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https://www.readbyqxmd.com/read/28700767/effect-of-non-insulin-based-glucose-lowering-therapies-on-cardiovascular-outcomes-in-patients-with-type-2-diabetes
#1
Szymon L Wiernek, Matthew A Cavender
Current guidelines for the treatment of patients with diabetes are focused on improving glycemic control and treating appropriate cardiovascular (CV) risk factors. Basic recommendations include blood pressure management with a goal of <140 mm Hg systolic pressure, statin therapy in all patients ≥40 years of age with diabetes (moderate intensity for all, and high intensity if at high risk of CVD events), and aspirin therapy in all adults at increased CV risk (10-year risk of CVD events >10%). Oral antihyperglycemic medications remain the cornerstone of treatment for optimizing glucose control in patients with diabetes...
June 2017: Journal of Family Practice
https://www.readbyqxmd.com/read/28699798/durability-of-response-to-dapagliflozin-a-review-of-long-term-efficacy-and-safety
#2
Serge Jabbour
BACKGROUND: Due to the chronic nature of type 2 diabetes (T2D), it is essential for an antidiabetic drug to have durable efficacy and a good long-term safety profile. Dapagliflozin is a member of a unique class of antidiabetic drugs that inhibit the sodium-glucose cotransporter 2 (SGLT-2) in the renal tubules and have an insulin-independent mechanism of action. In short-term studies (≤24 weeks), dapagliflozin reduced glycated hemoglobin (A1c), weight, and systolic blood pressure, and had a good safety profile...
July 12, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28699150/effect-of-insulin-infusion-line-on-glycaemic-variability-in-a-perioperative-high-dependency-unit-hdu-a-prospective-randomised-controlled-trial
#3
Stéphanie Genay, Bertrand Décaudin, Sabine Ethgen, Arnaud Alluin, Elodie Babol, Julien Labreuche, Hélène Behal, Marie-Christine Vantyghem, Pascal Odou, Gilles Lebuffe
BACKGROUND: Glucose control is an important issue in post-operative patients. The objective here was to compare two insulin infusion lines by syringe pumps to assess the impact of medical devices on glycaemic variability in surgical patients under intensive insulin therapy. This open, prospective, single-centre randomised study was conducted in a fifteen-bed perioperative high dependency unit (HDU) in a university hospital. In total, 172 eligible patients receiving insulin therapy agreed to participate in the study...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28691497/increased-mortality-risk-in-diabetic-patients-discharged-from-hospital-with-insulin-therapy-after-an-acute-myocardial-infarction-data-from-the-fast-mi-2005-registry
#4
Vincent Bataille, Jean Ferrières, Nicolas Danchin, Etienne Puymirat, Marianne Zeller, Tabassome Simon, Didier Carrié
BACKGROUND: Merits of insulin use for diabetes treatment in patients with advanced atherosclerosis are debated. This observational study conducted in diabetic patients after an acute myocardial infarction aimed to assess whether insulin prescription at discharge (IPD) was related to all-cause mortality during follow-up. METHODS: Subjects were diabetic patients admitted in intensive- or coronary-care units for acute myocardial infarction (consecutively recruited in 223 centres in France) and discharged alive from the hospital, with or without an IPD...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28686045/challenges-of-diabetes-management-in-toddlers
#5
Asma Deeb
Toddlers with type 1 diabetes have distinctive combination of challenges to their families and healthcare providers. A major factor is the difficulty in achieving metabolic control without risking hypoglycemia. The rising incidence of type 1 diabetes in toddlers increases the magnitude of the problem and creates a greater need for providing specialized service to cater for this age group's unique need. Type 1 has a specific disease nature in younger children and its clinical presentation mimics common childhood diseases...
July 7, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28662684/atypical-blood-glucose-response-to-continuous-and-interval-exercise-in-a-person-with-type-1-diabetes-a-case-report
#6
Othmar Moser, Gerhard Tschakert, Alexander Mueller, Werner Groeschl, Thomas R Pieber, Gerd Koehler, Max L Eckstein, Richard M Bracken, Peter Hofmann
BACKGROUND: Therapy must be adapted for people with type 1 diabetes to avoid exercise-induced hypoglycemia caused by increased exercise-related glucose uptake into muscles. Therefore, to avoid hypoglycemia, the preexercise short-acting insulin dose must be reduced for safety reasons. We report a case of a man with long-lasting type 1 diabetes in whom no blood glucose decrease during different types of exercise with varying exercise intensities and modes was found, despite physiological hormone responses...
