InsulinPub Date : 2010-01-01Epub Date: 2010-03-05DOI: 10.1016/S1557-0843(10)80005-3
Timothy S. Reid MD
{"title":"Making our diabetes patients' office visits more productive","authors":"Timothy S. Reid MD","doi":"10.1016/S1557-0843(10)80005-3","DOIUrl":"10.1016/S1557-0843(10)80005-3","url":null,"abstract":"<div><p>Improving our health care procedures is ideally a collaborative and ongoing process, yet it takes time we may not feel we can easily afford. If we can consider how we might make even one change to improve our procedures, we might also be able to help improve not only the capabilities and skills of each member of our health care teams but also the ability of our patients to engage in effective diabetes self-care.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"5 1","pages":"Pages 11-12"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(10)80005-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75752628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2010-01-01Epub Date: 2010-03-05DOI: 10.1016/S1557-0843(10)80015-6
Mona Shimshi MD, Christopher K. Johnson MD
{"title":"","authors":"Mona Shimshi MD, Christopher K. Johnson MD","doi":"10.1016/S1557-0843(10)80015-6","DOIUrl":"https://doi.org/10.1016/S1557-0843(10)80015-6","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"5 1","pages":"Pages 65-66"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(10)80015-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136417402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2010-01-01Epub Date: 2010-03-05DOI: 10.1016/S1557-0843(10)80013-2
{"title":"Azúcar en la sangre baja","authors":"","doi":"10.1016/S1557-0843(10)80013-2","DOIUrl":"https://doi.org/10.1016/S1557-0843(10)80013-2","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"5 1","pages":"Page 62"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(10)80013-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137313627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2009-07-01Epub Date: 2009-08-18DOI: 10.1016/S1557-0843(09)80029-8
Jeff Unger MD, Christopher G. Parkin MS
{"title":"Appropriate, timely, and rational treatment of type 2 diabetes mellitus: Meeting the challenges of primary care","authors":"Jeff Unger MD, Christopher G. Parkin MS","doi":"10.1016/S1557-0843(09)80029-8","DOIUrl":"10.1016/S1557-0843(09)80029-8","url":null,"abstract":"<div><p>Diabetes now affects >24 million people in the United States. As the prevalence of diabetes continues to increase, long-term complications of diabetes have emerged as major health care issues. Although much focus has been placed on diabetes, it is important to note that prediabetes, the intermediate state of type 2 diabetes mellitus (DM), is not benign. The progression to type 2 DM for patients with impaired glucose tolerance (IGT) is 6% to 10% per year; for persons with both impaired fasting glucose and IGT, the cumulative incidence of diabetes in 6 years may be as high as 60%. Given the significant clinical and financial impact of both conditions, it is vital that clinicians initiate treatment of diabetes and prediabetes early and aggressively. Despite advances in diabetes treatment, many health care providers do not initiate or intensify therapy appropriately during patient visits, which contributes to poor diabetes control. Although management of blood pressure and lipid levels can be complex, glycemic control is often problematic for patients and their clinicians. Thus, clinicians must learn to use the various pharmacologic and nonpharmacologic strategies effectively to achieve glucose targets in their patients with type 2 DM. 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.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 3","pages":"Pages 144-157"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80029-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88317559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2009-07-01Epub Date: 2009-08-18DOI: 10.1016/S1557-0843(09)80028-6
Jonathan Klonsky MD, Michel M. Murr MD
{"title":"Metabolic surgery for type 2 diabetes mellitus","authors":"Jonathan Klonsky MD, Michel M. Murr MD","doi":"10.1016/S1557-0843(09)80028-6","DOIUrl":"10.1016/S1557-0843(09)80028-6","url":null,"abstract":"<div><p><strong>Background:</strong> 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 diabetes mellitus (DM). Such changes seem to precede significant weight loss in this population shortly after undergoing diversionary procedures.</p><p><strong>Objective:</strong> This article explores the evidence for salutary metabolic benefits of bariatric surgery, with special emphasis on glycemic control and remission of type 2 DM.</p><p><strong>Methods:</strong> We conducted a query of the PubMed database for articles published in English within the past 15 years using the search terms <em>bariatric surgery, obesity, type 2 diabetes, gastric bypass, gastric banding, incretins, enteroinsular axis, GLP-1</em> (glucagon-like peptide-1), and <em>GIP</em> (glucose-dependent insulinotropic polypeptide). We targeted review articles as well as those discussing the effects of bariatric surgery on the enteroinsular axis and the respective effects on glyce-mic control.</p><p><strong>Results:</strong> Most of the clinical reports indicated a high remission rate (≥85%) for type 2 DM, and relatively higher rates in patients who underwent diversionary procedures. Studies with small cohorts and laboratory data suggested a role for gastrointestinal hormones in the regulation of glucose homeostasis after bariatric surgery.</p><p><strong>Conclusions:</strong> Gastrointestinal surgery for severe obesity, through restrictive and/or neurohormonal effects, is an effective treatment for type 2 DM. Surgically induced weight loss was found to be sustainable, durable, and associated with remission of type 2 DM, a reduction in mortality, and improvement in quality of life.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 3","pages":"Pages 136-143"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80028-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88965558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
InsulinPub Date : 2009-07-01Epub Date: 2009-08-18DOI: 10.1016/S1557-0843(09)80031-6
John W. Hare MD
{"title":"Birth defects in infants of diabetic mothers: A historical review","authors":"John W. Hare MD","doi":"10.1016/S1557-0843(09)80031-6","DOIUrl":"10.1016/S1557-0843(09)80031-6","url":null,"abstract":"<div><p><strong>Background:</strong> Over the past 80+ years, outcomes in diabetic pregnancies have improved remarkably. In the preinsulin era, both fetal and maternal deaths were common. After insulin was discovered, the likelihood of a successful pregnancy increased, but fetal losses were still common. By the end of the 20th century, a number of medical advances allowed women with diabetes to reasonably expect to deliver a healthy infant, although the perinatal mortality rate was twice that reported for women without diabetes. The excess losses were attributable to birth defects.</p><p><strong>Objective:</strong> The purpose of this article was to use the recognition of, and approach to, birth defects in infants of mothers with diabetes as an example of the gradual evolution of clinical care and research from the dawn of the insulin era to the age of molecular biology.</p><p><strong>Methods:</strong> Archival material from the Joslin Diabetes Center (Boston, Massachusetts) was used to document the early history of the problem. Particular emphasis was given to the writings of Priscilla White, MD. Illustrative articles, especially those cited in textbooks, were chosen to highlight developments over the mid to late 20th century.</p><p><strong>Results:</strong> Before the discovery of insulin, maternal death was the primary issue in diabetic pregnancies. With the availability of insulin, the maternal death rate decreased sharply and fetal deaths became the preeminent problem. Many of these losses were due to iatrogenic prematurity complicated by respiratory distress syndrome; early deliveries avoided stillbirth in late gestation. In the last quarter of the 20th century, methods of assessing fetal well-being and lung maturity allowed pregnancies to proceed nearer to term. Birth defects then emerged as the leading cause of perinatal mortality. The risk for birth defects was linked to diabetes control early in the first trimester, and the mechanism was related to free oxygen radicals from excess glucose. Preconception programs have been shown to reduce the risk.</p><p><strong>Conclusions:</strong> Clinical advances often are not dramatic. This article illustrates how resolution of a problem may evolve incrementally over decades. 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. Epigenetic mechanisms responsible for malformations have been elucidated.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 3","pages":"Pages 169-176"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80031-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75873267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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