Web Exclusives

A consensus report on hypoglycemia and diabetes from the American Diabetes Association (ADA) and the Endocrine Society defines iatrogenic hypoglycemia as any episode of an abnormally low plasma glucose concentration that exposes the patient to potential harm. The workgroup also recommends individualization of glycemic targets based on several factors. It emphasizes that patients with type 2 diabetes might be particularly vulnerable to adverse events associated with hypoglycemia, including an increased risk of subsequent mortality and cardiovascular mortality.

Despite 1 in 3 American adults having prediabetes, only 11% report being told that they have prediabetes, according to researchers from the Division of Diabetes Translation at the US Centers for Disease Control and Prevention (CDC). The finding comes from an analysis of 3 sampling cycles of the National Health and Nutrition Examination Surveys (NHANES).

Intensive glucose control in patients with type 2 diabetes can reduce the risk of progression to end-stage renal disease but the number needed to treat is large, according to a post hoc analysis of the ADVANCE trial. The analysis appears in Kidney International (2013;83:517-524).

Management of blood glucose, blood pressure, and lipids in patients with diabetes has improved markedly over the past decade, but achievement of goal levels is still suboptimal.

Only about half of patients achieved the American Diabetes Association (ADA) targets for each of these measures in the period from 2007 to 2010, and fewer than 1 in 5 achieved all 3 of the goals, according to data from the National Health and Nutrition Examination Surveys (NHANES).

Two recent studies, one a randomized controlled clinical trial and the other an observational study, show potential cardiovascular advantages to using metformin over sulfonylureas in the treatment of type 2 diabetes.

Randomized controlled data favor metformin

Insulin treatment of patients with type 2 diabetes could expose such patients to complications including myocardial infarction, stroke, cancer, renal complications, and eye complications, according to data from a retrospective cohort study by researchers in the United Kingdom.

The data “are consistent with a variety of previous evidence observing worse outcomes in people with type 2 diabetes mellitus treated with insulin,” write the investigators.

A coronary artery calcium (CAC) scan can identify patients with type 2 diabetes who are at particularly high risk of a cardiovascular event as well as those with lower risk, according to a recent study in Diabetes Care, published online December 10, 2012.

The finding challenges the notion that all patients with type 2 diabetes have the same cardiovascular risk, says the study’s lead investigator, Donald Bowden, PhD. He says that measuring CAC is key to predicting the specific level of risk.

The central dilemma of type 2 diabetes management is that the progressive, unremitting loss of beta-cell function that is the hallmark of type 2 diabetes begins before the clinical diagnosis of type 2 diabetes. Thus, for lifestyle modification to be truly effective long-term, we must recognize the potential for diabetes before its onset and implement effective change strategies that deal with and reverse processes leading to beta-cell loss.

An intensive lifestyle intervention that results in weight loss does not reduce the risk of cardiovascular events in overweight/obese patients with long-standing type 2 diabetes. Although the intensive diet and exercise intervention failed to reduce cardiovascular risk, it did have other important health benefits, said researchers from the Look AHEAD (Action for Health in Diabetes) study, which was supported by the National Institutes of Health (NIH).

Patient-centered care is the guiding principle of the management of hyperglycemia in patients with type 2 diabetes, according to a joint position statement released by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

Compared with 2008 ADA-EASD treatment algorithm, the new position statement is not as prescriptive and calibrates treatment targets to patient needs while individualizing the treatment options. It also acknowledges the role of lifestyle changes prior to initiating metformin therapy.

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