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American Diabetes Association (american + diabetes_association)
Selected AbstractsHeart Failure and Diabetes: Collateral Benefit of Chronic Disease ManagementCONGESTIVE HEART FAILURE, Issue 3 2006Molly G. Ware MD To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64±11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8±1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF. [source] Colesevelam lowers glucose and lipid levels in type 2 diabetes: the clinical evidenceDIABETES OBESITY & METABOLISM, Issue 5 2010Vivian A. Fonseca Simultaneous control of blood glucose and other risk factors such as hypertension and dyslipidaemia is essential for reducing the risk of complications associated with type 2 diabetes mellitus (T2DM). As relatively few patients with T2DM have their risk factors managed to within the limits recommended by the American Diabetes Association, American College of Endocrinology or National Cholesterol Education Program Adult Treatment Panel III guidelines, treatment that can simultaneously control more than one risk factor is of therapeutic benefit. Clinical studies have shown that bile acid sequestrants have glucose-lowering effects in addition to their low-density lipoprotein cholesterol-lowering effects in patients with T2DM. The bile acid sequestrant colesevelam hydrochloride is approved as an adjunct to antidiabetes therapy for improving glycaemic control in adults with T2DM. This review examines data from three phase III clinical trials that evaluated the glucose- and lipid-lowering effects of colesevelam when added to the existing antidiabetes treatment regimen of patients with T2DM. [source] Reflecting on Type 2 Diabetes Prevention: More Questions than Answers!DIABETES OBESITY & METABOLISM, Issue 2007J. Rosenstock Given the enormous public health and economic burden posed by the global epidemic of type 2 diabetes mellitus (T2DM), intervention in the prediabetes stage of disease to prevent progression to T2DM and its vascular complications seems the most sensible approach. Precisely how best to intervene remains the subject of much debate. Prudent lifestyle changes have been shown to significantly reduce the risk of progression in individuals with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Although lifestyle modifications are notoriously difficult to maintain, there is evidence that intensive intervention results in continued preventive benefit after the stopping of structured counselling. A number of drug therapies, including metformin, acarbose, orlistat and rosiglitazone, have also been proven effective in preventing progression from IFG/IGT, but unresolved issues still remain. Specifically, whether large numbers of individuals with glucose dysregulation who may never progress to T2DM should be exposed to the risk of pharmacological adverse effects is a topic of discussion and debate. Furthermore, there are limited data on the effectiveness of implementing interventions during the prediabetic state to prevent cardiovascular complications that may be hyperglycaemia related. A recent American Diabetes Association (ADA) consensus statement on IFG/IGT recommends lifestyle modification for individuals with IFG or IGT. Of note, the ADA consensus statement introduces the option of adding metformin treatment to lifestyle changes in those individuals who have combined IFG/IGT plus an additional risk factor for progression and who also have some features that increase the likelihood of benefiting from metformin treatment. The dipeptidyl peptidase-4 inhibitors are a new class of oral antidiabetic agents that, in addition to being effective in improving glycaemic control, may exert beneficial effects in preserving ,-cell function. These characteristics, combined with a low risk of hypoglycaemia, weight neutrality and what appears , so far , to be a relatively benign tolerability profile, make these agents intriguing candidates for preventive treatment. [source] Thiazolidinediones: effects on the development and progression of type 2 diabetes and associated vascular complicationsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2009Andrew Krentz Abstract In addition to reducing hyperglycaemia, the metabolic actions of TZDs (pioglitazone and rosiglitazone) in theory might improve the prognosis of patients with type 2 diabetes. However, it appears from recent data that pioglitazone and rosiglitazone have different cardiovascular risk profiles. The scope of this paper is to examine the benefits and risks of pioglitazone and rosiglitazone. Three large clinical studies (DREAM, and ADOPT with rosiglitazone; PROactive