Basic Management Of Diabetes Mellitus: Practical Guidelines
Basic Management of Diabetes Mellitus: Practical guidelines We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Basic Management of Diabetes Mellitus: Practical guidelines Diabetes mellitus is a major health problem associated with microvascular and macrovascular complications, leading to increased morbidity and mortality. It is rapidly growing worldwide with a huge economical and social burden. Although prevention and treatment of diabetes and its complications play a key role in reducing its morbidity and mortality, they require an integrated team approach at national and international levels. Early diagnosis, correct treatment, and effective follow-up are essential in any health care system to prevent complications of diabetes and ensure patients well being. Diabetes Mellitus (DM) is a rapidly growing chronic and multifactorial disease with a worldwide projection of 324 million diabetics by the year 2025 ( 1 ). In Africa, the prevalence of diabetes is expected to rise by 98%, from 13.6 million at 2003 to 26.9 million at 2025. A similar increase (97%) is expected in the Middle East region with an estimated prevalence of 35.9 million diabetics by 2025. This emphasizes the health and economic threat diabetes poses in these countries as well as the importance of having recognized guidelines for the management of diabetes in order to prevent the complications and ensure a normal quality of life to the patients. The prevalence of DM in Continue reading >>
Treatment Of Type 2 Diabetes Mellitus
Type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes) causes abnormal carbohydrate, lipid and protein metabolism associated with insulin resistance and impaired insulin secretion. Insulin resistance is a major contributor to progression of the disease and to complications of diabetes. Type 2 diabetes is a common and underdiagnosed condition that poses treatment challenges to family practitioners. The introduction of new oral agents within the past three years has expanded the range of possible combination regimens available for treating type 2 diabetes. Despite the choice of pharmacologic agents, physicians must stress the nonpharmacologic approaches of diet modification, weight control and regular exercise. Pharmacologic approaches must be based on patient characteristics, level of glucose control and cost considerations. Combinations of different oral agents may be useful for controlling hyperglycemia before insulin therapy becomes necessary. A stepped-care approach to drug therapy may provide the most rational, cost-efficient approach to management of this disease. Pharmaco-economic analyses of clinical trials are needed to determine cost-effective treatment strategies for management of type 2 diabetes. Diabetes mellitus affects approximately 16 million people in the United States and accounts for about one sixth of all expenditures for health care.1 Ninety percent of patients with diabetes have type 2 diabetes (formerly known as non–insulin-dependent diabetes) and often require oral agents or insulin for glucose control. The mortality rate in patients with diabetes may be up to 11 times higher than in persons without the disease.1 Diabetes is a leading cause of blindness, renal failure, and foot and leg amputations in adults. Managed care and Continue reading >>
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- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
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Intensive Diabetes Management
Intensive diabetes management aims to achieve lower blood sugars Intensive diabetes management is a term to describe treatment therapies which aim to achieve lower average blood glucose results. Tighter blood glucose control is widely believed to reduce the risk of diabetic complications. Tighter blood glucose control has been shown to reduce the risk of diabetic complications but it may not be appropriate for everyone. We look here at the benefits of intensive diabetes treatment as well as under which circumstances HbA1c targets may be relaxed. What is an intensive diabetes treatment therapy? An intensive diabetes therapy can be regarded as any treatment regime designed to significantly reduce blood sugar control over the long term. How this is achieved may well vary between patients. For people with type 2 diabetes, this could involve adding a more potent medication, such as a sulfonylurea (eg gliclazide), insulin or a combination of drugs. For people with type 1 diabetes, it could involve being put on a regime of multiple insulin injections or going onto a diabetes pump - this is known as intensive insulin therapy . Long term studies have shown that achieving and maintaining a 1% (11 mol/mol) reduction in HbA1c can significantly reduce the risk of developing long term diabetes complications including microvascular complications (retinopathy, nephropathy and neuropathy) and macrovascular complications such as heart disease and stroke. How safe is intensive diabetes management? In recent years there has been discussion about the safety of intensive diabetes management within healthcare circles. Generally studies have found lowering of HbA1c values to be positive, however, some people may be less able to achieve lower HbA1c results without increasing the risk of severe Continue reading >>
