Dec 032014
 

Insulin Tactics in Type 2 Diabetes.

Med Clin North Am. 2015 Jan;99(1):157-186

Authors: Meah F, Juneja R

Abstract
Type 2 diabetes is a heterogeneous disorder with multiple pathophysiologic defects resulting in an inability to maintain euglycemia. When exogenous insulin is used in its treatment, it is important to take into account its pharmacokinetic properties and attempt to match its peaks and troughs with those of glucose. In this article, the authors discuss strategies on introducing insulin as a treatment option in patients with Type 2 diabetes and how to decrease it when other noninsulin drugs are added to the treatment regimen.

PMID: 25456649 [PubMed - as supplied by publisher]

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Dec 032014
 

Insulin Therapy in Type 1 Diabetes.

Med Clin North Am. 2015 Jan;99(1):145-156

Authors: Stephens E

Abstract
Although not curable, type 1 diabetes is controllable. Intensive insulin therapy provides primary care providers with a blueprint for reducing the frequency of the devastating complications of diabetes that were all too common in the recent past. Considering the remarkable advances in contemporary therapy, including multiple daily injections and subcutaneous insulin infusions, the likelihood of even greater future improvements in quality of life and survivability can be anticipated. Success requires patient engagement and education, an informed primary care provider, and an interdisciplinary team to maximize the benefits of insulin therapy and avoid the risks of hypoglycemia.

PMID: 25456648 [PubMed - as supplied by publisher]

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Dec 032014
 

Incretin-Based Therapies.

Med Clin North Am. 2015 Jan;99(1):107-129

Authors: Neumiller JJ

Abstract
Incretin hormones, namely glucagon-like peptide 1 (GLP-1) and gastric inhibitory peptide, have been recognized for some time as playing a key role in glucose homeostasis, with the effects of incretin hormones believed to be responsible for up to 60% of postprandial insulin release. Two predominant therapeutic strategies have been developed to augment the incretin response: (1) GLP-1 receptor agonists resistant to degradation by the enzyme dipeptidyl peptidase 4 (DPP-4); and (2) DPP-4 inhibitors. With an expanding arsenal of incretin-based therapies available, understanding the differentiating efficacy and safety profiles for available agents is important in optimizing drug selection and patient outcomes.

PMID: 25456646 [PubMed - as supplied by publisher]

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Dec 032014
 

Update on Diabetes Classification.

Med Clin North Am. 2015 Jan;99(1):1-16

Authors: Thomas CC, Philipson LH

Abstract
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The goal in diagnosing diabetes mellitus is to identify those with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications. This brief review shows the evolving nature of the classification of diabetes mellitus. No classification scheme is ideal, and all have some overlap and inconsistencies. Diabetes mellitus classification will continue to evolve as we work to fully understand the pathogenesis of the major forms.

PMID: 25456640 [PubMed - as supplied by publisher]

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Dec 032014
 

Sodium Glucose Cotransporter 2 Inhibitors.

Med Clin North Am. 2015 Jan;99(1):131-143

Authors: White JR

Abstract
This article provides an overview of the physiologic basis, pharmacology, and current clinical experience with sodium glucose cotransporter 2 (SGLT2) inhibitors. It details the role of the kidneys in glucose homeostasis and the impact on that regulatory system of the use of SGLT2 inhibitors. The article also includes an overview of the impact of SGLT2s on glycemic control in patients with diabetes. In addition, it outlines the potential benefits and problems encountered with the use of these agents.

PMID: 25456647 [PubMed - as supplied by publisher]

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Jul 062014
 
Related Articles

Acute and Chronic Low Back Pain.

Med Clin North Am. 2014 Jul;98(4):777-789

Authors: Patrick N, Emanski E, Knaub MA

Abstract
Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

PMID: 24994051 [PubMed - as supplied by publisher]

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