Insulin as a strategy to optimize glycemic control in patients with type 2 diabetes
November 14th 2008Treatment 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.
Alogliptin: The newest agent to fight the diabetes pandemic
November 14th 2008According to the American Diabetes Association (ADA), 23.6 million children and adults have diabetes (8% of the US population) and another 5.7 million cases remain undiagnosed. Epidemiologists predict that these statistics will double by 2030, further taxing the healthcare system. Medical expenditures are approximately 2.3 times higher for diabetic versus nondiabetic patients, and the annual cost of diabetes is estimated to be $116 billion.
Nonfasting triglycerides and ischemic heart disease in men and women
Triglyceride levels are usually measured after the patient has fasted, and then exclude remnant lipoproteins. Except for the first few hours of the morning, individuals are usually in a nonfasting state for most of the day. We investigated whether nonfasting triglyceride levels predicted the risk of myocardial infarction (MI), ischemic heart disease, and death in the general population. Results showed that increased nonfasting triglyceride levels were associated with an increased risk of MI, ischemic heart disease, and death.