Obstructive sleep apnea (OSA) is independently associated with glucose intolerance and insulin resistance, and recent studies have shown that continuous positive airway pressure (CPAP) improves insulin sensitivity. The objective of this study was to describe the change in glycosylated hemoglobin (HbA1c) after treatment with CPAP in patients with type 2 ...

Tadalafil, a type 5 phosphodiesterase inhibitor, is a new and effective therapy for erectile dysfunction. It has unique pharmacokinetic properties in its drug class, which also includes sildenafil and vardenafil. It is also well tolerated with few side-effects, and can be used in difficult patients such as neuropaths or diabetics.

BACKGROUND: The new onset of posttransplant diabetes mellitus (PTDM) is a common problem after solid organ transplantation. Because insulin resistance plays a significant role in the development of PTDM, we treated 40 consecutive patients with PTDM after liver and kidney transplantation with the insulin sensitizer rosiglitazone (ROSI). METHODS: Thirty-three of ...

The long-term benefits of providing intensive insulin therapy to control blood glucose levels have been demonstrated in people with type 1 or type 2 diabetes mellitus. However, achieving good glycaemic control in clinical practice continues to be a major challenge with only a small proportion of people with diabetes achieving ...

PURPOSE: Individuals whose diabetes is being treated in the outpatient setting via an insulin pump often wish to maintain this therapy during hospitalization. The authors propose guidelines for management of patients on insulin pumps who require a hospital admission. METHODS: A collaborative interinstitutional task force reviewed current available information regarding ...

OBJECTIVE: To study the patterns of hypoglycaemic treatment in our community and to estimate the prevalence of known and drug-treated diabetes mellitus. METHODS: From all the diabetic patients who attended the Healthcare Centers of the National Health Service in Gran Canaria in 1999, a random sample of 2924 diabetic patients ...

BACKGROUND: Control of hyperglycemia has been shown to decrease mortality in critically ill adults, but the benefits of strict glucose control have not been established in children. Since January 2002, our pediatric burn center has adopted a policy of 'intensive' insulin therapy to achieve blood glucose levels 90 to 120 ...

OBJECTIVE: To examine the correlates of patient and provider attitudes toward insulin therapy. RESEARCH DESIGN AND METHODS: Data are from surveys of patients with type 2 diabetes not taking insulin (n = 2,061) and diabetes care providers (nurses = 1,109; physicians = 2,681) in 13 countries in Asia, Australia, Europe, ...

OBJECTIVES: To characterize the impact of several important clinical variables on the rate of anticoagulation during warfarin initiation (i.e., the first 30 days). DESIGN: Retrospective study. SETTING: An anticoagulation service of a large horizontally integrated, multispecialty group practice in central and northern Wisconsin. PARTICIPANTS: Patients with sufficient laboratory data obtained ...

BACKGROUND: Patients with type 2 diabetes who do not achieve glycemic control with oral agent therapy eventually require insulin. OBJECTIVE: To determine the effect on glycemic control of inhaled insulin alone or added to dual oral therapy (insulin secretagogue and sensitizer) after failure of dual oral therapy. DESIGN: Open-label, randomized, ...

Overactive bladder is a very common condition, affecting an estimated 50 to 100 million people worldwide. More than 90% of women with overactive bladder have no recognizable pathology. Several risk factors have been recognized for overactive bladder syndrome and incontinence including age, diabetes, Caucasian race, and hormone replacement therapy. The ...

OBJECTIVE: To evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes mellitus. DESIGN: Systematic review of trials. MEASUREMENTS AND MAIN RESULTS: We found no study that assessed Ayurvedic as a system of care. Botanical therapy was by far the most commonly studied Ayurvedic treatment. Herbs were ...

Diabetes is a syndrome of disordered metabolism and inappropriate hyperglycemia resulting from a deficiency of insulin secretion or insulin resistance. Insulin, a pancreatic hormone, helps to lower the blood sugar levels. The structural features of insulin and insulin receptors are summarized. Diabetic patients use insulin in the form of injections, ...

AIMS: The anti-anginal efficacy and safety of ranolazine in diabetic and non-diabetic patients included in the Combination Assessment of Ranolazine In Stable Angina (CARISA) trial (JAMA 2004;291:309) were studied. Glycaemic control was also assessed in CARISA and its long-term open-label extension study. METHODS AND RESULTS: Patients with chronic angina enrolled ...

The aim of the current study was to assess the reliability of two enzyme immunoassays in detecting the Helicobacter pylori status of stool specimens of Turkish dyspeptic patients in the post-treatment period. Forty-eight patients with non-ulcer dyspepsia who were positive for H. pylori underwent a 1 week regimen of triple ...

BACKGROUND: In order to prevent the propagation of genetic mutations, human keratinocytes irradiated with ultraviolet (UV) B light in vitro undergo premature stress-induced senescence or apoptosis. This response to UVB irradiation is dependent on the functional activation of the insulin-like growth factor-1 receptor (IGF-1R). Based on this in vitro functional ...

