Glycemic management and clinical outcomes in underserved minority kidney transplant recipients with type 2 and posttransplantation diabetes: A single-center retrospective study.

Aims: Little is known about glycemic management, particularly with novel cardio-nephroprotecive agents, in underserved minority kidney transplant recipients with pre-transplant type 2 (T2DM) and posttransplantation diabetes mellitus (PTDM). We assessed glycemic management and outcomes in this high-risk population.

Methods: We reviewed records of patients who received kidney transplants between June 2012 and December 2014 at a single center.

A DRAMATIC RESPONSE TO DENOSUMAB: PROTRACTED HYPOCALCEMIA RELATED TO HUMAN T-CELL LYMPHOTROPIC VIRUS TYPE 1-ASSOCIATED ADULT T-CELL LEUKEMIA/LYMPHOMA.

Objective: Adult T-cell leukemia/lymphoma (ATL) is known for its aggressive behavior, frequently presenting with hypercalcemia. ATL tumor cells uniquely secrete parathyroid hormone-related protein, viral peptides, and inflammatory cytokines, inducing a state of high bone turnover and activation of the receptor activator of nuclear factor kappa-B signaling pathway resulting in hypercalcemia.

Methods: A 54-year-old woman diagnosed with ATL presented with severe hypercalcemia refractory to bisphosphonate therapy.

Strategies for Diabetes Management: Using Newer Oral Combination Therapies Early in the Disease.

Introduction: The duration of uncontrolled type 2 diabetes mellitus (T2DM) can adversely impact small and large vessels, eventually leading to microvascular and macrovascular complications. Failure of therapeutic lifestyle changes, monotherapy, and clinical inertia contribute to persistent hyperglycemia and disease progression. The aim was to review the complex pathophysiology of type 2 diabetes and how different oral agents can be used effectively as first-line therapy in combination with metformin, as well as in patients not achieving glycemic goals with metformin therapy.

Triglyceride High-Density Lipoprotein Ratios Predict Glycemia-Lowering in Response to Insulin Sensitizing Drugs in Type 2 Diabetes: A Post Hoc Analysis of the BARI 2D.

Glycemic management is central in prevention of small vessel and cardiovascular complications in type 2 diabetes. With the plethora of newer medications and recommendations for a patient centered approach, more information is necessary to match the proper drug to each patient. We showed that BARI 2D, a five-year trial designed to compare two different glycemic treatment strategies, was suitable for assessing different responses according to different phenotypic characteristics.

Understanding hypoglycemia in hospitalized patients.

Controlling blood glucose in hospitalized patients is important as both hyperglycemia and hypoglycemia are associated with increased cost, length of stay, morbidity and mortality. A limiting factor in stringent control is the concern of iatrogenic hypoglycemia. The association of hypoglycemia with mortality has led to clinical guideline changes recommending more conservative glycemic control than had previously been suggested, with the use of patient specific approaches when appropriate.

Is there a paradox in obesity?

In an industrialized society, the increase in obesity incidence has led to an increase in premature morbidity and mortality rates. There is a relationship between body mass index (BMI) and the increased incidence of hypertension, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease, an increase in mortality. However, obese individuals with these conditions may have better outcomes than their lean counterparts, thus the term "obesity paradox.

The clinical impact of inpatient hypoglycemia.

Hypoglycemia is common in hospitalized patients and is associated with poor outcomes, including increased mortality. Older individuals and those with comorbidities are more likely to suffer the adverse consequences of inpatient hypoglycemia. Observational studies have shown that spontaneous inpatient hypoglycemia is a greater risk factor for death than iatrogenic hypoglycemia, suggesting that hypoglycemia acts as a marker for more severe illness, and may not directly cause death.

Population management of diabetes in a high-need urban community in the Bronx: the experience of Montefiore Medical Center.

Purpose: The purpose of this study is to examine the impact of a Care Management Organization (CMO) Diabetes Disease Management Program (DDMP) in improving diabetes outcomes among high-risk patients with type 2 diabetes (T2DM) in the Bronx, New York.

Methods: An interventional, nonrandomized study design was used to assess the effectiveness of the DDMP. Patients older than 18 years who had T2DM and an A1C persistently 8% or greater or with a cardiovascular comorbidity were characterized as high risk and received intensive disease management.

Determinants of successful glycemic control among participants in the BARI 2D trial: a post-hoc analysis.

Objective: The BARI 2D trial compared insulin provision (IP) versus insulin sensitization (IS) for the primary outcome of total mortality in participants with T2DM and cardiovascular disease (CVD). In this analysis we examine baseline characteristics that are associated with successful long-term glycemic control.

Research Design And Methods: In a 2×2 factorial design, 2368 participants were randomized to either IP or IS therapy, and to either prompt revascularization with medical therapy or medical therapy alone.

