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NNC CMU
DPP-4 inhibitor and
the Brain
Surat Tanprawate, MD, MSc(Lond.), FRCP(T)1, 2
1Division
NNC CMU
Issue of DM and the Brain
DM
Risk
complicatio
n
-
First
stroke
Recurrent
stroke
DM double risk of
stroke
DM may be
responsible for >8%
of first ischemic
stroke
20% of DM pt. will
die of stroke
DM is RR for the first
stroke -> 1.5-3.7
Trials of glycemic
control to prevent
stroke
Result from
the trial
Recommendation
from ASA stroke
guideline (2014)
No effect on
reducing stroke
on therapeutic
group
No major study
NNC CMU
DDP-4 inhibitor, glycemic control and
stroke prevention
NNC CMU
Diabetic neuropathy
Risk
DPN
4% to 10% by 5
years
50% by 25 years
Trials of glycemic
Result from the
control to prevent DPN
trial
Recommendation
NNC CMU
Diabetic neuropathy, glycemic control
with DPP-4 inhibitor
NNC CMU
The studies on hypoglycaemic event
related to cognitive impairment
NNC CMU
Association between
hypoglycaemia and
dementia in biracial cohort
of older adult with DM
Yaffe K. et al. JAMA Intern Med. 2013 July 22; 173(14)
Microangiopathy
Hypoglycemia
NNC CMU
Cognitive disorders
HT and Dyslipidemia
Macroangiopathy
Inflammation
Dementia
Insulin resistance
Insulin can regulate
phosphorylation of tau
protein and clearance of
amyloid protein
Genetics
Age
Buysschaert M et al. Medecine Maladies Mtaboliques 2015;9:47-52
peripheral hyperinsulinemia
decrease insulin transport into the
CNS
Long term
increase can
transport into
the brain
Hiranya Pintana, Nattayaporn Apaijai, Nipon Chattipakorn and Siriporn C Chattipakorn from
Chiang Mai University Journal of Endocrinology 218.1 (2013): 1-11.
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