with pioglitazone) have recently been reported. A lower annual rate of decline of ß-cell function observed with rosiglitazone in the ADOPT study, compared with metformin and glyburide (glibenclamide), along with a reduced progression to insulin use seen with pioglitazone in the PROactive study, provides evidence that TZDs are effective in treating progressive hyperglycaemia. In PROactive, although the primary endpoint was not met, pioglitazone was associated with a reduction in a secondary composite endpoint of clinical cardiovascular events in high-risk patients with existing macrovascular disease who were already receiving other glycaemic and cardiovascular medications. Further evidence supporting an anti-atherogenic effect of pioglitazone was gained from the PERISCOPE study of carotid intima-media thickness. Recent controversy concerning a possible increased risk of myocardial infarction associated with rosiglitazone has fuelled uncertainty about the risk,benefit profile of this agent. In 2008, an update of an American Diabetes Association,European Association for the Study of Diabetes consensus statement on initiation and adjustment of therapy in patients with type 2 diabetes advised clinicians against using rosiglitazone. Skeletal fractures have recently emerged as a side effect of both TZDs. Available data suggest that cardiovascular benefits observed with pioglitazone might not be a class effect of TZDs. Copyright © 2009 John Wiley & Sons, Ltd. [source] Gestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk populationDIABETIC MEDICINE, Issue 8 2009M. M. Agarwal Abstract Aims, In populations at high risk of gestational diabetes mellitus (GDM), screening every pregnant woman by an oral glucose tolerance test (OGTT) is very demanding. The aim of this study was to determine the value of the fasting capillary glucose (FCG) as a screening test for GDM. Methods, FCG was measured by a plasma-correlated glucometer in 1465 pregnant women who underwent a one-step diagnostic 75-g OGTT for universal screening of GDM. Results, One hundred and ninety-six (13.4%) women had GDM as defined by the criteria of the American Diabetes Association. The area under the receiver operating characteristic curve (AUC) of the FCG was 0.83 (95% confidence interval 0.80,0.86). A FCG threshold of 4.7 mmol/l (at an acceptable sensitivity of 86.0%) independently could rule-out GDM in 731 (49.9%) women, while the FCG could rule-in GDM (100% specificity) in 16 (1.1%) additional women; therefore, approximately half of the women would not need to continue with the cumbersome OGTT. Conclusions, Screening using a FCG significantly reduces the number of OGTTs needed for the diagnosis of GDM. Wider assessment, particularly in low-risk populations, would confirm the potential value of the FCG as a screening test for GDM. [source] Changing aspirin use in patients with Type 2 diabetes in the UKPDSDIABETIC MEDICINE, Issue 12 2004C. A. Cull Abstract Aims To examine the proportion of UK Prospective Diabetes Study (UKPDS) patients with Type 2 diabetes taking aspirin regularly for the primary and secondary prevention of cardiovascular disease (CVD) before and after publication of the 1997 American Diabetes Association (ADA) Clinical Practice Recommendations and the 1998 Joint British Recommendations on the Prevention of Coronary Disease in Clinical Practice. Methods UKPDS annual review data from 1996/7 (n = 3190) and 2000/1 (n = 2467) were used to determine the prevalence of patients taking aspirin regularly in relation to known CVD risk factors and pre-existing CVD. Results Patients taking aspirin regularly were more often male than female (24 vs. 20%, P = 0.0033), older (66 ± 8 vs. 62 ± 9 years, P < 0.0001) and less often Afro-Caribbean than White Caucasian or Indian Asian (11 vs. 23 vs. 22%, respectively, P < 0.0001). Between 1996/7 and 2000/1 aspirin use in patients without pre-existing CVD increased from 17 to 31% (P < 0.0001) and for those with pre-existing CVD from 76 to 82% (P = 0.032). Conclusion The majority of patients with pre-existing CVD were taking aspirin regularly. Although aspirin use in those without pre-existing CVD approximately doubled after publication of the ADA and Joint British Recommendations, less than two-thirds of these high-risk patients were being treated according to guidelines. This may relate to a lack of convincing evidence for primary CVD prevention or failure to adhere to guidelines. It may be that more trial data is needed to convince clinicians of the value of aspirin therapy in Type 2 diabetes. [source] Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly KoreansDIABETIC MEDICINE, Issue 