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Which Type Of Antidiabetic Drugs Is Injected Subcutaneously To Treat Type 2 Diabetes?

Incretin Mimetics And Enhancers: New Insulin Secretagogues For Type-2 Diabetes

Incretin Mimetics And Enhancers: New Insulin Secretagogues For Type-2 Diabetes

Rajiv Mahajan1* and Kapil Gupta2 1Department of Pharmacology Adesh Institute of Medical Sciences and Research, Bathinda, India 2Department of Biochemistry Adesh Institute of Medical Sciences and Research, Bathinda, India Corresponding Author: Department of Pharmacology Adesh Institute of Medical Sciences and Research Bathinda-151109 (Punjab) India E-mail: [email protected] Abstract Hyperglycemia, obesity, insulin resistance, dyslipidemia and hypertension are interrelated cardiometabolic risk factors for the development of type-2 diabetes and metabolic syndrome. Prevalence of type-2 diabetes is growing at an alarming rate. Treatment target for type-2 dia-betes is to keep daily glucose profile as close as possible to that of a non-diabetic person. Sul-fonylureas, thiazolidinediones, meglitinides, biguanides and acarbose inhibitors are already being used in controlling glucose levels in type-2 diabetes. Mimicking or enhancing the actions of incretin is a new strategy which can help to control glucose levels in type-2 diabetics. This review discusses the incretin mimetics and enhancers, drug group with novel mechanism of ac-tions; which were marketed recently or will be in market in near future. Exenatide and liraglutide are injectable glucagon-like peptide-1 receptor agonists, while vildagliptin and si-tagliptin are oral dipeptidyl peptidase 4 inhibitors. Keywords Type-2 diabetes, Pharmacotherapy, Incretins, Exenatide Introduction Type-2 diabetes is the most common metabolic disorder worldwide, and its prevalence is growing at an alarming rate in both developed and developing countries. This growth has been related to the increased prevalence of obesity. A cluster of interrelated cardiometabolic risk factors is closely related to the development of type-2 diabet Continue reading >>

Curcumin Combination With Anti-type 2 Diabetic Drugs For Prevention And Treatment Of Disease Sequelae, Drug-related Adverse Reactions, And Improved Glycemic Control

Curcumin Combination With Anti-type 2 Diabetic Drugs For Prevention And Treatment Of Disease Sequelae, Drug-related Adverse Reactions, And Improved Glycemic Control

Compositions and methods for treating type 2 diabetes and its sequelae by intravenous or subcutaneous administration of formulations of synthesized curcumin (diferuloylmethane) and concomitantly one or more anti-diabetic agents to human subjects are disclosed herein. The composition of the present invention may be used to: (i) treat patients with diabetes in advanced stages with evidence of any or all encephalopathy, retinopathy, nephropathy, pancreatitis or neoplasias; (ii) treat patients with diabetic disease status without symptomatic or pathologic evidence of associated sequelae but requiring better glycemic control than that offered by standard of care anti-diabetic; and (iii) patients with objective signs or symptoms of sequelae from diabetes of anti-diabetic drugs. One three-drug combination of the present invention includes a slow release PLGA-curcumin and an oral gliptin (DPP-4)-inhibitor or any incretin-mimetic and metformin. 1. A composition for ameliorating symptoms and/or treating type 2 diabetes and one or more associated pathological conditions (sequelae) in a human subject comprising: a therapeutically effective amount of a formulation comprising curcumin, curcumin analogues, curcumin derivatives, curcuminoids or combinations thereof dissolved or dispersed in a suitable aqueous or non-aqueous medium, wherein the curcumin is enclosed in at least one of one or more liposomes, enclosed in a polymeric nanoparticle, conjugated to one or more biodegradable polymers or formulated into a liposome that is surrounded or incorporated into a polymeric nanoparticle; 4. The composition of claim 1, wherein the one or more biodegradable polymers are selected from the group consisting of polyesters, polylactides, polyglycolides, polycaprolactones, polyanhydrides, polyami Continue reading >>

