Understanding Diabetes Prevention better than cure By: Dr. Riyaz Consultant Endocrinologist Medical Director EDSC

Understanding DiabetesPre v e n t i o n b e t t e r t h a n c u re

By:Dr. RiyazConsultant Endocrinologist Medical DirectorEDSC

Almost half of all people with diabetes live in just three countries

ChinaIndia USA

IDF Diabetes Atlas, 6th Edition. Diabetes,prevelance,mortality and health expendiature for 2013 to 2035

Top 10 Countries/ territories of number of people with diabetes (20-79 years), 2013

India

Why the need for improved global awareness ?

Healthy diet and exercise could prevent up to 80% of type 2 diabetes

7 million new cases of diabetes each year

At least 50% of people with diabetes do not know they are affected

Every 10 seconds, a person diesfrom diabetes-related causes

International Diabetes Federation. Did You Know?http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A

Some misconceptions about diabetes

“I don’t need to take my tablets – I don’t feel ill”

“Complications only occur in patients who take insulin”

“Only old people get diabetes”

International Diabetes Federation. Did You Know?http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A

What is Human body ?

• Human body is like a complex machine

• Glucose is the fuel of the human body

How does body use glucose ?

• Glucose is used by our body with the help of insulin

• Glucose can be used for– Either immediate requirement– Or stored for future use

Action of Insulin

What is Diabetes ?

Diabetes is a disease in which glucose levels in the blood remains higher than normal

Diabetes has serious implications

Blindness

Leading causeof blindnessin working ageadults1

Kidney failure

Leading cause of end-stage kidney disease2

Heart Disease

Stroke

2 to 4 fold increase in cardiovascular mortality and stroke3

Amputations

Leading cause of non-traumatic lower extremity amputations5

8/10 diabetic patients die from cardiovascular events4

1 Fong DS et al. Diabetes Care 2003; 26 (Suppl. 1):S99–S102. 2Molitch ME et al. Diabetes Care 2003; 26 (Suppl. 1):S94–S98. 3 Kannel WB et al. Am Heart J 1990; 120:672–676. 4Gray RP & Yudkin JS. In Textbook of Diabetes 1997 Chapter 57.

5Mayfield JA et al. Diabetes Care 2003; 26 (Suppl. 1):S78–S79.

Am I At Risk?

• I have a parent, brother or sister with diabetes.

• I had diabetes when I was pregnant.

• I gave birth to a baby who weighed over 4 kilograms (9 pounds) at birth.

• I have been diagnosed with any of the following conditions:

− Polycystic ovary syndrome − Acanthosis nigricans (darkened patches of skin) − Schizophrenia.

Am I At Risk?

• I have high blood pressure.• I am overweight, especially around the waist.• I have high cholesterol in my blood.• I have health problems that are linked to

diabetes such as diabetes eye, nerve or kidney problems.

How Do I Know If I Have Diabetes?• Review the list of risk factors

• Talk to your health care provider about your risk for developing diabetes

• Ask your health care provider to check your blood glucose, blood pressure and blood cholesterol

What you can do to prevent type 2 DIABETES ?What you can do to prevent type 2 DIABETES ?

Diabetes can be prevented or delayed Small steps, Big rewards

Diabetes can be prevented through small steps: Lose a modest amount of

weight (5–7%)

• by building up to 30 mins of physical activity/day

• following a low-calorie, low-fat eating plan

National Diabetes Education Program. Small steps. Big Rewards. Prevent Type 2 Diabetes. http://ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htm.

Exercise

The Exercise Prescription

Exercise Choices

Choose an exercise that you enjoy and that fits your personality

www.cdph.ca.gov/.../MO-CDAPP-DiabetesPreventionForYouAndYourF...

Getting Started with Exercise

• Make it as enjoyable as you can

• Doing a little is better than doing nothing

• Consider lessons or joining a group

• Exercise daily to get used to it

• Start slowly

www.cdph.ca.gov/.../MO-CDAPP-DiabetesPreventionForYouAndYourF...

Healthy Diet

Make Simple Changes

• Reduce Fat, Salt and Sugar

• Eat more of vegetables; whole grains; low fat dairy products and high fibre foods

faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule

• 1/2 is non-starchy vegetables such as salad or cooked vegetables.

• 1/4 is starchy foods such as breads, grains or starchy vegetables.

• 1/4 is meat, fish or poultry or meat substitute.

• Milk and fruit completes the meal.