10 2002K. M. Choi Abstract Aims This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. Methods This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist,hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (, statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. Results The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted , = 0.228 men, weighted , = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. Conclusions Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans. [source] Glycaemia and insulinaemia in elderly European subjects (70,75 years)DIABETIC MEDICINE, Issue 2 2001A. U. Teuscher SUMMARY Aims To determine glycaemia and insulinaemia in elderly subjects aged 70,75 years, living across Europe, who participated in the EURONUT-SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) study. Methods Fasting plasma glucose (FPG) and fasting insulin concentrations were measured in 1830 subjects aged 70,75 years living in 15 traditional towns in 11 European countries. For the diagnosis of diabetes, the recommendations of the 1997 report of the American Diabetes Association ,Expert Committee on the diagnosis and classification of diabetes mellitus' were used. Results A total of 31.6% of the study subjects had either diabetes (17.5%) or impaired fasting plasma glucose (FPG) (14.1%). Fifty-one per cent of the subjects with diabetes were unaware of the disease. No difference in diabetes prevalence was found for sex, but male subjects were more likely to have impaired FPG than female subjects (16.8 vs. 11.5%, P = 0.001). Hyperinsulinaemia (fasting insulin levels in the highest quartile) was associated with increased FPG, body mass index, and waist-to-hip ratio. Conclusions It was found that a substantial number of elderly Europeans have impaired glucose homeostasis, with diabetes and impaired FPG being present in almost a third of European subjects aged 70,75 years. [source] Comparison of ADA 1997 and WHO 1985 criteria for diabetes in south Indians , the Chennai Urban Population StudyDIABETIC MEDICINE, Issue 12 2000R. Deepa SUMMARY Aims To compare the American Diabetes Association (ADA) fasting criteria and World Health Organization (WHO) 2-h criteria for diabetes in an urban south Indian population. Methods Subjects were drawn from the Chennai Urban Population Study. Of the 1001 subjects studied, 52 (5.2%) were diagnosed as having diabetes according to WHO 2-h criteria and 32 (3.2%) according to the ADA fasting criteria. Results Twenty-five (48%) of the subjects diagnosed with diabetes by the WHO 2-h criteria were not classified as having diabetes by the ADA fasting criteria. Similarly, of the 78 subjects (7.8%) classified as having impaired glucose tolerance (IGT), only eight (10.3%) had impaired fasting glucose (IFG) according to the ADA fasting criteria. The overall agreement between the WHO 2-h criteria and ADA fasting criteria was poor (, = 0.40). Conclusions Use of the ADA fasting criteria results in a lower prevalence rates of diabetes in this lean urban south Indian population. [source] Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort StudyHIV MEDICINE, Issue 6 2006TR Glass Objective Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10-year risk of CHD in a large cohort of HIV-infected individuals. Methods All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut-offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. Results Overall, 8033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high-density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10,20%) 10-year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART-naive patients. Conclusion During the 6-year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol. [source] An adaptive clinical Type 1 diabetes control protocol to optimize conventional self-monitoring blood glucose and multiple daily-injection therapyINTERNATIONAL JOURNAL OF ADAPTIVE CONTROL AND SIGNAL PROCESSING, Issue 5 2009Xing-Wei Wong Abstract The objective of this study was to develop a safe, robust and effective protocol for the clinical control of Type 1 diabetes using conventional self-monitoring blood glucose (SMBG) measurements, and multiple daily injection (MDI) with insulin analogues. A virtual patient method is used to develop an in silico simulation tool for Type 1 diabetes using data from a Type 1 diabetes patient cohort (n=40) . The tool is used to test two prandial insulin protocols, an adaptive protocol (AC) and a conventional intensive insulin therapy (IIT) protocol (CC) against results from a representative control cohort as a function of SMBG frequency. With the prandial protocols, optimal and suboptimal