- Type 2 Diabetes Remission With Intensive Treatment
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- NIHR Signal Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes
Management Of Diabetes In Long-term Care And Skilled Nursing Facilities: A Position Statement Of The American Diabetes Association
Published online 2016 Jan 11. doi: 10.2337/dc15-2512 Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association 1Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Harvard Medical School, Boston, MA 2Geriatric Research Education and Clinical Centers, Miami Veterans Affairs Healthcare System and University of Miami, Miami, FL 3Section of General Internal Medicine, The University of Chicago, Chicago, IL 4Johns Hopkins University School of Medicine, Baltimore, MD 5American Diabetes Association, Alexandria, VA 6Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL 7Kadlec Regional Medical Center, Richland, WA 8University of Rhode Island College of Pharmacy, Providence, RI Copyright 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. This article has been cited by other articles in PMC. Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tail Continue reading >>
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Diabetes Mellitus: Management Of Microvascular And Macrovascular Complications
The management of type 1 and 2 diabetes mellitus (DM) requires addressing multiple goals, with the primary goal being glycemic control. Maintaining glycemic control in patients with diabetes prevents many of the microvascular and macrovascular complications associated with diabetes. This chapter presents a review of the prevalence, screening, diagnosis, and management of these complications. Definitions Microvascular complications of diabetes are those long-term complications that affect small blood vessels. These typically include retinopathy, nephropathy, and neuropathy. Retinopathy is divided into two main categories: Nonproliferative retinopathy and proliferative retinopathy. Nonproliferative retinopathy is the development of microaneurysms, venous loops, retinal hemorrhages, hard exudates, and soft exudates. Proliferative retinopathy is the presence of new blood vessels, with or without vitreous hemorrhage. It is a progression of nonproliferative retinopathy. Diabetic nephropathy is defined as persistent proteinuria. It can progress to overt nephropathy, which is characterized by progressive decline in renal function resulting in end-stage renal disease. Neuropathy is a heterogeneous condition associated with nerve pathology. The condition is classified according to the nerves affected and includes focal, diffuse, sensory, motor, and autonomic neuropathy. Macrovascular complications of diabetes are primarily diseases of the coronary arteries, peripheral arteries, and cerebrovasculature. Early macrovascular disease is associated with atherosclerotic plaque in the vasculature supplying blood to the heart, brain, limbs, and other organs. Late stages of macrovascular disease involve complete obstruction of these vessels, which can increase the risks of myocardial infar Continue reading >>
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Diabetes Management
The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentration of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes. The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment. Overview[edit] Goals[edit] The treatment goals are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies. The targets are: HbA1c of 6%[1] to 7.0%[2] Preprandial blood Continue reading >>
Management Of Type 1 Diabetes
Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. Type 1 diabetes describes a condition in which the pancreas is no longer able to produce sufficient insulin due to the destruction of the pancreatic beta cells by an autoimmune process. It is a condition which occurs predominantly in younger people, from childhood to young adults, and is increasing in the population, particularly in the under-5 age group. See the separate Diabetes Mellitus article. Type 1 diabetes accounts for over 90% of diabetes in young people aged under 25 years. 12-15% of young people aged under 15 years with diabetes have an affected first-degree relative. Children are three times more likely to develop diabetes if their father has diabetes than if their mother has diabetes.[1] Initial assessment The successful management of the person with diabetes depends on working in partnership with the person affected and all members of the team responsible for the various elements of their care. Before a management plan can be agreed, an initial assessment of the health and lifestyle of the patient must be undertaken with particular reference to:[1] History Diabetic history, both recent and historical. Symptoms of potential complications - eg, deterioration in eyesight. Other medical conditions. Drug history, current medications. Family history. Occupation and social history - eg, level of exercise, type of diet, smoking history, use of alcohol and recreational drugs. Prior knowledge of, attitudes to and concerns about the condition. Examination General examination. H Continue reading >>
Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)
TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body becomes resistant to normal or even high levels of insulin. This causes high blood sugar (glucose) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medicines, which can minimize the risk of diabetes and cardiovascular (heart-related) complications. This topic review will discuss the treatment of type 2 diabetes. Topics that discuss other aspects of type 2 diabetes are also available: (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)".) (See "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)".) TYPE 2 DIABETES TREATMENT GOALS Blood sugar control — The goal of treatment in type 2 diabetes is to keep blood sugar levels at normal or near-normal levels. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood sugar (diabetic complications of the eye, kidney, nervous system, and cardiovascular system). Home blood sugar testing — In people with type 2 diabetes, home blood sugar testing might be recommended, especially in those who take certain oral diabetes medicines or insulin. Home blood sugar testing is not usually necessary for people who are diet controlled. (See "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)".) A normal fasting blood sugar is less than 100 mg/dL (5.6 mmol/L), although some people will have a different goal. Continue reading >>
Type 2 Diabetes Mellitustreatment & Management
Type 2 Diabetes MellitusTreatment & Management Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers , highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: Diagnosis and treatment of vascular complications Intensification of insulin therapy in type 2 diabetes The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations 2015 . [ 121 ] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [ 2 ] Management includes the following: Appropriate self-monitoring of blood glucose (SMBG) Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, Continue reading >>
Role Of Self-care In Management Of Diabetes Mellitus
Role of self-care in management of diabetes mellitus 1 Prateek Saurabh Shrivastava ,1 and Jegadeesh Ramasamy 1 1Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108, , Kancheepuram, Tamil Nadu, India Find articles by Saurabh RamBihariLal Shrivastava 1Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108, , Kancheepuram, Tamil Nadu, India Find articles by Prateek Saurabh Shrivastava 1Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108, , Kancheepuram, Tamil Nadu, India 1Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108, , Kancheepuram, Tamil Nadu, India Received 2013 Jan 22; Accepted 2013 Feb 28. Copyright 2013 Shrivastava et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Diabetes mellitus (DM) is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute (Type 1 DM) or relative (Type 2 DM) deficiency of insulin hormone. World Health Organization estimates that more than 346 million people worldwide have DM. This number is likely to more than double by 2030 without any intervention. The needs of diabetic patie Continue reading >>
Diabetes Mellitus Treatment
In patients diagnosed with diabetes mellitus (DM), the therapeutic focus is on preventing complications caused by hyperglycemia. In the United States, 57.9% of patients with diabetes have one or more diabetes-related complications and 14.3% have three or more.[1] Strict control of glycemia within the established recommended values is the primary method for reducing the development and progression of many complications associated with microvascular effects of diabetes (eg, retinopathy, nephropathy, and neuropathy), while aggressive treatment of dyslipidemia and hypertension further decreases the cardiovascular complications associated macrovascular effects.[2-4] See the chapter on diabetes: Macro- and microvascular effects. Glycemic Control Two primary techniques are available to assess a patient's glycemic control: Self-monitoring of blood glucose (SMBG) and interval measurement of hemoglobin A1c (HbA1c). Self-Monitoring of Blood Glucose Use of SMBG is an effective method to evaluate short-term glycemic control. It helps patients and physicians assess the effects of food, medications, stress, and activity on blood glucose levels. For patients with type 1 DM or insulin-dependent type 2 DM, clinical trials have demonstrated that SMBG plays a role in effective glycemic control because it helps to refine and adjust insulin doses by monitoring for and preventing asymptomatic hypoglycemia as well as preprandial and postprandial hyperglycemia.[2,5-7] The frequency of SMBG depends on the type of medical therapy, risk for hypoglycemia, and need for short-term adjustment of therapy. The current American Diabetes Association (ADA) guidelines recommend that patients with diabetes self-monitor their glucose at least three times per day.[8] Those who use basal-bolus regimens should s Continue reading >>
Treatment Of Diabetes Mellitus: General Goals And Clinical Practice Management