June 30, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28661564/short-term-intensive-insulin-therapy-could-be-the-preferred-option-for-new-onset-t2dm-patients-with-a1c%C3%A2-%C3%A2-9
#7
EDITORIAL
Jianping Weng
Type 2 diabetes mellitus (T2DM) is a heterogeneous disease. Currently, the typical clinical therapeutic pathway for the disease consists of the stepwise addition of anti-hyperglycemic preparations over time, followed lastly by insulin therapy when functional beta-cell capacity is severely deteriorated.
June 29, 2017: Journal of Diabetes
https://www.readbyqxmd.com/read/28660565/biopsychosocial-aspects-of-weight-management-in-type-1-diabetes-a-review-and-next-steps
#8
REVIEW
Kimberly A Driscoll, Karen D Corbin, David M Maahs, Richard Pratley, Franziska K Bishop, Anna Kahkoska, Korey K Hood, Elizabeth Mayer-Davis
PURPOSE OF REVIEW: This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss. RECENT FINDINGS: Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising...
August 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28652565/ketoacidosis-in-neonatal-diabetes-mellitus-part-of-wolcott-rallison-syndrome
#9
Poorna Gopal Azad Sreeramaneni, Subba Rao V Ambula
BACKGROUND Neonatal diabetes mellitus is a rare condition and it is important to differentiate it from other causes, such as hyperglycemia in infancy, for better outcomes. We report a case of an infant who presented to our neonatal intensive care unit in ketoacidosis and a comatose state. CASE REPORT Our case was an infant who presented to the neonatal intensive care unit at 38 days of age in ketoacidosis. The female infant, born to consanguineous parents (first cousins), weighing 2,300 grams at birth, presented with extreme dehydration and pale skin...
June 27, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28648964/factors-associated-with-prolonged-inaction-in-the-hypoglycaemic-treatment-in-people-with-non-insulin-dependent-type-2-diabetes-and-elevated-glycated-haemoglobin-a-registry-based-cohort-study
#10
Geert Goderis, Bert Vaes, Marjan Van den Akker, Steven Elli, Chantal Mathieu, Frank Buntinx, Séverine Henrard
AIMS: To assess factors associated with Prolonged Inaction (PI) in insulin-naïve patients with Type 2 Diabetes Mellitus (T2DM). PI was defined as the absence of treatment initiation or intensification for ≥12 months despite HbA1c >7% (53mmol/mol). METHODS: A retrospective cohort study was conducted based on data from Intego, a Flemish General Practice registry. The study period ranged from January 1, 2006 to December 31, 2013. Patients with insulin therapy before the start of the study period were excluded from the analysis...
June 22, 2017: Primary Care Diabetes
https://www.readbyqxmd.com/read/28645302/untangling-glycaemia-and-mortality-in-critical-care
#11
Vincent Uyttendaele, Jennifer L Dickson, Geoffrey M Shaw, Thomas Desaive, J Geoffrey Chase
BACKGROUND: Hyperglycaemia is associated with adverse outcomes in the intensive care unit, and initial studies suggested outcome benefits of glycaemic control (GC). However, subsequent studies often failed to replicate these results, and they were often unable to achieve consistent, safe control, raising questions about the benefit or harm of GC as well as the nature of the association of glycaemia with mortality and clinical outcomes. In this study, we evaluated if non-survivors are harder to control than survivors and determined if glycaemic outcome is a function of patient condition and eventual outcome or of the glycaemic control provided...
June 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28630246/ominous-triad-triggered-by-high-dose-glucocorticosteroid-therapy
#12
Sarah Bär, Fritz Daudel, Thomas Zueger
Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis-a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy...
June 18, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28624504/proinsulin-protects-against-age-related-cognitive-loss-through-anti-inflammatory-convergent-pathways
#13
Rubén Corpas, Alberto M Hernández-Pinto, David Porquet, Catalina Hernández-Sánchez, Fatima Bosch, Arantxa Ortega-Aznar, Francesc Comellas, Enrique J de la Rosa, Coral Sanfeliu
Brain inflammaging is increasingly considered as contributing to age-related cognitive loss and neurodegeneration. Despite intensive research in multiple models, no clinically effective pharmacological treatment has been found yet. Here, in the mouse model of brain senescence SAMP8, we tested the effects of proinsulin, a promising neuroprotective agent that was previously proven to be effective in mouse models of retinal neurodegeneration. Proinsulin is the precursor of the hormone insulin but also upholds developmental physiological effects, particularly as a survival factor for neural cells...
June 15, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28613947/the-effects-of-basal-insulin-suspension-at-the-start-of-exercise-on-blood-glucose-levels-during-continuous-versus-circuit-based-exercise-in-individuals-with-type-1-diabetes-on-continuous-subcutaneous-insulin-infusion
#14
Dessi Zaharieva, Loren Yavelberg, Veronica Jamnik, Ali Cinar, Kamuran Turksoy, Michael C Riddell
BACKGROUND: Exercise causes glycemic disturbances in individuals with type 1 diabetes (T1D). Continuous moderate-intensity aerobic exercise (CON) generally lowers blood glucose (BG) levels and often leads to hypoglycemia. In comparison, circuit-based exercise (CIRC) may attenuate the drop in BG. The goal of this study is to contrast the effects of basal insulin suspension at the onset of two different forms of exercise (CON vs. CIRC). METHODS: Twelve individuals (six men and six women) with T1D on insulin pump therapy were recruited for the study...