basal insulin replacement using a clinically validated, forced-titration regimen is also evaluated. A Monte Carlo (MC) analysis using variability and error distributions derived from the clinical and physiological literature is used to test efficacy and robustness. MC analysis is performed for over 1 400 000 simulated patient hours. All results are compared with control data from which the virtual patients were derived. In conditions of suboptimal basal insulin replacement, the AC protocol significantly decreases HbA1c for SMBG frequencies ,6/day compared with controls and the CC protocol. With optimal basal insulin, mild and severe hypoglycaemia is reduced by 86,100% over controls for all SMBG frequencies. Control with the CC protocol and suboptimal basal insulin replacement saturates at an SMBG frequency of 6/day. The forced-titration regimen requires a minimum SMBG frequency of 6/day to prevent increased hypoglycaemia. Overaggressive basal dose titration with the CC protocol at lower SMBG frequencies is likely caused by uncorrected postprandial hyperglycaemia from the previous night. From the MC analysis, a defined peak in control is achieved at an SMBG frequency of 8/day. However, 90% of the cohort meets American Diabetes Association recommended HbA1c with just 2 measurements a day. A further 7.5% requires 4 measurements a day and only 2.5% (1 patient) required 6 measurements a day. In safety, the AC protocol is the most robust to applied MC error. Over all SMBG frequencies, the median for severe hypoglycaemia increases from 0 to 0.12% and for mild hypoglycaemia by 0,5.19% compared with the unrealistic no error simulation. While statistically significant, these figures are still very low and the distributions are well below those of the controls group. An adaptive control protocol for Type 1 diabetes is tested in silico under conditions of realistic variability and error. The adaptive (AC) protocol is effective and safe compared with conventional IIT (CC) and controls. As the fear of hypoglycaemia is a large psychological barrier to appropriate glycaemic control, adaptive model-based protocols may represent the next evolution of IIT to deliver increased glycaemic control with increased safety over conventional methods, while still utilizing the most commonly used forms of intervention (SMBG and MDI). The use of MC methods to evaluate them provides a relevant robustness test that is not considered in the no error analyses of most other studies. Copyright © 2008 John Wiley & Sons, Ltd. [source] The impact of publishing medical specialty society guidelines on subsequent adoption of best practices: a case study with type 2 diabetesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2010E. A. Huang Summary Aims:, Our goal was to determine the effect of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus algorithm for the initiation and adjustment of type 2 diabetes (T2D) therapy, published in 2006, on the incidence of early metformin monotherapy (EMM), defined as the prescription of metformin and no other antidiabetic medications within 30 days of initial T2D diagnosis. Methods:, The incidence of EMM in the United States (US) from January 2005 to December 2007 was estimated using data from the i3 InVisionÔ Data Mart, an integrated database of enrolment dates, inpatient and outpatient medical claims, pharmaceutical claims, and laboratory results from a diverse group of US health plans. The trend in the incidence of EMM was analysed using joinpoint regression modelling. Results:, A statistically significant joinpoint was found in July 2006 (p < 0.05). From January 2005 to July 2006, EMM increased at an annualised rate of 15.6%. From July 2006 to December 2007, EMM increased at an annualised rate of 66.0%. Conclusions:, Our findings suggest that publication of the ADA/EASD algorithm caused a significant acceleration in the incidence of EMM. [source] Microalbuminuria: Definition, Detection, and Clinical SignificanceJOURNAL OF CLINICAL HYPERTENSION, Issue 2004Robert D. Toto MD Proteinuria is a sign of abnormal excretion of protein by the kidney but is a nonspecific term including any or all proteins excreted. In contrast, albuminuria specifically refers to an abnormal excretion rate of albumin. Microalbuminuria refers to an abnormally increased excretion rate of albumin in the urine in the range of 30,299 mg/g creatinine. It is a marker of endothelial dysfunction and increased risk for cardiovascular morbidity and mortality especially, but not exclusively, in high-risk populations such as diabetics and hypertensives. Testing for microalbuminuria is now made easy by in-office dipstick tests (semi-quantitative) and widely available laboratory testing (quantitative). Physicians should screen all diabetics for albuminuria and strongly consider screening hypertensives to identify those at higher risk for cardiovascular disease. Appropriate intervention, including use of drugs that block the renin-angiotensin-aldosterone system, may be appropriate in such cases as suggested by the American Diabetes Association and the Seventh Report of Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. [source] Meeting American Diabetes Association Guidelines In Endocrinologist PracticeJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2000C.D. Miller OBJECTIVE,To determine whether American Diabetes Association (ADA) guidelines can be met in the context of routine endocrinology practice. RESEARCH DESIGN AND METHODS,Charts were reviewed for a group of patients who were examined in 1998, followed for greater than or equal to 1 year, and had two or more visits during that year. Process measures and metabolic outcomes were studied for patients with type 2 diabetes, and glycemic control was assessed for patients with type 1 diabetes. RESULTS,A total of 1.21 patients with type 2 diabetes had a mean age of 63 years, a mean BMI of 31 kg/m(2), and a mean duration of diabetes of 12 years. Many had comorbidities or complications: 80% had hypertension, 64% had hyperlipidemia, 78% had neuropathy, 22% had retinopathy, and 21% had albuminuria. Management of type 2 diabetic patients was complex: 38% used oral hypoglycemic agents alone (54% of these were using two or more agents), 31% used oral hypoglycemic agents and insulin, and 26% used insulin alone, 42% of patients taking insulin therapy injected insulin three or more times per day. Within 12 months, 74% of patients had dilated eye examinations, 70% had lipid profiles, and 55% had urine albumin screening. Of the patients, 87% had a foot examination at their last visit. Blood pressure levels averaged 133/72 mmHg, cholesterol levels averaged 4.63 mmol/l, triglyceride levels averaged 1.99 mmol/l. HDL cholesterol levels averaged 1.24 mmol/l, and LDL cholesterol levels averaged 2.61. mmol/l. Random blood glucose levels averaged 8.0 mmol/l, and HbA(1c) levels averaged 6.9 +/, 0.1%. A total of 87% of patients had HbA(1c) levels less than or equal to 8.0%. A total of 30 patients with type 1 diabetes had mean age of 44 years, a mean BMI of 26 kg/m(2), and a mean duration of diabetes of 20 years. All type 1 diabetic patients used insulin and averaged 3.4 injections a day, their average HbA(1c) level was 7.1 +/, 0.2%, and 80% had HbA(1c) levels less than or equal to 8.0%. CONCLUSIONS,Although endocrinologists must manage patients with multifaceted problems, complex treatment regimens yield glycemic control levels comparable with the Diabetes Control and Complications Trial and allow ADA guidelines to be met in a routine practice setting. [source] 12 Effects of synchronized intestinal electrical stimulation on small intestinal motility in dogsNEUROGASTROENTEROLOGY & MOTILITY, Issue 6 2006J YIN Our previous studies showed that synchronized gastric electrical stimulation enhanced antral contractions, accelerated gastric emptying in dogs. It has never been reported whether synchronized electrical stimulation could improve small intestinal motility. The aim of this study was to investigate the effects of synchronized intestinal electrical stimulation (SIES) on small bowel motility in both fasting and fed states in dogs. Methods:, Five healthy female dogs (18,24 kg) were equipped with a duodenal cannula for the measurement of small bowel motility using manometry. Two pairs of bipolar electrodes were implanted on the small intestinal serosa with an interval of 25 cm; the first one was 10 cm beyond the pylorus and used for stimulation. The experiment was consisted of four sessions in each dog with a randomized order. In the fasting state, 20 min after occurrence of phase III, SIES was initiated and maintained for 45 min, small bowel motility was recorded during the entire experiment, and no stimulation was performed in the control session. In other two sessions, dogs were fed with solid meal at the beginning of the experiment; glucagon (0.1 mg kg1) was injected 20 min after feeding, SIES was initiated at the same time for 20 min followed by 20 min recovery period. The stimulus was composed of train of pulses with on-time of 0.5 s, frequency of 20 Hz, pulse width of 2 ms and amplitude of 4 mA. Results:, 1). In the fasting state, SIES induced small intestinal contractions during phase I. The motility index was 5.2 ± 0.6 in the control session and significantly increased to 10.3 ± 0.7 with SIES (P = 0.003). 