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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes is the leading cause of blindness, end-stage renal failure, non-traumatic limb amputations, and cardiovascular morbidity and mortality. The vast majority of patients with diabetes receive routine care from primary care providers who are not endocrinologists. Primary care providers, including internists, family practice physicians, and physician extenders with advanced skills, face the important task of implementing standards of care recommendations for persons with diabetes. These recommendations draw upon an emerging body of compelling evidence regarding the prevention and management diabetes and its complications. The challenge of diabetes must be tackled on three fronts: Primary prevention, secondary prevention (of diabetes complications), and tertiary prevention (of morbidity and mortality from established complications). There is now abundant evidence that type 2 diabetes, which accounts for greater than 90% of diabetes world-wide, is preventable. Moreover, the complications of diabetes are preventable by a policy of tight glycemic control and comprehensive risk reduction. Even after complications have set in, intensive glucose control dramatically reduces the risk of progression of complications. The challenge, therefore, is the identification of strategies that enable translation of existing scientific data to pragmatic benefits. This article proposes 10 strategies for preventing or reducing diabetes-related morbidity and mortality at the primary care level. These strategies include provider education; patient empowerment through promotion of lifestyle and self-care practices; surveillance for microvascular complications; cardiovascular risk reduction; efficient use of medications; goal setting; and stratification of patients and triaging of those with poor glycemic control for more intensive management.
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PMID:Preventing diabetes-related morbidity and mortality in the primary care setting. 1251 Jul 10

Nearly 16 million adults in the United States have diabetes mellitus, and the incidence of type 2 diabetes, the most prevalent form of diabetes, has steadily increased during the past decade. Patients with diabetes are at increased risk for microvascular and macrovascular complications and experience significant morbidity and mortality. Diabetes is the leading cause of blindness, end-stage renal disease, and nontraumatic amputations in adults. Because diabetes is a progressive disorder, the importance of early and appropriate treatment cannot be overemphasized. Present therapeutic strategies for the management of type 2 diabetes are adequate but are not maximally effective. Clearly, reappraisal of the pharmacologic approach to the optimal management of patients with type 2 diabetes is needed. A number of oral hypoglycemic agents, including thiazolidinediones, biguanides, sulfonylureas, and alpha-glucosidase inhibitors, may be used to normalize glucose levels in patients with type 2 diabetes. Because insulin resistance is an underlying pathologic defect in patients with type 2 diabetes, agents that increase insulin sensitivity should be used early in the course of therapy. By using a multifaceted approach to target insulin resistance, many patients with type 2 diabetes may achieve normoglycemia and improved long-term outcomes.
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PMID:Reappraisal of the pharmacologic approach to treatment of type 2 diabetes mellitus. 1223 Oct 78

Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes, estimated to be the most frequent cause of new cases of blindness in the working population of the Western world. The prevalence of retinopathy is strongly related to the duration of diabetes and glycemic control, even though a multifactorial pathogenesis should be probably considered in genetically susceptible subjects. Intensive diabetes management, with the goal of achieving near-normal glycemia, has been shown to prevent and/or delay the onset of diabetic retinopathy and laser photocoagulation has an established clinical efficacy in preventing visual loss. However, as laser scars always destroy the retinal anatomy permanently, a medical approach to nonproliferative retinopathy should be preferred if its clinical efficacy could be demonstrated. In this paper, recently published reports supporting this hypothesis are reviewed and their conclusions critically discussed.
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PMID:Is medical treatment for diabetic retinopathy still an unreal dream? 1244 13

Diabetes mellitus has been declared to be at an epidemic level by the World Health Organization. The syndrome is characterised as either Type I (insulin-dependent) or Type II (non-insulin-dependent) diabetes mellitus. Impaired glucose tolerance for extended periods of time results in serious complications such as kidney damage and impaired blood circulation and is the main cause for blindness and amputations in patients with diabetes. A combination of life-style change, dietary change and oral medications can treat Type II diabetes mellitus effectively and prevent long-term complications. Combination therapy appears to be the most effective approach in controlling blood glucose levels. This review updates the progress made in medicinal chemistry towards promising biological targets, with the development of a new generation of small molecules having improved efficacy and safety profiles.
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PMID:Treatment of non-insulin-dependent diabetes mellitus. 1266 17

Diabetic retinopathy is the principal cause of irreversible blindness in patients of working age in the industrialized world (1,2). For some types of retinopathy (e.g., proliferative disease), effective treatment in the form of laser photocoagulation has been available for more than 20 years, but many patients seek help too late when treatment is no longer effective. Macular edema, which is much more common in patients with type 2 diabetes mellitus, may be the presenting sign and therefore may already be established at diagnosis. If vision is significantly reduced, current treatment options are often ineffective. Screening of diabetic persons for early signs of retinopathy, which are treatable, improves the visual prognosis. Medical factors such as good blood glucose control, management of hypertension, and regulation of blood lipid levels are also considered to be of major importance.
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PMID:Diabetic retinopathy. 1280 Apr 77

