford Diabetes Trials Unit UKPDS slides are copyright and remain the property of the University of Oxford Diabetes.

UKPDS Paper 36 Slides © University of Oxford Diabetes Trials Unit UKPDS slides are copyright and remain the property of the University of Oxford Diabetes.
UKPDS Paper 35 Slides © University of Oxford Diabetes Trials Unit

UKPDS Paper 35 Slides © University of Oxford Diabetes Trials Unit
Facts and Fiction about Type 2 Diabetes Michael L. Parchman, MD Department of Family & Community Medicine September 2004.

Facts and Fiction about Type 2 Diabetes Michael L. Parchman, MD Department of Family & Community Medicine September 2004.
Canadian Diabetes Association 2013 Clinical Practice Guidelines Targets for Glycemic Control Chapter 8 S. Ali Imran, Rémi Rabasa-Lhoret, Stuart Ross.

Canadian Diabetes Association 2013 Clinical Practice Guidelines Targets for Glycemic Control Chapter 8 S. Ali Imran, Rémi Rabasa-Lhoret, Stuart Ross.
Diabetic Microvascular Disease: The Role of Glycemic Control and the Impact on Public Health Robert E. Ratner, MD MedStar Research Institute Georgetown.

Diabetic Microvascular Disease: The Role of Glycemic Control and the Impact on Public Health Robert E. Ratner, MD MedStar Research Institute Georgetown.
ACCORD - Action to Control Cardiovascular Risk in Diabetes ADVANCE - Action in Diabetes to Prevent Vascular Disease VADT - Veterans Administration Diabetes.

ACCORD - Action to Control Cardiovascular Risk in Diabetes ADVANCE - Action in Diabetes to Prevent Vascular Disease VADT - Veterans Administration Diabetes.
Blood glucose: is lower better for diabetic patients?

Blood glucose: is lower better for diabetic patients?
Session II: Glycemic control, when the lower is not the better Strict glycemic control and cardiovascular diseases Stefano Genovese Diabetologia e Malattie.

Session II: Glycemic control, when the lower is not the better Strict glycemic control and cardiovascular diseases Stefano Genovese Diabetologia e Malattie.
VBWG HPS. Lancet. 2003;361:2005-16. Gæde P et al. N Engl J Med. 2003;348:383-93. Recent statin trials: Reduction in primary outcome in patients with diabetes.

VBWG HPS. Lancet. 2003;361: Gæde P et al. N Engl J Med. 2003;348: Recent statin trials: Reduction in primary outcome in patients with diabetes.
PPAR  activation Clinical evidence. Evolution of clinical evidence supporting PPAR  activation 20002005 and beyond Surrogate outcomes studies Large.

PPAR  activation Clinical evidence. Evolution of clinical evidence supporting PPAR  activation and beyond Surrogate outcomes studies Large.
Lower the better; the case for glucose Professor Taner DAMCI Istanbul University Cerrahpaşa Medical School, TURKEY.

Lower the better; the case for glucose Professor Taner DAMCI Istanbul University Cerrahpaşa Medical School, TURKEY.
The ADVANCE trial: update and new results Jean-François Gautier Saint Louis Hospital, Paris 12 th Meeting of the Mediterranean Group for the Study of Diabetes.

The ADVANCE trial: update and new results Jean-François Gautier Saint Louis Hospital, Paris 12 th Meeting of the Mediterranean Group for the Study of Diabetes.
Glycemic Control: When the Lower is Not the “Better”?

Glycemic Control: When the Lower is Not the “Better”?
Study Design Scirica BM, Bhatt DL Braunwald et al, Sexagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013.

Study Design Scirica BM, Bhatt DL Braunwald et al, Sexagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med
Lancet 373:1765-72, 2009 Baseline Characteristics of Participants and Study Design of Clinical Trials to Compare Intensive glucose- lowering versus.

Lancet 373: , 2009 Baseline Characteristics of Participants and Study Design of Clinical Trials to Compare Intensive glucose- lowering versus.
UKHDS (UKPDS): UK Hypertension in Diabetes Study Purpose To determine whether tight control of blood pressure (aiming for BP

UKHDS (UKPDS): UK Hypertension in Diabetes Study Purpose To determine whether tight control of blood pressure (aiming for BP
Background There are 12 different types of medications to lower blood sugar levels in patients with type 2 diabetes. It is widely agreed upon that metformin.

Background There are 12 different types of medications to lower blood sugar levels in patients with type 2 diabetes. It is widely agreed upon that metformin.

Similar presentations

Ads by Google