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Author Topic: Patient-Centered Diabetes Management:
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Post Patient-Centered Diabetes Management:
on: May 8, 2012, 02:42
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<a href=”http://diabetesdailypost.com/wp-content/uploads/2012/05/patient-centered-care.jpg”><img class=”alignleft size-thumbnail wp-image-1614″ title=”patient-centered care” src=”http://diabetesdailypost.com/wp-content/uploads/2012/05/patient-centered-care-150×150.jpg” alt=”” width=”150″ height=”150″ /></a>PNN Pharmacotherapy Line: For professional reading

Providing news and information about medications and their proper use

<strong>>>>Diabetes Highlights</strong>

<strong>Source:</strong> Early-release article from and May issue of <em><a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=http%3a%2f%2fcare.diabetesjournals.org%2fcontent%2fcurrent” target=”_blank”>Diabetes Care</a></em> (2012; 35).

<strong>Patient-Centered Diabetes Management:</strong> In an official position statement, ADA and the European Association for the Study of Diabetes project a world where pharmacogenetics drives personalized care of patients with type 2 diabetes and comparative trials are plentiful (<a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=http%3a%2f%2fcare.diabetesjournals.org%2fcontent%2fearly%2f2012%2f04%2f19%2fdc12-0413.full.pdf” target=”_blank”>10.2337/dc12-0413</a>): “For antihyperglycemic management of type 2 diabetes, the comparative evidence basis to date is relatively lean, especially beyond metformin monotherapy. There is a significant need for high-quality comparative-effectiveness research, not only regarding glycemic control, but also costs and those outcomes that matter most to patients-quality of life and the avoidance of morbid and life-limiting complications, especially [cardiovascular disease]. Another issue about which more data are needed is the concept of durability of effectiveness (often ascribed to beta-cell preservation), which would serve to stabilize metabolic control and decrease the future treatment burden for patients. Pharmacogenetics may very well inform treatment decisions in the future, guiding the clinician to recommend a therapy for an individual patient based on predictors of response and susceptibility to adverse effects. We need more clinical data on how phenotype and other patient/disease characteristics should drive drug choices. As new medications are introduced to the type 2 diabetes pharmacopeia, their benefit and safety should be demonstrated in studies versus best current treatment, substantial enough both in size and duration to provide meaningful data on meaningful outcomes. It is appreciated, however, that head-to-head comparisons of all combinations and permutations would be impossibly large. Informed judgment and the expertise of experienced clinicians will therefore always be necessary.” (S. F. Inzucchi, <a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=mailto%3asilvio.inzucchi%40yale.edu”>silvio.inzucchi@yale.edu</a>)

<strong>Exenatide Plus Insulin Glargine in Type 2 Diabetes:</strong> Particularly in moderately obese patients and those with longer duration of type 2 diabetes, twice-daily exenatide improves glycemic control and aids weight loss when added to optimized insulin glargine therapy, researchers report (<a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=http%3a%2f%2fcare.diabetesjournals.org%2fcontent%2f35%2f5%2f955.abstract” target=”_blank”>pp. 955-8</a>). In a 30-week study comparing exenatide with placebo in 259 patients on optimized insulin glargine, these outcomes were recorded: “Exenatide participants had greater A1C reductions compared with optimized insulin glargine alone, irrespective of baseline A1C (P < 0.001). Exenatide participants with longer diabetes duration and those with lower BMI had greater A1C reductions (P < 0.01). Exenatide participants lost more weight, regardless of baseline A1C or BMI (P < 0.05). Exenatide participants with longer diabetes duration lost the most weight (P < 0.001).” (B. J. Hoogwerf, <a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=mailto%3ahoogwerf_byron_james%40lilly.com”>hoogwerf_byron_james@lilly.com</a>)