Fda Approves Two New Drug Treatments For Diabetes Mellitus

Fda Approves Two New Drug Treatments For Diabetes Mellitus

Release The U.S. Food and Drug Administration today approved Tresiba (insulin degludec injection) and Ryzodeg 70/30 (insulin degludec/insulin aspart injection) to improve blood sugar (glucose) control in adults with diabetes mellitus. According to the Centers for Disease Control and Prevention, approximately 21 million people in the United States have been diagnosed with diabetes. Over time, diabetes increases the risk of serious health complications, including heart disease, blindness, nerve and kidney damage. Improvement in blood sugar control can reduce the risk of some of these long-term complications. "Long-acting insulins play an essential role in the treatment of patients with type-1 diabetes and in patients with type-2 diabetes with advanced disease," said Jean-Marc Guettier, M.D., director of the Division of Metabolism and Endocrinology Products in the FDA’s Center for Drug Evaluation and Research. “The FDA remains committed to support the development of innovative therapies for the treatment of diabetes.” Tresiba is a long-acting insulin analog indicated to improve glycemic control in adults with type 1 and 2 diabetes mellitus. Dosing of Tresiba should be individualized based on the patient’s needs. Tresiba is administered subcutaneously once daily at any time of day. The efficacy and safety of Tresiba used in combination with mealtime insulin for the treatment of patients with type-1 diabetes were evaluated in two 26-week and one 52-week active-controlled clinical trials involving 1,102 participants exposed to Tresiba. The efficacy and safety of Tresiba used in combination with mealtime insulin or used as add-on to common background oral antidiabetic drugs for the treatment of patients with type-2 diabetes were evaluated in four 26-week and two 52-wee Continue reading >>

Diabetes Medication

Diabetes Medication

There are different types of medications available for diabetes mellitus with each having their own mechanism of action and side effects. The best drug should be chosen by a doctor assessing the condition of the patient – please note all these are prescription medicines and need to be taken properly, under medical-supervision and with correct dosage and at the right timings. You must, at all times, follow instructions from your doctor. Never self-medicate. Basically, anti-diabetic drugs can be categorized into two classes: A. Oral anti-diabetic drugs: This includes the following classes: Insulin secretagogues: sulphonylureas and non-sulphonylureas(Glinides/Meglitinide) Biguanides Thiazolidinediones a-glucosidase inhibitors Di-peptydyl Peptidase-4 (DPP-4) inhibitors/gliptins Sodium-glucose co-transporter 2 (SGLT2) inhibitors B. Injectable anti-diabetic drugs: Insulin preparations Glucagon-like peptide 1 (GLP1) agonists According to A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes, a tier system is used to prescribe medicines depending on how validated (tested) the medication is. The tier is divided into steps depending on the stage of diabetes and how the patient responds to the lifestyle changes and medicines. Tier 1: This includes the best established, most-effective and most cost effective therapeutic strategies to control blood sugar. This is also the most preferred strategy for patients with type 2 diabetes. The tier is divided into 3 steps. Step 1: These are prescribed at when someone is diagnosed with type 2 diabetes. Apart from a lifestyle change, a mild medication that is well tested, has low and less severe side-effects and is cheap is prescribed. Step 2: A second medication is added when step 1 Continue reading >>