Article INTRODUCTION Diabetes mellitus is a chronic disease with one of the highest social and healthcare costs and is associated with a 3-fold to 4-fold increment in cardiovascular morbidity and mortality. In fact, ischemic heart disease is the main cause of death in diabetic patients.1,2 This article places special emphasis on the therapeutic management of type 2 diabetes, which is the most prevalent type and, consequently, the modality that will cause the greatest cardiovascular morbidity and mortality in absolute figures. The treatment of diabetes must be based on an understanding of its pathophysiology. Thus, in type 1 diabetes mellitus a severe insulin secretion deficit exists and the only treatment, at present, is the administration of insulin or insulin analog. However, type 2 diabetes mellitus is a much more complex disease, in which insulin resistance predominates in the early stages. In more advanced stages, insulin resistance persists but the deficit in insulin secretion is more evident. Therefore, the therapeutic approach will depend on the stage of the disease and characteristics of the patient. GOALS OF TREATMENT The general goals of the treatment of diabetes are to avoid acute decompensation, prevent or delay the appearance of late disease complications, decrease mortality, and maintain a good quality of life. As for chronic complications of the disease, it is clear that good control of glycemia makes it possible to reduce the incidence of microvascular complications (retinopathy, nephropathy, and neuropathy),3,4 whereas good control of glycemia per se does not seem to be as determinant in the prevention of macrovascular complications (ischemic heart disease, cerebrovascular disease, peripheral arteriopathy).4 In this sense, the treatment of hyperglycemi Continue reading >>
Structuring Diabetes Mellitus Care In Long-term Nursing Home Residents
Structuring Diabetes Mellitus Care in Long-Term Nursing Home Residents D Fitzpatrick1, ES Ibrahim1, S Kennelly2, M Sherlock 3, D ONeill2 2Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin 3Department of Endocrinology and Diabetes, Tallaght Hospital, Dublin Nursing home residents with diabetes have more complex care needs with higher levels of comorbidity, disability and cognitive impairment. We compared current practice in the 44 long-term residents in Peamount hospital with the standards recommended in the Diabetes UK Good Clinical Practice Guidelines for Care Home Residents with Diabetes. Of 44 residents, 11 were diabetic. Residents did not have specific diabetes care plans. There were some elements of good practice with a low incidence of hypoglycaemia and in-house access to dietetics and chiropody. However, diabetes care was delivered on an ad-hoc basis without individualised care plans, documented glycaemic targets, or scheduled monitoring for complications and no formal screening for diabetes on admission. National and local policy to guide management of diabetes mellitus should be developed. There should be individualised diabetes care plans, clear policies for hypoglycaemia, hyperglycaemia and long-term diabetes complications, screening on admission and increased uptake of the national retinal screening and foot care programmes. Compared to community dwelling older adults, nursing home residents have more complex care needs with higher levels of comorbidity, disability and cognitive impairment1. Diabetes mellitus is also associated with cognitive deficits, functional dependence and multi-morbidity2,3, making nursing home residents with diabetes a particularly vulnerable cohort. Diabetes and its complications are associated with reduced Continue reading >>
Long Term Type 2 Diabetes Treatment Guide
The American Diabetes Association stresses individualized glucose targets for older adults. Talk to your doctor about what target is best for you. Despite the difficulties of managing diabetes, today older adults with type 2 diabetes are more likely than ever to live a healthy life without major complications. Exercise is one of the most important strategies to slow the effects of diabetes over time. The downward spiral of aging, both for people with and without diabetes, is often a result of inactivity. Muscles that arent used sufficiently become weak, falls become more common, and the activities of everyday life become more difficult. Here are some recommendations if youre looking to start a new exercise routine: Start walking. Aerobic exercise lowers blood pressure and blood sugar levels. Over time it lowers the risk of cardiovascular disease. If walking is difficult, use an exercise bike, swim, or just move your limbs while sitting to get your heart rate up. Do strength training. Building muscle mass improves glucose metabolism and blood sugar control and helps maintain muscle as we age. Try yoga or tai chi. Both of these enhance flexibility and balance, relieve stress, and improve mood. In addition to exercising, eating right is important for people with diabetes. This typically means eating regularly and focusing on high-fiber, less processed foods. Ideally, the diet will include many plant-based foods and healthy fat choices. Make sure not to skip meals, and try to time meals to meet your medications peak activity time. Taking your medication as prescribed is also important. Be sure to discuss the correct way to take all of your medications with your doctor or pharmacist, and then stick with this schedule. Getting the proper amount of sleep will also keep you he Continue reading >>
Type 2 Diabetes
Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>
