Diabetes

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.

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.

AMSTERDAM -- Average blood glucose appears to accurately reflect the daily variations in glycosylated hemoglobin that patients experience, and it may become a new glycemia measure that's easier for patients to grasp than HbA1c.

CALGARY, Alberta -- Exercise strengthens glycemic control for type 2 diabetes patients whether they walk on a treadmill or pump iron, but combining aerobic and resistance exercise appears to have the greatest benefit.

AMSTERDAM -- Inhaled insulin can't entirely replace injections, but it might help patients with type 1 or type 2 diabetes get better control of their glucose levels, said diabetologists here.

AMSTERDAM -- Patients with poorly controlled type 2 diabetes were four-times more likely to achieve target glycemia levels when metformin therapy was combined with a novel dipetidyl peptidase-4 (DPP-4) inhibitor, reported researchers here.

CLEVELAND -- Meta-analyses of the two FDA-approved thiazolinediones for diabetes -- rosiglitazone (Avandia) and pioglitazone (Actos) -- left neither drug unscathed.

SAN DIEGO -- There was unexpected resolution of silent myocardial ischemia for almost 80% of diabetic patients over three years, possibly because of aggressive therapy, according to a study reported here.

NEW YORK -- Experiments in mice suggest that the type 2 diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) increase uptake of both glucose and triglycerides in cardiac tissue, causing or exacerbating heart failure.

DALLAS -- A fatty heart, cardiac steatosis, can occur in patients on the road to type 2 diabetes and in the presence of normal left ventricular dysfunction, investigators here have determined.

VIENNA, Sept. 4 -- Even normotensive patients with diabetes can reduce their risk of heart attack, stroke, and renal failure by lowering of blood pressure, researchers reported here.

ABSTRACT: Low-density lipoproteins are the most common atherogenic particles in diabetic dyslipidemia; therefore statins, which dramatically reduce low-density lipoprotein (LDL) cholesterol, are first-line therapy for patients with diabetes. These agents produce equivalent relative risk reductions in those with and without diabetes but confer greater absolute risk reduction because of the increased incidence of ischemic cardiovascular events in those with diabetes. The LDL cholesterol goal for patients with diabetes who do not have coronary heart disease is below 100 mg/dL. For secondary prevention, the goal is below 70 mg/dL. High-dose statin therapy may be required to achieve these goals. Fibric acids are a reasonable initial option for patients with triglyceride levels above 200 mg/dL and high-density lipoprotein (HDL) cholesterol levels below 40 mg/dL; in such patients they reduce risk as effectively as statins. Intermediate-release niacin raises HDL cholesterol levels; the effect is enhanced when niacin is combined with a statin.