Chapter 30 - Antidiabetic

Chapter 30 - Antidiabetic

Sort Mr. Goddard, age 78 years, was recently diagnosed with type 2 diabetes, and his health care provider has prescribed an antidia-betic drug. Mr. Goddard says his friend with diabetes takes insulin and he wonders why insulin was not prescribed for him. What explanation should be given to Mr. Goddard's initial question? a. Antidiabetics are used to treat patients with type 2 diabetes because insulin is used only for type 1 diabetes. b. Insulin is sometimes used for type 2 diabetes, but Mr. Goddard's case may not require it. c. Older patients are more responsive to antidiabetics than to insulin. d. Both a and c b. Insulin is sometimes used for type 2 diabetes, but Mr. Goddard's case may not require it. As a patient with newly diagnosed disease, Mr. Goddard requires instruction on which of the following topics? a. Diet b. Diet and exercise c. Diet, exercise, and stress reduction d. Diet, exercise, stress reduction, and alcohol intake d. Diet, exercise, stress reduction, and alcohol intake Ms. May has been diagnosed with type 1 diabetes. She is 15 years old. Her physician has prescribed an insulin regimen for her. How is insulin administered? a. Intradermally b. Subcutaneously c. Intramuscularly d. Intravenously b. Subcutaneously Where are insulin injections given? a. Upper arms, outer portion b. Stomach, except for a 2-in. margin around the umbilicus (belly button) c. Back, right, and left sides just below the waist d. All of the above d. All of the above Which of the following symptoms indicate a possible hyperglycemic reaction? a. Fatigue, weakness, confusion b. Pale skin, elevated temperature c. Thirst, abdominal pain, nausea d. Rapid, shallow respirations, headache, nervousness c. Thirst, abdominal pain, nausea First-generation sulfonylureas are contraindicated in pa Continue reading >>

Curcumin Combination With Anti-type 2 Diabetic Drugs For Prevention And Treatment Of Disease Sequelae, Drug-related Adverse Reactions, And Improved Glycemic Control

Curcumin Combination With Anti-type 2 Diabetic Drugs For Prevention And Treatment Of Disease Sequelae, Drug-related Adverse Reactions, And Improved Glycemic Control

Compositions and methods for treating type 2 diabetes and its sequelae by intravenous or subcutaneous administration of formulations of synthesized curcumin (diferuloylmethane) and concomitantly one or more anti-diabetic agents to human subjects are disclosed herein. The composition of the present invention may be used to: (i) treat patients with diabetes in advanced stages with evidence of any or all encephalopathy, retinopathy, nephropathy, pancreatitis or neoplasias; (ii) treat patients with diabetic disease status without symptomatic or pathologic evidence of associated sequelae but requiring better glycemic control than that offered by standard of care anti-diabetic; and (iii) patients with objective signs or symptoms of sequelae from diabetes of anti-diabetic drugs. One three-drug combination of the present invention includes a slow release PLGA-curcumin and an oral gliptin (DPP-4)-inhibitor or any incretin-mimetic and metformin. WHAT IS CLAIMED IS: 1. A composition for ameliorating symptoms and/or treating type 2 diabetes and one or more associated pathological conditions (sequelae) in a human subject comprising: a therapeutically effective amount of a formulation comprising curcumin, curcumin analogues, curcumin derivatives, curcuminoids or combinations thereof dissolved or dispersed in a suitable aqueous or non-aqueous medium, wherein the curcumin is enclosed in at least one of one or more liposomes, enclosed in a polymeric nanoparticle, conjugated to one or more biodegradable polymers or formulated into a liposome that is surrounded or incorporated into a polymeric nanoparticle; 2. The composition of claim 1, wherein the formulation is administered concomitantly with the one or more anti-diabetic agents, wherein the anti-diabetic agents may be administered ora

Insulin Administration

Insulin Administration

Injection and infusion are the two ways to deliver insulin. Injection is the most common, and infusion is the most the most sophisticated. Injection Insulin syringe: This is the most common insulin delivery method. The classic injection device is an insulin syringe. The plastic, disposable syringes currently are available in three sizes, and hold up to 30, 50 or 100 units of insulin. The needles are fine (up to 31 gauge) with lengths ranging from 3/16th of an inch for infants, to ½ inch or more for adults. The insulin is injected into the layer of fat (subcutaneous tissue) just under the skin. (Rarely, insulin may be injected into a muscle. This should happen only under a medical supervision in a hospital or medical care setting.) A popular alternative to the insulin syringe is an insulin pen. An insulin pen has a replaceable reservoir of insulin called a cartridge, a replaceable needle to puncture the skin and to deliver insulin to the subcutaneous tissue, a dial to choose the insulin dose, and a mechanical pumping or insulin release mechanism. These may be disposable devices or re-useable devices with disposable insulin cartridges. They are very convenient for active individuals taking multiple injections, as well as those who are visually or dexterity-challenged. Continuous Subcutaneous Insulin Infusion Device: Continuous subcutaneous insulin infusion (CSII) devices (also known as insulin pumps) are the most sophisticated form of insulin delivery. These are small, computerized devices that are programmed to deliver insulin under the skin. The insulin pump is durable and lasts for years, but the insulin supply and certain pump components (insulin reservoir, tubing and infusion set) are changed every few days. We have provided more detailed information in the insulin Continue reading >>

