2. Type 2 diabetes Years from diagnosis 0 5 -10-5 10 15 Pre-diabetes Onset Diagnosis Insulin secretion Insulin “efficiency” Ramlo-Halsted BA, Edelman SV. Prim Care. 1999;26:771-789 Nathan DM. N Engl J Med. 2002;347:1342-1349 Post-Meal glucose Fasting glucose Natural History of Type 2 Diabetes Pancreas function Progressive Pancreatic Failure “Pre-diabetes” “Metabolic Syndrome” PLASMA GLUCOSE Normal: Normal: 99 mg/dl or less Pre-Diabetes: Pre-Diabetes: 100-125 mg/dl) Diabetes Diabetes > 126 mg/dl fasting); > 200 mg/dl )(PostPrandial)

3. Relative Risk of MI or Stroke 0 1 2 3 4 5 6 7 Nondiabetic Throughout 2.4 >15 Yr Before Dx 10-14.9 Yr Before Dx 3.64 <10 Yr Before Dx Diabetic Throughout 5.02 3.19 1.0 Hu FB, et al. Diabetes Care. 2002;25:1129-1134. Non-Diabetic Diabetes Cardiovascular Risk in Pre-diabetes Pre-Diabetes

4. Insulin receptor Plasma membrane Glucose carriers move to the surface Blood Sugar Insulin Chemical Signals Pre-diabetes Carriers insert into cell surface Blood Sugar enters body Glucose (“sugar”) carriers GLUT4=glucose transporter 4 Insulin “Efficiency”

5. Obesity Insulin Efficient (“resistance”) High Cholesterol Elevated Blood Pressure Blood Vessel Dysfunction Heart Disease Physical Inactivity Aging High Blood Sugar “Metabolic” Syndrome Modified from S. Grundy MD

8. High Waist/Hip (  0.95 in men) (  0.80 in women) Low Waist/Hip (<0.95 in men) (<0.80 in women) An Index of Abdominal vs Peripheral Obesity Body Shape Matters!!! “Central” obesity

9. Larsson. Acta Med Scand Suppl. 1988;723:45-51. Risk of diabetes mellitus during 13 years in relation to WHR at baseline. Comparison between these in upper and lower 10% of WHR distribution. Waist Measurement and Diabetes Risk 25 20 15 10 5 0 54 Age Risk (%) Upper 10% WHR Lower 10% WHR 55565758596061626364656667

10. Lean et al. Lancet. 1998;351:853-856. Waist/Hip Ratio and Risk Men: waist size >40 vs 40 vs <37 inches Women: waist size >34 vs 34 vs <31 inches ~4-fold greater risk for type 2 diabetes ~3- to 4-fold greater risk for major cardiovascular event

11. Cumulative hazard (%) Follow-up (y) YES Metabolic Syndrome: NO Heart Disease Deaths 0 268124 10 0 5 15 Death Increases with Metabolic Syndrome

12. Visceral Fat Distribution: Normal vs Type 2 Diabetes Type 2 DiabetesNormal

13. To diabetes Metabolic Syndrome ? Diabetes R. Heine MD

14. Type 2 diabetes Type 2 Diabetes Predicted Treatment Paradigm Years from diagnosis 0 5 -10-5 10 15 Pre-diabetes Onset Diagnosis Combination (two) Medications Insulin Diet and exercise Single Medication Other Injected meds Nutritional Preventive Strategies Increased Heart Disease

15. NIH Funded Botanical Research Centers Botanical Center for Age-Related DiseaseBotanical Center for Age-Related Disease Purdue University/UAB Purdue University/UAB Botanical Dietary Supplements for Women’s HealthBotanical Dietary Supplements for Women’s Health University of Illinois at Chicago University of Illinois at Chicago Botanical and Lipids (Cholesterol)Botanical and Lipids (Cholesterol) Harvard and Wake Forest Universities Harvard and Wake Forest Universities Botanicals and Cancer Botanicals and Cancer Memorial Sloan-Kettering Cancer Center/ Memorial Sloan-Kettering Cancer Center/ Rockefeller University Rockefeller University Botanicals and Metabolic SyndromeBotanicals and Metabolic Syndrome PBRC-LSU/Rutgers PBRC-LSU/Rutgers “Your Tax Dollars at work”

16. Tarragon and Diabetes Extract of Artemisia dracunculus with antidiabetic propertiesExtract of Artemisia dracunculus with antidiabetic properties Produced from hydroponically grown plants under controlled conditionsProduced from hydroponically grown plants under controlled conditions Russian tarragon

17. Clinical Research: BENCH to BEDSIDE! Cells tested with ExperimentalIntervention Years 1-3 Animal Testing to monitor Safety and effectiveness Years 1-4 Human Testing in Several Phases Years 3-5

18. Are Claims for “over the counter” supplements real?

19. Botanicals Studied “Eat and Drink the Rainbow”