Use of the Continuous Glucose Monitoring System to guide therapy in patients with insulin-treated diabetes: a randomized controlled trial.

Objective: To show improved glycemic control in patients with insulin-treated diabetes after adjustments to the diabetes management plan based on either continuous glucose monitoring using the Continuous Glucose Monitoring System (CGMS) or frequent self-monitoring of blood glucose (SMBG) using a home blood glucose meter.

Patients And Methods: From January to September 2000, patients aged 19 to 76 years with insulin-treated diabetes were assigned to insulin therapy adjustments based on either CGMS or SMBG values. At the end of the study, patients in both groups used the CGMS for 3 days; these values were used to calculate measures of hypoglycemia.

ImmunoDip: an improved screening method for microalbuminuria.

Background: It is important to test for microalbuminuria in patients with diabetes, hypertension and possible insulin resistance syndrome. Current screening methods are suboptimal. This study evaluates a new office screening test for microalbuminuria that utilizes a monoclonal antibody against human serum albumin (ImmunoDip).

Impact of adjunctive thiazolidinedione therapy on blood lipid levels and glycemic control in patients with type 2 diabetes.

Objective: This study was undertaken to assess the effect of pioglitazone hydrochloride and rosiglitazone maleate on blood lipid levels and glycemic control when these drugs are used as adjunctive therapy in type 2 diabetes.

Research Design And Methods: Patients with type 2 diabetes receiving metformin and/or sulfonylurea (n = 829) were evaluated in this national, multicenter, retrospective study. Medical records from 318 endocrinology practices in the USA were randomly selected and screened for study inclusion.

Atherosclerosis in type 2 diabetes mellitus: the role of insulin resistance.

Type 2 diabetes mellitus is associated with a marked increase in the risk of atherosclerotic diseases, including coronary heart disease, peripheral arterial disease, and cerebrovascular disease. Insulin resistance is a key factor in the pathogenesis of type 2 diabetes mellitus. Insulin resistance and its attendant metabolic abnormalities may cause much of the increased cardiovascular risk of type 2 diabetes mellitus.

Impact of the new National Cholesterol Education Program (NCEP) guidelines on patient management.

Purpose: To update nurse practitioners (NPs) on the latest National Cholesterol Education Program (NCEP) guidelines for the management of high blood cholesterol in adults.

Data Sources: The 2001 NCEP Adult Treatment Panel (ATP) III guidelines and supporting scientific reviews and reports of clinical trials related to the evidence upon which the guidelines are based.

Conclusions: The many new features of the ATP III guidelines include an increased emphasis on the patient with multiple risk factors in order to identify appropriate candidates for primary prevention and on more stringent classifications of elevated lipid/lipoprotein levels.

The insulin resistance syndrome and coronary artery disease.

Insulin resistance is an increasingly common metabolic abnormality characterized by an impaired physiological response to insulin. The constellation of insulin resistance and several other metabolic and vascular disorders is known as the insulin resistance syndrome. The characteristic features of the insulin resistance syndrome include central obesity, hypertension, dyslipidemia, glucose intolerance and specific abnormalities of both endothelial cell and vascular function.

The metabolic syndrome, type 2 diabetes, and cardiovascular disease: understanding the role of insulin resistance.

The most common and clinically important complication in adults with diabetes is cardiovascular disease (CVD), which includes coronary heart disease, peripheral vascular disease, and stroke. Both type 2 diabetes and the insulin resistance syndrome are associated with a marked increase in the risk for CVD. The metabolic syndrome and the closely related insulin resistance syndrome have recently been recognized as important disorders, each being associated with an increase in CVD risk even in the absence of glucose intolerance.

Glycohemoglobin assessment program: glycated hemoglobin and epidemiologic variables in patients with type 2 diabetes.

Objective: To obtain data on glycated hemoglobin (HbA1c) levels and a variety of epidemiologic variables in patients with type 2 diabetes living in the western United States.

Methods: This study was a noncomparative, multicenter, epidemiologic survey. Data were collected from consecutively enrolled patients at nine separate primary-care sites.

Treating diabetes: cardiovascular benefits of antidiabetes drugs.

Type 2 diabetes is a metabolic disorder that, if untreated, can result in macrovascular and microvascular complications. Lowering blood glucose levels primarily reduces microvascular risk; other treatment strategies are necessary to lower the risk for macrovascular disease. Because most patients with diabetes die of macrovascular disease, it is vitally important that patients with diabetes receive aggressive therapies to lessen this risk.

Considerations for treating dyslipidemia in special diabetic populations.

This is a review of the problem of dyslipidemia and cardiovascular disease (CVD) in special diabetic populations. Clearly all patients with diabetes are at increased risk for CVD compared to non-diabetic populations. But within the subset that is patients with diabetes there are individuals who are particularly vulnerable.