Byetta Side Effects Center

Byetta Side Effects Center

Byetta (exenatide) is an injectable diabetes medicine that helps control blood sugar levels. Exenatide is used to treat type 2 (non-insulin dependent) diabetes. Side effects of Byetta include: nausea, upset stomach, diarrhea, constipation, weight loss, dizziness, or headache. Although Byetta by itself usually does not cause low blood sugar (hypoglycemia), low blood sugar may occur if this drug is prescribed with other anti-diabetic medications. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. Byetta is administered as a subcutaneous injection, and should be initiated at a 5 mcg dose administered twice daily at any time within the 60-minute period before the morning and evening meals. Byetta may interact with oral diabetes medications that can lower blood sugar, levothyroxine, lithium, lovastatin, pimozide, cyclosporine, sirolimus, tacrolimus, theophylline, birth control pills, blood thinners, diuretics (water pills), ergot medicines, pain medications, seizure medications, or heart or blood pressure medications. Tell your doctor all medications and supplements you use. Tell your doctor if you are pregnant or plan to become pregnant while using Byetta; it is unknown it will harm a fetus. Byetta can make birth control pills less effective. If you take birth control pills, take your pill at least 1 hour before your Byetta injection. It is unknown if Byetta passes into breast milk or if it could harm a nursing baby. Consult your doctor before breastfeeding. Our Byetta Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. This is not a complete list of side effects and others may occur. Call your doct Continue reading >>

Anti-diabetic Drugs

Anti-diabetic Drugs

Tweet Antidiabetic drugs are medicines developed to stabilise and control blood glucose levels amongst people with diabetes. Antidiabetic drugs are commonly used to manage diabetes. There are a number of different types of antidiabetic drug including: Insulin Pramlintide (Amylin) GLP-1 receptor agonists (such as Byetta and Victoza) Oral hypoglycemics (tablets) Antidiabetic drugs for type 1 diabetes For people with type 1 diabetes, daily insulin injections are essential to maintain health. Type 1 diabetics must also eat properly, keep blood glucose levels from going too low or too high, and monitor blood sugar levels. In America, pramlintide, marketed as Amylin, is used in addition to insulin by some people with type 1 diabetes to further help control their diabetes. Amylin is not currently prescribed in the UK. Antidiabetic drugs for type 2 diabetes For people with type 2 diabetes, diet and exercise may be enough to control blood glucose levels in some. However, when diet and exercise is no longer efficient, anti-diabetic drugs may be prescribed. Medication will either be taken orally in the form of tablets (oral hypoglycemics), or be injected (insulin and GLP-1 receptor agonists). Read more about oral hypoglycemics Antidiabetic treatment considerations for type 2 diabetes Biguanides, such as Metformin, are commonly prescribed as a first antidiabetic medication. If biguanides are not effective on their own you may be given alternative medication either instead of, or in addition to, biguanides. The type of medication you are offered could depend on a variety of factors as different medication have different advantages and disadvantages. Some common factors that your doctor will consider are as follows: How effective is the medication for reducing blood sugar levels? Wil Continue reading >>