Impact of hypoglycemia in hospitalized patients.

Hypoglycemia is a common problem in hospitalized patients, particularly the elderly, frail, and severely ill. Hypoglycemia has been implicated in the development of adverse clinical outcomes, including increased mortality. Fear of iatrogenic hypoglycemia remains an obstacle to adequate inpatient glycemic control.

Hypoglycemia-associated mortality is not drug-associated but linked to comorbidities.

Objective: Although tight glucose control is used widely in hospitalized patients, there is concern that medication-induced hypoglycemia may worsen patient outcomes. We sought to determine if the mortality risk associated with hypoglycemia in hospitalized noncritically ill patients is linked to glucose-lowering medications (drug-associated hypoglycemia) or merely an association mediated by comorbidities (spontaneous hypoglycemia).

Methods: A retrospective cohort of patients admitted to the general wards of an academic center during 2007 was studied.

The impact of race/ethnicity on baseline characteristics and the burden of coronary atherosclerosis in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.

Objectives: We aimed to test the impact of race/ethnicity on coronary artery disease (CAD) after adjusting for baseline risk factors.

Background: Whether race/ethnicity remains an important determinant of the burden of CAD even among patients with long-standing type 2 diabetes (diabetes mellitus) and established CAD is unknown.

Methods: Analysis of baseline data from the BARI 2D trial (January 1, 2001, to March 31, 2005) was performed.

Mortality trends and disparities among racial/ethnic and sex subgroups in New York City, 1990 to 2000.

New York City census data for 1990 and 2000 for all-cause and disease-specific mortality adjusted by age were examined by race/ethnicity. Primary cause of death was coded as HIV/AIDS, cardiovascular disease, coronary heart disease, acute myocardial infarction, stroke, diabetes, or cancer. For White, Black, Hispanic and Asian groups, relative mortality ratios (RMR) were derived for 2000 relative to 1990.

Training community health promoters to implement diabetes self-management support programs for urban minority adults.

Objective: To develop, implement, and evaluate a peer-led diabetes self-management support program in English and Spanish for a diverse, urban, low-income population. The program goals and objectives were to improve diabetes self-management behaviors, especially becoming more physically active, healthier eating, medication adherence, problem solving, and goal setting.

Methods: After a new training program for peers led by a certified diabetes educator (CDE) was implemented with 5 individuals, this pilot evaluation study was conducted in 2 community settings in the East and South Bronx.

Racial disparity in amputation-free survival after infrainguinal bypass procedure: contribution of socioeconomic status.

Objective: To investigate amputation-free survival after infrainguinal bypass in African Americans and Hispanics compared with non-Hispanic whites and to determine the contribution of socioeconomic status to potential racial disparity.

Design: This is a retrospective cohort study of subjects who underwent infrainguinal bypass due to critical limb ischemia from 1997 through 2004. The primary end point was major amputation or death, whichever occurred first.

Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes.

Objective: To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes.

Research Design And Methods: This study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C.

Using insulin as a drug rather than as a replacement hormone during acute illness: a new paradigm.

The direct correlation between glucose levels and cardiovascular disease in individuals with type 2 diabetes can now be applied to individuals that share an abnormal metabolic milieu similar to that found in central obesity, the metabolic syndrome, and type 2 diabetes. Premature macrovascular complications with a very high morbidity and mortality rate can be found in these nondiabetic populations. The typical phenotype has visceral or central obesity, excess of free fatty acids, insulin resistance, increased insulin secretion, and hypertension.

Pharmacotherapy of diabetes mellitus: implications for the prevention and treatment of cardiovascular disease.

Diabetes mellitus in adults is associated with an increased risk of premature vascular disease and a higher mortality rate. The presence of other risk factors, often seen in diabetic patients, such as systemic hypertension, augments the rate of vascular diseases. Evidence is growing that tight control of hyperglycemia using insulin and/or oral hypoglycemic agents will modify this risk.

Diagnosis and management of endocrine disorders of erectile dysfunction.

Organic causes of erectile dysfunction with androgen deficiency may be associated with aging, systemic illness, and a number of specific endocrine disorders stemming from pituitary, thyroid, and adrenal dysfunction. Central hypogonadism is the main mechanism in the majority. Erectile dysfunction in diabetes mellitus is caused by chronic complications due to poor metabolic control.

Diabetes care needs of Hispanic patients treated at inner-city neighborhood clinics in New York City.

The charts of 254 Hispanic patients were selected from a sample of 321 patients with diabetes in four urban clinics that received federal funding to provide medical care in underserved communities. A standardized chart-audit protocol was used to assess the process of healthcare delivery and the presence of diabetes-associated comorbidities and complications in patients. Inconsistent recognition of obesity (11% identified vs 59% present), hyperlipidemia (17% identified vs 69% present), and renal dysfunction (3.