Fill Your Plate for Healthy Eating


Type of Diabetes

Absolute

deficiency of

Insulin It is diagnosed in

childhood

Deficiency of

Insulin production Loss in efficiency

of Insulin

Type I Type II

Types of Diabetes

Gestational

• Recognized,

during pregnancy.• It is often

temporary.

Signs and Symptoms of Diabetes

| Presentation Title | Presenter Name | Date | Subject | Business Use Only27

Frequent urination

Unusual thirst

Extreme hunger

Extreme fatigue (tiredness)

Frequent infections

Cuts slow to heal

Tingling/ numbness in hands & feet

Blurred vision

Diet in Diabetes

• The proper diet is essential for diabetic treatment. It helps magically in patients suffering from diabetes. It provides relief from symptoms and various complications in diabetics.

• Following are the food which are good for Diabetes :


Food good for Diabetes

Bittergourd

Apple

Soya protein

Fish

Bengal gram

Curd

Onion

Peas

Broccoli

Beans

Groundnut Banana

(In m

oder

atio

n)

Orange

Soyabean

Garlic

Protein should take in moderation, high protein meal should be avoided


Do’s for diabetes diet

• DO drink plenty of water each day. • DO eat at least 3 servings of fresh vegetables daily. • DO eat at the same times everyday. • DO switch to low fat milk. • DO eat 20 - 25 grams of raw onion everyday. • DO eat a daily allotment of fresh fruit. • DO try to switch to herbal tea rather

than caffeinated tea


Don’ts for diabetes diet

• DON'T overeat at any time. • DON'T eat or drink anything containing a lot of sugar. • DON'T eat fried or fatty foods. • DON'T have more than 2 cups of regular coffee or

tea daily. • DON'T drink whole milk. • DON'T eat cheese high in fat. • DON'T eat lots of rice, potatoes, bananas or carrots.

These can raise your blood sugar.


Don’ts for a diabetic patients

Smoking

Mental stress

Avoid gaining weight

Avoid of getting hypoglycemia


Monitoring Your Diabetes:

Testing Your Sugars at Home

www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%

Testing Sugars- How often?• Depends what kinds of medicine you take:

• Test more often if:– You have had low blood sugars (BG<70)– Sugars have been unusually high (over 200)– You are sick– You are starting a new exercise program


Hypoglycemia or Low Sugar:

Step 1- 10 to 15 Grams of Carbs Pick One of these

2 to 3 Glucose Tablets

5 to 8 Life Savers®

1/4 to 1/3 cup raisins

4 oz. orange juice

3 to 5 peppermint candies

8 oz. milk

½ can of regular soda



Step 2- Recheck Blood Sugar


http://www.medicalsupplygroup.com/Diabetic/Meters/ISG172200/


Step 3- Eat a protein snackPick One

½ meat sandwich

crackers & cheese

peanut butter sandwich or

crackers


Personal Habits You Can Do

• Check your blood sugar• Maintain a healthy weight• Stop smoking• Exercise• Eat a healthy diet• Take medicines regularly• Check your feet every day• Brush and Floss your teeth every day


Basic Succinct Statement - GALVUS®

Presentation: Tablets containing 50 mg of Vildagliptin.

Indications: ♦Galvus is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus (T2DM). It is indicated: as monotherapy, IN COMBINATION: with metformin, when diet, exercise and metformin alone do not result in adequate glycemic control. with a sulphonylurea (SU), when diet, exercise and a SU alone do not result in adequate glycemic control. with a thiazolidinedione (TZD), when diet, exercise and a TZD alone do not result in adequate glycemic control. IN TRIPLE COMBINATION: with a sulphonylurea and metformin when diet and exercise plus dual therapy with these agents do not provide adequate glycemic control.

♦Galvus is also indicated in combination with insulin (with or without metformin) when diet, exercise and a stable dose of insulin do not result in adequate glycemic control. ♦Galvus is also indicated as initial combination therapy with metformin in patients with T2DM whose diabetes is not adequately controlled by diet and exercise alone.

Dosage and administration: ♦Adults: The recommended dose is 50 mg or 100 mg daily for monotherapy, and for combination with metformin, with a TZD or with insulin (with or without metformin); 50 mg daily in combination with a SU; 100 mg daily for triple combination with metformin and a SU. Maximum dose is 100 mg/day (in two divided doses of 50 mg).♦Children (under 18 years of age): Not recommended. ♦Special population: In patients with moderate to severe renal impairment or End Stage Renal Disease (ESRD), the recommended dose is 50 mg once daily.

Contraindications: Hypersensitivity to vildagliptin or to any of the excipients.

