Type 2 Diabetes

I am convinced that we essentially sabotage both our guests and ourselves when we offer only these high calorie and often totally unhealthy options time and time again.

New evidence suggests that it may be time to rethink the suggested diabetic diet.

Modulation of the renin-angiotensin-aldosterone (RAA) system using angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) has been shown to have beneficial effects on blood pressure, diabetic nephropathy, coronary heart disease, and heart failure.

New technologies are improving the lives of people living with diabetes.

In their post hoc analysis of the DIGAMI 2 (Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction 2) study, Mellbin and colleagues suggest that insulin therapy after myocardial infarction (MI) may be associated with increased clinical events (not mortality), whereas metformin therapy may be associated with reduced events and sulfonylurea therapy with neutral effects.

The negative effects of high-fructose corn syrup have previously been reported in several types of studies.

New research from the Regional Hospital of Bolzano in Italy suggests that "pediatric obesity may induce alterations in thyroid function and structure."

A 77-year-old woman with diabetes, hypertension, and hypothyroidism was first assessed as an outpatient in 2004.

Patients with new-onset diabetes mellitus in the VALUE (Valsartan Antihypertensive Long-term Use Evaluation) trial had an increased incidence of atrial fibrillation compared with patients without diabetes. Clustering of risk factors or the presence of dysglycemia may make the heart more susceptible to arrhythmias.

The incidence of atrial fibrillation (AF), which is the most frequently encountered sustained cardiac arrhythmia, is increasing in the United States.

Treatment of type 2 diabetes should achieve and maintain euglycemia, thereby preventing complications from this progressive disease. Current antidiabetic therapies should be a part of a multimodal management program that includes diet, exercise, and blood pressure and lipid control. Oral antidiabetic drugs are still first-line therapy for type 2 diabetes, but intensification of therapy, including starting insulin, should occur every 2 to 3 months as needed to achieve euglycemia. The first insulin added is typically a basal insulin, which is effective in lowering fasting plasma glucose (FPG). A persistently elevated glycated hemoglobin (HgbA1C) level despite near or complete normalization of FPG, however, indicates postprandial hyperglycemia. In these cases, the addition of bolus insulin is required to reduce postprandial glucose (PPG). Several approaches to initiate and titrate insulin can be used based on FPG, PPG, HgbA1C, and patient factors.

The relationship of glucose levels to cardiovascular disease (CVD) risk, especially coronary heart disease (CHD), in observational data sets has been the subject of several studies. These studies have shown that the relationship between fasting (and postprandial glucose) and CHD risk is continuous and graded, and that this relationship extends below the currently defined threshold for diagnosing diabetes mellitus. The assumption has been that glycemic control in patients with diabetes mellitus should favorably affect CVD outcomes in randomized clinical trials; however, the results of several large trials have not consistently confirmed this hypothesis. In fact, ACCORD (Action to Control Cardiovascular Risk in Diabetes) data suggest a small increased risk in mortality for patients at high risk for CHD events.

Being a relative newcomer to the field, I face new medical, ethical, technical situations on a daily basis, a reminder that learning does not end with medical school and residency.

There have already been some snags and alarms raised in questioning just how successful this new batch of tech toys for diabetes will be in the end.

The number of children taking medications for chronic conditions significantly increased between 2002 and 2005.

The government has found that new cases of diabetes rose by more than 90% among adults over the last 10 years; helping patients prevent and manage this disease is a top priority for pharmacists.

Two 42-year-old men with a serum cholesterol level of 225 mg/dL presented to our institution.

Patients with type 2 diabetes mellitus gain added benefit if their exercise regimen included aerobic activities and eccentric resistance training.

A 75-year-old former dentist was admitted to our department for evaluation of chronic angina pectoris.

Despite some caveats, the vast majority of people I know on insulin pumps are very happy with their control and flexibility.

Rates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.

The British Medical Journal concluded that their research does "not provide evidence to support the use of aspirin in primary prevention of cardiovascular events and mortality."

The benefits of intensive glycemic control appear to be confined to microvascular disease, with 3 randomized controlled clinical trials failing to demonstrate a macrovascular benefit with intensive glycemic control in patients with type 2 diabetes.

Many of us will see a big increase in the number of patients who are simply unable to afford their medications.

Early warning signs of gestational diabetes can be found within nine weeks of gestation.

The AMIS (Acute Myocardial Infarction in Switzerland) Plus prospective cohort study compared treatment and in-hospital outcomes between men and women with acute coronary syndrome (N = 26,452) admitted to Swiss hospitals between 1997 and 2007. The study reached several important conclusions: women had different baseline characteristics than men at admission, were treated with different drug regimens, and were significantly less likely to undergo percutaneous coronary intervention. After adjusting for these differences, researchers found no significant difference in the rates of in-hospital mortality between men and women, except for women aged 51 to 60 years, who were more likely to die in-hospital.

We analyzed the results of the Trial of Invasive Versus Medical Therapy in the Elderly with Chronic Coronary Artery Disease (TIME) in which invasive treatment was compared with optimized medical treatment in patients with chronic angina aged 75 years and older. Patients with diabetes had higher mortality than nondiabetic patients, but revascularization improved overall survival similarly in diabetic and nondiabetic patients.