Impact of data from recent clinical trials on strategies for treating patients with type 2 diabetes mellitus.

Type 2 diabetes is associated with increased risk for the development of cardiovascular disease (CVD) secondary to hyperglycemia's toxicity to blood vessels. The escalating incidence of CVD among patients with type 2 diabetes has prompted research into how lowering glycated hemoglobin (HbA(1c)) may improve CVD-related morbidity and mortality. Data from recent studies have shown that some patients with type 2 diabetes actually have increased mortality after achieving the lowest possible HbA(1c) using intensive antidiabetes treatment.

Metabolic risk factors, endothelial dysfunction, and erectile dysfunction in men with diabetes.

Background: The prevalence of men with erectile dysfunction (ED) and concomitant diabetes mellitus continues to increase. ED, diabetes, hypertension, and dyslipidemia (components of the metabolic syndrome) are associated with endothelial dysfunction. ED has been reported to be a marker for cardiovascular arterial disease.

Temporal trends in prevalence of diabetes mellitus in a population-based cohort of incident myocardial infarction and impact of diabetes on survival.

Objective: To determine the temporal trends in prevalence of confirmed diabetes mellitus (DM), time from the date DM criteria were met to myocardial infarction (MI), and impact of DM on survival.

Subjects And Methods: A retrospective cohort design was used to identify residents of Olmsted County, Minnesota, with incident MI from 1979 to 1998. The MI cases were characterized according to prevalent DM.

Addition of insulin to oral therapy in patients with type 2 diabetes.

Background: A majority of individuals with type 2 diabetes will eventually require exogenous insulin therapy to achieve or maintain glycemic control. This review provides practical recommendations for adding insulin therapy for patients with type 2 diabetes whose glucose levels are inadequately controlled with oral medications.

Methods: We used a systematic review of MEDLINE to retrieve relevant articles from 1990 to 2004 using the search terms insulin therapy, combination oral therapy, glycemic control, insulin analogs, insulin glargine, and basal insulin, which we supplemented with a review of clinical practice guidelines from the American Diabetes Association and the American Association of Clinical Endocrinologists.

Relative risk of mortality associated with diabetes as a function of birth weight.

Objective: Birth weight is a risk factor for both diabetes and mortality. Diabetes is a risk factor for mortality. Whether the excess mortality observed for diabetes varies with birth weight is unclear.

Peripheral arterial disease, diabetes, and mortality.

Objective: The aims of this study were to provide estimates of 1) the risk of mortality for individuals with both diabetes and peripheral arterial disease (PAD) relative to that for individuals with either condition alone and 2) the association between PAD progression and mortality for individuals with diabetes, PAD, and both conditions.

Research Design And Methods: This longitudinal cohort study was conducted in Rochester, Minnesota. Local residents age 50-70 years with a prior diagnosis of PAD and/or diabetes were identified from the Mayo Clinic diagnostic registry and invited to a baseline examination (1977-1978).

The case for insulin treatment early in type 2 diabetes.

Most patients with type 2 diabetes ultimately need insulin therapy. This paper presents the case for starting insulin therapy sooner rather than later, preferably without oral drugs and in a "basal/bolus" regimen consisting of a daily dose of a long-acting insulin for basal coverage plus preprandial doses of a short-acting insulin.

Trends in the mortality burden associated with diabetes mellitus: a population-based study in Rochester, Minn, 1970-1994.

Background: The prevalence of diabetes mellitus (DM) has increased markedly in recent decades, but trends in the mortality burden associated with DM are unclear. Therefore, we analyzed population-based longitudinal data to address this issue.

Methods: The community-based medical records of all Rochester residents 45 years and older who died between January 1, 1970, and December 31, 1994, were reviewed to identify those who met the standardized criteria for DM before death.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM.

These clinical practice guidelines summarize the recommendations of the American Association of Clinical Endocrinologists for the diagnostic evaluation of hyperthyroidism and hypothyroidism and for treatment strategies in patients with these disorders. The sensitive thyroid-stimulating hormone (TSH or thyrotropin) assay has become the single best screening test for hyperthyroidism and hypothyroidism, and in most outpatient clinical situations, the serum TSH is the most sensitive test for detecting mild thyroid hormone excess or deficiency. Therapeutic options for patients with Graves' disease include thyroidectomy (rarely used now in the United States), antithyroid drugs (frequently associated with relapses), and radioactive iodine (currently the treatment of choice).

Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study.

Objectives: The study was conducted to test the hypothesis that the prevalence of coronary atherosclerosis is greater among diabetic than among nondiabetic individuals and is similar for diabetic individuals without clinical coronary artery disease (CAD) and nondiabetics with clinical CAD.

Background: Persons with diabetes but without clinical CAD encounter cardiovascular mortality similar to nondiabetic individuals with clinical CAD. This excess mortality is not fully explained.

Impact of case ascertainment on recent trends in diabetes incidence in Rochester, Minnesota.

The authors previously reported an increase in the incidence of diabetes mellitus among Rochester, Minnesota, residents during the period 1970-1989. This study provides updated rates from data collected through 1994. Trends in diabetes surveillance, i.