Diabetes

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.

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.1 Highlights of those recommendations are presented here.

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?

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.