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?
A 68-year-old African American man presents for a checkup. He has had type 2 diabetes mellitus for the past 5 years but has no nephropathy and no history of cardiovascular disease. He is currently taking atorvastatin, 80 mg/d, and his low-density lipoprotein cholesterol level is 80 mg/dL. His blood pressure was 148/98 mm Hg at the last visit and is now 150/98 mm Hg. What is the best treatment for him?
Forty-five percent of adults in the United States have hypertension, high serum total cholesterol levels, or diabetes, according to a recent report from the CDC.1 Of these persons, approximately 13% have 2 conditions and nearly 3% have all 3 (Figure 1). In nearly 15% of those with 1 of these conditions, it remains undiagnosed.
A 68-year-old African American man presents for a checkup. He has had type 2 diabetes mellitus for the past 5 years but has no nephropathy and no history of cardiovascular disease. He is currently taking atorvastatin, 80 mg/d, and his low-density lipoprotein cholesterol level is 80 mg/dL. His blood pressure was 148/98 mm Hg at the last visit and is now 150/98 mm Hg. What is the best treatment for him?
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.
Dr Rutecki makes some excellent points about the costs of diabetes care and how the reduction of complications such as myocardial infarction, heart failure, and renal disease will decrease costs and suffering. But I have difficulty with the tone of his comments that seem to shift blame for the cause of these costs.
In the United States, it has been estimated that 7.8% of the total population has diabetes. In 2007, the direct medical expenditures for diabetes were about $116 billion and the total direct and indirect costs were $174 billion, according to the CDC.1
Only 7% of patients with diabetes have reached goals for hemoglobin A1c, LDL cholesterol, and blood pressure. What can be done to help more patients achieve their goals? In this 2-part interview, Dr Edward Shahady shows how group visits can help your patients with diabetes better control their disease and reduce their risk of diabetic complications.
American medicine is undergoing the greatest financial scrutiny in its history. The hue and cry for reform stems primarily from the soaring costs of health care. However, placing the blame for these costs solely on increased utilization of technology, cutting-edge pharmaceuticals, cost-shifting hospitals, and physicians misses a bigger mark.
The gap in Medicare prescription drug coverage, or the doughnut hole, may be why many seniors with diabetes are not adhering to medications. Researchers from Kaiser Permanente and the David Geffen School of Medicine at the University of California, Los Angeles, focused their study on what happens during the gap, or when patients are paying for their medications out of pocket.1
What is the highest dose of insulin that can be used in a patient whose diabetes remains uncontrolled on a regimen of insulin plus an oral antidiabetic agent?
The authors are affiliated with the University of Mississippi School of Pharmacy, in University, Miss. Dr Yang is assistant professor in the department of pharmacy administration.
Both seasonal and H1N1 influenza pose a greater risk of severe illness and complications in patients with diabetes-and these infections can also wreak havoc with blood glucose levels.
Case 1: Mr A. is a 55-year-old man who comes to your office for a routine physical examination. He is a traveling salesman and has recently gained weight. He does not exercise much and is a frequent visitor to fastfood establishments. His father had “a touch of diabetes” and died of a myocardial infarction (MI) at age 59.
Chronic diseases and multiple comorbid conditions can be a frustrating part of any primary care day. Health care professionals work hard and are long overdue to see the “fruits” of their many labors. One area in which progress and personal satisfaction have been particularly slow in coming is the day-to-day management of diabetes.
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.