Warnings and precautions: ♦Galvus should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. ♦Not recommended in patients with hepatic impairment including patients with a pre-treatment ALT or AST>2.5X the upper limit of normal. Liver function tests (LFT) to be performed prior to treatment initiation, at three-month intervals during the first year and periodically thereafter. Withdrawal of therapy with Galvus recommended if an increase in AST or ALT of 3X upper limit normal or greater persist. Following withdrawal of treatment with Galvus and LFT normalisation, treatment with Galvus should not be reinitiated. ♦Clinical experience in patients with NYHA functional class III treated with vildagliptin is still limited and results are inconclusive. ♦Not recommended in patients with NYHA Class IV.

Women of child-bearing potential, pregnancy: Should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus.

Breast-feeding: Should not be used.

Special excipients: Contains lactose

Adverse reactions: Rare cases of angioedema. Rare cases of hepatic dysfunction (including hepatitis) ♦Monotherapy - Common: dizziness - Uncommon: headache, constipation, oedema peripheral. ♦Combination with metformin - Common: tremor, dizziness, headache. ♦Combination with a sulphonylurea - Common: tremor, headache, dizziness, asthenia. ♦Combination with a thiazolidinedione - Common: weight increase, oedema peripheral. ♦Combination with insulin - Common: headache, nausea, gastrooesophageal reflux disease, chills, decreased blood glucose – Uncommon: Diarrhoea, flatulence. ♦Combination with metformin and a sulphonylurea - Common: dizziness, tremor, asthesia, hypoglycaemia, hyperhidrosis. ♦Post-marketing experience - Rare: hepatitis (reversible with drug discontinuation) – Unknown: urticaria, pancreatitis, localized exfoliation or blisters.

Interactions: ♦Vildagliptin has a low potential for drug interactions. ♦No clinically relevant interactions with other oral antidiabetics (glibenclamide, pioglitazone, metformin), amlodipine, digoxin, ramipril, simvastatin, valsartan or warfarin were observed after co-administration with vildagliptin.

Packs: Box of 2 strips of 14 tablets each

Note: Before prescribing, please consult full prescribing information available from Novartis Healthcare Private limited, Sandoz House, Dr. Annie Besant Road, Worli, Mumbai- 400 018, Tel: 022 2495 8888

For the use only of a registered medical practitioner or a hospital or a laboratory.

India BSS dtd 27 Jan 2014 based on international BSS dtd 18 Dec 2013

Basic Succinct Statement – GalvusMet®

Presentation: Tablets containing Vildagliptin/Metformin hydrochloride fixed dose combination: 50 mg/500 mg, 50 mg/850 mg, 50 mg/1,000mg.

Indications: ♦Galvus Met is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus (T2DM) whose diabetes is not adequately controlled on metformin hydrochloride or vildagliptin alone or who are already treated with the combination of vildagliptin and metformin hydrochloride, as separate tablets. ♦Galvus Met is indicated in combination with a sulphonylurea (i.e., triple combination therapy) as an adjunct to diet and exercise in patients inadequately controlled with metformin and a sulphonylurea. ♦Galvus Met is indicated in combination with insulin (i.e., triple combination therapy) as an adjunct to diet and exercise to improve glycemic control in patients when stable dose of insulin and metformin alone do not provide adequate glycemic control. ♦ Galvus Met is also indicated for the treatment of Type 2 Diabetes mellitus having HbA1c > 8% where diabetes is not adequately controlled by diet and exercise alone.

Dosage and administration: ♦Do not exceed the maximum recommended daily dose of vildagliptin (100 mg). ♦Should be given with meals. ♦Adults: Starting dose for patients inadequately controlled on vildagliptin or metformin hydrochloride monotherapy: 50 mg/500mg twice daily and gradually titrated after assessing adequacy of therapeutic response. ♦Starting dose for patients switching from combination therapy of vildagliptin plus metformin hydrochloride as separate tablets: 50 mg/500 mg, 50 mg/850 mg or 50 mg/1,000 mg based on the dose of vildagliptin or metformin already being taken. ♦Starting dose for treatment naïve patients: may be initiated at 50 mg/500 mg qd and gradually titrated to a maximum dose of 50 mg/1,000 mg bid after assessing adequacy of therapeutic response. ♦Use in combination with a sulphonylurea or with insulin: the dose of Galvus Met should provide vildagliptin dosed as 50 mg twice daily (100 mg total daily dose) and a dose of metformin similar to the dose already being taken. ♦Children (under 18 years of age): Not recommended.

