Transcript Diabetes Mellitus 101 for Cardiologists (and Alike)

Diabetes Mellitus 101 for
Cardiologists (and Alike): 2015
An Aggressive Pathophysiologic Approach to Therapy of Type 2 Diabetes
in Cardiometabolic Patients:
Looking at Diabetes Medications with a Cardiologists Eye
Part 8
Stan Schwartz MD,FACP
Affiliate, Main Line Health System
Emeritus, Clinical Associate Professor of Medicine,
U of Pa.
6105472000
Pioglitazone
 ADVANTAGES
Improves insulin resistance (fat/muscle), decreases insulin conc.,
improves endothelial dysfunction , dysfibrinolysis, BP, decreased
microalbumin, improved beta-cell function, treats PCOS and
steatohepatitis
Lipids (GLIA study)

Advantage to pio - decrease TG, decreased # of buoyant LDL
particles, decrease non-HDL chol.
May use in renal insufficiency

No hypoglycemia used alone or with metformin , incretin mimetics

Potential to delay or prevent DM and progression; lower secondary
failure rate than SU/met

Pio decreased prospective composite endpoint (MI,CVA, death) 16%
in PROactive trial (Can’t assume class effect) , dec. risk second MI/
ACS, decreased risk second stroke 47%
Non-Insulin Therapy for Hyperglycemia in Type 2 Diabetes,Treating
Defronzo’s Octet: Match Patient Characteristics to Drug Characteristics:
PIOGLITAZONE improves 5 of 8 MOAs
5.Gut CHO
Absorption:
8.Kidney-
SGLT2
-
Incretin,
Pramlintide,
Glucosidase inh.
1.Pancreatic
insulin
Secretion:
Incretin, ranolazine
2.Pancreatic
glucagon
Secretion- Incretin
7.BrainTZD,INCRETIN
bromocryptine
HYPERGLYCEMIA
De
-
-
3.MuscleTZD, Incretin
4.Liver
Hepatic glucose
production:
Metformin, incretin
Peripheral
glucose
uptake
6.Fat- TZD, metformin
Pioglitazone in Dysmetabolic Syndrome,
Prediabetes, Type 2 Diabetes
 Safety

No liver toxicity

Increased distal fractures in women

Edema-renal sodium and total body water retention
- can be prevented/minimized (patient selection, NAS diet)
- treated with spironolactone, amilioride, triamterene

Weight gain not an obligatory side effect- studies- portion control/ education
freq.

Bone loss in women = risk/benefit evaluation for each patient

CHF not a cardiac issue except more susceptible with diastolic dysfunction
–function of renal sodium and total body water retention
-Can be prevented/reduced- low salt diet/ patient selection;
ranolazine
© 2000 educateMD.com
University
Pennsylvania
Wang
CH, etof al.
Glitazones and Heart Failure. Circulation. 2003;107:1350-1354. Reprinted with permission
School of Medicine