The Diabetes TideJohn Doig

228,004

268,154

Number of drugs increasing

• Metformin• Sulphonylureas (Clopropamide, Tolbutamide, Gluiquidone,

Glibenclamide,Glipizide, Gliclazide, Glimepiride)• Alpha 1 Gliclasidase inhibitors (Acarbose)• Thiazolidinediones (Troglitazone,Rosiglitazone, Pioglitazone)• GLP1 Analogues (Exenatide, Liraglutide, Albiglutide)• DDP4 Inhibitors (Sitagliptin, Saxagliptin, Linagliptin, Alogliptin, Vildagliptin)• SGLT2 Inhibitors (Ddapagliflozine, Canagliflozine, Empagliflozine)• ?Amylin analogues (Pramlintide)

Antihyperglycemic therapy in type 2 diabetes: general recommendations.

American Diabetes Association Dia Care 2014;37:S14-S80Copyright © 2014 American Diabetes Association, Inc.

Lim EL Diabetologia [0012-186X] Lim, E L yr:2011 vol:54 iss:10 pg:2506 -14

Prof Roy Taylor twin cycle hypothesis for T2 DM

Bariatric Interventions

Bariatric surgery is recommended as a treatment option for people with obesity if all of the following criteria are fulfilled:

• BMI > 40 kg/m2, or between 35 kg/m2 and 40 kg/m2 and other significant disease (e.g, type 2 diabetes or HBP) (=25% Dibetic population in Scotland)

• all appropriate non-surgical measures have been tried• the person will receive intensive management in a specialist obesity

service • fit for anaesthesia and surgery • the person commits to long-term follow-up

HbA1c Changes after bariatric surgical intervention in Type 2 diabetes mellitus

Islet cell transplantation

typically receive two infusions with an average of 400,000 to 500,000

 

HbA1c (mean ± SE), time post-transplantation in subjects who lost all graft function (—●),subjects whose graft function remained but had to resume insulin (—○), and those subjects who remained insulin independent (—♦).

Islet cell transplantation

• Criteria Strict• Type 1 DM only• Severe hypoglycaemia• Wt <85kg• Insulin < 0.7U/Kg• Normal renal function

• Long Term Immunosuppression• Availability• Multiple procedures• Graft rejection• Only 19 % insulin independent

• Marked improvement in hypoglycaemia

• QOL• Improved glycaemic control

Beating the immune system

1. Glucose sensor under skin

2. Wireless transmission

3. Monitor picks up data

Outcomes Better glucose control, which reduces the risk of

complications

Glucose levels monitored continuously

Risk of overnight hypos reduced

Improved quality of life and peace of mind

I

Artificial Pancreas

• No short term let up in diabetes tide• 2030 likely to be 0.5 million patients in Scotland• Public/government attitudes to high calorific foods• Radical dietetic measures• Possible scope for new meds (betatropin)• Technology• Increased access to bariatric surgery• ?Stem cell treatments

• Retinal screening job is for life