Insulin Journal
VOLUME 3, NUMBER 2
Editorial
One of the most important features of successful diabetes management is cooperation—namely, a "team approach." This includes not just the physician and the patient, but all health care providers and educators, a fact that is made clearer in this issue of Insulin. Patients and providers work closely to prevent much of the weight gain that tends to occur with insulin therapy, even when using basal-bolus regimens. This is in contrast to patients with type 1 diabetes mellitus, who may not necessarily gain weight on pump therapy with multiple daily injections of insulin. This issue also highlights the results of a multicenter study showing that, if used appropriately, intensive IV insulin therapy generally avoids hypoglycemia despite fairly rapid correction of hyperglycemia, whether in an intensive care unit (ICU) in a large teaching hospital or a surgical ICU in a midsize hospital.
On the topic of cooperation and collaboration, it is with great enthusiasm that we announce a new partnership between Insulin and the Council for the Advancement of Diabetes Research and Education (CADRE). CADRE is primarily an educational organization whose mission is to promote diabetes education to health care providers in an effort to achieve excellent diabetes management. Every issue of Insulin will have space dedicated to CADRE. This first collaborative issue presents a case report from the CADRE Web site. We invite all our readers to review this case, visit the CADRE Web site, and participate in the many CADRE educational materials that complement the excellent articles and case studies available in every issue of Insulin.
Physicians' Corner - Sunshine on a Rainy Day: Good News
An article published in January 2008 reported a decrease in the average glycosylated hemoglobin (A1C) level in America for the first time in more than a decade! This is wonderful news, indeed! The decrease itself is noteworthy, but the news gets even better. It seems that aggressive treatment of our patients with type 2 diabetes mellitus (DM) is paying off in lasting ways. The extended results from the Steno-2 study reported a few weeks ago indicate that careful attention to overall control of multiple risk factors in patients with type 2 DM produces long-term benefits by reducing the risk of stroke and heart attack, the major complications of the disease.
The Epidemiology of Diabetes Interventions and Complications Study showed the importance of early, intensive insulin treatment in patients with type 1 DM. Intensive treatment using MDIs or CSII is one aspect of attaining enhanced control. Current evidence also indicates that education and guidance from a diabetes care team are useful in improving control. The International Diabetes Center has developed an innovative, outcomes-driven, Advanced Insulin Management (AIM) program to assist patients in achieving better control.
In early 2002, the Partnership for Health and Accountability identified hospitalized patients with diabetes and/or hyperglycemia as a high-risk group. It was determined that application of best practices may have a dramatic impact on inpatient morbidity and mortality rates. Multiple studies revealed striking decreases in morbidity and mortality rates when hyperglycemia was controlled in hospitalized patients.
DM has been present in South Asia for centuries. Epidemiologic studies reveal that the prevalence of this condition has increased exponentially in urban populations and that even the underprivileged are not exempt. The region of South Asia that includes India, Pakistan, Bangladesh, Sri Lanka, and Nepal is home to 1.5 billion people, and recent estimates show that this area houses the largest number of people with DM in the world. This article summarizes studies that have been conducted on the epidemiology of DM in India and other countries of South Asia, discusses these findings in the context of worldwide data, and suggests population-based interventions for control of this epidemic. A novel national chronic care program is suggested.
Weight gain is considered to be a standard clinical complication of insulin therapy. This complication bears heavily on patient populations at risk for obesity, such as those in the southeastern United States. This study was designed to evaluate the weight changes associated with intensive basal-bolus insulin therapy in the Deep South Diabetes Program. Effectiveness was assessed by evaluating the relationship between changes in glycosylated hemoglobin (A1C) and changes in body weight that occurred during therapy.
CADRE's "Diabetes Tactics" (New Feature)
In December 2007, the Council for the Advancement of Diabetes Research and Education (CADRE) implemented a new Web site initiative "Diabetes Tactics" case study each month that explores a different challenge in diabetes treatment. The scenarios presented are among those a health care provider is likely to encounter in practice, and each treatment challenge is followed by practical treatment information and suggestions from the experts on the CADRE Advisory Board. All case studies are available on the CADRE Web site (www.cadre-diabetes.org) free of charge. This month's "Diabetes Tactics" case discusses the treatment challenge created when an adolescent male with type 1 DM participates in sports and exercise programs. The treatment discussion was provided by Desmond Schatz, MD, Professor and Associate Chairman of Pediatrics, and Medical Director, Diabetes Center at the University of Florida (Gainesville, Florida); scientific research and writing assistance was provided by Julie Martin, MS.
Keeping your blood glucose levels in the recommended target range can help to prevent or delay the long-term complications of diabetes.
A 58-year-old, obese man with type 2 diabetes mellitus (DM), uncontrolled cardiovascular risk factors, and recently diagnosed, nonobstructive coronary disease comes to your office for comprehensive management.
A 50-year-old white male with type 2 diabetes mellitus (DM) is being treated with Humulin(R) 70/30 (Eli Lilly and Company, Indianapolis, Indiana) 10 U BID and glucophage 500 mg TID. The patient decided to seek another endocrinologist's opinion and was referred by his primary care provider.
