Highlights

Physicians' Corner-Shopping for Basal Insulin on the Coffee Aisle: Lots of Choices for Lots of Tastes

Charles F. Shaefer, Jr., MD, FACP, FCCP

I think most clinicians would agree that there has been widespread acceptance of the use of basal insulin in the primary care community.  In recent months, I have rarely encountered primary care practitioners who are uncomfortable with initiation and titration of basal insulin. Most practitioners understand and accept its utility in the diabetes treatment paradigm. When I do find confusion relating to basal insulin, I have been impressed that it relates most often to uncertainty about which product to use.

Pregnancy Loss and Neonatal Death in Women with Type 1 or Type 2 Diabetes Mellitus

Tim Cundy, MD

In women with type 1 DM, the perinatal mortality rate decreased substantially in most western countries by the early 1980s and has remained stable over the past 25 years. The decrease in perinatal mortality was achieved predominantly by a reduction in the number of late intrauterine deaths and stillbirths. Currently, the major causes of pregnancy loss in type 1 DM are major congenital anomalies and complications of prematurity. Pregnancy in type 2 DM has been recognized as a problem in developing countries since the late 1980s, but is now emerging as a significant problem in western countries, particularly in disadvantaged communities.

Reducing Oxidative Stress in Patients with Type 2 Diabetes Mellitus: A Primary Care Call to Action

Jeff Unger, MD

The effects of chronic hyperglycemia, hyperlipidemia, and hypertension in patients with diabetes mellitus places these individuals at high risk for microvascular and macrovascular complications. Approximately 80% of patients with type 2 DM will succumb to cardiovascular complications such as stroke, peripheral arterial disease, and heart disease. Given the important role of oxidative stress in the development of complications of type 2 DM, physicians should consider methods to reduce oxidative stress that may occur during both acute (postprandial) and chronic hyperglycemia.