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Part 2
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Educational Objectives
Upon completion of this activity, participants will be able to
• Name 5 current challenges for glycemic control in individuals with type 2 diabetes
• List the key physiologic, biochemical, and molecular events involved in the renal regulation of glucose metabolism
• Understand the effects of inhibiting glucose reuptake by the kidney in individuals with type 2 diabetes
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Magnitude of the Diabetes EpidemicMagnitude of the Diabetes Epidemic
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28.3 M40.5 M43.0%
16.2 M32.7 M102%
53.2 M64.164.1 M20%
67.0 M 99.4 M 48%
10.4 M18.7 M80%
46.5 M
80.3 M
73%
M=million; AFR=Africa; EMME=Eastern Mediterranean and Middle East; EUR=Europe; NA=North America; SACA=South and Central America; SEA=South-East Asia; WP=Western Pacific.
International Diabetes Federation. Diabetes Atlas. 3rd ed. Available at: http://www.eatlas.idf.org/index.asp.
World
2007=246 M2025=380 M
54%
AFR
NA
SACA
EUR
SEA
WP24.5 M44.5 M82%
EMME
2007 2025
Global Projections for theGlobal Projections for theDiabetes Epidemic: 2007-2025Diabetes Epidemic: 2007-2025
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Global Increase in Obesity
Overweight, BMI ≥25 kg/m2; obese, BMI >28 kg/m2 (Asian) or >30 kg/m2.
James WP. J Intern Med. 2008;263:336-352.
USAUSA
UKUK
AustraliaAustraliaFinlandFinland
SwedenSwedenNorwayNorwayBrazilBrazilCubaCuba
JapanJapan
19701970 19751975 19801980 19851985 19901990 19951995 20002000 20052005
Pre
vale
nce
of
Ob
esit
y (%
)P
reva
len
ce o
f O
bes
ity
(%)
3535
3030
2525
2020
1515
1010
55
00
20022002 20072007 20152015
Obese 356 million 523 million 704 million
Overweight 1.4 billion 1.5 billion 2.3 billion
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Increasing Problem of Obesity Increasing Problem of Obesity and Diabetes: United Statesand Diabetes: United States
*BMI ≥30 kg/m2.
Centers for Disease Control and Prevention. National diabetes fact sheet. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008;Mokdad AH, et al. JAMA. 1999;282:1519-1522; Mokdad AH, et al. Diabetes Care. 2000;23:1278-1283; Ogden CL, et al. NCHS data brief no 1. Hyattsville, MD: National Center for Health Statistics, 2007.
Obesity*Obesity* DiabetesDiabetes
US Population
(%)6.5
7.8
0
5
10 20% increase
1998 2007
17.9
34.3
0
20
40 92% increase
1998 2006
4040
2020
00
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Increasing Problem of Obesity Increasing Problem of Obesity and Diabetes: Mexicoand Diabetes: Mexico
ObesityObesity DiabetesDiabetes
Mexican Population
(%)
Aguilar-Salinas CA, et al. Am J Med. 2002;113:569-574; Aguilar-Salinas CA, et al. Diabetes Care. 2003;26:2021-2026; Sánchez-Castillo CP, et al. Public Health Nutr. 2005;8:53-60.
14.9
19.4
25.129.0
0
20
40
1993 2000
Men MenWomen Women
4040
2020
00
21% increase
7
8.2
0
5
10
17% increase
1993 2000
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1.8
6.9
4.1
9.0
0
5
10
1991 1999-2000
Men MenWomen Women
1010
55
00
169% increase
2.5
5.5
0
3
6
Increasing Problem of Obesity Increasing Problem of Obesity and Diabetes: Chinaand Diabetes: China
Obesity*Obesity* DiabetesDiabetes
Chinese Population
(%)
*Asian-specific obesity cut-point: BMI ≥28 kg/m2.
Gu D, et al. Diabetologia. 2003;46:1190-1198; Wildman RP, et al. Obesity (Silver Spring). 2008;16:1448-1453.
1994 2000-2001
120% increase
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Increasing Problem of WeightIncreasing Problem of WeightGain and Diabetes: IndiaGain and Diabetes: India
Rural Indian Population
(%)
*BMI ≥25 kg/m2.
Ramachandran A, et al. Diabetologia. 2004;47:860-865.
Overweight*Overweight* DiabetesDiabetes
2.2
6.4
0
4
8 191% increase
1989 2003
2.0
17.1
0
10
20 750% increase
1989 2003
2020
1010
00
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HyperglycemiaHyperglycemia
• Biochemical marker by which the diagnosis of diabetes is made
– Assessed with HbA1c, daily SMBG, and eAG
• Major and treatable risk factor for microvascular disease (DCCT, UKPDS 33 and 35)
• Independent and treatable risk factor for macrovascular disease (DCCT-EDIC, UKPDS 35 and 80)
• Self-perpetuating cause of diabetes
– Glucotoxicity → insulin resistance and impaired insulin secretion
eAG=estimated average glucose.SMBG=self-monitoring of blood glucose.
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HbAHbA1c1c Is Correlated With Is Correlated With
Average GlucoseAverage Glucose
AG=average glucose.
Nathan DM, et al. Diabetes Care. 2008;31:1473-1478.
450
400
350
300
250
200
150
100
50
03 5 7 9 11 13 15
AG
(m
g/d
L)
HbA1c (%)