| Diabetes Master Clinician Program |
|
|
Glycemic Control
This article suggests strategies to improve β-cell function, prevent β-cell death and individualize A1C target based on patient characteristics, safety and effectiveness. Does lowering A1C reduced CV disease? Conflicting data about the safety and effectiveness of intensive glycemic control have caused confusion over the best approach to cardiovascular risk reduction in patients with diabetes. This article reviews the data and provides a way for primary care clinicians to reconcil the contradictory data. Suggestions for the extent of glycated hemoglobin reduction are provided for different populations. Diabete and Prediabetes-New guidelines Recent publications by the ADA have introduced A1C as a tool for making the diagnosis of Diabetes and Pre-Diabetes. This has created some controversy. This article provides an overview of the guidelines and suggestions for how to use them in the Primary Care Setting. CVD risk higher in pre-diabetes This study of a large population reviews the increased incidence of CVD at all levels of abnormal glucose. It suggests that CVD prevention Value of Monitoring Urine Microalbumin in Diabetes A change in albuminuria tells the physician whether the patient has an increased or decreased risk of cardiovascular and renal events. Measuring albumin is also a tool for judging the success of treatment. This report discusses evidence from the ONTARGET study. National Data increased B/P, Lipids and Glucose This report provides national data that indicates many patients with hypertension, hyperglycemia and hyperlipidemia are not treated or adequately treated. Also provides data on nutrition and other behaviors. Depression and Diabetes This link will provide access to a document from the American College of Physicians with input from several disciplines. There is no charge but you will need to create a user name and password. |
Importance of Non-HDL Cholesterol in Diabetes
The most common cause of mortality and morbidity in diabetes is CV disease. Use of statins to lower LDL is the mainstay of lowering CV risk in diabetes. After reduction of LDL to goal residual risk remains. Non-HDL (total cholesterol minus HDL) is a simple inexpensive way to access this residual risk. This article reviews use on Non-HDL in the Primary Care setting. Hypoglycemia increases CVD This article discusses the evidence for hypoglycemia leading to CVD and the inflammation as the cause. Autonomic Neuropathy This article covers the epidemiology; pathophysiology, clinical presentation, and diagnosis of cardiac autonomic neuropathy (CAN) in diabetes. Signs of CAN include a decrease in heart rate variability, resting tachycardia, nocturnal hypertension, and postural hypotension. The longer the patient has diabetes and poor control the greater chance of CAN.This article is a nice review of the subject. Metformin decreases cancer risk The anti-diabetic properties of metformin are mediated through its ability to activate the AMP-activated protein kinase (AMPK). Activation of AMPK can suppress tumor formation and inhibit cell growth in addition to lowering blood glucose levels Hypertension in Diabetes This slide set describes several of the aspects of hypertension in diabetes including importance of outpatient measurement, medication and non- medication treatment issues and resistant hypertension. Diabetes University This a link to an excellent educational program for nurses, medical assistants and other office staff. Please encourage staff to use this. |