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The Why and Wherefore of Glucose Control in Type 2 Diabetes Mellitus
John W. Hare, MD
Insulin was first used to treat diabetes mellitus (DM) in 1922. Most of the diagnosed cases of DM then were symptomatic and, thus, type 1 DM. Blood glucose testing generally was not done unless the patient developed symptoms; as a result, most cases of type 2 DM went undiagnosed. As insulin therapy rapidly became available, deaths from diabetic ketoacidosis (DKA) plummeted. In the mid-20th century it became apparent that, although insulin therapy conferred an immediate survival benefit, it allowed the later development of vascular complications. By the mid-1940s, most deaths from diabetes were cardiorenal in nature and few were ascribed to DKA. |
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Incorporating Postprandial and Fasting Plasma Glucose into Clinical Management Strategies
Bruce W. Bode, MD
Targeting plasma glucose is a widely accepted practice in the treatment of both type 1 and type 2 diabetes mellitus (DM). Although clinicians have traditionally relied on fasting plasma glucose (FPG) levels for diagnosis and as a target for therapy, the focus has expanded to include the contribution of postprandial glucose (PPG) to glycosylated hemoglobin (A1C) levels. This article examines the contributions of FPG and PPG to A1C levels in patients with diabetes and discusses the impact of these findings on insulin treatment strategies for patients who fail to achieve recommended A1C goals.
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