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The purpose of this article is to describe how self-monitoring of blood glucose (SMBG) data is a useful tool for identifying and managing postprandial hyperglycemia (PPHG). PPHG and postprandial glucose excursions occur frequently in patients with diabetes even when hemoglobin A1C is controlled below 7.0%, and convey increased risk of cardiovascular morbidity and mortality. Consequently, effective management of diabetes must include control of postprandial glucose levels. Postprandial plasma glucose (PPG) depends on the composition of meals, specifically the amount of carbohydrates. Reduced-carbohydrate diets offer short-term improvements in glycemic control and other metabolic parameters, but await the support of long-term efficacy and safety studies. Glucose profiling and paired-meal SMBG are useful tools for detecting PPHG and glucose excursions. They provide immediate feedback to patients on the effect of foods and meals, thereby allowing appropriate food and medication adjustments to improve postprandial glycemic control.

The effects of diabetes in pregnancy were first noticed in the beginning of the 19(th) century. Today approximately seven percent of all pregnancies in the United States are affected by gestational diabetes. Since becoming more knowledgeable of the disease, the medical community has developed diagnostic criteria for detecting gestational diabetes and has created treatment options for lowering the risk of adverse fetal outcomes. A pregnancy affected by diabetes is associated with macrosomia, fetal malformations, spontaneous preterm delivery, and labor complications. These risks can be minimized by tight glycemic control through diet, insulin, and attentive monitoring of blood glucose levels. Although most pregnant diabetic women currently monitor their diabetes using self-monitoring blood glucose, the technology of continuous glucose monitoring (CGM) offers a myriad of benefits. This mini-review looks at the advantages of using CGM in pregnancy which includes decreasing the risks of poor fetal outcomes, improving a patient's overall glucose profile, helping start or adjust insulin treatment, adjusting current screening protocol and developing a normoglycemic target for gestational diabetic women to aim for during their pregnancy. With the use of CGM, the complications of diabetic pregnancies first seen nearly two centuries ago will become a problem of the past.

Diabetes shows an increased prevalence among minority groups, including Asians, African Americans, Hispanics, Native Americans, and Pacific Islanders. The sedentary lifestyle and high-fat diet of modern industrialized societies promote obesity at an early age. There is a strong correlation between the development of diabetes and increased visceral adiposity in American minority groups. This review focuses on the 2 largest minority groups in the United States, African Americans and Hispanics. The risk of diabetes is 20% to 50% greater in African American men and twice as great in African American women as well as twice as high in Hispanic adults than in whites. Furthermore, the prevalence of diabetes-associated complications, such as retinopathy and amputations, is 50% to 100% higher in African Americans and Hispanics. The unfavorable consequences of diabetes in African American and Hispanic individuals do not seem to be due to inherent biological differences. Rather, it appears that differences in medical care and self-management of diabetes may be the major factor. The key to improving outcomes in these minority groups lies in enhancement of communication to overcome barriers to self-care. It is important to better understand the cultural milieu in minority communities to enhance patient involvement in their own management. Where this has been done, marked improvements in diabetes healthcare have occurred.

Treatment-emergent diabetes mellitus (DM) has been described for conventional and atypical antipsychotics. In our study, antipsychotic prescription claims from AdvancePCS's database were used to identify patients starting antipsychotic monotherapy. The relative risk of developing DM was determined using prescription claims for antidiabetic agents in the following cohorts: AdvancePCS general patient population, combined conventional antipsychotics, and combined atypical antipsychotics. Cox proportional hazards regression was used to adjust for differences in age, gender, and duration of antipsychotic exposure between cohorts in the estimation of risk of developing diabetes. Hazard ratios for developing DM in the combined conventional, combined atypical, and individual conventional and atypical antipsychotic treatment cohorts were greater than the AdvancePCS general patient population cohort. An increased risk of developing diabetes compared with the AdvancePCS general patient population was observed during treatment with conventional or atypical antipsychotics.

Objective: To investigate whether pregnancies complicated by type 1 diabetes are associated with a decrease in first-trimester insulin requirement., Research Design and Methods: We examined the weekly insulin requirement (as units per kilogram per day) during the first trimester of pregnancy in diabetic women in the Diabetes in Early Pregnancy Study (DIEP) with accurate gestational dating, regular glucose monitoring, daily insulin-dose recording, and monthly glycohemoglobin measurements., Results: In pregnancies that resulted in live-born full-term singleton infants, a significant 18% increase in mean weekly dosage was observed between weeks 3 and 7 (P = 0.000), followed by a significant 9% decline from week 7 through week 15 (P = 0.000). Further testing localized a significant change in insulin dose in the interval beginning weeks 7-8 and ending weeks 11-12 (P = 0.014). Within this interval, the maximum decrease was between weeks 9 and 10 (mean), 10 and 11 (median), and 8 and 9 (most frequent maximal decrease). To determine whether prior poor glucose control exaggerated these trends, we categorized the women based on their glycohemoglobin values: <2 SDs above the mean of a normal population (subgroup 1), 2-4 SDs (subgroup 2), and >4 SDs (subgroup 3) at baseline. Late first-trimester declines in dosage were statistically significant in subgroup 2 (P = 0.002) and subgroups 2 and 3 together (P = 0.003). Similarly, women with BMI >27.0 had a greater initial insulin rise and then fall compared with leaner women., Conclusions: Observations in the DIEP cohort disclose a mid-first-trimester decline in insulin requirement in type 1 diabetic pregnant women. Possible explanations include overinsulinization of previously poorly controlled diabetes, a transient decline in progesterone secretion during the late first-trimester luteo-placental shift in progesterone secretion, or other hormonal shifts. Clinicians should anticipate a clinically meaningful reduction in insulin requirement in the 5-week interval between weeks 7 and 12 of gestation.

The increasing prevalence of obesity, which has reached epidemic proportions, raises the likelihood that a similar increase in diabetes will follow. Linkage between the two conditions is clear. Overweight is not only an important risk factor for the development of diabetes, but also has a significant impact on progression and complications. Diagnostic criteria for the recognition of diabetes and for monitoring of the disease process will become increasingly important. The role of laboratory evaluation needs to be reassessed in light of new concepts regarding classification and diagnostic criteria. The relative utility of glucose and glycosylated protein measurements should be addressed, particularly the relationship between laboratory findings and clinical guidelines. Blood glucose monitoring depends on establishment of the threshold for diagnosis. Additional issues are bedside monitoring, the goal of noninvasive glucose sensors and targeting of therapy. The laboratory scientist is likely to play a key role in the application of advances in the detection and management of diabetes.