Clinical Dilemmas in Diabetes E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Clinical Dilemmas
• Sprache: Englisch

Seitenzahl: 463

Veröffentlichungsjahr: 2011

Beschreibung

Clinical Dilemmas in Diabetes provides evidence-based clinical guidance on the most common and problematic areas of concern encountered in diagnosing, treating and managing patients with diabetes. Each chapter is highly topical and has been selected due to current interest, specific recent developments, and areas of controversy. This valuable guide provides assistance in managing the life-long treatment of diabetes and the complications that often develop in patients. Clinical Dilemmas in Diabetes guides the medical team in their decision-making, particularly when there are conflicts in the treatment for the disease and the complications. Part of the Clinical Dilemmas series, the well-focused chapter structure allows for quick retrieval of information, and each opens with a "Learning Points" box to aid easy assimilation of the main issues. With a leading team of contributors and editors, Professor Robert A. Rizza is the immediate Past-President of the American Diabetes Association. This book is perfect for use on the wards and clinics as well as for self-study by diabetologists, diabetes specialist nurses, endocrinologists, GPs and cardiologists.

Leseprobe

Contents

Cover

Title Page

Copyright

Contributors

Preface

PART I: Prediabetes and the Diagnosis of Diabetes

1: Is prediabetes a risk factor or is it a disease?

Prediabetes, diabetes, micro- and macrovascular disease

Prediabetes and atherosclerosis: Why do they associate and how to best predict the risk?

Is there a role for OGTT in clinical practice?

What is the underlying pathogenesis and natural history of IGT and IFG?

Management of prediabetes

2: Early diagnosis of type 1 diabetes: Useful or a phyrrhic victory?

Introduction

Pathogenesis of T1D: an update in view of defining preventive tools

Prediction of T1D as the basis for disease prevention

Prevention of T1D: current status

Conclusions

Acknowledgments

3: How should secondary causes of diabetes be excluded?

Introduction

Hereditary hemochromatosis

Cystic fibrosis-related diabetes

Pancreatic-cancer-associated diabetes

Diabetes due to hormone excess

Post-transplant diabetes mellitus

Diabetes associated with atypical antipsychotic drug use

Diabetes associated with HIV infection and its treatment

Genetic forms of diabetes

4: Screening patients with prediabetes and diabetes for cardiovascular disease

Introduction

Current screening guidelines in asymptomatic patients with diabetes

Hyperglycemia and the risk of cardiovascular disease

What are other risk factors for cardiovascular disease? How should they be managed?

How do we “risk stratify” patients?

Traditional risk factors

Nontraditional risk factors

Highly sensitive C-reactive protein (hsCRP)

Coronary Artery Calcium Scoring (CAC)

Summary

PART II: Initial Evaluation and Management of Diabetes

5: What is the role of self-monitoring in diabetes? Is there a role for postprandial glucose monitoring? How does continuous glucose monitoring integrate into clinical practice?

Self-monitoring of blood glucose

Continuous glucose monitoring systems

6: The optimal diet for diabetes is?

Starting with the basics: Calories

Breaking down calories: Macronutrients

Alcohol

Sweeteners

Hypoglycemia

Special considerations

Weight management

Implementation

Carbohydrate counting

Glycemic index

Summary

7: How to determine when to pursue lifestyle change alone versus pharmacotherapy at diagnosis?

8: Insulin sensitizers versus secretagogues as first-line therapy for diabetes: Rationale for clinical choice

Introduction

Glucose control

Effect on body weight

Lipid effects

Risk of hypoglycemia

Risk of bone disease

Risk of developing cancer

Cardiovascular disease

Other risks and benefits

Conclusions

9: Are insulin sensitizers useful additions to insulin therapy?

Insulin sensitizers

Discussion

10: Is there a role for incretin-based therapy in combination with insulin?

11: HbA1c: Is it the most important therapeutic target in outpatient management of diabetes?

Is HbA1c the best measure for glycemic exposure, glucose control, and risk?

Why HbA1c is the best measure for glycemic exposure, glucose control, and risk?

What is the evidence for glucose control in managing the risks of complications of diabetes?

Efficacy: What are the plausible arguments that glucose control can reduce risk?

Effectiveness: What is the evidence that glucose control is effective in reducing risk and adds value?

What is the Evidence for Glucose Control in Managing the Risks of Complications of Diabetes?

What can we conclude? Is HbA1c the most important therapeutic target in outpatient management of diabetes?

PART III: Management of Associated Risk Factors and Disease

12: Primary therapy for obesity as the treatment of type 2 diabetes

13: Are statins the optimal therapy for cardiovascular risk in patients with diabetes? Are triglycerides an important independent risk factor for diabetes?

Dyslipidemia in type 2 diabetes

Treatment of dyslipidemia in patients with diabetes mellitus

Evidence linking hypertriglyceridemia to CHD risk in diabetes mellitus

Evidence that treating hypertriglyceridemia will reduce CV risk in DM

Discussion

14: The role of bariatric surgery in obese patients with diabetes: Primary or rescue therapy?

