Diabetes Type 2

The past 3 decades have seen a profound paradigmatic shift in the treatments available for type 2 diabetes mellitus. Because the disease is complicated by a variety of macrovascular and microvascular pathologies, interventions must be broad-based (tight glycemic and blood pressure [BP] control, serum lipid and urinary protein reductions). This "multifactorial" approach has proven successful.

Diabetes is the most demanding chronic illness. It challenges every fiber of a patient’s body and spirit and demands a system of care that ministers to the biological, social, and psychological aspects of the illness. It takes a “village” to accomplish this task.

The results of a meta-analysis indicate that intensive glycemic control significantly reduces the risk of coronary events in patients with type 2 diabetes mellitus. The meta-analysis, conducted by Ray and colleagues,1 included 5 randomized controlled trials that compared intensive with standard glucose-lowering regimens in more than 33,000 patients. The general treatment protocols are shown in the Table.

Evidence-based medicine supports the aggressive management ofdyslipidemia to prevent cardiovascular disease (CVD) in patients withtype 2 diabetes

The rate of onset of type 2 diabetes and related hospitalizations is rising in young adults in the United States aged 20 to 29, according to results of a study published in the December issue of Diabetes Care.

I recommend having a “diabetes stamp” made up that includes in its imprint fasting blood glucose, low-density lipoprotein cholesterol, hemoglobin A1c, urine microalbumin, ECG, eye examination, podiatric examination, flu shot, and pneumococcal vaccine-along with lines on which to write dates and results.

New treatment options for pain caused by diabetic peripheral neuropathy were presented at the annual meeting of the American Academy of Neurology. While oral medications from 2 different drug classes appear effective, injection of botulinum toxin does not.

A 58-year-old man sought medical attention because of the recent sudden onset of blurred vision in his left eye. His vision had not improved over several days. The patient had hypertension and had recently sustained a myocardial infarction. He was taking metoprolol, 25 mg/d, and aspirin, 81 mg/d.

I have never used an insulin pump in adult patients with diabetes mellitus. One of my patients is asking for this device, and I would appreciate information about dose calculations and what to tell the patient before beginning use of the pump.

Researchers at Northwestern University, Evanston, Ill, report that insulin, by shielding memory-forming synapses from injury, may slow or prevent the damage and memory loss caused by amyloid b–derived diffusible ligands (ADDLs)-toxic neuroproteins associated with Alzheimer disease (AD). Findings of the study, which provides additional evidence that AD may be caused by a new, third form of diabetes, were published in the February 10 issue of the Proceedings of the National Academy of Sciences of the United States of America.

A 59-year-old woman presents with right-sided, nonradiating, “aching” chest pain that has been continuous and increasing in severity for the past 3 days. It began as a tightness that gradually became more painful; it is aggravated by palpation and movement and has not been relieved by acetaminophen.

As many as 10% of Americans older than 20 years have type 2 diabetes, and more than 20% of the total population has the metabolic syndrome. Type 2 diabetes will develop in many of those with the metabolic syndrome.

As the numbers of patients with diabetes continue to climb, physicians and health policy experts are devoting increasing attention to strategies that can improve care for these patients. One of the strategies frequently mentioned is the Chronic Care Model, developed in 1998 by the MacColl Institute for Healthcare Innovation.

Most patients who self-monitor their blood glucose levels stick the lancet into the finger pad to obtain a drop of blood for the glucometer. A more effective strategy is to stick the side of the finger instead. The sides are the most vascular areas on the finger, making it easier to obtain blood.

Diabetes is a destructive disease that kills thousands eachyear in the United States and disables thousands more, and its incidence hasbeen rising dramatically. Glycemic control is imperative to forestallcomplications; however, it can be difficult for patients to achieve glycemicgoals.

Nephropathy develops in about 30% of patients with diabetes. Screen for albuminuria at the time type 2 diabetes is diagnosed and within 5 years of diagnosis of type 1 diabetes.

Treatment of hypertension can minimize both microvascular and macrovascular complications of diabetes and helps prevent nephropathy and cardiovascular events.

Over the past 20 years, the treatment armamentarium for diabetes has greatly expanded: 8 different classes of non-insulin drugs and 8 different types of insulin are now available. The newer classes of agents include disaccharidase inhibitors, thiazolidinediones, meglitinides, glucagonlike peptide analogs, and dipeptidyl peptidase IV inhibitors.

BOSTON -- Women with high or rising blood pressure are up to three times more likely to develop diabetes, researchers here found.

Here: a look at the many possible causes of poorly controlled blood glucose levels, and steps to overcome them.

CHICAGO -- Treatment for type 2 diabetes may rival in inconvenience the complications of the disease, researchers here found.

DENVER-A higher intake of omega-3 fatty acids found in fish was linked to a lower risk of pancreatic islet autoimmunity in children at genetic risk for type 1 diabetes, according to a preliminary study.

ANN ARBOR, Mich. -- Differences in self-management and socioeconomic factors account only in part for the disparities in glycemic control and asthma outcomes between minority and white patients with diabetes and asthma, investigators in two studies found.

ORANGE, Calif. -- The goal of noninvasive glucose monitoring for children with type 1 diabetes has gained momentum from early results with an experimental breath test, researchers here found.

AMSTERDAM -- Adding insulin to oral antidiabetic agents early in the course of disease can help patients achieve better glucose control, but many patients will need a combined insulin regimen, investigators reported.

AMSTERDAM -- Patients with type 1 diabetes who used insulin detemir (Levemir) for two years had better glycemic control and less nocturnal hypoglycemia than patients on NPH insulin, investigators reported here.

AMSTERDAM -- Type 2 diabetes may be linked to mental health disorders, but age and gender may be contributing factors, according to two separate studies.

AMSTERDAM -- Men are up to two and a half times more likely to have newly diagnosed type 2 diabetes than women, but once a woman is diagnosed, the disease is just as deadly for them as for men.

AMSTERDAM -- A glass of merlot or perhaps sauvignon blanc a day may offer modest benefits for patients with type 2 diabetes, said researchers here.

AMSTERDAM -- Inflammation in patients with type 2 diabetes is independent of obesity, an observation that may partly explain the increased risk of cardiovascular disease among patients with diabetes.