2). In the fed state, glucagon substantially and significantly inhibited small intestinal motility. The motility index was 11.3 ± 0.7 after feeding and reduced to 3.4 ± 0.5 with glucagon injection (P < 0.001). SIES significantly enhanced glucagon-induced small intestinal postprandial hypomotility. The motility index was 3.4 ± 0.5 in the control session and increased to 6.0 ± 0.3 with the presence of SIES (P = 0.03). Conclusions:, Intestinal electrical stimulation synchronized with intestinal slow waves induces intestinal contractions during phase I and enhanced small intestinal postprandial hypomotility induced by glucagon. SIES may have the therapeutic potential for treating small intestinal motility disorders. (Supported by a grant from American Diabetes Association). [source] Global nutritional recommendations: a combination of evidence and food availability?PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2008K Kapur BSc, PGDipDiet Dietitian/Diabetes Educator Abstract Diet and exercise are vital diabetes management strategies. Health professionals (HPs) use dietary guidelines to advise their clients but the current macronutrient recommendation in the guidelines varies. The aim of this study was to explore the similarities and differences in macronutrient dietary advice in different parts of the world and suggest some reasons for any differences identified. The study was undertaken in two phases: (1) a one-shot cross-sectional survey of HPs and global diabetes organisations using self-completed, anonymous questionnaires (n=40), and (2) a review of dietary guidelines from relevant diabetes associations (the American Diabetes Association [ADA], the Diabetes and Nutrition Study Group [DNSG] of the European Association for the Study of Diabetes [EASD], the Canadian Diabetes Association [CDA], the Joslin Diabetes Center, Diabetes UK, and the Indian Council of Medical Research [ICMR]). Dietary recommendations differed among countries and from the guidelines, and reflected socioeconomic factors and local food availability. With regard to macronutrient recommendations, carbohydrate ranged from 40,70%, protein 12,20% and fat 15,40% of total energy intake. Nations with higher gross domestic product (GDP) based on purchasing-power-parity (PPP) per capita tended to recommend a much lower ratio of carbohydrate than those with lower GDP PPP per capita. However, all guidelines stressed the importance of healthy eating. It was concluded that socioeconomic factors and local food availability appear to influence HPs' dietary recommendations. Copyright © 2008 John Wiley & Sons. [source] 63rd Scientific Sessions of the American Diabetes AssociationPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2004Article first published online: 1 MAR 200 No abstract is available for this article. [source] Meeting the Health Care Needs of a Rural Hispanic Migrant Population With DiabetesTHE JOURNAL OF RURAL HEALTH, Issue 3 2004Loretta Heuer PhD ABSTRACT: Context: There is a need for models of health care that provide accessible, culturally appropriate, quality services to the population of Hispanic migrant farmworkers at risk for or diagnosed with diabetes. Purposes: The purposes of this study were to describe the Migrant Health Service, Inc (MHSI), Diabetes Program, the conceptual model on which it is based, and 4 types of outcomes achieved over a 3-year period. Methods: Types and amounts of medical services and education were studied. Qualitative data obtained from program records and documents were analyzed to determine the nature of the program. Quantitative data were used to measure outcomes of the program. Findings: The multiplecomponent MHSI Diabetes Program is addressing economic, cultural, and language barriers experienced by the target population. The program provides a continuum of health services and education that meet American Diabetes Association (ADA) Clinical Practice Recommendations on diabetes. The program exposes regional health care professionals and university students from numerous academic disciplines to Hispanic farmworker culture. Conclusions: Evidence-based program management, patient care, and program evaluation are traits of this program, which offers accessible, culturally appropriate, quality health services and education to Hispanic farmworkers. The multicomponent program model has high potential for positively impacting the health of the target population. [source] High prevalence of impaired fasting glucose in Chinese children and adolescents with prehypertension/hypertensionACTA PAEDIATRICA, Issue 10 2009Lei Zhao Abstract Aim:, To assess the prevalence