Physicians' Corner - Sunshine on a Rainy Day: Good News
Charles F. Shaefer, Jr., MD, FACP, FCCP
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.
Advanced Insulin Management Program Reduces A1C Levels and Regimen-Related Distress Without Weight Gain in Patients With Type 1 Diabetes Mellitus
Lisa H. Fish, MD, Harry P. Wetzler, MD, Janet L. Davidson, RN, Cori L. Ofstead, MSPH, and Mary L. Johnson, RN
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.
Development and Implementation of Evidence-Based Guidelines for IV Insulin: A Statewide Collaborative Approach
Lawrence Stockton, RPh, Marianne Baird, RN, Curtiss B. Cook, MD, Robert C. Osburne, MD, Joyce Reid, RN, Kathryn McGowan, MPH, Sabrina Jarvis, MS
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.
Global Diabetes Landscape -Type 2 Diabetes Mellitus in South Asia: Epidemiology, Risk Factors, and Control
Rajeev Gupta, MD, PhD and Praneet Kumar, MBBS, DHA
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 Management in Basal-Bolus Insulin Therapy for Type 2 Diabetes Mellitus: The Deep South Diabetes Program
JosAnn Duane, PhD and William Conway, MD
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)
Desmond Schatz, MD
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.
Response to Previous Case Study
Derek LeRoith, MD, PhD
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.
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