Current Diabetes Reviews - Volume 3, Issue 4, 2007

Hand-in-hand with obesity, the type 2 diabetes epidemic has become a major health problem in both developed and developing countries, with the estimated number of cases increasing from 170 million to 366 million worldwide by 2030 [1,2]. In the US, diabetes is the 6th leading cause of death and in some race/ethnic groups the predicted chance of developing diabetes among children born today is 40% [3, 4]. Proportionate wit Read More

There is a significant gap between evidenced-based diabetes care and actual care delivery. The Chronic Care Model (CCM) was developed to bridge this gap and translate scientific knowledge directly to the care of patients. The CCM is a primary care based framework that identifies the essential elements of high quality chronic disease care. It includes attention to self-management support, delivery system design, decision suppor Read More

More so than most other diseases, effective control of type 2 diabetes (DM) requires that patients are actively engaged in the self-management of their health. In this paper we define and characterize the elements of self-management and review the published literature for the evidence of the benefit of interventions that support patient self-management.

Current methods of analyzing the use of communication technologies in diabetes care improvement programs are limited by a poor understanding of the impact of technology on the delivery of care. We applied a standardized methodology using a functional framework to analyze 14 diabetes care improvement programs that used communications technology. Controlled trials and observational studies were selected after sear Read More

Wagner's modern construct for chronic care recognizes the primacy of ‘productive interactions’ among the patient, their personal community and the care provider team. No longer the only locus of care, the health system should operate within the context of and have access to the people and resources of the larger community involved in the patient's care. Shared medical visits in the care of patients with diabetes serve as a m Read More

The epidemic of diabetes and results from several recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on inpatient glycemic control on general hospital wards, where over 25% of patients have diabetes. Current management of inpatient glycemia is haphazard, relying on corrective doses of insulin after hyperglycemia has occurred (the insulin “sliding scale”). Alth Read More

Type 2 diabetes disproportionately affects socially disadvantaged groups, including racial and ethnic minority groups and low income and less educated persons [1-7]. Although effective therapies are available for managing diabetes and preventing or treating its complications, these therapies are underutilized, particularly among these socially disadvantaged groups [8-10]. Social disadvantage may affect diabetes out Read More

Depression is a severe medical illness that can interfere with an individual's self-care behaviors. Depression is prevalent [1], burdensome [2], treatable [3], and costly [4]. Recognizing depression in diabetic individuals is critical because depression may play a role in worse control of diabetes and worse diabetes outcomes [5-10]. Depression also appears to increase the costs associated with treating diabetes [11]. A n Read More

Obesity and type 2 diabetes continue to be major public health burdens with type 2 diabetes rising in epidemic proportions. Since known risk factors do not explain all of the variance in the population, it is important to identify novel risk factors that can lead to development of new preventive measures. Chronic psychological stress and depression are associated with type 2 diabetes but the mechanism remains unclear. Neuroe Read More

Modern diabetes care may benefit a significant proportion of adults living with diabetes; however, these benefits may not be consistently realized among the heterogeneous subpopulation of elderly patients over 65 years of age. There are three clinical constraints that have been proposed as important considerations for individualizing diabetes care among elderly patients. Life expectancy should be an important determinant o Read More

Recent findings from several groups demonstrate that ABC-A1 participates in the pathogenesis of the metabolic syndrome and type 2 diabetes. A variant of the ABC-A1 gene (R230C) is associated with the metabolic syndrome and its co-morbidities in Mexicans. Its presence is associated with an increased risk for obesity, the metabolic syndrome and type 2 diabetes. R230C is found exclusively in Amerindian and Amerindian-de Read More

In diabetic patients the incidence of cardiovascular diseases (CVD) is higher compared with those without diabetes. This elevated incidence may be due to an increased prevalence of established risk factors, such as obesity, dyslipidemia and hypertension. However, several other determinants must be considered. Attention must be paid to the role that specific factors strictly related to diabetes, insulin- resistance and post-pran Read More

Earlier studies and reviews have shown an association between high fasting blood glucose levels (FBG) and increased mortality. Less is known about the association between low FBG and mortality. This study aimed at reviewing the literature on this topic. A search was performed primarily of Medline through PubMed, and secondarily by searching other databases and using the information from articles already found. Altogeth Read More

People with diabetes have a marked increase in morbidity and mortality. The American Diabetes Association has recommended evidence-based process and outcome measures to improve diabetes care. However, these are not met in the majority of patients under our current medical care system. There have been many (mostly unsuccessful) approaches to improving these outcomes including reminding patients about app Read More