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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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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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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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Diagnosing and Managing Latent Autoimmune Diabetes in Adults. Practical Diabetology. 21(1): 32-37. March 2008.

This article reviews the diagnosis and management of latent autoimmune diabetes in adults (LADA), defined as a slowly progressive form of autoimmune diabetes mellitus characterized by mature age at diagnosis, the presence of pancreatic autoantibodies, and the lack of an insulin requirement at diagnosis. The author notes that patients with LADA present with better-preserved beta-cell function than those with classic type 1 diabetes mellitus, but they usually experience a rapid and progressive loss of beta-cell function and tend to become rapidly unresponsive to intervention with oral medications and parenteral agents such as incretin mimetics. The article discusses the importance of the correct diabetes diagnosis, differentiating autoimmune diabetes from diabetes caused by insulin resistance, the prevalence of LADA, the pathogenesis of LADA, screening and testing that can be done for LADA, and treatment strategies for these patients. The author concludes that, although treatment guidelines for LADA have not been published, intensive management with insulin therapy provides a theoretical advantage by preserving any remaining endogenous pancreatic beta-cell function and minimizing long-term complications. 2 tables. 23 references.

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Diagnosis And Classification of Diabetes Mellitus. Diabetes Care. 31(Suppl 1): S55-S60. January 2008.

This position statement on the diagnosis and classification of diabetes mellitus is from the special supplement issue of Diabetes Care journal that contains the latest update of the American Diabetes Association’s (ADA) major position statement, “Standards of Medical Care in Diabetes.” Selected position statements are provided about certain topics not adequately covered in the standards. This position statement includes a definition and description of diabetes mellitus, notably type 1 diabetes and type 2 diabetes; the classification of diabetes mellitus and other categories of glucose regulation, including impaired glucose tolerance and impaired fasting glucose; and the diagnostic criteria for diabetes mellitus, including gestational diabetes mellitus (GDM). Specific, practical recommendations are provided, particularly in the section about the diagnostic criteria for GDM. 3 tables. 4 references.

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Executive Summary: Standards of Medical Care in Diabetes: 2008. Diabetes Care. 31(Suppl 1): S5-S11. January 2008.

This executive summary is from the special supplement issue of Diabetes Care journal that 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). The executive summary outlines the revisions to the clinical practice recommendations made for 2008, covering the diagnosis of diabetes, testing for pre-diabetes and diabetes, testing for type 2 diabetes in children, the detection and diagnosis of gestational diabetes mellitus, the prevention or delay of type 2 diabetes, self-monitoring of blood glucose (SMBG), glycemic goals, medical nutrition therapy, DSME, physical activity, psychosocial assessment and care, hypoglycemia, immunization, hypertension control, dyslipidemia management, antiplatelet agents, smoking cessation, coronary heart disease (CHD), nephropathy, retinopathy, neuropathy, foot care, children and adolescents, preconception care, older adults, diabetes care in the hospital, diabetes care in schools and daycare settings, diabetes care at diabetes camp, diabetes management in correctional institutions, emergency and disaster preparedness, and third-party reimbursement. The standards are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. Targets that are desirable for most patients with diabetes are provided. The recommendations included are screening, diagnostic, and therapeutic actions known or believed to favorably affect health outcomes of patients with diabetes. For each recommendation, the ADA has assigned a letter grade that represents the level of supporting evidence.

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Is Pancreatic Diabetes (Type 3c Diabetes) Underdiagnosed and Misdiagnosed?. Diabetes Care. 31(Suppl 2): S165-S169. February 2008.

This article, from a special supplement of Diabetes Care magazine that reports the proceedings of the 1st World Congress on Controversies in Diabetes, Obesity, and Hypertension (CODHy) held in Berlin in 2006, discusses pancreatic diabetes, known as type 3c diabetes. Exocrine pancreatic insufficiency is frequency associated with both type 1 and type 2 diabetes. The incidence of diabetes caused by exocrine pancreatic disease appears to be underestimated and may make up 8 percent or more of the general diabetes patient population. The authors review the multiple mechanisms by which nonendocrine pancreas disease can cause diabetes. Both regulation of beta-cell mass and physiological incretin secretion are directly dependent on normal exocrine function. The authors comment on the presence of genetic mutations that can induce both exocrine and endocrine failure. The authors conclude by calling for the adaptation of diagnostic and screening strategies to detect exocrine diseases at earlier stages and possibly to stop progression to overt exocrine and endocrine pancreas insufficiency. 1 table. 47 references.

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