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Medication Management in Diabetes Care: Advanced FaaizaAlibhai,PharmDEndocrineandDiabetesCareCenterUWMedicineWADEConferenceApril26,2019
Disclosures to Participants
• NoticeofRequirementsforSuccessfulCompletion:• Forsuccessfulcompletion,participantsarerequiredtobeinattendanceinthefullactivityandcompletetheprogramevaluationattheconclusionoftheeducationalevent.• PresenterConflictsofInterest/FinancialRelationshipsDisclosures• Noconflictsexist.• DisclosureofRelevantFinancialRelationshipsandMechanismtoIdentifyandResolveConflictsofInterest:Noconflictsofinterest.• Non-EndorsementofProducts:AccreditedstatusdoesnotimplyendorsementbyAADE,ANCC,ACPEorCDRofanycommercialproductsdisplayedinconjunctionwiththiseducationalactivity.• Off-labelUse:ParticipantswillbenotifiedbyspeakerstoanyproductusedforapurposeotherthanthatforwhichitwasapprovedbytheFoodandDrugAdministration.
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Ancient Egypt
TheEbersPapyruscontainsremedies“toeliminateurinewhichistooplentiful”
AmeasuringglassfilledwithWaterfromtheBirdpond,Elderberry,Fibresoftheasitplant,FreshMilk,Beer-Swill,FloweroftheCucumber,andGreenDates
Rectalinjectionsofoliveoil,honey,sweetbeer,seasalt,andseedsofthewonderfruitwerealsousedforurinarytroubles
Indian Ayurveda
InAncientIndia,physiciansnotedantswereattractedtotheurineofpeoplewithmadhumehaor“honeyurine”
Diabetesprimarilyaffectedrichcastes;relatedtoexcessivefoodconsumption
Recommendedabstainingfromsweetfoodsandreducingtheintakeofriceandothergrains
The Greeks and Persians
GreekphysicianAretaeusdubbeddiabetes“meltingdownoffleshandlimbsintourine”
EarlyGreeksrecommendeddrinkinglargequantitiesofwine,thoughttomakeupforfluidlostthroughurination
Alsoprescribedexercise,oftenhorsebackriding,thoughttorelieveexcessiveurination
PersianphysicianAvicennareferredtoabnormalappetiteandobserveddiabeticgangreneandconcoctedamixtureofseeds(lupin,fenugreek,zedoary)asapanacea
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The 18th and 19th Centuries
DuringtheFranco-PrussianWar,FrenchphysicianandpharmacistApollinaireBouchardatnotedthatwar-relatedfoodrationingimproveddiabetessymptoms
Thisledtothefaddiets:- Oatcure- Potatotherapy- Starvationdiet- Ricecure- Opium
ItaliandiabetesspecialistCatonilockeduphispatientstogetthemtofollowtheirspecial,low-carbohydratediets
Turn of the Century
AmericandiabetesspecialistsFrederickM.AllenandElliottP.Joslinadvocatedforseverecalorie-restricteddiets
Priortothe1920’s,adiagnosisofdiabeteswasadeathsentenceformostpatients
19thcenturyresearchidentifiedtheroleofapancreatichormoneinvolvedinglucosehomeostasis.Thisledtoexperimentationwithdogswhosepancreaseshadbeenremoved
The Dawn of a New Era
CanadianphysicianFrederickBanting,assistantCharlesBest,andbiochemistBertramCollipestablishedthatthedeficiencyofinsulinwasthecauseofdiabetesusingcaninepancreaticextracts
LeonardThompsonwasthefirstpatienttoreceiveinsulin
Havingbeenclosetodeath,Leonardlivedforanother13years
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1915 2020
1922-Firstexogenousinsulinadministeredtoa
human
1923-Insulin(Iletin)commercially
availableintheUnitedStates
1936-PZIinsulin
1946-NPHinsulin
1956-Lenteinsulins
1983-Recombinanthumaninsulin
1952-Firstconcentrated
insulins2006–First
inhaledinsulin
Evolution of Insulin
Development of New Classes
1915
1918-Earlyworkwithguanidine
1920s–Synthalinusestopped
1956-FirstcommerciallyavailableSUinUnitedStates
1959-Metforminintroduced(outsideUnited
StatesintroducedtoUnitedStatesin1990s)
1984-SecondgenerationSU
1995-FirstAGI
1996-FirstTZD
1997-Firstmeglitinide
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Development of New Classes Cont.
2020
2005-FirstGLP-1RA
2005-Firstamylinagonist
2006-FirstDPP-4i
2008-colesevelamapprovedfordiabetes
2009-Bromocriptineapprovedfordiabetes
2013-FirstSGLT-2i
MetforminInsulinThiazolidinediones
SodiumGlucoseCotransporter-2Inhibitors
SulfonylureasMeglitinidesGLP-1ReceptorAgonistsDPP-4Inhibitors Thiazolidinediones
MetforminGLP-1ReceptorAgonistsDPP-4Inhibitors
GLP-1ReceptorAgonistsAmylinAgonistsBromocriptine
Metforminα-GlucosidaseInhibitorsColesevelam
GLP-1ReceptorAgonistsDPP-4InhibitorsAmylinAgonists
α-GlucosidaseInhibitorsColesevelam
ADA 2019 Standards of Medical Care in Diabetes
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ADA 2019 Standards of Medical Care in Diabetes
Completed and Ongoing Cardiovascular Outcomes Trials
ADA 2019 Standards of Medical Care in Diabetes
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ADA 2019 Standards of Medical Care in Diabetes
ADA 2019 Standards of Medical Care in Diabetes
ADA 2019 Standards of Medical Care in Diabetes
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ADA 2019 Standards of Medical Care in Diabetes
AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm 2019