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Apr 15, 2005 Issue
Improving the Quality of Care for Adults with Type 2 Diabetes Mellitus [Practice Guidelines]
Guidelines for the diagnosis and treatment of diabetic foot infections have been developed by the Infectious Diseases Society of America (IDSA). In persons with diabetes, foot infections can cause substantial morbidity and are the most common nontraumatic cause of amputations.
NPH insulin and metformin taken at bedtime appears to be the most favorable combination studied, but this conclusion is based on poor-quality, inconsistent studies that measure disease-oriented outcomes. There are no data on the effect of these drug combinations on patient-oriented outcomes.
The American Cancer Society (ACS), the American Diabetes Association (ADA), and the American Heart Association (AHA) have issued core recommendations for the prevention and early detection of cancer, cardiovascular disease, and diabetes.
There is no evidence that metformin causes lactic acidosis, even in patients with renal insufficiency or other comorbidities. Although caution is still indicated in patients with multiple or severe comorbidities, it appears that the initial concern about lactic acidosis with this drug was misplaced.
A guideline on the management of dyslipidemia, particularly hypercholesterolemia, in patients with type 2 diabetes mellitus has been published by the Clinical Efficacy Assessment Subcommittee of the American College of Physicians (ACP).
Type 2 diabetes is characterized by progressive beta-cell failure. Indications for exogenous insulin therapy in patients with this condition include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need ...
Impaired glucose tolerance and impaired fasting glucose form an intermediate stage in the natural history of diabetes mellitus. From 10 to 15 percent of adults in the United States have one of these conditions. Impaired glucose tolerance is defined as two-hour glucose levels of 140 to 199 mg per dL ...
Case study: KC, a 46-year-old woman, visits your office to refill her cholesterol-lowering medication. She says she saw a recent news feature on the “diabetes epidemic” and asks if she needs to be tested.
Healthy eating and increased physical activity can prevent or delay diabetes and its complications. Techniques that facilitate adherence to these lifestyle changes can be adapted to primary care. Often, the patient's readiness to work toward change must be developed gradually. To prepare patients wh...