Introduction

Possible mechanisms by which bariatric surgery improves T2DM

Role of bariatric surgery in T2DM: First-line therapy or rescue therapy when medical options fail?

Gastric banding or gastric bypass?

Role of weight loss surgery in the treatment of patients with T2DM and BMI < 35 kg/m2

New techniques that can be an option in the future

15: Hyperglycemia should be avoided in critical illness and the postoperative period

Introduction

Large intervention studies

Acknowledgments

16: Is there an optimal revascularization strategy in diabetic patients with ischemic heart disease?

Introduction

Coronary revascularization

Risk factor modification

Conclusions

Index

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Library of Congress Cataloging-in-Publication Data

Clinical dilemmas in diabetes / Edited by Adrian Vella, MD, Associate Professor of Medicine, Department of Endocrinology, Mayo Clinic, Rochester, MN, USA, Robert A. Rizza, MD, Professor of Medicine, Department of Endocrinology, Mayo Clinic, Rochester, MN, USA. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4051-6928-8 (pbk. : alk. paper) 1.  Diabetes. 2. Evidence-based medicine. I. Vella, Adrian, editor. II. Rizza, Robert A., editor. [DNLM: 1. Diabetes Mellitus–therapy. 2. Diabetes Mellitus–diagnosis. 3. Evidence-Based Medicine–methods. WK 810] RC660.C4635 2011 616.4′62–dc22 2010052327

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444340266; Wiley Online Library 9781444340280; ePub 9781444340273

Contributors

Rami Almokayyad, MD Endocrine Fellow Division of Endocrinology, Department of Medicine, University of Minnesota Medical School University of Minnesota Minneapolis, MN, USA

Morgan L. Brown, MD, PhD Resident University of Alberta Edmonton, AB, Canada

William T. Cefalu, MD Douglas L. Manship, Sr. Professor of Diabetes Chief, Joint Program on Diabetes, Endocrinology and Metabolism Pennington Biomedical Research Center & LSUHSC School of Medicine New Orleans, LA and Baton Rouge, LA, USA

Maria L. Collazo-Clavell, MD Associate Professor of Medicine Division of Endocrinology, Diabetes, Metabolism & Nutrition Mayo Clinic Rochester, MN, USA

Robert M. Cuddihy, MD Medical Director International Diabetes Center World Health Organization Collaborating Center for Diabetes Education, Translation and Computer Technology Minneapolis, MN, USA

Sean F. Dinneen, MD, FRCPI Senior Lecturer in Medicine Department of Medicine Clinical Science Institute NUI Galway Galway, Ireland

Vivian Fonseca, MD Professor of Medicine and Pharmacology Tullis Tulane Alumni Chair in Diabetes Chief, Section of Endocrinology Tulane University Health Sciences Center New Orleans, LA, USA

Robert L. Frye, MD Professor of Medicine Division of Cardiovascular Diseases Mayo Clinic Rochester, MN, USA

Praveena Gandikota, MD Endocrine Fellow Endocrine, Diabetes and Nutrition Division Department of Medicine St Luke's Roosevelt Hospital New York, NY, USA

Chiara Guglielmi, MD, PhD PostDoc Fellow Department of Endocrinology & Diabetes University Campus Bio-Medico Rome, Italy

Michael D. Jensen, MD Tomas J. Watson, Jr. Professor in Honor of Dr. Robert L. Frye Mayo Foundation Rochester, MN, USA

Blandine Laferrère, MD Assistant Professor of Medicine Division of Endocrinology Diabetes and Nutrition Obesity Research Center Department of Medicine St Luke's Roosevelt Hospital Center Columbia University College of Physicians and Surgeons New York, NY, USA

Stephen H. McKellar, MD, MSc Resident Division of Cardiovascular Surgery Mayo Clinic Rochester, MN, USA

L. Yvonne Melendez- Ramirez, MD Assistant Professor of Medicine Joint Program on Diabetes, Endocrinology and Metabolism Pennington Biomedical Research Center & LSUHSC School of Medicine New Orleans, LA & Baton Rouge, LA, USA

John M. Miles, MD Professor of Medicine Endocrine Research Unit Mayo Clinic Rochester, MN, USA

Manpreet S. Mundi, MD Senior Associate Consultant Division of Endocrinology Mayo Clinic Rochester, MN, USA

Kalpana Muthusamy, MD Clinical Fellow Division of Endocrinology Mayo Clinic Rochester, MN, USA

Timothy O'Brien, MD, PhD Professor of Medicine, Consultant Endocrinologist/Director of REMEDI Department of Medicine and Endocrinology/Diabetes Mellitus University College Hospital/National University of Ireland Galway Galway, Ireland

Aonghus O'Loughlin, MB, MRCPI Specialist Registrar in Endocrinology/Diabetes Mellitus Department of Medicine and Endocrinology/Diabetes Mellitus University College Hospital/National University of Ireland Galway, Ireland

Michael O'Reilly, MB, BCh, BAO, MRCPI Specialist Registrar in Endocrinology/Diabetes Mellitus Department of Medicine and Endocrinology/Diabetes Mellitus University College Hospital/National University of Ireland Galway, Ireland

