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Diabetes Update Vol. 2

We are proud to present this diabetes monograph with feature stories on several important topics relating to the disease. Most of the articles were created with the assistance of key opinion leaders recommended by the American Diabetes Association. These features rely on clinical and evidence-based information and the expertise of our contributing physician authors. Physician’s Weekly will continue to feature diabetes news in the coming months and we hope you find this information...

New Guidelines for Glucose Testing

Research suggests that approximately one-third of patients admitted to hospitals in the United States have a blood glucose level greater than 180 mg/dL. The CDC estimates that admissions for patients with diabetes increased from 2.8 million in 1990 to 5.5 million in 2009. These are conservative estimates that do not account for patients who experience a transient increase in blood glucose during stress or illness. Previous guidelines have addressed the care of hospital patients with hyperglycemia, but these recommendations focus mostly on individuals in the ICU. “We’re still missing many individuals because most hospital patients aren’t admitted to the ICU,” explains Guillermo Umpierrez, MD. “Studies have shown that hyperglycemia is associated with an increased number of complications in general medical and surgical patients. More recently, data suggest that treating these patients can decrease the number of complications they experience and improve glucose control.” Addressing the Issue In 2012, the Endocrine Society collaborated with five other medical associations to release a consensus guideline on the management of hyperglycemia in non-critically ill hospitalized patients. The guidelines are divided into eight areas, beginning with diagnosis and recognition of hyperglycemia and diabetes (Table 1). “In agreement with previous guidelines, hyperglycemia is defined as a fasting or pre-meal blood glucose level greater than 140 mg/dL in hospitalized patients with and without a history of diabetes,” says Dr. Umpierrez, who was the lead author of the guidelines. “Patients with elevated blood glucose are recommended to undergo an A1C test in the hospital because it can assess the level of glucose control they have at home and guide therapy when patients are being prepared for discharge....
Early Observations From Look AHEAD

Early Observations From Look AHEAD

Type 2 diabetes continues to adversely impact life expectancy, quality of life, and medical costs. Compounding the problem is that obesity among patients with diabetes is also increasing, further impacting the potential for future improvements in life expectancy and quality of life for these patients. It has been well established that the excess morbidity and mortality experienced by people with diabetes is primarily due to increased cardiovascular disease (CVD) risk, specifically the triad of hyperglycemia, hypertension, and hyperlipidemia. People with type 2 diabetes die about 8 years earlier than those without the disease, primarily due to their increased risk of CVD. Interventions to reduce the adverse health outcomes of diabetes are primarily directed at cardiovascular risk factors, but despite these efforts most patients do not appear to be achieving optimal care goals for CVD risk reduction. Clinical studies have demonstrated that effective programs for people with diabetes that achieve long-term weight loss and increase physical activity are promising for improving cardiovascular risk while minimizing use of pharmacologic agents. More research continues to explore the role of lifestyle interventions in these patients. The Look AHEAD (Action for Health in Diabetes) study is an ongoing NIH trial, which is examining the effect of an intensive lifestyle intervention (ILI) on CVD morbidity and mortality in people with diabetes. The ILI includes group and individual meetings to achieve and maintain weight loss by decreasing caloric intake and increasing physical activity; the comparator is a traditional diabetes support and education intervention (DSE). In the June 2010 issue of Diabetes Care, my colleagues and I examined the effect of the Look AHEAD intervention on medication...
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