10/12/2015

Baptist Health South Florida 3rd Annual Diabetes Symposium October 17, 2015

Update on Strategies & Treatment of Type 2 Diabetes Silvio Inzucchi MD Section of Endocrinology Yale University School of Medicine

Disclosures Advisor / Consultant Merck BMS/AstraZeneca Sanofi/Regeneron Janssen Transtech Pharma Poxel

Clinical Trial Steering Committees Boehringer Ingelheim Lexicon Eisai

Clinical Trial DSMB/DMCs Novo Nordisk Intarcia

Research Support NIDDK NINDS Takeda* *study drug & placebo

Update on Current Diagnosis and Treatment of Type 2 Diabetes 1. Diagnostic Testing 2. Pathophysiological Underpinnings 3. Major Glucose Lowering Drug Classes 4. Niche Agents 5. T2DM Therapy Guidelines 6. The Future of DM Management?

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10/12/2015

Diagnosis of Diabetes

FPG

2- hr PG during OGTT

ADA

ADA

ADA

Pre-1997

1997-2009

2010

> 140 mg/dl

> 126 mg/dl

> 126 mg/dl*

(7.8 mmol/l)

(7.0 mmol/l)

(7.0 mmol/l)

> 200 mg/dl

> 200 mg/dl

> 200 mg/dl

(11.1 mmol/l)

(11.1 mmol/l)

(11.1 mmol/l)

Random (Casual) PG* A1C

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> 200 mg/dl

> 200 mg/dl

(11.1 mmol/l)

(11.1 mmol/l)

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> 6.5%**

** If FPG & A1c results discordant,

* If accompanied by classic

default to most abnormal test.

hyperglycemic symptoms.

At Risk States (‘Pre-Diabetes’)

FPG

“IFG”

ADA

ADA

ADA

1997-2003

2003-2010

2010

110-125 mg/dl

100-125 mg/dl

100-125 mg/dl

(6.1-6.9 mmol/l)

(5.6-6.9 mmol/l)

(5.6-6.9 mmol/l)

2-h PG (OGTT)

140-199 mg/dl

140-199 mg/dl

140-199 mg/dl

“IGT”

(7.8-11.1 mmol/l)

(7.8-11.1 mmol/l)

(7.8-11.1 mmol/l)

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5.7 -