Paolo Pozzilli, MD Professor of Endocrinology Head of Department of Endocrinology & Diabetes University Campus Bio-Medico, Rome, Italy; Professor of Diabetes Research Barts & the London School of Medicine & Dentistry London, UK

Philip Raskin, MD Professor of Medicine Clifton and Betsy Robinson Chair in Biomedical Research University of Texas Southwestern Medical Center at Dallas Dallas, TX, USA

Deepika S. Reddy, MD Assistant Professor Department of Endocrinology Scott & White Clinic Temple, TX, USA

John W. Richard III, MD Endocrinology Fellow Division of Endocrinology, Diabetes, Nutrition and Metabolism University of Texas Southwestern Medical Center at Dallas Dallas, TX, USA

Robert J. Richards MD Associate Professor of Medicine Joint Program on Diabetes, Endocrinology and Metabolism Pennington Biomedical Research Center & LSUHSC School of Medicine New Orleans, LA and Baton Rouge, LA, USA

Matheni Sathananthan, MD Endocrinology Fellow Division of Endocrinology, Diabetes, Nutrition and Metabolism Mayo Clinic Rochester, MN, USA

F. John Service MD, PhD Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA

Steven A. Smith, MD Associate Professor of Medicine Medical Director, Mayo Patient Education Consultant in Endocrinology, Diabetes Nutrition and Metabolism Health Care Policy & Research Mayo Clinic Rochester, MN, USA

Galina Smushkin, MD Fellow Mayo Clinic Division of Endocrinology Rochester, MN, USA

Preface

Clinical Dilemmas in Diabetes is a book that arose out of several different motivations. The primary motivator may have been a desire to shed some light onto how to translate results of clinical trials to individual patient care. Indeed, the passage of time continues to demonstrate that “common sense” is still (unfortunately) an uncommon commodity, but one which is necessary for the optimal management of Diabetes.

Another potential motivator is the realization that blind adherence to algorithm-based approaches to clinical care is a poor substitute for informed decision making in the clinic. With this in mind, we chose several subjects of relevance to diabetes that deserve discussion and debate. We hope this will be the first iteration of a book that will develop and grow over time – assimilating new chapters and topics for debate – in much the same way that diabetes care continues to develop.

Adrian Vella Robert A. Rizza February 2011

PART I

Prediabetes and the Diagnosis of Diabetes

1

Is prediabetes a risk factor or is it a disease?

Kalpana Muthusamy1 and Adrian Vella2

1Clinical Fellow, Division of Endocrinology, Mayo Clinic Rochester, MN, USA

2Associate Professor of Medicine, Department of Endocrinology, Mayo Clinic, Rochester, MN, USA

LEARNING POINTS

The diagnostic criteria for prediabetes and diabetes are based on the relationship of hyperglycemia with microvascular disease.Defects in insulin secretion and action occur in people with impaired fasting glucose and impaired glucose tolerance.An oral glucose tolerance test may help to better characterize patients at higher risk of progression to type 2 diabetes.Intervention may delay the progression to diabetes.

Prediabetes, as previously defined by the American Diabetes Association (ADA), includes subjects with fasting plasma glucose (FPG) >100 mg/dl and <126 mg/dl and/or 2-hour plasma glucose following a 75-g oral glucose load >140 mg/dl and <200 mg/dl. The rate of progression to diabetes without any intervention is about 28.9% over a 3-year period as seen in the placebo arm of the Diabetes Prevention Program [1]. A 9-year longitudinal study from Olmsted County, Minnesota, reported a similar rate of diabetes progression of 34% [2]. The prevalence rate of prediabetes in the American adult population, as reported by CDC from 2003 to 2006, was 25.9% [3]. This represents 57 million American adults, a significant number of whom are predisposed to developing diabetes if adequate intervention is not undertaken. Therefore, understanding the definition of prediabetes, its implications, pathogenesis, and appropriate management becomes critical to any clinician.

Prediabetes includes two categories, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Examining the evolution of these criteria will help us understand not only the basis of the current definitions, but also provide us guidance for the necessary evaluation and management.

Prediabetes, diabetes, micro- and macrovascular disease

Impaired glucose tolerance (IGT) is defined by a plasma glucose 2 hours after a 75-g oral glucose load >140 mg/dl and <200 mg/dl, while impaired fasting glucose (IFG) is defined by a fasting plasma glucose >100 mg/dl and <126 mg/dl.

IGT is a terminology that has been long known and has been a part of the ADA classification since 1979 [4]. IFG as a separate entity was established in an ADA report published in 1997 [5] and was later adopted by an expert WHO panel in 1999 [6]. These categories were intended to be seen as risk factors for future diabetes and cardiovascular disease rather than distinct clinical groups. The definition for IGT has undergone little change since its inception. IFG was initially defined as fasting plasma glucose >110 mg/dl and <126 mg/dl. This classification was rather arbitrary and reflected the then available evidence suggesting an insulin secretory defect and an increased risk of cardiovascular disease.