DIABETES MANAGEMENT IN PRIMARY CARE This title has been archived.

Author: Jeff Unger, MD,
Affiliation: Loma Linda University School of Medicine; Loma Linda, CA
Publisher: Lippincott Williams & Wilkins
Publication Date: 2007
ISBN 10: 0781787629
ISBN 13: 9780781787628
Edition: 1st

Description:

This book offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. It covers all aspects of outpatient and hospital-based diabetes care for all age groups, and includes behavioral interventions for enhancing patient adherence. Coverage includes fine-tuning glycemic management with computerized self-blood glucose monitoring software, evaluating and treating patients with metabolic syndrome and polycystic ovary syndrome, managing mental illness in patients with diabetes, and prevention of microvascular and macrovascular complications. The book discusses newer insulin therapy protocols, insulin delivery devices such as pumps, pens, and inhaled insulin, and novel pharmacotherapies including incretin mimetics and DPP-IV inhibitors.

Table of Contents

Front Matter

  • ABOUT
  • Foreword
  • Preface

INTRODUCTION TO DIABETES

  • TAKE HOME POINTS
  • Primary Care Physicians Should Provide the Cornerstone for Diabetes Care
  • Managing Diabetes in the Primary Care Setting
  • Opportunities to Intervene in Diabetes Management Abound in the Primary Care Setting
  • Improving the Inertia toward Intensification of Therapy
  • Summary
  • REFERENCES

DIAGNOSING AND MANAGING THE METABOLIC SYNDROME IN ADULTS, CHILDREN, AND ADOLESCENTS

  • TAKE HOME POINTS
  • History of the Metabolic Syndrome
  • Metabolic Syndrome Diagnostic Criteria
  • Prevalence of Metabolic Syndrome in the United States
  • Controversies Surrounding the Diagnostic Criteria and Definition of the Metabolic Syndrome
  • Metabolic Syndrome Pathophysiology
  • Primary Care Management of the Metabolic Syndrome
  • Indications for Pharmacologic Intervention of the Metabolic Syndrome
  • Specific Metabolic Risk Factors as Targets for Therapy
  • Managing Metabolic Syndrome in Children and Adolescents
  • Summary
  • REFERENCES

POLYCYSTIC OVARY SYNDROME

  • TAKE HOME POINTS
  • Prevalence and Pathogenesis of Polycystic Ovary Syndrome
  • Diagnostic Criteria for Polycystic Ovary Syndrome
  • Clinical Evaluation of Polycystic Ovary Syndrome
  • Polycystic Ovary Syndrome Associated with the Metabolic Syndrome, Insulin Resistance, Cardiovascular Disease, and Type 2 Diabetes
  • Cancer Risk Associated with Polycystic Ovary Syndrome
  • Treatment of Polycystic Ovary Syndrome
  • Summary
  • REFERENCES

MANAGING TYPE 2 DIABETES IN ADULTS

  • TAKE HOME POINTS
  • Introduction
  • Screening for and Diagnosing Type 2 Diabetes
  • Prevention of Type 2 Diabetes by Using Diet, Exercise, and Pharmacologic Interventions
  • Prevention and Reversal of Type 2 Diabetes with Surgical Intervention
  • Pathogenesis of Type 2 Diabetes
  • Pharmacologic Intervention for Type 2 Diabetes
  • Meglitinides
  • Treatment Recommendations for Patients withType2 Diabetes
  • Summary
  • REFERENCES

PHYSIOLOGIC INSULIN REPLACEMENT THERAPY

  • TAKE HOME POINTS
  • Introduction
  • Setting the Sights on the Patient’s Glycemic Target
  • Primary Care Physicians Can Reduce the Costs of Managing Diabetes
  • Discussing the “I” Word with Patients and Their Families
  • Optimizing Adherence with Insulin Therapy
  • The Physician’s Mission: Prescribe an Exogenous Insulin Regimen That Mimics the Normal Physiologic Insulin Response to Fasting and Postabsorptive Hyperglycemia
  • Insulin Analogue Formulations
  • Initiating Insulin Therapy in Patients with Type 2 Diabetes
  • (Coaching) Physiologic Insulin Replacement Therapy
  • Summary
  • REFERENCES