Metformin belongs to a class of drugs known as the biguanides that are widely used in the treatment of type 2 diabetes mellitus. Its association with lactic acidosis is well established, although rare. Metformin-associated lactic acidosis is recognized as a potentially lethal condition that can occur in patients with contraindications to the drug, such as renal dysfunction, liver diseases, alcoholism, and cardiopulmonary diseases. In these cases, the plasma concentration of metformin is not necessarily abnormally high. We describe a 75-year-old diabetic woman with acute renal failure and life-threatening lactic acidosis due to metformin intoxication. Clinical manifestations included vomiting, diarrhea, hypothermia, hypotension and transitory blindness. Her initial renal function was recovered after hemodialysis and she was discharged 3 months after admission.
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PMID:Metformin-associated lactic acidosis and acute renal failure in a type 2 diabetic patient. 1460 17

Diabetes mellitus has been referred to as a vascular disease because of its effect on the vascular endothelial wall. In recent years, research has identified specific effects of hyperglycemia and insulin resistance on the vasculature of the diabetic patient. Atherosclerosis is known to develop earlier in the diabetic patient and is more aggressive due to the metabolic effects of hyperglycemia and insulin resistance. The results of many large, randomized, prospective trials have provided practice changes in the management of the patient with diabetes. Trials such as the Framingham Study identified risk factors associated with atherosclerosis. Additional studies, such as the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, provided information about risk factors for diabetes and contributed to treatment recommendations for the person with type 1 or type 2 diabetes. Results of these and many other trials continue to change the recommendations for the person with diabetes to reduce mortality and prevent coronary heart disease, blindness, renal failure, and amputation. This paper will identify the effects of diabetes on the vascular system and outline best practice recommendations on the basis of clinical trials.
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PMID:Effects of diabetes on the vascular system: current research evidence and best practice recommendations. 1498 97

The incidence of diabetes mellitus, particularly type 2 diabetes, is increasing dramatically in the United States and in other Westernized, industrialized societies because of increasing obesity, sedentary lifestyle, and population aging. There are currently 20 million persons with diabetes in the United States, of whom more than 5 million remain undiagnosed. The diabetic population consumes a disproportionate share of health care resources because of both microvascular and macrovascular complications. Diabetes is a major cause of new-onset blindness, end-stage renal disease, and nontraumatic amputation in the United States. Cardiovascular disease accounts for up to 80% of premature excess mortality in diabetic patients. Strategies to lessen the disease burden in these patients include hygienic measures (diet and exercise) as well as rigorous treatment of hypertension, dyslipidemia, and hyperglycemia.
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PMID:Epidemiology of diabetes. 1505 48

Burgeoning obesity is increasing the prevalence of type II diabetes mellitus. As a consequence, there will be an even greater burden of cardiovascular disease, end-stage renal disease, blindness, and lower extremity amputations. If diagnosed, impaired glucose tolerance presents an opportunity for intervention that potentially could delay or prevent the development of diabetes. Recent prospective studies document the effectiveness of exercise and weight reduction in preventing diabetes. Metformin is less effective than intense lifestyle interventions. Acarbose, losartan, orlistat, pravastatin, ramipril, and hormone replacement therapy are associated with lower rates of the development of diabetes. The Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) trial and the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial were designed to assess not only the prevention of diabetes but also the impact on cardiovascular morbidity and mortality.
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PMID:Preventing type II diabetes mellitus. 1505 49

Type 2 diabetes has now reached epidemic proportions across the world and is the cause of substantial morbidity and mortality. Patients with diabetes suffer from their mircovascular complications of retinopathy (blindness), nephropathy (renal failure, dialysis), and neuropathy (neropathic pain, trophic ulcers). However, ultimately, the majority of diabetics will die from macrovascular cardiovascular disease. Not only does cardiovascular disease develop earlier in the presence of diabetes, mortality from cardiovascular disease is increased by a factor of two to three in persons with diabetes as compared with the general population. To reduce this increased risk, a multifactorial approach to the management of type 2 diabetes has been advocated. The American Diabetes Association recommends not only good glycemic control but also identification and aggressive treatment of associated cardiovascular risk factors, with more stringent target levels for lipids and blood pressure than those recommended for the general population. Studies have shown that an intensified and goal-oriented approach to the treatment of type 2 diabetes addressing tight glucose control, optimal lipid and blood pressure management and the use of antiplatelet agents like aspirin reduces cardiovascular events, as well as nephropathy, retinopathy, and neuropathy.
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PMID:Intense management of diabetes mellitus: role of glucose control and antiplatelet agents. 1505 50


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