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American Diabetes Association: Clinical Practice Recommendations 2008. Diabetes Care. 31(Suppl 1): S1-S110. January 2008.
This special supplement issue of Diabetes Care journal contains the latest update of the American Diabetes Association’s (ADA) major position statement, “Standards of Medical Care in Diabetes.” The position statement contains all of the ADA’s key recommendations, including national standards for diabetes self-management education (DSME). This special issue presents selected position statements about certain topics not adequately covered in the standards. These topics are the diagnosis and classification of diabetes mellitus, nutrition recommendations and interventions for diabetes, diabetes care in schools and daycare settings, diabetes management in correctional institutions, hypoglycemia and employment or licensure, third-party reimbursement for diabetes care, self-management education, and supplies. A brief summary of the revisions made for the 2008 clinical practice recommendations begins the special supplement, followed by a more detailed executive summary of the changes. The publication includes a list of technical reviews, a list of committee reports and consensus statements, and a list of position statements.
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Case Study: Celiac Disease: An Important Comorbidity Associated With Type 1 Diabetes. Clinical Diabetes. 26(2): 85-87. Spring 2008.
This article presents the case of a 33-year-old caucasian woman with a history of type 1 diabetes, diagnosed when she was 19 years old and complicated by microalbuminuria. Since 2003, she has been treated with insulin pump therapy. She presented with a slow, steady weight loss of 20 pounds during the previous year, with no apparent cause. The authors review the diagnostic tests conducted, the patient’s laboratory results, and the eventual determination that she should undergo a small bowel biopsy, which resulted in a diagnosis of celiac disease. After undertaking a gluten-free diet, the patient experienced less abdominal bloating and a 3-pound weight gain over the next 3 months. Her glycosylated hemoglobin (A1C) decreased from 7.2 to 6.3 percent with the dietary modifications. The authors discuss the common clinical features of celiac disease; the relationships among celiac disease, type 1 diabetes, and Graves’ disease; and the screening recommendations for celiac disease and thyroid autoimmunity in patients with type 1 diabetes. 9 references.
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Case Study: Inpatient Hyperglycemia: Typical Versus Ideal Outpatient Follow-Up Care. Clinical Diabetes. 26(2): 41-42. Winter 2008.
This article presents a case of a 54-year-old Hispanic woman who presented to the emergency room with acute cholecystitis. She is 5 feet, 2 inches tall and weighs 186 pounds; she has had annual medical care but was never told her blood glucose levels were high. Both her parents died from complications of type 2 diabetes. The author describes the health care that the patient received at the time of the emergency, 10 days later at her appointment for outpatient cholecystectomy, and a second emergency visit 6 days postoperatively. The patient was placed on varying diabetes care by the hospital team, an endocrinologist, and her primary care physician. Eventually, the case patient completed 10 hours of diabetes education and lost 45 pounds. One year later, her diabetes was controlled with oral drugs, and her glycosylated hemoglobin was 6.8 percent. The author comments on this case, discussing the initial presentation, the lack of adequate insulin during the first hospital stay, when to call in a diabetes education team, the need to control blood glucose levels before surgery, and how a follow-up visit from the diabetes education team could have improved this patient’s care. 5 references.
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Comparison Between a “Terror” Reaction and a “Nonchalant” Reaction to the Diagnosis of Gestational Diabetes. Clinical Diabetes. 26(4): 177-178. Fall 2008.
This article presents the case of a 30-year-old woman who was diagnosed with gestational diabetes (GDM) in the 27th week of her second pregnancy and had a very frightened reaction to the diagnosis. The authors compare her with another case of a 38-year-old woman who was diagnosed with GDM in the 28th week of her third pregnancy. This woman had a very nonchalant attitude toward the diagnosis. The authors review the usual methods of screening for diabetes in pregnancy in the United States, outline the normal parameters for blood glucose in pregnancy, and make suggestions for counseling women with such widely varying reactions to this diagnosis. Readers are reminded that although there is no cause for unreasonable alarm, GDM requires treatment for the benefit of both woman and fetus. The author emphasizes the importance of referring a patient to a diabetes education program staffed by certified diabetes educators. 6 references.
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Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. 367 p.
This book addresses diabetes controversies, specifically in the etiology and management of the disease. The volume covers commonly accepted forms of therapies and complications, as well as new and emerging advances, therapies, and inadequacies in several standard treatments. The book offers 17 chapters, each written by experts in the field. Topics are patient selection for pancreas transplantation; the effectiveness of islet transplantation; appropriate treatment for metabolic syndrome; reducing the complications of diabetes through intensive treatment; when to introduce insulin into the treatment for type 2 diabetes; the prevention of diabetic retinopathy; the evaluation, management, and controversies in treatments for diabetic neuropathies; endpoints in clinical research studies on diabetic neuropathy; intensive insulin therapy for the critically ill patient; the recent explosion in childhood type 1 and type 2 diabetes; weight loss in type 2 diabetes patients; a unifying hypothesis of diabetic complications; the diabetic foot; developments in incretins; controversies in the evaluation and management of lipid disorders in diabetes; polypharmacy for the treatment of type 2 diabetes; and the natural history and clinical aspects of comorbid depression and diabetes. Each chapter includes an outline, a summary, and a list of references. A list of contributors and their affiliations is provided. A subject index concludes the volume.
