Learning objectives for the SYMPOSIUM ON CO-MORBIDITIES IN DIABETES
Learning objectives: the kidney session
New evidence on obesity/diabetes related renal changes and new therapeutic targets
Aim:
After the presentation, the participants will be able to recognize new aspects of renal histology in patients with type 2 diabetes without overt proteinuria.
Learning objectives:
To understand type 2 diabetes classification of diabetic nephropathy in stages or grades, each more severe than the previous one. The present characteristics of histology will be discussed and evaluated and new evidence and new studies will be demonstrated and discussed to illustrate the discrepancies between renal histology and clinical evolution of the disease and possibly new therapeutic targets.
Epidemiology and consequences of kidney complications in patients with type 2 diabetes at present and the next 10 years
Aim:
After the presentation, the participants will be able to recognize new markers or combinations of markers of diabetic kidney disease. Furthermore, the participants will be able to identify systems medicine models and subtypes of diabetic kidney diseases as they will be illustrated.
Learning objectives:
To learn about new studies of diabetic kidney disease. Omics-platforms, including genomics, transcriptomics, metabolomics, and the value and limitations proteomics is discussed together with diabetic kidney disease phenotypes in terms of rate of progression, degree of comorbidity, and response to interventions. Underlying pathophysiology for the individual patient and targeted personalized medicine is illustrated. The consequences of using these new screening and treatment strategies will be analyzed and interpreted inclusive the renal/cardiovascular risk reductions expected by these interventions.
GLP-1/SGLT2 treatment and renal endpoints
Aim:
After the presentation, the participants will have insight in the consequences of intensified, multifactorial intervention in type 2 diabetic patients with microalbuminuria, including improving glycemic control, treating blood-pressure with blockade of the renin–angiotensin system, treating with statins and implementing lifestyle interventions on the risk of ESRD.
Learning objectives:
New drugs with beneficial effect of improving glycemic control per se on survival and / or progression to ESRD is demonstrated and discussed.
Drugs that increase the endogenous insulin production using the incretin hormone function of glucagon-like- peptide 1 (GLP-1), by either inhibiting the degradation of the endogenous produced GLP-1 by blocking of the degrading enzyme DPP-4 (DPP-4 inhibitors) or by using slowly degraded analogues (GLP-1 analogues). Second, drugs that block the sodium-glucose cotransporter 2 are the so called sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors). These drugs basically lower blood-glucose by reducing the renal reabsorption of glucose, thereby increasing the urinary glucose excretion.
The SGLT2 inhibitors and GLP-1 analogues direct effects regarding death and progression of nephropathy is discussed.
New guidelines on treatment of type 2 diabetes recommending the use of empagliflozin and liraglutide in the line second to metformin and insulin are discussed inclusive the apparent cardiovascular and nephropathy benefits.
Learning objectives: the heart session
Epidemiology and pathophysiology – interactions between type 2 diabetes and the heart
Aim:
After the presentation, participants will be able to understand the epidemiology and pathophysiology behind heart failure and ischemic heart disease in patients with type 2 diabetes and understand the new drug classes’ effect on this condition.
Learning objectives:
Heart failure and ischemic heart disease is a common comorbidity in diabetes and patients with both conditions have a particularly poor prognosis- the studies describing this is analyzed and discussed.
Most clinical outcome trials investigating the effects of glucose-lowering agents have excluded patients with heart failure-the rationale is discussed and criticized.
Glitazones and, possibly, some dipeptidyl peptidase-4 inhibitors, cause an increased risk of developing heart failure and deterioration in existing heart failure, and the role in patients with ischemic heart disease, data is presented and discussed.
One class of drugs, the sodium glucose cotransporter 2 inhibitors, possible reduce the risk of developing heart failure and other drugs are under investigation including the GLP-1 agonists with an effect on ishemic heart disease will be evaluated.
Treatment of diabetic heart disease – present time and in the future
Aim:
After the presentation, participants will be able to evaluate the historic and present cardiovascular endpoint lowering drugs in diabetic patients with an effect on glycemic and metabolic profile.
Learning objectives:
The EMPA-REG OUTCOME, assessing the safety of the sodium–glucose cotransporter 2 (SGLT2) inhibitor empagliflozin and other drugs in this class, and the safety of the glucagon-like peptide 1 receptor agonist liraglutide, together with the addition of empagliflozin or liraglutide to standard therapy of type 2 diabetes with regards to primary composite endpoint of CV death, nonfatal myocardial infarction, and nonfatal stroke, compared with placebo is presented and discussed.
What did reduce the primary endpoints is discussed and the future role of these drugs and new therapeutic targets are analyzed and discussed.
Overall learning objectives: the liver session
Aim:
After the presentations, participants will be able to understand that type 2 diabetes patients with advanced liver disease constitute a large, yet under-diagnosed patient group, characterised by high morbidity and mortality.
Learning objectives:
The participants will be able to:
- To know the prevalence of steatosis, steatohepatitis and progressive fibrotic liver disease in the typical diabetes population.
- To learn how to differentiate between liver steatosis and more severe forms of the disease and which methods are used - in primary and secondary care - to evaluate a type 2 diabetes patient for advanced liver disease.
- To recognise the role of a multitude of different lipids for the progression of liver disease - that fatty liver is made up by far more than one kind of fat.
Overall learning objectives: the eye session
Aim:
After the presentation, the participants will be aware of the rationale to perform eye screening in diabetes and have a basic understanding of pathophysiological changes in the eye as well as treatment options.
Learning objectives:
The participants will be able to:
- Recognize pathophysiological changes in early and late diabetic retinopathy
- Explain the reason to perform eye screening in diabetes – even in asymptomatic patients.
- Recognize the four steps of the International Clinical Diabetic Retinopathy Disease Severity Scale.
- Discuss pros and cons for different methods in diabetic retinopathy screening.
- Understand the basic concepts for diabetic retinopathy screening by artificial intelligence.
- Be aware of advantages and disadvantages of treatment options (laser, intravitreal injections and surgery) for diabetic macular edema and proliferative diabetic retinopathy.