2. Deaths by cause in the world Noncommunicable diseases: Cardiovascular disease 30.2% Cancer 15.7% Diabetes 1.9% Other chronic diseases 15.7% Infectious diseases: HIV/AIDS 4.9% Tuberculosis 2.4% Malaria 1.5% Other Infectious Diseases 20.9% Injuries 9.3% Total: 58Million (WHO, 2004)
21. Step 1: Lifestyle intervention and metformin Step 2: Add a sulfonylurea or insulin Disadvantages Advantages Expected total decrease in A1C (%) Interventions Metformin Lifestyle to: ↓ weight & ↑ activity GI side effects, rare lactic acidosis Weight-neutral, no hypoglycemia, inexpensive 1.5 Fails for most in the first year Low cost, many benefits 1–2 Weight gain, hypoglycemia Inexpensive 1.5 Sulfonylureas Injections, requires frequent blood glucose self-monitoring, hypoglycemia, weight gain No dose limit, inexpensive, improved lipid profile 1.5–2.5 Insulin
22. Alternative medications Infections, 3x/day dosing, frequent GI side effects, expensive, little experience Weight loss 0.5–1.0 Pramlintide three times/day dosing, expensive Short duration 1–1.5 Glinides (meglitinides Infections, 3x/day dosing, frequent GI side effects, expensive, little experience Weight loss 0.5-1.0 Exenatide Frequent GI side effects, 3x/day dosing, expensive Weight-neutral 0.5–0.8 Alpha-glucosidase inhibitors Fluid retention, weight gain, expensive, increased risk of congestive heart failure Improved lipid profile 0.5–1.4 Glitazones (TZDs-- thiazolidinediones
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30. Insulin and Insulin Analogues Ultra-rapid-acting onset Peak 30 min–2 hrs 12–30 min Insulin glulisine (Apidra) 30 min–2 hrs 12–30 min Insulin aspart (Novolog) 30 min–2 hrs 12–30 min Insulin lispro (Humalog)
31. Insulin and Insulin Analogues Short-acting 2–3 hrs 30 min–1 hr Regular (human) Humulin R/Novolin R
32. Insulin and Insulin Analogues Intermediate-acting 4–10 hrs 1.5–4 hrs NPH (human) Humulin N/Novolin N
33. Insulin and Insulin Analogues Long-acting 9 hrs–unknown 1–3 hrs Insulin detemir (Levemir) No peak 1–3 hrs Insulin glargine (Lantus)