What Are Antidiabetic Drugs? Medication For Sugar Diabetes

What Are Antidiabetic Drugs? Medication For Sugar Diabetes

Diabetes mellitus is a disease with high blood glucose levels resulting from a deficiency of insulin. Drugs that are used in treatment of diabetes mellitus are called antidiabetic drugs. It is useful for reducing blood sugar levels. Insulin, its analogues and oral hypoglycemic drugs are the commonly used antidiabetic drugs. What are common antidiabetic injections? Common Diabetes Medication Injections Most popular insulin preparations are a short-acting insulin called regular (crystalline) insulin. Other insulin preparations available are rapid-acting insulins (lispro, glulisin, aspart), intermediate-acting insulins (neutral protamine Hagedorn [NPH], lente insulin) and long-acting insulins (glargine, detemir, ultralente, protamine-zinc insulin). Incretin mimetics or GLP-1 analogues (exenatide, liraglutide) and amylin mimetics (pramlintide) are non-insulin antidiabetic drugs that are injected subcutaneously. What are the common oral antidiabetic drugs? Common Diabetes Medication Tablets and Capsules The common oral antidiabetic (hypoglycemic) drugs are : sulfonylureas (glimepiride, gliburide, glipizide, gliclazide) meglitinides (repaglinide, nataglinide) biguanides (metformin) thiazolidinediones (pioglitazone, rosiglitazone) α-glucosidase inhibitors (acarbose, miglitol) dipeptidyl peptidase-4 (DPP-4) inhibitors (sitagliptin, saxagliptin). How do antidiabetic drugs act? Actions of Diabetes Drugs Insulin and its analogues reduce the blood sugar levels by increasing glucose uptake from blood to the tissues. Insulin is also responsible for a host of other actions that is responsible for its beneficial effects. Ask a Doctor Online Now! Sulfonylureas and meglitinides stimulate insulin release from pancreatic beta cells. Biguanides decrease glucose production in liver and incr Continue reading >>

Comparison Of Nn5401 With Insulin Glargine, Both In Combination With Oral Antidiabetic Drugs, In Subjects With Type 2 Diabetes (boost™)

Comparison Of Nn5401 With Insulin Glargine, Both In Combination With Oral Antidiabetic Drugs, In Subjects With Type 2 Diabetes (boost™)

This trial is conducted in Africa, Asia, Europe and the United States of America (USA). The aim of this clinical trial is to compare NN5401 (insulin degludec/insulin aspart) with insulin glargine in patients with type 2 diabetes inadequately controlled with insulin and oral anti-diabetic drugs (OADs). Subjects continued their ongoing treatment with OADs in the trial. Study Type : Interventional (Clinical Trial) Actual Enrollment : 465 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment Official Title: A Trial Comparing Efficacy and Safety of NN5401 With Insulin Glargine, Both in Combination With Oral Antidiabetic Drugs in Subjects With Type 2 Diabetes (BOOST™ : INTENSIFY BASAL) Study Start Date : January 2010 Primary Completion Date : October 2010 Study Completion Date : October 2010 Secondary Outcome Measures : Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. Inclusion Criteria: Type 2 diabetes mellitus (diagnosed clinically) for at least 6 months Treatment with basal insulin regimen (insulin detemir, insulin glargine or neutral protamine Hagedorn [NPH] insulin) once daily (OD), for at least 3 months Ongoing treatment with: metformin with or without other oral antidiabetic drugs (OADs) for at least 3 months prior to randomisation HbA1c 7.0-10.0 % (both inclusive) by central laboratory analysis BMI maximum 40.0 kg/m^2 Exclusion Criteria: Treatment with insulin regi Continue reading >>

Overview Of Current Therapeutic Options In Type 2 Diabetes

Overview Of Current Therapeutic Options In Type 2 Diabetes

These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. ORIGINAL ARTICLE Rationale for combining oral agents with insulin therapy John B. Buse, MD, PHD The overriding goals of the treatment of type 2 diabetes are first to relieve symptoms and then to prevent acute and chronic complications of the disease. The former goal can be largely achieved by maintaining the fasting and premeal glucose levels substantially below the renal threshold for glucose, ~200 mg/dl. The latter goal is more difficult to achieve because it requires long-term patient and provider attention to the principles of self-care, a healthful lifestyle, cardiovascular risk factor management, and the more intensive glycemic goal of achieving near-normal glucose control. In most patients with diabetes, near-normal glycemia can be achieved with single oral agents, combinations of oral agents, or insulin. However, a significant proportion of patients, particularly those with more longstanding disease, do not achieve near-normal glucose levels despite large doses of insulin or combinations of oral agents. This is documented in a recent study in which maximum doses of troglitazone and micronized glyburide achieved a HbA1c level of 7% in 41% of subjects and <8% in only 60% of patients (1) and in the Veterans Affairs Cooperative Study in Type II Diabetes (VACSDM), in which some patients did not achieve a HbA1c<7% despite maximal educational intervention and large doses of insulin delivered as multiple injections (2). This inability to control diabetes in some cases despite intensive oral or injected therapy is likely due to the dual pathophysiology of type 2 diabetes Continue reading >>