June 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28609547/intensive-insulin-therapy-combined-with-metformin-is-associated-with-reduction-in-both-glucose-variability-and-nocturnal-hypoglycaemia-in-patients-with-type-2-diabetes
#15
Yifei Zhang, Zhiyun Zhao, Shujie Wang, Wei Zhu, Yiran Jiang, Shouyue Sun, Chen Chen, Kai Wang, Liangshan Mu, Jinyi Cao, Yingxia Zhou, Weiqiong Gu, Jie Hong, Weiqing Wang, Guang Ning
BACKGROUND: The effect on glucose variability in patients with intensive insulin therapy has not been fully understood. This observational study investigated the different glucose variability and hypoglycaemia patterns in type 2 diabetes patients treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) with or without metformin administration. METHODS: During hospitalization, a total of 501 patients with poor glycaemic control and in initial treatment with either CSII alone (n = 187), CSII + Metformin (n = 81), MDI alone (n = 146), or MDI + Metformin (n = 87) were involved in the final analysis...
June 13, 2017: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/28586518/combination-therapy-with-multiple-oral-hypoglycaemic-agents-together-with-short-term-basal-insulin-in-new-onset-type-2-diabetes-mellitus-with-marked-hyperglycaemia
#16
S Ray, J J Mukherjee
Type 2 diabetes mellitus is characterized by the relentless loss of β-cell function, which is partly attributable to glucotoxicity and lipotoxicity. Prolonged exposure to excess glucose and oxidative stress leads to β-cell destruction [1,2]. Evidence suggests that early intensive intervention to achieve normoglycaemia can preserve β-cell function, probably by correcting glucotoxicity and lipotoxicity [3]. This article is protected by copyright. All rights reserved.
June 6, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28572099/nurse-directed-blood-glucose-management-in-a-medical-intensive-care-unit
#17
Friederike Compton, Robert Ahlborn, Torsten Weidehoff
BACKGROUND: Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy. OBJECTIVES: To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28571934/intensive-glycemic-control-in-younger-and-older-u-s-adults-with-type-2-diabetes
#18
Sarah Casagrande, Catherine C Cowie, Judith E Fradkin
AIMS: To determine the extent to which older vs. younger adults with diabetes intensively control glycemia. METHODS: Participants were age≥40years who self-reported a physician diagnosis of diabetes in the 2009-2014 National Health and Nutrition Examination Surveys (N=1554). Intensive glycemic control was defined as A1c<7.0% and taking insulin, sulfonylureas, or ≥2 glycemic medications. Logistic regression was used to determine the adjusted odds of intensive control in older (≥65years) vs...
May 18, 2017: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/28550194/the-risk-of-severe-hypoglycemia-in-type-1-diabetes-over-30-years-of-follow-up-in-the-dcct-edic-study
#19
Rose A Gubitosi-Klug, Barbara H Braffett, Neil H White, Robert S Sherwin, F John Service, John M Lachin, William V Tamborlane
OBJECTIVE: During the DCCT, intensive diabetes therapy achieving a mean HbA1c of ∼7% was associated with a threefold increase in the rate of severe hypoglycemia (defined as requiring assistance) compared with conventional diabetes therapy with a mean HbA1c of 9% (61.2 vs. 18.7 per 100 patient-years). After ∼30 years of follow-up, we investigated the rates of severe hypoglycemia in the DCCT/EDIC cohort. RESEARCH DESIGN AND METHODS: Rates of severe hypoglycemia were reported quarterly during DCCT and annually during EDIC (i...
May 26, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28544654/hypogonadism-in-testicular-cancer-patients-is-associated-with-risk-factors-of-cardiovascular-disease-and-the-metabolic-syndrome
#20
C Bogefors, S Isaksson, J Bobjer, M Kitlinski, I Leijonhufvud, K Link, A Giwercman
More than 95% of testicular cancer are cured but they are at increased long-term risk of cardiovascular disease. The risk of cardiovascular disease and treatment intensity was reported, but it is unknown whether this effect of cancer therapy is direct or indirect, mediated through androgen deficiency. Our aim was, therefore, to evaluate whether testicular cancer patients have increased the prevalence of risk factors of cardiovascular disease and if these risk factors are associated with hypogonadism and/or the cancer treatment given...
May 23, 2017: Andrology
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