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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