The Future Of Insulin Therapy For Patients With Type 2 Diabetes Mellitus | The Journal Of The American Osteopathic Association

The Future Of Insulin Therapy For Patients With Type 2 Diabetes Mellitus | The Journal Of The American Osteopathic Association

The Future of Insulin Therapy for Patients With Type 2 Diabetes Mellitus From the Albert Einstein College of Medicine in Flushing, New York Address correspondence to Joseph M. Tibaldi, MD, Queens Diabetes and Endocrinology Associates, 59-45 161st St, Flushing, NY 11365-1414. E-mail: [email protected] The Future of Insulin Therapy for Patients With Type 2 Diabetes Mellitus The Journal of the American Osteopathic Association, April 2013, Vol. 113, S29-S39. doi: The Journal of the American Osteopathic Association, April 2013, Vol. 113, S29-S39. doi: Tibaldi JM. The Future of Insulin Therapy for Patients With Type 2 Diabetes Mellitus. J Am Osteopath Assoc 2013;113(4_suppl_2):S29S39. doi: . The Future of Insulin Therapy for Patients With Type 2 Diabetes Mellitus You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account Insulin therapy has been the mainstay of therapy for patients with type 2 diabetes mellitus for the past 90 years. This trend is likely to continue as new formulations are developed to more closely mimic physiologic insulin secretion and to provide patients who have diabetes with more convenient options for integrating this therapy into their lifestyle. The present article reviews how the role of insulin continues to evolve, from its earlier use in the treatment paradigm (even at first diagnosis) to its role in combination therapy with incretin-based therapies, as well as new formulations that provide more-convenient forms of insulin replacement therapy. The number of patients with type 2 diabetes mellitus (T2DM) far exceeds the number of endocrinologists and diabetes specialists available to treat them. The majority of patients are treated in primary care environme Continue reading >>

Diabetes And Glucose Control

Diabetes And Glucose Control

Goals of Treatment Many conventional sources agree on diabetes treatment priorities. A self-management and self-care program that includes an understanding of home glucose monitoring, lifestyle changes, and medication is critical. Diet and exercise are emphasized in order to help bring blood sugar under control and allow the patient to lose weight, if necessary. Stopping smoking is universally recommended. Metformin treatment is typically initiated immediately upon diagnosis. All these measures have the goal of minimizing complications and improving the diabetic patient’s overall quality of life. Ultimately, their purpose is to bring blood sugar under control and control blood sugar- and insulin-derived damage to the heart, small and large blood vessels, and other tissues (Whitlatch 2015; O'Connor 2015; Inzucchi 2012b; Fonseca 2013). Achieve blood sugar goals. Blood sugar control (as assessed by the HbA1C test) is the primary goal of diabetes treatment (Delamater 2006; ADA 2014c; Inzucchi 2012b; Whitlatch 2015; Fonseca 2013). HbA1C is a test that reflects average blood sugar over 2‒3 months. Specifically, it measures glycated hemoglobin. Hemoglobin is the oxygen-carrying component of red blood cells; glycated hemoglobin is irreversibly bound to glucose, forming an AGE. HbA1C testing should be performed routinely as part of continuing care to monitor how well blood glucose is being managed (Bozkaya 2010; ADA 2014a). Conventional glycemic control goals. The American Diabetes Association recommends diabetic patients attempt to achieve an HbA1C level of 7% or less (ADA 2015f). Fasting glucose levels alone are not generally relied upon to follow blood sugar control (O'Connor 2015). The International Diabetes Foundation recommends a post-meal glucose upper limit of 140 mg Continue reading >>

Diabetes Mellitus Treatment

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 >>

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