Diabetes

A 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.

BUFFALO, N.Y. -- The countdown to diabetes and coronary heart disease may start earlier for women with prediabetes than for men, researchers said here.

ORLANDO -- The risks of tight glycemic control for patients in intensive care outweigh the benefits, a Belgian researcher said here.

SAN FRANCISCO -- Tight glucose control during hospitalization for a stroke may not improve survival, British researchers said here.

Although most persons infected with Coccidioides immitis (Figure) are asymptomatic or have only mild illness, those who are immunocompromised are at increased risk for more severe disease. This is also true for patients with diabetes mellitus.

During a routine diabetes follow-up visit, a 55-year-old man complains of increasing pain in his right groin and hip. He is also being treated for hypertension, and his body mass index is 28.

HAIFA, Israel -- The phosphodiesterase-5 inhibitors led to a 26.7% successful intercourse rate, compared with controls, for men with diabetes-related erectile dysfunction, according to a meta-analysis.

LEICESTER, England -- Lifestyle changes appear to be at least as effective as drugs to prevent type 2 diabetes among patients with impaired glucose tolerance, according to a meta-analysis.

CHICAGO -- Inhibitors of the renin-angiotensin system trumped calcium-channel-blockers, beta-blockers, and diuretics in preventing diabetes, according to a network meta-analysis of hypertension trials.

A 63-year-old man presented for his annual eye examination. He has had type 2 diabetes for the past 20 years and takes glipizide.

VILLEJUIF, France -- Risk factors for new-onset diabetes following liver transplantation include hepatitis C status, weight, and impaired fasting glucose status, French investigators reported.

A 54-year-old woman reported a red jagged area of new onset in her right eye, along with many dark red spots and streaks in that eye. She also felt that her vision had become blurrier in that eye.

Your middle-aged patientwith type 2 diabetes wishesto start a weight-trainingprogram. What recommendationswill you offerhim? Another diabetic patient hasperipheral neuropathy; which exercisesare safest for her?

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.