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Diabetes and Your Kidneys. Rockville, MD: American Kidney Fund. 2008. 24 p.
Diabetic kidney disease, also called diabetic nephropathy, can result when high blood glucose levels damage the filtering structures in the kidney. This large-print booklet helps readers recently diagnosed with diabetes understand the risk factors that diabetes creates for kidney disease. The authors outline diabetes and how the disease can hurt the kidneys, issues that patients ought to discuss with their health care provider, suggestions for ways to stay healthy, and where to find additional sources of information and assistance. Diabetes causes more than 40 percent of all kidney failure in the United States. Monitoring tests for diabetes and kidney disease include blood glucose tests; glycosylated hemoglobin (HbA1c), a measure of blood glucose over time; blood pressure; urine tests; and glomerular filtration rate (GFR), a measure of kidney function. Other topics include the patient health care team, dietary strategies for managing diabetes, the role of medications including angiotensin-converting enzyme (ACE) inhibitors, symptoms of early kidney disease, the importance of self-monitoring of blood glucose (SMBG), and the interaction between blood pressure and the kidneys. The contact information for seven resource organizations is provided. The booklet includes a glossary of related medical terms, highlighted in the text and defined at the end of the booklet. 16 figures. 2 tables.
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Diabetes Numbers At-A-Glance. Rev. ed. Bethesda, MD: National Diabetes Education Program. 2008. 2 p.
This brochure, printed as an information card, summarizes many of the monitoring tests and recommended levels for people who have diabetes. Included on the card are the criteria for diagnosis of pre-diabetes; criteria for diagnosis of diabetes; and treatment goals for the ABCs of diabetes, which are A1c or glycosylated hemoglobin, blood pressure, and cholesterol and lipid profiles. The guidelines are recommended for nonpregnant adults, and readers are reminded to individualize treatment goals as necessary. The reverse side of the card lists the recommended diabetes patient management schedule, summarizing recommended care for each regular diabetes visit, for quarterly visits, annual tests, and lifetime recommendations. Readers are referred to the National Diabetes Education Program (NDEP) contact sites at 1–800-438-5383 or www.ndep.nih.gov for more information.
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Diabetes Skin And Foot Care: In Step. 4th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).
This DVD program reviews the importance of skin and foot care for people who have diabetes. The program describes practical suggestions for maintaining healthy skin and feet, how to check for problems, appropriate footwear, and how to work in tandem with a health care provider to minimize any complications. The program depicts the use of the monofilament test that is used to detect diabetic neuropathy or nerve disease, particularly in the extremities. Viewers are reminded of the importance of a self-management plan for keeping diabetes under control and preventing or minimizing these complications with good blood glucose control. The video depicts a variety of people who share their experiences with diabetes management and self-care. Simple graphics are used to explain most of the topics covered. Viewers are referred to the American Association of Diabetes Educators website for more information and to find a local diabetes educator.
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Diabetes. Washington, DC: National Women’s Health Information Center. 2008. 6 p.
This fact sheet answers common questions about diabetes, including type 1 diabetes and type 2 diabetes. Topics covered include a definition of diabetes and its complications, the condition of pre-diabetes or metabolic syndrome, the different types of diabetes, who gets diabetes and what causes the disease, risk factors for diabetes, how to know whether testing for diabetes is needed, the signs and symptoms of diabetes, good self-care for people with diabetes, important self-care for pregnant women with gestational diabetes, and how to prevent type 2 diabetes. Most of the suggestions for improved health, regardless of diabetes diagnosis, focus on achieving and maintaining a healthy weight, eating a nutritious diet, and exercising. The fact sheet refers readers to five resource organizations for more information: the American Diabetes Association at www.diabetes.org or 1–800–342–2383, the National Diabetes Education Program at www.ndep.nih.gov or 1–888–693–6337, the Juvenile Diabetes Research Foundation International at ww.jdrf.org or 1–800–533–2873, the Centers for Disease Control and Prevention at www.cdc.gov/diabetes or 1–800–232–4636, and the National Diabetes Information Clearinghouse (NDIC) at www.niddk.nih.gov or 1–800–860–8747. One side bar briefly reports the story of two women, one with type 2 diabetes and one with gestational diabetes, and how they took care of themselves and their diabetes. 2 figures. 1 table.
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Diabetic Foot. Diabetes Care. 31(2): 372-376. February 2008.
This is the sixth in a series of articles based on presentations given at the American Diabetes Association’s 67th Scientific Sessions in June 2007 in Chicago. This article focuses on presentations on the diabetic foot. Topics include diabetes and wound healing, the medical care of diabetic foot wounds, preventing amputation, the role of osteomyelitis, debridement, growth factor treatment, the use of offloading while an infection or ulcer heals, the interrelationship between stress and wound healing, new approaches to wound healing, evaluating for ischemia, moist wound healing, the treatment of chronic foot ulcers, the role of sensory neuropathy and loss of protective sensation in the feet, the stimulation of angiogenesis to promote wound healing, the prevention of foot wounds, the incidence of foot wounds in people with diabetes, rates of recurrence, the risk factors for amputation, the importance of patient education, measuring surface temperature of the foot as a prevention measure, footwear, and the use of larval debridement for ulcers infected with antibiotic-resistant organisms. The author provides the names and locations of the presenting researchers for readers who want to follow up and obtain additional information about the research summarized in this article. 38 references.
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