<strong>Treatment Intensification & Severe Hypoglycemia:</strong> Intensification of antihyperglycemic therapy over the past decade and half has produced significantly increased episodes of severe hypoglycemia, according to a study conducted in the Lippe-Detmold area of Germany (<a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=http%3a%2f%2fcare.diabetesjournals.org%2fcontent%2f35%2f5%2f972.abstract” target=”_blank”>pp. 972-5</a>). Based on number of symptomatic events requiring treatment with intravenous glucose and confirmed by a blood glucose measurement of <50 mg/dL, the investigators determined: “Severe hypoglycemia increased considerably from 264 events in 1997-2000 to 495 events in 2007-2010, which translated into an increase in frequency of severe hypoglycemia among all emergency admissions from 0.68 to 0.83% (P = 0.015). This was mostly related to intensification of antihyperglycemic therapy, particularly in the increasingly morbid group of hypoglycemic patients with type 2 diabetes indicated by lower HbA<sub>1c</sub>, more comedication (3.3 vs. 7.7 drugs), and more concomitant diseases (3.6 vs. 4.4) (all P values <0.001).” (A. Holstein, <a href=”http://email17.secureserver.net/redir.aspx?C=f749002e8b684847aa04acd9d08029f4&URL=mailto%3aandreas.holstein%40t-online.de”>andreas.holstein@t-online.de</a>)

Reported by Diabetes Daily Post Health Care Staff

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  1. Myth #1: Carbohydrates are bad for you.

    All carbohydrates aren’t alike. Easily digested carbohydrates, such as those from white bread and white rice, if eaten often and in large quantities, may add to weight gain. But carbohydrates are also found in fruits, vegetables, beans, and dairy products; and these deliver essential vitamins, minerals, and fiber. Diabetes carbohydrates also give your body energy and help keep organs functioning properly.

    A system called the glycemic index measures how fast and how far blood sugar rises after you eat a food with carbohydrates. White rice, for example, is almost immediately converted to blood sugar (glucose), causing it to rise rapidly, and so has a high glycemic index. Whole grain bread is digested more slowly, making blood sugar climb more slowly and not as high. It has a low glycemic index. Whenever possible, select carbohydrates that is whole grain, such as whole grain bread, whole wheat pasta, and old fashioned oats.

    Myth #2. Vegetables mainly add fiber to your diabetic diet foods.

    Vegetables are excellent sources of fiber and they supply vitamins and minerals, with very few calories. Orange vegetables like carrots, and dark leafy greens, such as spinach and collards, are good sources of vitamin A, an important nutrient to keep your eyesight keen, your skin healthy, and your immune system strong. Broccoli, pepper, and tomatoes are full of vitamin C, which promotes healing and keeps keep ligaments, tendons, and gums healthy. And beans and lentils supply potassium, which enables the body to convert blood sugar into glycogen, a stored form of energy that’s held in reserve by the muscles and liver.

    Myth #3: To get calcium in your diabetic diet, you have to consume dairy products.

    Milk, yogurt, and cheese are rich in calcium, which is important for building and protecting bones, Calcium Sources but they’re not the only sources of this mineral. Today, many foods are fortified with calcium, including orange juice, soy milk, breads, and cereals. Other nondairy sources of calcium are canned salmon and sardines with bones, collard greens, broccoli, and almonds. If you find it difficult to get enough calcium from your diet, you can also take calcium and glucose supplements.
    Food for Type 2 Diabetes – Nutrition Mythbusters

    Myth #4: Meat, chicken, and fish are the best sources of protein.

    Foods with protein help your body build muscle and tissue, and provide diabetes vitamins and minerals. Animal sources—meat, poultry, fish, and dairy products–have what’s called complete protein, that is, they contain all the amino acids needed to build new proteins. Proteins from fruits, vegetables, grains, and nuts are called incomplete proteins—they’re missing one or more amino acids. But animal sources of protein have their drawbacks: red meat and poultry skin are high in fat, especially saturated fat (a healthy diabetic diet plan should have less than 10% of calories from saturated fat). If you eat meat, stick to lean cuts, chicken with the skin removed, and fish. If you want to try vegetable sources of protein, try beans, nuts, and whole grains.

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