February 08, 2010
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| Hyperglycemia Not Due to Diabetes Mellitus - Clinical Pediatric Emergency Medicine |
| Finlayson C et al. – Intercurrent illness may trigger hyperglycemia as a result of the secretion of stress hormones and cytokines. This condition is termed "stress hyperglycemia." Patients with stress hyperglycemia usually do not have a lengthy history of polyuria, polydipsia, or weight loss. They do not manifest symptoms or signs of ketoacidosis. In addition, biochemical evidence of ketoacidosis is absent. If hyperglycemia is associated with a serum glucose above the low 200s, inpatient evaluation is preferred. In the emergency department, hemoglobin A1c can help acutely in estimating chronicity, with high levels prompting admission. Levels of diabetes antibodies should be drawn, and follow–up should be arranged to ascertain normalcy of glucose after resolution of the intercurrent illness.... |
| Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study - Journal of General Internal Medicine |
| Katon WJ et al. – Over the 5–year period, 36 of 455 (7.9%) patients with major depression and diabetes (incidence rate of 21.5 per 1,000 person–years) versus 163 of 3,382 (4.8%) patients with diabetes alone (incidence rate of 11.8 per 1,000 person–years) had one or more ICD–9 diagnoses of dementia. Patients with comorbid major depression had an increased risk of dementia (fully adjusted hazard ratio 2.69, 95% CI 1.77, 4.07). Patients with major depression and diabetes had an increased risk of development of dementia compared to those with diabetes alone. These data add to recent findings showing that depression was associated with an increased risk of macrovascular and microvascular complications in patients with diabetes.... |
| On what evidence-base do we recommend self-monitoring of blood glucose? - Diabetes Research and Clinical Practice |
| Kolb H et al. – Self–monitoring of blood glucose (SMBG) has been considered one major breakthrough in diabetes therapy because, for the first time, patients were able to determine their blood glucose levels during daily life. It seems obvious that this must be of advantage to disease management and clinical outcome, but it has become a nightmare for those trying to provide evidence. Randomised controlled trials have yielded inconsistent results on a benefit of SMBG–based treatment strategies not only in type 2 but – surprisingly – also in type 1 and gestational diabetes. Despite this, SMBG is being considered indispensible in intensive insulin treatment, but is being debated for other clinical settings. When considering the non–RCT based reasons for recommending SMBG in type 1 and gestational diabetes it becomes apparent that the same reasons also apply to type 2 diabetes.... |
| International Diabetes Federation: An update of the evidence concerning the prevention of type 2 diabetes - Diabetes Research and Clinical Practice |
| Simmons RK Et al. – Individual countries should aim to develop and evaluate cost–effective, setting–specific diabetes risk identification and prevention strategies based on available resources. These should be linked to initiatives aimed at reducing the burden of cardiovascular disease, and complemented with population–based strategies focusing on the control and reduction of behavioural and cardiovascular risk factors by targeting their key determinants.... |
| Adipose tissue fatty acids and insulin sensitivity in elderly men - Diabetologia - Clinical and Experimental Diabetes and Metabolism |
| Riserus U et al. – Adipose tissue enriched with palmitic acid and depleted of essential PUFAs is associated with insulin resistance. The positive association between minor SFAs and insulin sensitivity merits further investigation.... |
| The economic burden of obesity worldwide: a systematic review of the direct costs of obesity - Obesity Reviews |
| Alter DA et al. – Although variations in inclusion/exclusion criteria, reporting methods and included costs varied widely between the studies, a lack of examination of how and why the excess costs were being accrued appeared to be a commonality between most studies. Accordingly, future studies must better explore how costs accrue among obese populations, in order to best facilitate health and social policy interventions.... |
| High-risk Diabetic Patients in Medicare Part D Programs: Are They Getting the Recommended ACEI/ARB Therapy? - Journal of General Internal Medicine |
| Yang Y et al. – ACEI/ARB utilization rates were 63%, 58.3%, and 43.1% among diabetic patients with hypertension and renal disease, hypertension without renal disease, and renal involvement without hypertension, respectively. After adjusting for all other characteristics studied, patients in the hypertension only and renal disease only risk groups were less likely to use ACEI/ARB compared to diabetes patients with both hypertension and renal disease. Several demographics, including male gender, age older than 65, and white race, were all predictors of suboptimal ACEI/ARB use. Results from state–specific analyses are consistent with those for all six states. In this cohort, less than 60% of high–risk patients with diabetes were receiving the recommended ACEI/ARB therapy. Several patient demographic and clinical characteristics are strongly associated with suboptimal ACEI/ARB use.... |
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