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Moving Toward Weight-Centric Care in Diabetes

Moving Toward Weight-Centric Care in Diabetes

Obesity is now recognized as one of the leading causes of many diseases. There are also other impor-tant factors to consider, such as the medical costs associated with obesity and obesity-related comorbidities. “It’s essential to improve our treatment strategies for managing obesity so that we can effectively reduce the rate of obesity-related conditions, most notably type 2 diabetes,” says Louis J. Aronne, MD, FACP. Shifting the Approach According to Dr. Aronne, much of the focus on managing patients with diabetes is to get A1C levels within a normal range. “While this is an important part of caring for patients with diabetes, it’s also paramount that clinicians recognize that many commonly used diabetes therapies can cause weight gain as a side effect,” he says. Patients can gain a significant amount of weight in a relatively short period after initiating diabetes medications. Drug-induced weight gain can have many consequences, including patient non-compliance with treatment regimens once weight gain occurs and health complications associated with weight gain itself. “If patients gain weight from taking their diabetes drugs,” Dr. Aronne says, “it’s possible that this can mitigate control of their diabetes. Although effective glucose control remains important, it cannot come at the expense of worsening obesity. A paradigm shift is needed in which physicians use a weight-centric approach to managing diabetes rather than a glucose-centric model.” Even modest weight loss can improve multiple cardiovascular risk factors while simultaneously improving glycemic control. Published guidelines have supported the concept of shifting treatment plans for diabetes toward a weight-centric approach. “Weight loss via lifestyle modifications and pharmacotherapy are now encouraged earlier in the treatment of diabetes...
The Connection Between Sleep Apnea & Diabetes

The Connection Between Sleep Apnea & Diabetes

In clinical research, sleep disordered breathing conditions like obstructive sleep apnea (OSA) have been associated with insulin resistance and glucose intolerance. OSA is typically characterized by loud snoring and pauses in breathing while sleeping. Excess weight is often considered the cause of OSA because fat deposits around the upper airways obstruct breathing. Obesity has been identified as a significant risk factor for OSA as well as diabetes, but studies suggest that obesity status is not the only determinant. Also, diabetes itself is a major risk factor and complication of OSA. In addition to causing poor sleep quality and daytime sleepiness, OSA has other important clinical consequences, including an increased risk of hypertension and cardiovascular disease (CVD). Despite the significant burden that OSA and other sleep disorders has on patients, these health problems are not well recognized by clinicians. “OSA is commonly found in people with type 2 diabetes, but clinicians need to ask their patients about daytime drowsiness, snoring, and impaired sleep symptoms in order to identify the problem,” says Daniel Einhorn, MD, FACP, FACE. He notes that the link between OSA and type 2 diabetes has important clinical, epidemiologic, and public health implications. “When OSA is treated appropriately, it’s possible to prevent serious health problems,” he says. “This is particularly relevant in the context of coexisting type 2 diabetes, when patients are already at significant risk of CVD.” Understanding the Clinical Picture Sleep-disordered breathing encompasses several characteristic complications (Table 1). Other symptoms and associated clinical disorders are seen more commonly in those with OSA than would be expected by chance. “Sleep apnea can decrease quality of life,” says...
Who Broke The American Healthcare System?

Who Broke The American Healthcare System?

Healthcare is a hot topic in the media these days. Yet, few people are satisfied with the way it is working. Many claim that the American healthcare system is broken. Patients are increasingly frustrated with finding a doctor, getting tests and medications they need, and paying for out-of-pocket expenses. Numerous doctors are disenchanted with their career choice, and burnout is a common complaint. Frequently, doctors are now looking to retire early or for alternate career paths. Treating patients has become unfulfilling for many due to administrative burdens, increasing government regulations, and overbearing insurance over-sight. Doctors fight daily to get procedures and medications covered that their patients need. Most often, the battle is with someone who is not even a doctor or has any clue about the patient. These daily battles become wearing. Additionally, doctors now have to fight on a more abundant basis to get paid for services they provided. Their incomes are stagnant or shrinking while overhead costs are soaring. Increasingly, doctors are selling out their practices and joining large groups and hospitals. “When I go in the exam room and close the door, I face my patient and am again reminded of why I became a doctor: to alleviate suffering.”   Many people look to put blame on doctors for the broken healthcare system. Yet, it has been years since doctors truly had any control over it. More often these days, doctors are treated like pawns and servants, our independence and integrity being worn away and questioned. But, who really is to blame for the broken healthcare system? 1. Commercial insurance companies who have no oversight and...
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