Type 2 Diabetes

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.

It is difficult to make generalizations about treatment of elderly diabetic patients with coronary artery disease (CAD).

We evaluated the prognostic role of metabolic syndrome after myocardial infarction and found that metabolic syndrome correlated with an increased risk of cardiovascular events and death. The risk of developing diabetes decreased with weight loss in patients with metabolic syndrome. These results indicate that a more aggressive approach to the treatment of patients with metabolic syndrome, particularly with regard to changes in lifestyle, would be beneficial.

If only we could do for diabetes what we have done in the past decade for hyperlipidemia.

The study by Kurth and Buring consisted of a prospective analysis among nearly 40 000 women participating in the Women's Health Study.

A 36-year-old Hispanic man was diagnosed with type 1 diabetes in 1987 and dyslipidemia in 2001.