Diabetes

Apr 14, 2017

More than 15 million Americans have coronary heart disease and most should be taking aspirin daily.1  Given aspirin’s ubiquity in cardiovascular medicine and patients’ pill boxes, it is shocking that there are still so many unanswered questions about aspirin use.  Which dose and dosage forms should be prescribed?  How common is aspirin resistance?  What is the relationship between platelet inhibition and clinical outcomes?

 

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Feb 24, 2017

Hypertension affects more than 70% of patients with type 2 diabetes mellitus and further increases the risk of cardiovascular disease in this high risk population.1 While renin angiotensin system (RAS) blockers are clearly indicated in patients with heart failure, chronic kidney disease with proteinuria, and coronary artery disease (CAD), experts have come to different conclusions regarding their role as initial antihypertensive therapy for patients with diabetes (See Table 1).

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Jan 13, 2017

Pharmacotherapy for diabetes management has expanded in recent years with several new drug classes.

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Nov 11, 2016

Approximately one in three patients with diabetes in the United States have chronic kidney disease (CKD).1 As CKD is progressive and irreversible, the goal is to slow its progression.

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Sep 29, 2016

A recent paper published in Diabetes Care proposes a new classification system for diabetes that challenges our existing paradigm and has significant implications for our treatment approach to diabetes.1  Here are eleven key takeaway points that every practitioner should know about the proposed beta-cell centric classification schema:

 

Background:

 

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Sep 2, 2016

Cardiovascular disease is the leading cause of morbidity and mortality in patients with type 2 diabetes.1 While many medications effectively treat the hyperglycemia and microvascular complications associated with diabetes, there has been a recent focus on medications that not only lower blood glucose but mitigate the risk of cardiovascular events.1  The need for more data regarding the macrovascular safety of antidiabetic drugs entered the spotlight in 2008 when the FDA

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Apr 22, 2016

After cardiovascular (CV) safety concerns emerged with rosiglitazone use, the Food and Drug Administration (FDA) now requires outcome studies to be performed for all new diabetes medications.1-3  Naturally, we’d prefer to use medications to treat diabetes that actually reduce CV risk – but, at a minimum, they shouldn’t be harmful.  The first CV safety study (ELIXA) for a drug in the glucagon-like peptide 1-receptor agonist (GLP-1 RA) class – lixisenatide - was recently pub

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Mar 11, 2016

Basal, prandial, NPH, ultra-long, inhaled, 70/30, 75/25, 50/50, U-100, U-200, U-300, and U-500 insulin … the list of options for patients with diabetes requiring insulin continues to expand. Current guidelines for glycemic management of patients with type 2 diabetes provide specific recommendations for the initiation of insulin therapy, but not insulin intensification. This is due to a lack of clinical trials comparing treatment strategies.

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Jan 8, 2016

With increased emphasis on disease prevention, gestational diabetes (GDM) is worthy of more attention. The incidence of GDM is on the rise not only in the United States (U.S.) but worldwide.1,2 Complications of GDM such as preeclampsia, cesarean delivery, neonatal hypoglycemia, macrosomia, and birth trauma negatively impact maternal and fetal health.  And result in a heavy economic burden.

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Nov 19, 2015

When deciding which medications to use to treat a patient with type 2 diabetes, there are many options after initial treatment with metformin. The selection of a second-line agent is based on many factors including efficacy, cost, adverse effects, effect on weight, comorbidities, hypoglycemia risk, and patient preference.1  No clear consensus exists.  One characteristic that would truly help differentiate agents is their effect on cardiovascular events.

 

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Jul 9, 2015

The role of continuous subcutaneous insulin infusion (CSII) in Type 2 Diabetes Mellitus (T2DM) is not clearly defined.1 In patients with type 1 diabetes mellitus, CSII improves glycemic variability, lowers the risk of hypoglycemia, reduces hemoglobin A1C (A1C), and increases treatment satisfaction as well as quality of life when compared with multiple daily injections (MDI).2,3 However, studies in patients with T2DM have produced conflicting findings.4,5,6,7 S

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Feb 12, 2015

The treatment options for type 2 diabetes mellitus (T2DM) have increased dramatically over the past decade. Despite these advancements, treatment recommendations remain largely unchanged. The American Diabetes Association (ADA) recommends that patients newly diagnosed with T2DM modify their diet, exercise, and take oral medication (i.e. metformin).  Only later should injectable therapies be considered.

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Sep 24, 2014

Your patients with diabetes may have heard through the grapevine about resveratrol to control blood sugar.

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Jun 28, 2014

This is a brief review of the CANTATA-SU trial and a discussion about the role of sodium glucose co-transporter 2 (SGLT2) inhibitors for the treatment of type 2 diabetes.

Are medications in this new class of agents something we should consider earlier in the treatment of type 2 diabetes?  Or perhaps even for the treatment of type 1 diabetes?  Are you concerned about their adverse effects and long-term safety?  Tell us what you think by posting a comment.

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May 1, 2014

Should we use a GLP-1 receptor agonist (GLP-1RA) rather than basal insulin in patients with type 2 diabetes whose glycemic control are falling short on oral agents alone? Metformin is strongly recommended as initial therapy by both the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE).1,2  But most patients will require more than one agent to get to goal.

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Feb 26, 2014

A simple fecal sample may be able to predict your patient’s risk for developing type 2 diabetes.  That’s right, not a blood test, but a STOOL test.   Our microbiome, the ecological community of microorganisms that share our bodies, influence our risk for disease.  And not just irritable bowel syndrome but many other diseases including type 2 diabetes, depression, cancer, asthma, psoriasis, and autism.1  Research regarding the connections between our microbiome and disease

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Feb 5, 2014

In the United States, nearly 70% of adults are overweight or obese.1  Excess adipose tissue increases the likelihood of developing sleep apnea, type 2 diabetes mellitus (T2DM), dyslipidemia, and hypertension. The rate of all-cause mortality in obese individuals is higher when compared to normal weight individuals.2 Its imperative that we address body weight with all patients in all health care settings – but particularly in primary care settings.

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Sep 14, 2013

The recently published Look AHEAD trial found intensive lifestyle interventions had no benefit on cardiovascular (CV) morbidity and mortality in patients with diabetes mellitus (DM).  Could the results possibly be valid?  Should we stop emphasizing diet and exercise?

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Sep 30, 2012

Does insulin worsen cardiovascular outcomes and cause cancer? Should insulin be reserved as the last resort?

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Jun 16, 2012

Blood pressure is known to follow a circadian rhythm in which the blood pressure falls by approximately 10% overnight. In many patients with hypertension (HTN) this drop in nocturnal blood pressure is blunted.  These patients are affectionately called “non-dippers.”  The non-dipping blood pressure pattern has been associated with a higher risk of cardiovascular events.  Several studies have evaluated the utility of changing blood pressure medication dosing times to bedtime.

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Jan 31, 2012

For diabetes patients uncontrolled on basal insulin therapy, is adding exenatide a good choice?

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May 3, 2011

Are you treating to an evidence-based blood pressure goal in patients with diabetes?

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Apr 18, 2010

The primary study (glycemia) in the ACCORD trial was terminated early after concerns emerged regarding the safety of a very aggressive treatment strategy.  This landmark trial has led many to re-examine the risks and benefits of intensive glycemic control in patients with type 2 diabetes. 

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