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Text

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Audio Recording May 24, 2021 at 11:14:29 AM

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People at risk Family H/O diabetes physical inactivity History of GDM or  delivery of baby >4 kg HDL cholesterol  level Hypertension Race/ethnicity Obesity

Audio Recording May 17, 2021 at 4:04:00 PM

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Diagnosing Prediabetes & Diabetes Mellitus

Audio Recording May 17, 2021 at 4:05:30 PM

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AACE: Managing diabetes  American Association of Clinical Endocrinologists

Intensive glycemic control Intensive management of comorbid conditions* A1C  ≤6.5% Glucose (mg/dL) Preprandial  ≤110 Postprandial ≤140 Lipid modifying BP lowering ASA for prevention of vascular events Lifestyle intervention Optimal nutrition Physical activity Smoking cessation Weight control   AACE.  Endocr Pract . 2002;8(suppl 1):40-65. *Dyslipidemia, hypertension, early renal disease

Audio Recording May 17, 2021 at 4:07:57 PM

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Normal glucose absorption and action of  acarbose * 1,2

* Lifestyle intervention is the first and basic component in the management of diabetes.  1.  Figure modified from Bischoff, H.  Clin  Invest Med 1995;18:303-11. 2.   Rosak  C,  Mertes  G. Diabetes  Metab   Syndr   Obes  2012;5:357-67. 3.   Samulitis  BK, et al. Drugs Exp  Clin  Res 1987;13:517-24.  Glucose Membrane-bound  α- glucosidases   Glucose   &   fructose Starch  (plant polysaccharides) Oligosaccharides Absorption Glycogen  (animal polysaccharides)  - glucosidase Microvillus Glucose Acarbose Oligosaccharide Pancreatic   -amylase Maltase Glucoamylase Dextrinase Sucrase Sucrose Inhibition by acarbose 1,3 Inhibition  by  Acarbose 1,3 Inhibition  by  Acarbose 1,3 Blood glucose rise Microvillus

Audio Recording May 17, 2021 at 4:52:01 PM

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Acarbose* acts non-systemically †,1  to delay carbohydrate digestion and absorption

* Lifestyle intervention is the first and basic component in the management of diabetes.  †  The bioavailability of  acarbose  is 1-2%. 1.  Summary of product characteristics (2012). Available at http://  www.medicines.org.uk . 2.  Figure modified from  Standl  E, et al.  Diab   Vasc   Dis  Res 2012;9:163-9.

Upper small intestine Lower small intestine Without acarbose  Carbohydrate absorption Carbohydrates With acarbose  Carbohydrate absorption

Audio Recording May 17, 2021 at 4:56:29 PM

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Acarbose Treatment and the Risk of
Cardiovascular Disease and Hypertension
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Audio Recording Apr 27, 2021 at 9:00:11 PM

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Gluco  VIP  study  findings n >15,000, more than 90% of participants were Asians  Follow up period of 3-4 months At the final follow up visit HbA1C  levels decreased by  1.1% to  7.2% PPBG reduced by  70mg/dl to 170 mg/dl FPG reduced by  33mg/dl to 134mg/dl

Clin  Drug  Investig  2013 Apr:33(4); 263-274

Audio Recording Apr 27, 2021 at 9:07:18 PM

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excteted as 13C02 in breath (CP 37.5±2.8 cum %dcxse/
6 h vs CPac 27.2±2.2; p=O.004) over the 30) min post-test
meal.
A Cochrane meta-analysis found that acarbose therapy
reduced glycated haemoglobin (HbA1c) levels by a
mean of 0.8%. This decrease was accentuated in indivi-
duals with higher baseline HIXAIC levels (baseline
1-1bA1c of 7-9%, and had decreases of 0.56%
(95% Cl 0.36 to 0.76), 0.78% (95% Cl 0.63 to 0.93) and
0.93% (95% Cl 0.53 to 1.33), lespectively). A
meta-regression analysis revealed regtession coefficient
of —0.12 (95% CI —0.26 to 0.03), showing an additional
0.12% decrease in HbA1c for evety 1 % increase in base-
line HbA1c. Moreover, acarbose was shown to teduce
Elsting blood glucose by 1.09 mm01/L ( 28 comparisons;
95% CI 0.83 to 1.36) and 1 h postprandial glucuse by
2.32 mm01/L (acarbuse; 22 comparisons; 95% CI 1.92 to
2.73)."
The glycaemic effect of acarbuse on HbA1c did not
valy with dose, however, acarbcxse did decrease postpran-
dial gluccxse in a dose-dependent manner. Acarbose 50,
100, 200 and 300mg three times a day reduced HbA1c
by 0.90, 0.76, 0.77 and 0.78%, respectively, and postpran-
dial glucose by 1.63, 2.26, 2.78 and 3.62 mmol/l„
lespectjvely.ll This glycaemic benefit of acarbose has
been more significant in Asian trials than those in the
West, due to predominant consumption
carbohydrate-rich diet among -Asian populations.
The minimal efficacy of acarbcxse on HbA1c, as
described by a UK-Prospective Diabetes Study trial with
a reduction of 0.5%, could be an undetestimation. In
dinucleotide (NADH) and flavin adenine dinucleotide
(FADH2), and an increased proton transport via the
inner mitochondrial membrane. This inhibits the ETC
and prolongs the half-life of fire radicals. These free
radicals interact with oxygen and cause supemxide
anion overpmduction.
Marfella et all demonstrated the effect of glucose
excursions on plasma nitrotyrcxsine levels, markers of
oxidative damage. Nitrotyrcxsine levels were unchanged
in states of euglycaemia (5 mm01/L for 120 min) while
hyperglycaemic states (15 mm01/L for 120 min) caused
incteased nitrotyrcxsine levels and incteased blood Ples-
sutr. Further lesearch by Ceriello et ate showed that
oral glucuse tolerance test (OGTT) in people with and
without diabetes blunted antioxidant mechanisms, as
assessed by total radical trapping antioxidant parameter
(TWW). TRAP levels were significantly lower in people
with diabetes compated to thcxse without diabetes (660.3
+46 vs 832.6+56 gm01/L p<0.03) and signifi-
cantly reduced in both groups following the OGTI:
Similar findings were demonstrated after a meal.
Nitrotyrcxsine levels were measured after standard meal
tests in 23 people with T2DM and 15 matched contml.s.
The former group teceived two standard meals—one
30 min prior to tegular insulin (Actrapid) and the other
with insulin aspart. This was carried out to evaluate post-
prandial hyperglycaemia. The results revealed a linear
correlation between pcxstprandial hyperglycaemia and
nitro tyrcxsine levels. Insulin aspart reduced pcxstprandial
glucose excursion (p<O.03) and nitrotymsine levels
(p<O.03) as compared to regular insulin. 33 The above
2
DiNic01antonio Bhutani J, O'Keefe 'H. open doi:10.113ftpenhrt-2015-000327
Downloaded from http•]\openheart_bmj.com/ on March 15, 2018 - Published by group.bmj.com
Review

Audio Recording Apr 27, 2021 at 9:11:40 PM

Glucobay

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