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Beyond Oral Agents & Insulin: New Frontiers in the Management of Diabetes and Cardiometabolic Risk A...
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Beyond Oral Agents & Insulin: Beyond Oral Agents & Insulin: New Frontiers in the Management of New Frontiers in the Management of Diabetes and Cardiometabolic RiskDiabetes and Cardiometabolic Risk
A Primary Care InitiativeA Primary Care Initiative
Learning ObjectivesLearning Objectives
• Describe the role of incretin physiology in Describe the role of incretin physiology in diabetes and diabetes treatmentdiabetes and diabetes treatment
• Explain the mechanism of action of the Explain the mechanism of action of the incretin mimetics incretin mimetics
• Identify the role of glucose metabolism in Identify the role of glucose metabolism in addressing cardiometabolic riskaddressing cardiometabolic risk
• Integrate incretin mimetics in clinical practiceIntegrate incretin mimetics in clinical practice
Therapy for Type 2 Diabetes (T2DM):Therapy for Type 2 Diabetes (T2DM):Sites of ActionSites of Action
PancreasPancreas
LiverLiver MusclesMuscles
GutGut
Thiazolidinedione Thiazolidinedione Exogenous insulinExogenous insulin
BiguanidesBiguanidesIncretin mimeticsIncretin mimeticsAmylin analoguesAmylin analogues
HyperglycemiaHyperglycemia
Incretin mimeticsIncretin mimetics
Alpha glucosidase Alpha glucosidase inhibitorsinhibitorsIncretin mimeticsIncretin mimeticsAmylin analoguesAmylin analogues
SulfonylureaSulfonylureaSecretagoguesSecretagogues
Clearly, we have many choices in Clearly, we have many choices in
diabetes management, and yet...diabetes management, and yet...
master rheumatology series
Master Rheumatology SeriesMaster Rheumatology SeriesInflammatory Cytokines in Rheumatoid Inflammatory Cytokines in Rheumatoid
Arthritis: Disease Modulators and Arthritis: Disease Modulators and Therapeutic TargetsTherapeutic Targets
Development of New Drugs Development of New Drugs Directed at Inflammatory CytokinesDirected at Inflammatory Cytokines
Dr White, MDDr White, MD
master rheumatology series
master rheumatology series
Certolizumab: ACR ResponsesCertolizumab: ACR ResponsesAfter 8 Weeks of Treatment After 8 Weeks of Treatment
Pat
ien
ts (
%)
16.7
0
25
12.5
75
12.5
75
50
0
20
40
60
80
ACR20 ACR50
Placebo
Certolizumab 1 mg/kg
Certolizumab 5 mg/kg
Certolizumab 20 mg/kg
Managing the Strains of Influenza:Managing the Strains of Influenza:An Effective Model for An Effective Model for
Prevention and TreatmentPrevention and Treatment
Structure of the Influenza VirusStructure of the Influenza Virus
InfluenzaInfluenzaVirusVirus
AnatomyAnatomy
NeuraminidaseNeuraminidase
HemagglutininHemagglutininCapsidCapsid
ViralViralRNARNAM2M2
ProteinProtein
LipidLipidEnvelopeEnvelope
Transmission and ReproductionTransmission and Reproductionof Influenza Virusof Influenza Virus
Plasma membranePlasma membrane
EndoplasmicEndoplasmicreticulumreticulum
CoatedCoatedpitpit
CellCellreceptorreceptor
ExtracellularExtracellular
Stage 1:Stage 1:AttachmentAttachment
Stage 2:Stage 2:EntryEntry
Stage 3:Stage 3:UncoatingUncoating
CytoplasmCytoplasm
BuddingBudding
GolgiGolgiapparatusapparatus
mRNAmRNA
(HA, NA)(HA, NA)
Synthesis ofSynthesis ofenvelope proteinsenvelope proteins
NucleusNucleus
1997-19981997-1998Influenza-like IllnessesInfluenza-like Illnesses
1998-19991998-1999Influenza-like IllnessesInfluenza-like Illnesses
VaccineVaccine(n=576)(n=576)
PlaceboPlacebo(n=554)(n=554)
PP VaccineVaccine(n=582)(n=582)
PlaceboPlacebo(n=596)(n=596)
PP
IllnessesIllnesses 0.280.28 0.240.24 NSNS 0.140.14 0.220.22 <0.001<0.001
Days IllDays Ill 2.382.38 1.731.73 0.010.01 1.021.02 1.541.54 <0001<0001
Physician VisitsPhysician Visits 0.110.11 0.090.09 NSNS 0.050.05 0.090.09 <0.001<0.001
Lost WorkdaysLost Workdays 0.290.29 0.200.20 0.0470.047 0.080.08 0.120.12 0.0020.002
Patients With Patients With Lost WorkdaysLost Workdays
0.080.08 0.090.09 NSNS 0.080.08 0.120.12 <0.001<0.001
Effectiveness of VaccinationEffectiveness of Vaccinationin Healthy Working Adultsin Healthy Working Adults