Diabetes

Despite impressive advances in the treatment of diabetesmellitus over the past quarter century, the disease continuesto have devastating consequences. It is the leading cause ofblindness in adults younger than 75 years, the cause of morethan 50% of lower leg amputations, and the cause of deathin 75% of affected patients. Moreover, the incidence of diabetesis rising rapidly. This 5th edition of a classic referenceprovides step-by-step guidance on the office management ofthe disease, from the initial evaluation through approachesto such specific issues as travel, hygiene, and weight control.The discussion of treatment options has been updated andincludes newer insulin analogs, recently approved medications,and combination therapy. New chapters cover medicalnutrition therapy, insulin resistance and macrovascular disease,and diabetes in children. Up-to-date discussions of thepsychological implications of the disease and findings fromthe United Kingdom Prospective Diabetes Study are also included.The book is illustrated with numerous tables, algorithms,graphs, and diagrams. In addition, patient educationworksheets and handouts are provided.

Should statin therapy be initiated in all patients with diabetesregardless of their HbA1c and low-density lipoprotein(LDL) cholesterol levels?

I recently diagnosed type 2 diabetes mellitus in a 33-year-old man who has no diabeticsymptoms, proteinuria, or evidence of nephropathy. His blood pressure is low(100/60 mm Hg).

When should children who have a family history of either type 1 or type 2 diabetesbe screened for prediabetes?

When a patient with diabetes presentswith a foot wound, prompt and aggressiveintervention is required topromote healing and to prevent progressionthat could lead to a leg amputation.Fortunately, the majority ofdiabetic foot wounds heal rapidly withlittle difficulty.

My patient is a 10-year-old boy with asthma. After an exacerbation of his asthmawas treated with albuterol and solumedrol, his blood glucose level was 250 mg/dLwith 1+ glucosuria (no ketones).

Men and women with diabetes are 2 to 4 times more likelythan other persons to die of complications of cardiovasculardisease (CVD). Solid evidence from primary andsecondary prevention trials has prompted the AmericanDiabetes Association to recommend low-dose aspirin therapyfor patients with diabetes who either have or are athigh risk for CVD (Table).

Is there evidence that treating elevated fasting glucose levels or impairedglucose tolerance, from early in pregnancy until term, improves outcomes(ie, fewer cesarean deliveries, fewer macrosomic babies, fewer patients in whompreeclampsia develops, fewer mothers who subsequently require insulin)?

In his article “High-Risk Hypertensive Patients: How to Optimize Therapy UsingACE Inhibitors and ARBs” (CONSULTANT, October 2003, page 1390), Dr JanBasile recommends angiotensin-converting enzyme (ACE) inhibitors for patientswith type 1 diabetes with or without hypertension, whether or not nephropathyis present.

A 57-year-old African American man comes to your office because he isconcerned about his blood pressure (BP). When it was measured at a healthfair a month earlier, it was 157/96 mm Hg; a week later at a clinic it was162/97 mm Hg. Now his resting BP is 166/101 mm Hg.

Over the past 8 years, fragile vesicles,painful ruptured bullae, and erosionshave developed on the sun-exposed skinof a 57-year-old man. Some of the vesicleserupt at sites of minor trauma; othersarise spontaneously. A corticosteroidcream prescribed by another practitionerfor presumed atopic dermatitisfailed to clear the lesions.

In recent years, 2 large randomized,controlled studies have documentedthe efficacy of the anticonvulsantgabapentin in the management ofpainful diabetic neuropathy (PDN)1and post-herpetic neuralgia (PHN).2Although vastly different in origin,these 2 neuropathies have exhibitedsome similarities in their response totherapeutic agents of various classes.The discovery that yet another typeof pharmaceutical is useful in treatingpain from either PDN or PHN hasraised questions about the similaritiesand differences in the managementof these 2 painful neuropathicsyndromes.

ROCKVILLE, Md. -- Against the background of the growing incidence of type 2 diabetes and obesity in the United States came news this year about the first new insulin delivery system in 80 years, as well as new categories of drugs for type 2 disease.

CAPE TOWN, South Africa -- The thiazolidinedione Avandia (rosiglitazone) has a more durable response than two older oral type 2 diabetes agents, but it was more expensive and had more side effects, researchers reported here.

BOSTON -- Even if diabetes is left out of the equation, higher-than-optimum blood glucose is a major worldwide killer, according to researchers here.

ST. LOUIS -- Decreasing caloric intake and increasing activity are equally effective at reducing the risk of diabetes, reported researchers here.

NEW YORK -- Uncomplicated diabetes does not affect 10-year heart transplant survival, but patients with diabetes-related renal disease or stroke do not do as well, reported surgeons here.

BOSTON -- The presence of diabetes may triple the risk of hepatocellular carcinoma in patients with advanced fibrosis or cirrhosis from hepatitis C infection, researchers reported here.

ATLANTA -- Excess mortality, common among Medicare-age diabetics, is greatest for women who use insulin to control their diabetes, according to an analysis of data from the Cardiovascular Health Study.

ROCKVILLE, Md. -- The FDA approved Januvia (sitagliptin) today, the first dipetidyl peptidase-4 (DDP-4) inhibitor, an oral agent for type 2 diabetes as monotherapy or in combination with Glucophage (metformin) or a PPAR agonist.

A 54-year-old woman with a 10-year history of insulin-dependent type 2 diabetes mellitus was referred by her optometrist because of the recent onset of blurrinessin her right eye. Her optometrist told her that new blood vessel growth and leakage had developed.

A 54-year-old woman with a 10-year history of insulin-dependent type 2 diabetes mellitus was referred by her optometrist because of the recent onset of blurrinessin her right eye. Her optometrist told her that new blood vessel growth and leakage had developed.

EDMONTON, Alberta -- Two years after receiving transplants of insulin-producing beta islet cells, only five of 36 patients with type 1 diabetes remained free of the need for insulin injections, reported investigators in a small multinational trial.

LEXINGTON, Ky. -- Diabetes is a strong predictor of acute organ failure and early death for obese or non-obese patients alike, eclipsing even obesity without diabetes, researchers here reported.

BOSTON -- The use of a GnRH agonist for local or regional prostate cancer is associated with an increased risk of diabetes, coronary heart disease, heart attack, and sudden cardiac death, according to researchers here.

CHICAGO -- Patients with type 2 diabetes who are chronically sleep deprived may have impaired glucose control and more serious complications of type 2 diabetes, researchers here found.

CHICAGO -- Patients with type 2 diabetes who are chronically sleep deprived may have impaired glucose control and more serious complications of type 2 diabetes, researchers here found.

COPENHAGEN -- The ACE-inhibitor Altace (ramipril) does not prevent type 2 diabetes in patients with impaired glucose metabolism, found DREAM trial researchers.

COPENHAGEN -- The ACE-inhibitor Altace (ramipril) does not prevent type 2 diabetes in patients with impaired glucose metabolism, found DREAM trial researchers.

My patient has diabetes, end-stage renal disease, and congestive heart failure (CHF)--and does not want to use insulin. What oral medication(s) would be considered optimal in this setting?