OBJECTIVE: To present a retrospective analysis of the effects of human U-500 insulin in 20 patients with type 2 diabetes and insulin resistance. METHODS: Medical records of 20 patients with type 2 diabetes who had received U-500 insulin for at least 6 months were reviewed to determine glycemic control before ...

PURPOSE OF REVIEW: This review gives an overview of the clinical outcome benefits associated with intensive insulin therapy administered to critically ill patients and of the progress in the unraveling of the mechanisms underlying these positive effects. RECENT FINDINGS: In a large, prospective, randomized, controlled study, strict blood glucose control ...

PURPOSE: To compare the prescribing of secondary preventative therapies for patients with both insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) in the eight health board regions of Ireland. METHODS: We utilized data from the national general medical services (GMS) prescribing database to examine the variability of prescribing for ...

Exenatide is a glucagon-like peptide-1 agonist. It is being investigated as an add-on therapy for patients with type 2 diabetes mellitus who are taking oral antidiabetic drugs. Evidence indicates that exenatide reduces glycosylated hemoglobin and plasma glucose levels when compared with placebo. Limitations of the therapy include the need for ...

The vascular endothelium controls vasomotor tone and microvascular flow and regulates trafficking of nutrients and biologically active molecules. When endothelial activation is excessive, compromised microcirculation and subsequent cellular hypoxia contribute to the risk of organ failure. We hypothesized that strict blood glucose control with insulin during critical illness protects the ...

There are scant data from African populations on the association between beta-cell function and response to treatment with oral hypoglycaemic agents in Type 2 diabetes mellitus (T2DM). Fasting plasma C-peptide (FCP) and glucagon-stimulated C-peptide (GSCP) levels were measured in 116 Nigerians with T2DM at a university teaching hospital. After 9 ...

The discovery of the antiinflammatory effect of insulin and the proinflammatory effect of glucose has not only provided novel insight into the mechanisms underlying several disease states but has also provided a rationale for the treatment of hyperglycemia in several acute clinical conditions. Van den Berghe et al. previously showed ...

OBJECTIVE: To report the late development of immune-mediated diabetes mellitus after completion of alfa-interferon therapy for hepatitis C in an Asian patient. CLINICAL PRESENTATION AND INTERVENTION: A 50-year-old male with chronic hepatitis C received treatment with alfa-interferon and ribavirin for 52 weeks. He developed immune-mediated diabetes mellitus with low C-peptide ...

Hyperglycemia is a common problem encountered in hospitalized patients, especially in critically ill patients and those with diabetes mellitus. Uncontrolled hyperglycemia may be associated with complications such as fluid and electrolyte disturbances and increased infection risk. Studies have demonstrated impairment of host defenses, including decreased polymorphonuclear leukocyte mobilization, chemotaxis, and ...

We report the case of a 29-year-old man with a 14-year history of type 1 diabetes, normal renal function, and mild diabetic retinopathy. The patient progressively developed a generalized allergic reaction to two insulin excipients--protamine and metacresol--with systemic manifestations of tremor, tachycardia, vertigo, shortness of breath, and short episodes of ...

PURPOSE: To describe the challenges and outcomes of continuous subcutaneous insulin infusion (CSII) pump therapy in a toddler and adolescent with type 1 diabetes. Insight into patient-family aspects motivating pump use is provided. METHODS: Two cases treated at the Pediatric Diabetes Clinic at Yale University. RESULTS: Upon parental request, CSII ...

OBJECTIVE: This study assesses the effects of insulin pump therapy on diabetes control and family life in children 1-6 years old with type 1 diabetes. RESEARCH DESIGN AND METHODS: Twenty-six children with type 1 diabetes for >/=6 months were randomly assigned to current therapy (two or three shots per day ...

OBJECTIVE: To evaluate the effects over 2 years of a weight loss program combining several weight loss strategies on weight loss and diabetes control in overweight subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 59 overweight or obese individuals with type 2 diabetes were randomly assigned ...

BACKGROUND: Observations by pharmacists monitoring anticoagulated patients suggested that patients with diabetes often require more frequent international normalized ratio (INR) monitoring than patients without diabetes. The purpose of this investigation was to examine the association between glycemic control and therapeutic anticoagulation control. METHODS: Patients with diabetes who were receiving warfarin ...

Mechanisms underlying biological effects of statin and angiotensin-converting enzyme inhibitor therapies differ. Therefore, we compared vascular and metabolic responses to these therapies either alone or in combination in patients with type 2 diabetes. This was a randomized, double-blind, placebo-controlled crossover trial with 3 treatment arms (each 2 months) and 2 ...

BACKGROUND: Type 1 diabetes mellitus is associated with an increased risk of cardiovascular disease (CVD) that is not fully explained by conventional risk factors. The Diabetes Control and Complications Trial (DCCT) showed that intensive diabetes therapy reduced levels of LDL cholesterol and triglycerides but increased the risk of major weight ...

Patients with type 2 diabetes mellitus are usually treated initially with oral antidiabetic agents, but as the disease progresses, most patients eventually require insulin to maintain glucose control. Optimal insulin therapy should mimic the normal physiologic secretion of insulin and minimize the risk of hypoglycemia. This article discusses the role ...

