Twenty-First Century Behavioral Medicine: A Context for Empowering Clinicians and Patients With Diabetes

Diabetes Care: February 2013

In the past decades, the sophistication of treatments for diabetes has increased dramatically, and evidence for effective interventions has proliferated. As a result, it is now possible to achieve excellent glucose control and reduce the risk of many of the complications associated with the disease. Despite these advances, however, many people with diabetes have less than optimal metabolic control and continue to suffer from preventable complications. The gap between optimal evidence-based medicine and actual practice can be great, dependent not only on the ability of the clinician to make changes in practice patterns but also on the central role of the patient in implementing optimal management plans in daily life. With recognition of the centrality of patients’ actions to achieve optimal outcomes must come awareness that those actions reflect much more than simple “self-control.” In addition to individual characteristics, the environment in which behaviors are enacted has great influence, from family eating patterns to the design of neighborhoods to workplace and national health policies. For patients and clinicians, these factors create the context or environment in which behaviors are enacted. Read more

Kidney Disease and Increased Mortality Risk in Type 2 Diabetes

JASN: January 29, 2013

Type 2 diabetes associates with increased risk of mortality, but how kidney disease contributes to this mortality risk among individuals with type 2 diabetes is not completely understood. Here, we examined 10-year cumulative mortality by diabetes and kidney disease status for 15,046 participants in the Third National Health and Nutrition Examination Survey (NHANES III) by linking baseline data from NHANES III with the National Death Index. Kidney disease, defined as urinary albumin/creatinine ratio ≥30 mg/g and/or estimated GFR ≤60 ml/min per 1.73 m², was present in 9.4% and 42.3% of individuals without and with type 2 diabetes, respectively. Among people without diabetes or kidney disease (reference group), 10-year cumulative all-cause mortality was 7.7% (95% confidence interval [95% CI], 7.0%–8.3%), standardized to population age, sex, and race.  Read more

Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents

Pediatrics: January 28, 2013

Over the past 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. The rapid emergence of childhood T2DM poses challenges to many physicians who find themselves generally ill-equipped to treat adult diseases encountered in children. This clinical practice guideline was developed to provide evidence-based recommendations on managing 10- to 18-year-old patients in whom T2DM has been diagnosed. The American Academy of Pediatrics (AAP) convened a Subcommittee on Management of T2DM in Children and Adolescents with the support of the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). These groups collaborated to develop an evidence report that served as a major source of information for these practice guideline recommendations. The guideline emphasizes the use of management modalities that have been shown to affect clinical outcomes in this pediatric population. Recommendations are made for situations in which either insulin or metformin is the preferred first-line treatment of children and adolescents with T2DM. The recommendations suggest integrating lifestyle modifications (ie, diet and exercise) in concert with medication rather than as an isolated initial treatment approach.  Read More

Divide and Conquer: The Multidisciplinary Approach to Achieving Significant Long-Term Weight Loss and Improved Glycemic Control in Obese Patients With Type 2 Diabetes

Clinical Diabetes: Winter 2013

ype 2 diabetes has become a worldwide epidemic, estimated to affect 1 in 14 adults, or 380 million people, globally by 2025.^1,2 The problem is particularly acute in Australia, where the prevalence of diagnosed diabetes more than doubled between 1989 and 2005, amounting to 3 million people affected by the disease.^3,4 Diabetes is the most common reason for renal dialysis, blindness in people < 60 years of age, nontraumatic lower-limb amputation, and cardiovascular disease and is the sixth-highest cause of death by disease in Australia.^3,5

First-line best-practice management includes brief counseling to promote lifestyle changes in diet, exercise, and education, with the aim to improve insulin resistance, reduce hypertension, correct dyslipidemia, and achieve weight reduction.⁶ Patients at high risk of developing type 2 diabetes and who are refractory to lifestyle intervention may be treated with pharmacological agents and insulin, many of which contribute to further weight gain. Read More

Population-Based Cohort Analyses of the Bidirectional Relationship Between Type 2 Diabetes and Depression

Diabetes Care: November 12, 2012

Doctors Hospital at Renaissance, health, mcallen, texas, type 2 Hispanics may face higher risk for Type 2 diabetes

Diabetes and Depression in the Hispanic/Latino Community

Clinical Diabetes: Winter 2013

Nearly 12% of all Hispanics have diabetes, compared to 7.1% of non-Hispanic whites. The prevalence of diagnosed diabetes is not homogenous within subgroups of the Hispanic population, but instead ranges from as low as 7.6% for Cubans to as high as 13.3 and 13.8% for Puerto Rican and Mexican Americans, respectively.¹ Disparities in some diabetes-related complications are also higher among Hispanics compared to non-Hispanic whites.^2,3

The prevalence rates for depression are significantly higher among adults with diabetes than among those without diabetes.⁴ People with type 1 or type 2 diabetes are twice as likely to experience depression. Read More