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Type 1 Diabetes, Celiac Disease, & Retinopathy

Among people with type 1 diabetes, having celiac disease for more than 10 years appears to be a risk factor for developing diabetic retinopathy. Based on their findings, the Swedish research team suggested that long-standing celiac disease in patients with type 1 diabetes warrants intense monitoring for diabetic retinopathy. Abstract: National Institutes of Health, September 10, 2012...

Transitioning From Pediatric to Adult Diabetes Care

This Physician’s Weekly feature covering the transitioning from pediatric to adult diabetes care was completed in cooperation with the experts at the American Diabetes Association. During childhood and adolescence, diabetes care gradually shifts from being supervised by parents and other adults or guardians to self-care management. “Preparation for this transition by patients, their families, and healthcare providers is essential,” says Lori Laffel, MD, MPH. Studies have shown that there are often significant gaps in diabetes care for patients as they transition to adulthood for many reasons. These include competing social, emotional, educational, and occupational needs as well as differences in the systems of care for pediatric and adult patients. “With the increasing occurrence of type 1 and type 2 diabetes in childhood and adolescence, more young people with diabetes will require a framework of care and education that prepares older teens and emerging adults for successful self-management and a seamless transfer to adult diabetes care providers,” Dr. Laffel says. Important New Guidance on Transitioning Diabetes Care In the November 2011 issue of Diabetes Care, the American Diabetes Association published a position statement on managing diabetes for emerging adults transitioning from pediatric to adult healthcare systems. The position statement was co-authored by Dr. Laffel and Anne Peters, MD, CDE, on behalf of the Transitions Working Group. The work group included representation from experts in several other medical associations and societies, including the CDC, the Endocrine Society, the American Association of Clinical Endocrinologists, and other well-respected organizations. Pediatric and adult endocrinologists, primary care providers, diabetes nurse educators, dietitians, exercise experts, mental health professionals, and others were part of the collaboration. “In...

2012 ADA Annual Scientific Sessions

New research was presented at the American Diabetes Association’s 72nd Scientific Sessions from June 8-12, 2012 in Philadelphia. The features below highlight just some of the studies that emerged from the conference Heart & Cancer Risks With Insulin The Particulars: Previous research suggests that there may be an association between insulin use and an increased risk of myocardial infarction, stroke, and several types of cancer. However, the long-term impacts of insulin on serious cardiovascular outcomes and cancers in patients at high risk for type 2 diabetes have not been examined. Data Breakdown: A study randomized people at high risk for type 2 diabetes or in the early stages of it to daily insulin glargine injections or no insulin for an average of 6.2 years. No differences in cardiovascular outcomes or the development of any cancer type were observed in the two groups. Patients who received insulin maintained normal glucose levels (90 to 94 mg/dL) throughout the study. Take Home Pearl: Long-term use of insulin glargine in patients at high risk for type 2 diabetes or in the early stages of the disease does not appear to put them at greater risk of developing cardiovascular conditions or cancer. Type 1 & 2 Diabetes Prevalence Increasing in the Young The Particulars: For years, the prevalence of type 1 and type 2 diabetes has been increasing in younger people worldwide. Few data, however, have explored trends in both type 1 and type 2 disease in the United States among younger individuals. Data Breakdown: An analysis from the CDC and NIH found that the prevalence of type 2 diabetes increased 21%, and the...

Setting the Stage for Good Nutrition in Diabetes

This Physician’s Weekly feature covering nutritional recommendations and interventions for diabetes was completed in cooperation with the experts at the American Diabetes Association.  Medical nutrition therapy (MNT) is an important part of preventing prediabetes and diabetes, managing existing diabetes, and preventing or slowing the rate of the development of diabetes complications. MNT is also an integral component of diabetes self-management education and training. The goals of MNT are to achieve and maintain healthy A1C, blood pressure, and cholesterol levels by modifying the intake of nutrients and improving lifestyle behaviors. “The United States has about 57 million people with pre-diabetes, and most of these people have problems with being overweight and obese,” says Wahida Karmally, DrPH, RD, CDE, CLS, FNLA. “In addition, people with diagnosed diabetes are often already overweight or obese. Using MNT and increasing physical activity are paramount to managing these individuals.” Clinical practice recommendations on MNT, which are based on scientific evidence, have recently been updated by the American Diabetes Association. Available at http://care.diabetesjournals.org, the recommendations can assist clinicians as they provide MNT to patients and offer strategies for specific patient groups (Table 1). “With MNT, it’s important to address individual nutrition needs,” says Dr. Karmally. “That requires taking into account personal and cultural preferences as well as willingness to change. Another goal is to help people maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.” Assessing the Evidence Clinical trials and outcome studies of MNT have reported decreases in A1C of about 1% in type 1 diabetes and 1% to 2% in type 2 diabetes, depending on the duration of...
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