Contraindications: Known hypersensitivity to vildagliptin or metformin hydrochloride or to any of the excipients ♦renal disease or renal dysfunction ♦congestive heart failure ♦acute or chronic metabolic acidosis including diabetic ketacidosis with or without coma ♦should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials.

Warnings and precautions: ♦Risk of lactic acidosis. ♦Monitoring of renal function. ♦Caution with concomitant use of medications that may affect renal function or metformin hydrochloride disposition. ♦Should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials. ♦Discontinue treatment in case of hypoxemia. ♦Temporary discontinuation in patients undergoing surgical procedure. ♦Excessive alcohol intake to be avoided. ♦Not recommended in patients with hepatic impairment including patients with a pre-treatment ALT or AST >2.5X the upper limit of normal. Liver function tests (LFT) to be performed prior to treatment initiation, at three-month intervals during the first year and periodically thereafter. Withdrawal of therapy with Galvus Met recommended if an increase in AST or ALT of 3X upper limit normal or greater persist. Following withdrawal of treatment with Galvus Met and LFT normalisation, treatment with Galvus Met should not be reinitiated. ♦Risk of decreased vitamin B12 serum levels. ♦Should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. ♦Risk of hypoglycemia. ♦May be temporarily withheld in case of loss of glycemic control. ♦Should only be used in elderly patients with normal renal function. ♦Not recommended in pediatric patients.

Women of child-bearing potential, pregnancy: Should not be used in pregnancy unless the potential benefit justifies the potential risk to the foetus.

Breast-feeding: Should not be used during breast-feeding.

Adverse reactions:

♦Vildagliptin: Rare cases of angioedema. Rare cases of hepatic dysfunction (including hepatitis). ♦Vildagliptin monotherapy - Common: dizziness – Uncommon: headache, constipation, oedema peripheral. ♦Metformin monotherapy – Very common: loss of appetite, nausea, vomiting, diarrhoea, abdominal pain. Common: dysgeusia. Very rare: lactic acidosis, hepatitis, skin reactions such as erythema, pruritus and urticarial, decrease of vitamin B12 absorption, liver function test abnormalities. ♦Other effects with combination of Vildagliptin and Metformin - Common: tremor, dizziness, headache. ♦Other effects with combination of Vildagliptin and Metformin with insulin – Common: headache, nausea, gastrooesophageal reflux disease, chills, blood glucose decreased– Uncommon: diarrhoea, flatulence. ♦Other effects with combination of Vildagliptin and Metformin with a sulphonylurea – Common: dizziness, tremor, asthenia, hypoglycemia, hyperhidrosis. ♦Post-marketing experience: - Rare: hepatitis (reversible with drug discontinuation) - Unknown: urticaria, pancreatitis, localized exfoliation or blisters.

Interactions: ♦Interactions with Vildagliptin: low potential for drug interactions, no clinically relevant interactions with other oral antidiabetics (glibenclamide, pioglitazone, metformin), amlodipine, digoxin, ramipril, simvastatin, valsartan or warfarin were observed after co-administration with vildagliptin. ♦Interactions with metformin hydrochloride: furosemide, nifedipine, cationic drugs, drugs tending to produce hyperglycemia, alcohol.

Packs: Box containing 6 strips of 10 tablets each

Note: Before prescribing, consult full prescribing information available from Novartis Healthcare Private Limited, Sandoz House, Dr. Annie Besant Road, Worli, Mumbai- 400 018, Tel: 022 2495 8888

For the use only of a registered medical practitioner or a hospital or a laboratory.

India BSS dtd 31 Jan 2014 based on international BSS dtd 18 Dec 2013, effective from 1 Apr 14.

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Basic Succinct Statement – GalvusMet®

Disclaimer

“The views, opinions, ideas etc expressed therein are solely those of the author. Novartis does not certify the accuracy, completeness, currency of any information and shall not be responsible or in anyway liable for any errors, omissions or inaccuracies in such information. Novartis is not liable to you in any manner whatsoever for any decision made or action or non-action taken by you in reliance upon the information provided. Novartis does not recommend the use of its products in unapproved indications and recommends to refer to complete prescribing information prior to using any of the Novartis products.”

“Issued in scientific service to medical professionals”

For full product information please write to :

Novartis Healthcare Private Limited, Sandoz House, 7th floor, Shivsagar Estate, Dr. Annie Besant Road, Worli, Mumbai, 400 018, INDIA

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Item Code_ Scientific Presentation/Galvus/CVM/ 306082 / 10 / 2014

Approved to be used till Oct’2015 only

Documents

Understanding Diabetes Prevention better than cure By: Dr. Riyaz Consultant Endocrinologist Medical Director EDSC