Diabetes

Persistent hyperglycemia despite triple oral antidiabetic therapy requires reassessment of medications with particular attention to risks for weight gain and hypoglycemia.

Hypertension is very common in people with diabetes; in this patient’s case, it may have been present for 5 to 10 years before the hyperglycemia appeared.

In addition to lifestyle changes, how would you treat this patient?

Up to 80% of those with necrobiosis lipoidica have diabetes mellitus; however, this disorder develops in fewer than 1% of people who have diabetes.

Early use of combination therapy to treat type 2 diabetes is shown to limit glucose toxicity and preserve beta-cell function.

Despite best efforts with lifestyle modification and adherence to metformin and glimepiride therapy, this man’s A1C continues to rise. What next?

The Outcomes Reduction with Initial Glargine Intervention trial: No elevated risk of cardiovascular disease, cancer when insulin is used early to treat T2DM.

The 2012 ADA/EASD Position Statement prescribes patient-centered care for type 2 diabetes management using lifestyle change, metformin, DPP-4Is, GLP-1 RAs.

This type 2 diabetes office-visit checklist tracks A1c, lipid, and blood pressure goals, and lets you monitor regular labs, exams, and diabetes education.

Would you treat the elevated A1C aggressively-and what would your target level be? Would you consider statins? Dr Shahady invites your insights.

Do you consider an LDL of 100 and a non-HDL of 150 significant? What is your diagnosis? Would you consider medication in addition to recommending lifestyle changes? Answers to these quiz questions here.

The American College of Physicians (ACP) has recently published its updated guidelines for type 2 diabetes mellitus (T2DM) management. While touted as "new," these guidelines offer no real breakthroughs in understanding. Our blogger offers a perspective; we’d like to hear yours.

Spots on the shins may indicate diabetes.

However, persistent, unexplained hypoglycemia can indicate a potentially grave, often treatable, underlying disorder, such as insulinoma, or adrenal or pituitary insufficiency.

I advise patients with diabetic neuropathy to break in new shoes gradually.

Diabetes is a demanding and difficult chronic disease. Life changes dramatically for a patient and his or her family once the diagnosis is made. Nutritional food choices, increased physical activity, multiple medications, visits to a physician, and blood tests are no longer optional. They now are a means of changing the length and quality of life. The patient has to rapidly become knowledgeable about nutritional content of any food he eats, different ways to be active, blood glucose testing, medication doses and side effects, and new words and abbreviations, such as A1c, LDL, HDL, and triglycerides.

From 1996 to 2007, the rate of end-stage renal disease (ESRD) in persons with diabetes decreased 35% nationwide, according to the CDC.

Increased dietary intake of selenium is associated with a heightened risk of type 2 diabetes, reported Italian researchers recently. Included in their prospective study were 7182 women from Northern Italy.

Type 2 diabetes mellitus is an epidemic with serious and fatal complications. Some predictions estimate that 440 million persons will have this disease by 2030. Current recommendations state that patients with type 2 diabetes who are receiving monotherapy and who have elevated hemoglobin A1c levels between 7.6% and 9.0% should receive a second agent.

Your patient is a middle-aged man with type 2 diabetes who wants to start a weight-training program. What recommendations would you offer him? Another patient with diabetes has peripheral neuropathy; which types of exercise are safest for her? Answers to these and other questions about physical activity by patients who have diabetes mellitus can be found in guidelines from the American Diabetes Association. Highlights of those recommendations are presented here.

Intensive control of blood glucose levels reduces the development and progression of certain microvascular complications of type 2 diabetes but does not reduce cardiovascular risk, according to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study investigators.

This generation’s diabetic control is preceded by the ever-present adjective “intensive.” Although a lower A1c seems to be a rational, and in many instances a proven target for type 2 diabetes with its constellation of micro- and macrovascular complications, are there downsides when prescribing exactly how low one’s A1c should go?

Is a once daily dose of insulin glargine or NPH the best treatment strategy for patients who are of Latino/Hispanic descent? Which ethnicity responds best to a lispro mix of 75/25 twice daily? With the brunt of type 2 diabetes affecting non-Caucasian populations, researchers shed light on treatment strategy efficacy across races and ethnicities.

At what blood pressure is it prudent to treat newly diagnosed hypertension with 2 antihypertensive agents, and what criteria should guide selection of the 2 drugs?

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.

Examining the feet is an essential part of care for patients with diabetes. I go one step further-also examine the patient's shoes. I discourage the wearing of pointed-toe shoes that can interfere with circulation and lead to serious foot problems. Instead, I recommend that patients with diabetes wear shoes with wide toe boxes.