Editorial

Steven V. Edelman, MD, and Derek LeRoith, MD, PhD

This issue of Insulin covers vital therapeutic topics over a lifetime of diabetes, from in utero to the typical population of older obese adults with type 2 diabetes mellitus (DM).

John Hare, who has devoted his long and impressive career with the Joslin Clinic to the field of diabetes and pregnancy, offers us a fascinating historical perspective of how far we have come in the past 100 years. It is crucial to know our progress, in terms of maternal and fetal health, so that we may understand and implement the necessary strategies for optimal health in 2009.

A pilot study by Stan De Loach examines how to successfully address young children and adolescents with type 1 DM in a camp setting. Although the challenges of coping with type 1 DM in any population are tremendous, with all the variables that affect glucose control, young people may have more physical and emotional barriers to overcome. This article helps us explore creative approaches to this important group of patients as they develop lifelong self-care habits.

As a population gets older, beyond adolescence and young adulthood, obesity plays a major role in the development of diabetes and heart disease. Bariatric surgery is becoming more prominent in the treatment of this growing problem. Drs. Klonsky and Murr provide us with an excellent, easily understood (especially for us nonsurgeons) description of the surgical procedures currently being used to address morbid obesity, along with an interesting discussion on the potential role of incretins in improving diabetes care and weight loss after a procedure that rearranges the normal structures of the small intestine.

Lastly, Jeff Unger and Chris Parkin detail a number of practical approaches to treating the typical adult with type 2 DM, dissecting the different therapeutic options including lifestyle changes and pharmaceutical agents. This article is meant to educate every medical professional, no matter what their specialty, about the important basics of diabetes care—one of the many goals it has in common with this journal. Insulin attempts to address the main issues of diabetes care in a way that is practical and informative for every professional interested in the prevention and treatment of this chronic condition.

Physicians’ Corner—The Pen Is Mightier Than the Sword

Charles F. Shaefer, Jr.

Because we now have a choice between pen and syringe when delivering every basal and rapid-acting insulin analogue, every premixed insulin product, and the amylin analogue pramlintide, the question of pen versus syringe seems quite pertinent.

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Metabolic Surgery for Type 2 Diabetes Mellitus

Jonathan Klonsky and Michel M. Murr

Metabolic surgery for morbid obesity induces significant weight loss and resolution of many obesity-related comorbidities, the most notable of which is remission of type 2 DM.

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Appropriate, Timely, and Rational Treatment of Type 2 Diabetes Mellitus: Meeting the Challenges of Primary Care

Jeff Unger and Christopher G. Parkin

Patients with prediabetes should be managed with a combination of lifestyle intervention and appropriately timed pharmacotherapy. Pancreatic β-cell preservation should be a primary metabolic target.

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A Pilot Study to Stabilize Normoglycemia During an Educational Camp for Children and Adolescents With Type 1 Diabetes Mellitus

Stan De Loach

The prime clinical objective is to minimize hypoglycemia and hyperglycemia by maintaining daily mean BG values within the target range (71–99 mg/dL), by limiting the 3-day estimated mean amplitude of glycemic excursion (eMAGE) value to ≤95 mg/dL, by advocating ad libitum self-monitoring of BG (SMBG) and physical activity, and by facilitating informed food selection and intake.

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Birth Defects in Infants of Diabetic Mothers: A Historical Review

John W. Hare

Birth defects, once unnoticed in infants of diabetic mothers, became a leading concern. It is now possible to reduce the incidence of these defects to levels seen in nondiabetic pregnancies.

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Insulin Therapy: Questions This Issue

Dina E. Green

Could a woman with type 1 diabetes mellitus (DM) begin to produce insulin after pregnancy? Are thiazolidinediones (TZDs) only effective when a patient with type 1 DM is still producing insulin, and not when any type of injectable insulin is required? Apart from clinical findings, how can you tell with certainty whether a patient has type 1 DM? How long can an insulin-resistant patient take high-dose steroids and insulin without loss of glycemic control?

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Responses to April 2009 Case Study

Ronald Tamler and Derek LeRoith

This was the case of a 56-year-old man with poorly controlled type 2 DM and ED.

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Incretin-Based Therapies

Julio Rosenstock, on behalf of CADRE

Conference Reporter III: Incretin-Based Therapies

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Patient Handouts

Provided by Learning About Diabetes, Inc.

Let’s Get Moving — Diabetes and Exercise
My Weekly Exercise Plan — Have Fun Being Active
Walking Works — Every Step Counts

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