Medical Management Of Hyperglycemia Research Articles

Genetic ablation of SGLT2 function in mice impairs tissue mineral density but does not affect fracture resistance of bone.

Selective sodium-dependent glucose co-transporter 2 inhibitors (SGLT2Is) are oral hypoglycemic medications utilized increasingly in the medical management of hyperglycemia among persons with type 2 diabetes (T2D). Despite favorable effects on cardiovascular events, specific SGLT2Is have been associated with an increased risk for atypical fracture and amputation in subgroups of the T2D population, a population that already has a higher risk for typical fragility fractures than the general population. To better understand the effect of SGLT2 blockade on skeletal integrity, independent of diabetes and its co-morbidities, we utilized the "Jimbee" mouse model of slc5a2 gene mutation to investigate the impact of lifelong SGLT2 loss-of-function on metabolic and skeletal phenotype. Jimbee mice maintained normal glucose homeostasis, but exhibited chronic polyuria, glucosuria and hypercalciuria. The Jimbee mutation negatively impacted appendicular growth of the femur and resulted in lower tissue mineral density of both cortical and trabecular bone of the femur mid-shaft and distal femur metaphysis, respectively. Several components of the Jimbee phenotype were characteristic only of male mice compared with female mice, including reductions: in body weight; in cortical area of the mid-shaft; and in trabecular thickness within the metaphysis. Despite these decrements, the strength of femur diaphysis in bending (cortical bone), which increased with age, and the strength of L6 vertebra in compression (primarily trabecular bone), which decreased with age, were not affected by the mutation. Moreover, the age-related decline in bone toughness was less for Jimbee mice, compared with control mice, such that by 49-50weeks of age, Jimbee mice had significantly tougher femurs in bending than C57BL/6J mice. These results suggest that chronic blockade of SGLT2 in this model reduces the mineralization of bone but does not reduce its fracture resistance.

How Basal Insulin Analogs Have Changed Diabetes Care

How Basal Insulin Analogs Have Changed Diabetes Care

New therapeutic algorithm of Type 2 diabetes: Lights and shadows

The prevalence of Type 2 diabetes mellitus (T2DM) continues to grow worldwide. Blood glucose control represents a central feature of risk factor management in patients with T2DM and several therapeutic options are now available to enforce blood glucose control. As a matter of fact, while before the year 2000 we only had 3 classes of drugs for diabetes (insulin, sulfonylureas, and metformin), 9 classes of drugs are now available, and several more are in a late development phase. This expands the range of clinical choice, but also forces the physician to face a more complicated array of options, where efficacy, safety, tolerability, and cost need to be carefully balanced. In the recent years, several scientific organizations have issued guidelines and proposed therapeutic algorithms allegedly intended to help care providers in making the “right” choice when treating patients with T2DM. Thus, in a fast-paced sequence the 2007 Texas Diabetes Council Glycemic Control Algorithm (1), the 2008 American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) Road Map (2), the 2009 AACE/ACE treatment algorithm (3), the 2008 Canadian Diabetes Association (CDA) Clinical Practice Recommendations for T2DM (4), the 2010 ADA Standards of Medical Care (5), and the 2009 ADA/EASD writing group consensus statement and algorithm on the medical management of hyperglycemia in Type 2 diabetes (6) appeared. On one hand, such a wealth of algorithms and guidelines does reinforce attention on a crucial topic for public health such as metabolic control in diabetes. On the other hand, different organizations can review the same body of evidence and yet not arrive to the exact same conclusions, with the ultimate result of increasing confusion rather than simplifying the issue. Furthermore, as Kahn and Gale have sharply noticed in a recent editorial (7), “…(guidelines) also serve a vital function for the organization that produces them. This need means that a guideline all too easily becomes an assertion of authority…..”. If one takes this concept a step further, he might be inclined to think that the slight or more consistent differences in the algorithms proposed could stem more from the desire of expressing an “original” point of view than from an objective and unbiased analysis of the evidence available.

A Study for the Factors Influencing Insulin Requirements in Type 2 Diabetic Patients

NathanDM,BuseJB,DavidsonMB,FerranniniE,HolmanRR,SherwinR,Zinman B; American Diabetes Association; European Association for Study of Diabetes: Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consen-sus statement of the American Diabetes Association and the European As-sociation for the Study of Diabetes. Diabetes Care 32:193-203, 2009

Comments on the Consensus statement of the American Diabetes Association and the European Association for the Studyof Diabetes on the medical management of hyperglycemia in type 2 diabetes

В декабре 2008 года опубликована обновленная версия ал- горитма медикаментозной терапии сахарного диабета 2 типа (СД2) Американской Диабетической Ассоциа- ции (ADA) и Европейской Ассоциации по изучению сахарного диабета (EASD) , в которой обсуждаются основные аспекты лечения данного заболевания. Мы хотели бы подчеркнуть чрезвычайную важность консенсуса, обусловленную целым рядом причин.

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement of the American Diabetes Association and the European Association for the Study of Diabetes

GlaxoSmithKline regrets the recommendation (1) of the recent American Diabetes Association/European Association for the Study of Diabetes consensus statement against the use of rosiglitazone for treatment of type 2 diabetes because it is contrary to scientific evidence. The evidence regarding a possible association of rosiglitazone with increased risk of cardiovascular ischemic morbidity remains inconclusive. Data from clinical trials assessing cardiovascular outcomes are inconsistent with the hypotheses of increases in myocardial ischemia or death that have arisen from meta-analyses. No long-term clinical trials have confirmed an increased cardiovascular ischemic risk with rosiglitazone. Moreover, data from …

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement of the American Diabetes Association and the European Association for the Study of Diabetes

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement of the American Diabetes Association and the European Association for the Study of Diabetes

Medical Management of Hyperglycemia in Type 2 Diabetes: a Consensus Algorithm for the Initiation and Adjustment of Therapy.