INSULIN PUMP THERAPY

  • TAKE HOME POINTS
  • Introduction
  • Evolution of Modern Pump Technology
  • To Pump or Not to Pump: That Is the Question!
  • Indications for Insulin Pump Therapy
  • Discussing Pump Therapy with Prospective Patients
  • Initiating Pump Therapy in the Primary Care Setting
  • Fine-tuning Pump Therapy
  • Long-term Follow-up of Insulin Pump Patients
  • Exercising with an Insulin Pump
  • Use of Insulin Pump Therapy for Patients with Type 2 Diabetes
  • APPENDIX 6-1
  • APPENDIX 6-2
  • APPENDIX 6-3
  • REFERENCES

ASSESSING GLYCEMIC CONTROL USING HOME BLOOD GLUCOSE MONITORING, CONTINUOUS GLUCOSE SENSING, AND GLYCATED HEMOGLOBIN (A1C) TESTING

  • TAKE HOME POINTS
  • The Link between Glycemic Variability and Long-term Diabetes-related Complications
  • Glycated Hemoglobin Testing
  • Improving the Utility of Self Blood Glucose Monitoring
  • Interpretation of Computer-generated Self Blood Glucose Monitoring Data
  • Continuous Glucose Monitoring
  • Summary
  • REFERENCES

MANAGEMENT OF DIABETES INPREGNANCY, CHILDHOOD, AND ADOLESCENCE

  • TAKE HOME POINTS
  • Preconception Planning
  • Gestational Diabetes Mellitus
  • Management of Type 1 Diabetes during Pregnancy
  • Delivery
  • Insulin and Medical Nutrition for Nursing Mothers 41
  • Management of Diabetes in Children and Adolescents
  • Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in Children and Adolescents
  • Summary
  • REFERENCES

LIFESTYLE INTERVENTIONS FOR PATIENTS WITH DIABETES

  • TAKE HOME POINTS
  • Improving Adherence to Diabetes Self-Management Skills
  • Is the Patient “Noncompliant” or “Nonadherent”?
  • Delegating Patient Care Responsibilities
  • Discussing Medical Nutritional Therapy with Patients
  • The Exercise Prescription for Diabetes
  • Traveling Tips for Patients with Diabetes
  • Self Blood Glucose Monitoring
  • Summary
  • REFERENCES

IN-PATIENT MANAGEMENT OF PATIENTS WITH DIABETES

  • TAKE HOME POINTS
  • Introduction: The Impact of Hyperglycemia on In-patient Morbidity and Mortality
  • The Mechanistic Link between Hyperglycemia and Poor Outcomes in the Hospital Setting
  • Glycemic Targets for Hospitalized Patients
  • Preoperative Evaluation of Patients with Diabetes
  • Preparing the Patient for Surgery
  • Pharmacologic Management of Hospitalized Patients with Diabetes
  • Use of Insulin Pump Therapy within the Acute Care Setting
  • Preparing Patients with Diabetes for Their Hospital Discharge
  • Treatment of Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome
  • Summary
  • REFERENCES

SCREENING, DIAGNOSIS, AND MANAGEMENT OF DIABETES RELATED COMPLICATIONS

  • TAKE HOME POINTS
  • The Economics of Diabetes Complications
  • Benefits of Intensive Diabetes Management in Reducing Diabetes Complications
  • MICROVASCULAR COMPLICATIONS
  • Diagnosis, Management, and Prevention of Diabetic Kidney Disease
  • Diabetic Retinopathy
  • MACROVASCULAR COMPLICATIONS
  • Relationship between Hyperglycemia and Cardiovascular Disease
  • Reducing Macrovascular Risk in Patients with Diabetes
  • Management of Dyslipidemia
  • Screening for Asymptomatic Coronary Heart Disease in Diabetes
  • Summary
  • REFERENCES

AMYLIN, GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS, AND DIPEPTIDYL PEPTIDASE IV (DPP-IV) INHIBITORS AS NOVEL TREATMENTS FOR DIABETES

  • TAKE HOME POINTS
  • Barriers to Normalizing Glycemia
  • Gastrointestinal Peptides Regulate Postprandial Glycemia
  • Noninsulin Pharmacologic Strategies for Improving Glycemic Control
  • Summary
  • REFERENCES

MANAGING MENTAL ILLNESS IN PATIENTS WITH DIABETES

  • TAKE HOME POINTS
  • Introduction: The Link between Mind and Body
  • Depression and Diabetes
  • Management of Depression in Patients with Diabetes
  • Schizophrenia and Diabetes
  • Pharmacologic Interventions
  • Bipolar Depression and Diabetes
  • Screening Protocols for Patients Using Antipsychotic Medications
  • Summary
  • REFERENCES