of impaired fasting glucose among Chinese children and adolescents with prehypertension/hypertension (PHP/HP), overweight/obesity (OW/OB) or both in the general population. Methods:, In total, 3409 children and adolescents among the age group of 10,18 years were enrolled. These subjects were then divided into four groups: OW/OB, PHP/HP, OW/OB + PHP/HP and a control group. Fasting plasma glucose (FPG) and lipid levels were measured in children with a body mass index ,85th percentile and/or blood pressure ,90th percentile and in 100 subjects randomly selected from the control group. The oral glucose tolerance test was performed in all the subjects with fasting glucose ,5.6 mmol/L. Results:, Eighty-one impaired fasting glucose subjects and one girl with type 2 diabetes were identified. The prevalence of impaired fasting glucose in PHP/HP (7.03%) was not significantly different from that in the OW/OB + PHP/HP group (8.59%), but was higher than that in the OW/OB group (3.31%). Conclusion:, Although the American Diabetes Association does not recommend the FPG test for children and adolescents with PHP/HP, in this study, we found that children and adolescents with PHP/HP have a higher prevalence of impaired fasting glucose than those with OW/OB. Further validation of these findings is warranted and a type 2 diabetes screening protocol for Chinese children and adolescents needs to be established. [source] Estimated Risk for Undiagnosed Diabetes in the Emergency Department: A Multicenter SurveyACADEMIC EMERGENCY MEDICINE, Issue 5 2007Adit A. Ginde MD BackgroundOne third of the 21 million Americans with diabetes remain undiagnosed. The emergency department (ED) is a novel setting for diabetes screening. ObjectivesTo estimate risk factors for undiagnosed diabetes in the ED. MethodsThis was a cross sectional survey in five Boston EDs. The authors enrolled consecutive adults without known diabetes over two 24-hour periods at each site. The focus was on diabetes risk factors and estimated risk for diabetes on the basis of American Diabetes Association (ADA) criteria. The authors also examined prior diabetes testing and willingness to participate in ED-based diabetes screening. ResultsSix hundred four patients (70% of eligible) were enrolled. On the basis of ADA risk score, 33% (95% confidence interval [CI] = 29% to 37%) were high risk for undiagnosed diabetes, and an additional 42% (95% CI = 38% to 46%) had elevated risk. For example, 58% (95% CI = 54% to 62%) of participants were overweight or obese (body mass index of ,25). Among these at-risk participants without prior diabetes testing, 73% (95% CI = 66% to 80%) reported amenability to having additional blood drawn for ED diabetes screening, and 98% (95% CI = 96% to 100%) indicated that they would follow up for confirmation of abnormal screening. ConclusionsMany ED patients in the study had risk factors for undiagnosed diabetes. Patient attitudes toward ED-based diabetes screening support further exploration of this important and currently underutilized opportunity for public health intervention. [source] Apolipoprotein Measurements: Is More Widespread Use Clinically Indicated?CLINICAL CARDIOLOGY, Issue 9 2009Michael H. Davidson MD Apolipoprotein (apo) B may be a more sensitive measure of atherogenicity than low-density lipoprotein cholesterol (LDL-C) and a better index for assessing cardiovascular risk. The refined risk assessment provided by apo B may be important in patients at high cardiometabolic risk such as those with diabetes mellitus or metabolic syndrome, as these conditions are often associated with normal LDL-C values but increased numbers of small, dense low-density lipoprotein (LDL) particles (indicating increased levels of apo B). Although apo B is not currently a treatment target in the United States cholesterol-lowering guidelines, a consensus conference endorsed by the American Diabetes Association and the American College of Cardiology recently recommended that apo B be added as a therapeutic target in patients at high cardiometabolic risk and in patients with clinical cardiovascular disease or diabetes. Suggested target goals are < 90 for high risk and < 80 mg/dL for highest risk patients. Current clinical data indicate that intensive statin therapy can lower apo B to meet this aggressive goal. While the proatherogenic/antiatherogenic ratio of apo B/apo A-I is a better risk discriminator than the single proatherogenic measurement (apo B), clinical trial data are lacking regarding the impact of increasing apo A-I and high-density lipoprotein on outcomes. Copyright © 2009 Wiley Periodicals, Inc. [source] | |||||||||||||||||||||||||