The typically long delay in starting insulin for patients with type 2 diabetes mellitus may be due in part to uncertainty about how best to make the transition from oral therapy to insulin. Recent studies show that when appropriate glycemic targets are sought, with systematic titration of insulin dosage, several ...

BACKGROUND AND OBJECTIVES: Insulin replacement regimens now stress the importance of administering throughout the day insulin doses that are based on flexible food choices and focusing on improved metabolic control. A flexible multiple daily insulin (FMDI) regimen (premeal lispro plus bedtime glargine) results in lower hemoglobin A1c (HbA1c) levels and ...

In normal humans, blood glucose and insulin are maintained within a narrow range despite wide variations in physical activity and dietary intake. At present, reproducing this pattern is an impossible task in type 1 diabetes and extremely difficult in type 2 DM. New approaches using novel insulin analogs and routes ...

Acne vulgaris has multiple pathogenic mechanisms that act in concert to produce disease. Effective therapy addresses more than one pathogenic factor to speed resolution of disease. Typically, retinoids are used to inhibit comedo formation and an antibacterial is used to suppress Propionibacterium acnes (P. acnes). Using combinations of agents can ...

A growing body of interest on the possible beneficial role of chromium, magnesium, and antioxidant supplements in the treatment of diabetes has contributed to debate about their value for reaching metabolic control and to prevent chronic complications in diabetic subjects. In this article we use a systematic approach focused on ...

Hyperglycemia is associated with excess mortality in AMI and should be treated aggressively in the intensive care setting. The exact goal of therapy is unclear because different blood glucose targets were used in earlier studies (eg, 215 mg/dL in DIGAMI versus 110 mg/dL in the Belgian study of critically-ill patients). ...

OBJECTIVE: We studied a systematic program to reeducate our medical house officers on how to manage inpatient hyperglycemia without the use of sliding-scale insulin (SSI). RESEARCH DESIGN AND METHODS: Patients admitted to the general medical service with diabetes or a blood glucose >140 mg/dl were included. HbA(1c) was measured in ...

OBJECTIVE: To investigate the effectiveness of maintaining blood glucose levels below 6.1 mmol/L with insulin as prevention of secondary injury to the central and peripheral nervous systems of intensive care patients. METHODS: The authors studied the effect of intensive insulin therapy on critical illness polyneuropathy (CIPNP), assessed by weekly EMG ...

OBJECTIVE: To evaluate the evidence for using high-dose insulin therapy with supplemental dextrose and potassium in calcium-channel blocker (CCB) overdose. DATA SOURCES: Evidence of efficacy for high-dose insulin therapy with supplemental dextrose and potassium was sought by performing a search of MEDLINE and Toxline between 1966 and July 2004 using ...

To compare the effectiveness of antihyperglycemic therapies in type 2 diabetic patients with poor glycemic control (baseline glycosylated hemoglobin [HbA1C] > 8%). Longitudinal (cohort) study. Study patients were 4775 type 2 diabetic patients who initiated new antihyperglycemic therapies and maintained them for up to 1 year. The study setting was ...

Type 2 diabetes is a disease characterised by peripheral insulin resistance, as well as by pancreatic beta cell dysfunction. This process is in part due to elevated blood glucose and free fatty acids--termed glucolipotoxicity. The traditional pathway of treating type 2 diabetes in a stepwise manner, beginning with life style ...

OBJECTIVE: Asymmetric dimethylarginine, which inhibits production of nitric oxide, has been shown to be a strong and independent predictor of mortality in critically ill patients with clinical evidence of organ dysfunction. Interestingly, intensive insulin therapy in critically ill patients improved morbidity and mortality, but the exact mechanisms by which these ...

The aim of this cross-sectional study is to analyse the current treatment schemes as well as the quality of control (metabolic; blood pressure) in a cohort of 800 type 2 diabetic patients recruited in a University Center and not by generalist practionners, in scope with current international recommendations. Insulin therapy ...

AIM: Endothelial dysfunction (ED) is the functional prestep in atherosclerosis. Aim of the present study was to evaluate the effects of a potent antioxidant (coenzyme Q(10), CoQ(10)) and of cerivastatin on ED of the brachial artery. METHODS AND RESULTS: Twenty-five male patients with manifest ED (flow-mediated vasodilation [FMD%]<4.5%) were included ...

Insulin pump therapy enjoys a steadily growing number of users and is associated with an approximately 0.5% lower A1c as compared to flexible insulin injection therapy in type 1 diabetes patients. An important question is whether superiority of insulin pump therapy persists in the era of rapid acting analogs and ...

The medical criteria for initiating insulin therapy, based on clinical profiles of type 2 diabetic patients, have not yet been clearly established. We explored various parameters with 48 type 2 diabetic patients who were taking oral hypoglycemic medication. Among parameters, body mass index (BMI), the fasting plasma glucose level (FPG), ...

Diabetes mellitus is a chronic disease that is growing in prevalence worldwide. Pharmacologic therapy is often necessary to achieve optimal glycemic control in the management of diabetes. Orally administered antihyperglycemic agents (OHAs) can be used either alone or in combination with other OHAs or insulin. The number of available OHAs ...