Medical Management of Hyperglycemia in Type 2 Diabetes: a Consensus Algorithm for the Initiation and Adjustment of Therapy.

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement of the American Diabetes Association and the European Association for the Study of Diabetes

We appreciate Dr. Woo's response to our study (1) and his comparison (2) of the Canadian Diabetes Association (CDA) clinical practice guidelines and the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus algorithm and welcome the opportunity to address the differences he has identified. The original ADA/EASD consensus algorithm and the subsequent revisions were developed independently by the consensus group and were then presented to the two major diabetes organizations for their review and approval of the process. Dr. Woo notes the CDA's process of data review with a “standardized evidence-based approach” and the participation of “over 90 authors and a steering committee of 18” and concludes that the process removed “as much bias as possible,” implying that this approach was superior to our consensus algorithm process. He further notes …

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement of the American Diabetes Association and the European Association for the Study of Diabetes

The evidence-based Canadian Diabetes Association (CDA) 2008 clinical practice guidelines for the prevention and treatment of diabetes in Canada (1) differ from the consensus statement by Nathan et al. (2), although both were published virtually at the same time. The consensus statement, which represents the authors’ collective analysis, evaluation, and opinion, is said not to represent official association opinion, yet it is listed as a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. In contrast, the CDA clinical practice guidelines do represent the CDA's official position. The CDA clinical practice guidelines follow the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument (3) and have a standardized evidence-based approach to …

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience. Diabetes Care 32:193–203, 2009 The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity have made the effective treatment of hyperglycemia a top priority.1–3 While the management of hyperglycemia, the hallmark metabolic abnormality associated with type 2 diabetes, has historically taken center stage in the treatment of diabetes, therapies directed at other coincident features, such as dyslipidemia, hypertension, hypercoagulability, obesity, and insulin resistance, have also been a major focus of research and therapy. Maintaining glycemic levels as close to the nondiabetic range as possible has been demonstrated to have a powerful beneficial effect on diabetes-specific microvascular complications, including retinopathy, nephropathy, and neuropathy, in the setting of type 1 diabetes;4,5 in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce microvascular complications.6–8 Intensive glycemic management resulting in lower A1C levels has also been shown to have a beneficial effect on cardiovascular disease (CVD) complications in type 1 diabetes;9,10 however, current studies have failed to demonstrate a beneficial effect of intensive diabetes therapy on CVD in type 2 diabetes. …

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy

T he epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity have made the effective treatment of hyperglycemia a top priority.1-3 While the management of hyperglycemia, the hallmark metabolic abnormality associated with type 2 diabetes, has historically taken center stage in the treatment of diabetes, therapies directed at other coincident features, such as dyslipidemia, hypertension, hypercoagulability, obesity, and insulin resistance, have also been a major focus of research and therapy. Maintaining glycemic levels as close to the nondiabetic range as possible has been demonstrated to have a powerful beneficial effect on diabetes-specific microvascular complications, including retinopathy, nephropathy, and neuropathy, in the setting of type 1 diabetes;4,5 in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce microvascular complications.6-8 Intensive glycemic management resulting in lower A1C levels has also been shown to have a beneficial effect on cardiovascular disease (CVD) complications in type 1 diabetes;9,10 however, current studies have failed to demonstrate a beneficial effect of intensive diabetes therapy on CVD in type 2 diabetes.11-13 The development of new classes of blood glucose-lowering medications to supplement the older therapies, such as lifestyle-directed interventions, insulin, sulfonylureas, and metformin, has increased the number of treatment options available for type 2 diabetes. Whether used alone or in combination with other blood glucose-lowering interventions, the increased number of choices available to practitioners and patients has heightened uncertainty regarding the most appropriate means of treating this widespread disease.14 Although numerous reviews on the management of type 2 diabetes have been published in recent years,15-17 practitioners are often left without a clear pathway of therapy to follow. We developed the following consensus approach to the management …

The Medical Management of Hyperglycemia Over a 10-Year Period in People With Diabetes

The purpose of the study was to examine changes in the medical management of glycemia in diabetes and its relation to changes in hyperglycemia as measured by glycated hemoglobin. A total of 765 patients with younger-onset diabetes diagnosed before 30 years of age and 533 older-onset diabetic patients participated in a population-based study in southern Wisconsin, at baseline (1980-1982), at 4 years (1984-1986), and at 10 years (1990-1992). Glycated hemoglobin, the presence of complications, and information regarding medical management of glycemia, hypoglycemic reactions, and socioeconomic factors were determined using standardized protocols at the three examinations. In the younger-onset group, there was a significant increase (P < 0.001) in the use of three or more insulin injections per day or in the use of an insulin infusion pump from 3.6% of the cohort at baseline to 24.4% at the 10-year follow-up. This increase was associated with female sex, the presence of gross proteinuria, more education, and better glycemic control at baseline. In the older-onset group, there was a significant (P < 0.05) increase in the proportion of patients taking insulin, from 49.2% at baseline to 61.9% at the 10-year follow-up. This was associated with being younger, having a longer duration of diabetes, having higher glycated hemoglobin values, and having more education at baseline, or developing proliferative diabetic retinopathy or macular edema between baseline and the 4-year follow-up. These data suggest a change in the pattern of use of insulin to treat people with diabetes. However, there is still a large number of individuals with poorly controlled diabetes in the population.