Download - Diabesity manchester march 2014
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Action on Diabesity
Dr C Rajeswaran
Consultant Physician ( Diabetes, Obesity & Endocrinology)
Chair, National Diabesity Forum
Director, simplyweight Ltd
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Diabesity - 21st century pandemic
Diabesity is now the single greatest contributor to chronic disease
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Diabesity describes the twin epidemic of obesity and diabetes that we are facing throughout the world.
Imagine having "diabesity" and being addicted to
alcohol, caffeine nicotine......................“Alconicocafdiabesity?"
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Multi hormone control of body weight:
Fat,gut and islets derived signals
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Obesity and overweight .. conditions in which body fat has accumulated to such an extent that health may be adversely affected (WHO, 2000)
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Adjusted odds ratio for death, by metabolic category for 51-61years age group
Diabetes 2.63
Obesity 0.78
Obesity and diabetes 6.81
Oldridge et al, Jr of clinical Epidemiology 54(2001);928-934
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Weight gain in patients with type 2 diabetes can contribute to patient frustration and may negatively impact their compliance to therapeutic regimens.
F. Xavier Pi-Sunyer, Postgraduate Medicine: Volume 121: No.5The Impact of Weight Gain on Motivation, Compliance, and Metabolic Control in Patients with Type 2 Diabetes Mellitus
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Glycaemic control and body weight
Weight gain appears unavoidable when patients with Type 2 diabetes are commenced on insulin
Body weight increases by 2Kg for each percentage point decrease in HbA1C during the first year1
.
1.Makimattila et al Diabetologia 1999;42;406-412
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Diabesity-Management?
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Potential benefits of 10kg weightloss in individuals of 100kg
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Diabesity Team
Endocrinologist
Diabesity Nurse specialist
Dietitian
Physiotherapist
occupational therapists
Social worker
Psychologists
Bariatric surgeon
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Evaluation:
Detailed History
Perception
Motivation
Hunger pattern
Body image
Glycaemic excursion
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Evaluation:Psychological state
Anthropometry
Problems with ADL (activities of daily living)
Mobility
Sleep study
Endocrine abnormality
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Evaluation:In addition to evaluating complications of diabetes, Obesity related complications are assessed
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WHY ARE YOU EATING SO FAST?
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I WANT TO EAT AS MUCH AS POSSIBLE
BEFORE I LOSE MY APPETITE!!
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Brain Reward System
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Control of appetite
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Genes and Weight
Genes
Environment
40%60%
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Drug Class May cause Weight gain Less weight gain, weight loss or weight neutral
Antipsychotics ClozapineRisperidoneOlanzipine
ZiprasidoneAripiprazole
Antidepressants and Mood stabilizers
CitalopramLithiumMAOIsTCAsVenlafaxineMirtazapineParoxetine
BupropionSertralineFluoxetine
Anticonvulsants CarbamazepineGabapentinValproate
LamotrigineTopiramate
Diabetes Drugs InsulinSulphonylureasThiazolidinediones
MetforminAcarboseGLP-1DDPIV
Antihypertensives Alpa blockersBeta blockers
ACE inhibitorsCalcium Channel Blockers
Oral Contraceptives Progesterone only pillCombination pill with progesterone
Barrier methodIUDs
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Understanding Hunger Pattern
NEAT: Non exercise activity thermogenesis
Dieting cause weight gain
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Surgery Effective Early Intervention for
Diabesity
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Gastric balloon
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http://www.healthierweight.co.uk/obesity-surgery/gastric-band/what-is-a-gastric-band/how-does-the-band-work/
Gastric Banding
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SA 46 years male
Type 2 Diabetes (2002)
Morbid Obesity
Metformin 2.5 gms
Insulin 180 units
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Examination:
Weight 164Kg (25.82 Stones)
Rest of examination unremarkable
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Child hood……..
Puberty………
Family………
Social history……..
Personal history……..
H/O weight loss management & medical history
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Investigations:
No evidence of Obstructive sleep apnoea
HbA1c-11.2%
Testosterone 6 nmol/l
SHBG 26
LH 2.1
FSH 1.3
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Management
Testosterone 5gm gel OD
Calorie restriction
Clinic follow up
Weight 148 Kg (Initial wt 164)
NOT tired, No day time sleepiness
Insulin160 units a day
HbA1c 10.2%
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Exenatide introduced
And
Insulin gradually weaned off
Under very close supervision
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Clinic( 6 months)
119Kg (Initial wt -164Kg)
HbA1c - 8%
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•Not every option is appropriate for every individual.
•Holistic approach is the key in a DIABESITY Clinic
Glycaemic control
Body weight and hunger pattern
Psychological issues
Underlying endocrine abnormalities
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“ Of course doughnuts are good for you.
They’re HOLE grain!”
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Thank you!