Search

Type 2 diabetes is a prevalent illness that causes major vascular, renal, and neurologic complications. Prevention and treatment of diabetes and its complications are of paramount importance. Many new treatments have emerged over the past 5-10 years. Recent evidence shows that newer treatments may substantially reduce risk for cardiac and renal disease, suggesting that it may be necessary to change existing treatment paradigms. This review summarizes the evidence supporting diabetes prevention and treatment, focusing on aspects that are commonly in the purview of primary care physicians. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the risk from different insulin types on severe hypoglycaemia (SHG) events requiring inpatient (IP) or emergency department (ED) care in patients with type 2 diabetes. Methods: Type 2 diabetes patients newly started on insulin in a large commercial claims database were evaluated for SHG events. Patients were classified into an insulin group based on their most frequently used insulin type. Multivariable Cox models assessed the association between insulin type and the risk of SHG events. Results: We identified 8626 patients (mean age 53.5 years; 55% female) with type 2 diabetes followed for an average of 4.0 years after insulin initiation. Of these, 161 (1.9%) had a SHG event at an average of 3.1y after insulin initiation. Patients with SHG events were slightly older (56.4 vs. 53.4 years), used a similar number of OADs (1.1 vs. 1.2) but had more co-morbidities compared with those without SHG events. In multivariate Cox models, premixed insulin (HR 2.12; p <0.01), isophane insulin (NPH) (HR 2.02; p <0.01), and rapid acting insulin (HR 2.75; p <0.01) had significantly higher risks of SHG events compared with glargine. No statistically significant difference in SHG events was seen with detemir (HR 1.20; p =0.73). Conclusions: Among patients with type 2 diabetes, the use of newer basal insulin analogues was associated with lower rates of SHG events requiring IP or ED care compared with users of other insulin formulations. Future research should examine the impact of hypoglycaemia events of different severity levels. [Copyright &y& Elsevier]

The article offers information on the screening, prevention, diagnosis and treatment for type 2 diabetes. It explains that the diabetes is one among the common illness encountered by internist, in which approximately 23.6 million persons have diabetes in the U.S. It discusses various topics related to diabetes including the importance screening for type 2 diabetes, how does it be prevented and which patient are likely to benefit from diabetes screening.

Management of diabetes, and in particular blood glucose, can be complex and burdensome. To evaluate patient views of the burdens of therapy and its impact on self-management. Veteran patients with type 2 diabetes. Mailed survey. Patients described their views of the burden of diabetes treatments, adherence, and clinical and demographic status. Factors associated with ratings of burden and adherence to therapy were examined using multivariate regression methods. The response rate was 67% ( n=1,653). Patients viewed pills as the least burdensome treatment and insulin as the most burdensome. Ratings of the burden of insulin were lower if a patient had prior experience with therapy. Adherence to prescribed therapy varied substantially; for example, patients followed medication recommendations more closely than other areas of self-management. Multivariate analyses showed that the main predictor of adherence was patients' ratings of the burden of therapy. Injected insulin regimens are viewed as highly burdensome by patients, although this burden is attenuated by experience. Adherence to self-management is strongly and independently correlated with views of treatment burden. The burden of diabetes-related treatments may be a source of suboptimal glucose control seen in many care settings. Providers should consider the burden of treatment for a particular patient and its impact on adherence as part of a decision-making process to design effective treatment regimens. [ABSTRACT FROM AUTHOR]

Evaluates goals and optimal agents for treatment of hypertension in type 2 diabetes. Review of the medical literature to obtain data; Extraction and synthesis of data for the study; Benefits of blood pressure control; Recommended blood pressure level and hypotensive agents.

Presents a study to evaluate the efficacy of glycemic control in type 2 diabetes. How benefits of intensive glycemic control is quantified in patients; Methodology of the study; Most common feared complications of diabetes; Results and conclusions of the study.

A response from the author of the article "In the clinic. Type 2 diabetes" in the previous issue is presented.

A letter to the editor is presented in response to an article by Rury Holman and colleagues about glucose-lowering strategies in type 2 diabetes, published in the June 7, 2008 issue.