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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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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 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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Diabetic Neuropathies: Evaluation, Management and Controversies in Treatment Options. IN: LeRoith, D.; Vinik, A., eds. Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. pp 109-134.

This chapter about diabetic neuropathies (DN) is from a book that addresses diabetes controversies, specifically in the etiology and management of the disease. The author of this chapter focuses on the evaluation, management, and controversies in treatment options for DN, a heterogeneous group of disorders that include a wide range of abnormalities. Distal symmetric polyneuropathy, the most common form of DN, usually involves small and large nerve fibers. Small nerve fiber neuropathy often presents with pain without objective signs or electrophysiologic evidence of nerve damage. The greatest risk of small fiber neuropathy is foot ulceration and subsequent gangrene and amputation. Large nerve fiber neuropathies produce numbness, ataxia, and incoordination, which can impair activities of daily living and contribute to falls and fractures. Symptomatic therapy is available for DN, but preventive strategies and patient education are still the key factors in reducing complication rates and mortality. The author reports on some research studies on new agents that target the pathophysiological mechanisms of DN. New drugs have recently been approved in the United States for the treatment of neuropathic pain of diabetes, including duloxetine. The chapter concludes with a description of adjunctive management strategies such as foot protection and ulcer prevention; mechanical measures, including transcutaneous nerve stimulation; and surgery for the treatment of neuropathy, notably for nerve tunnel entrapment syndromes. 3 figures. 2 tables. 96 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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Latent Autoimmune Diabetes in Adults and Pregnancy: Foretelling the Future. Clinical Diabetes. 26(1): 44-46. Winter 2008.

This case report presents the case of a 25-year-old woman referred for newly diagnosed gestational diabetes mellitus (GDM). Before the pregnancy, her baseline weight was 205 pounds, and her BMI was 33. Overall, she was feeling well and tolerating her pregnancy well. A previous pregnancy, uncomplicated by GDM, had resulted in a healthy, full-term girl who was subsequently diagnosed with type 1 diabetes at age 4. The authors describe the woman’s care, which included the use of bedtime human insulin NPH and close monitoring of blood glucose levels. Insulin lispro was added for mealtime coverage, and her blood glucose control improved on intensive insulin therapy. At term, she delivered a healthy boy by uncomplicated, spontaneous vaginal delivery. Follow-up therapy noted ongoing impaired glucose tolerance, and 4 weeks later the patient experienced symptoms of polyuria, polydipsia, and blurry vision. Her blood glucose values had been between 200 and 350 mg/dl for 3 days. Because of the family history of type 1 diabetes in her daughter and the acute exacerbation of hyperglycemia, an autoantibody test was ordered and she was diagnosed with latent autoimmune diabetes in adults (LADA). Intensive insulin therapy was started with insulin lispro for prandial coverage and insulin glargine for basal coverage. She used an insulin pump and had excellent glycemic control, including through her third pregnancy. The authors use this case to review LADA, how it is diagnosed, and how treatment for LADA varies from that for type 1 or type 2 diabetes. 2 figures. 8 references.

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Managing Preexisting Diabetes for Pregnancy: Summary of Evidence And Consensus Recommendations for Care. Diabetes Care. 31(5): 1060-1079. May 2008.

This article presents consensus panel recommendations for the medical care of pregnant women with preexisting diabetes, including type 1 and type 2 diabetes. The document is designed to help clinicians deal with the broad spectrum of problems that arise in the management of diabetes before and during pregnancy, and to prepare women with diabetes for treatment that may reduce complications in the years after pregnancy. Guidelines are presented in two sections. The first section addresses managing preexisting diabetes for pregnancy, including the organization of preconception and pregnancy care, initial evaluation, glycemic control, perinatal outcome and glycemic goals, assessment of metabolic control, medical nutrition therapy, insulin therapy, oral antihyperglycemic agents for type 2 diabetes, physical activity and exercise, and behavioral therapy. The second section covers the management of diabetes complications, including diabetic ketoacidosis (DKA), maternal hypoglycemia, thyroid disorders, management of cardiovascular risk factors, screening for cardiovascular disease (CVD), hypertension, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathies. Practical suggestions, including recommended laboratory values and goals, are highlighted. The recommendations for diagnostic and therapeutic actions are based on a grading system adapted by the American Diabetes Association that was used to clarify and codify the research evidence available.

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Metabolic Complications of Childhood Obesity: Identifying and Mitigating the Risk. Diabetes Care. 31(Suppl 2): S310-S316. February 2008.

This article reviews the metabolic complications of childhood obesity, focusing on identifying and reducing the risk factors for obesity. The authors discuss the impact of genetic, intrauterine, and childhood factors in obesity; the impact of race and ethnicity; the impact of the degree of obesity; the impact of lipid partitioning; altered glucose metabolism in obese children; nonalcoholic fatty liver disease (NAFLD) in obese children; lifestyle interventions for obese children; and the goals of behavior change programs. The authors recommend that clinicians who see growing numbers of obese children and adolescents should attempt to identify those at greatest risk for the development of early morbidity. Clinical judgment should be used to assess the degree of obesity and to identify greater visceral adiposity, both of which are strongly associated with increased metabolic risk. Screening for clinically silent conditions such as impaired glucose tolerance (IGT) and NAFLD should be based on a high index of suspicion, using information gathered from history taking and anthropometric parameters. The authors stress that focused lifestyle modification interventions are showing promising results in improving the metabolic profile of obese children. 77 references.

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Prevent Diabetes Problems: Keep Your Feet And Skin Healthy. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 23 p.

Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about foot and skin problems associated with diabetes. Topics include the importance of daily diabetes care to stay as healthy as possible, how diabetes can hurt the feet, the importance of daily foot care and wearing appropriate shoes and socks, the role of the health care team in foot care, common diabetes foot problems, the use of special shoes, how diabetes can affect and damage the skin, and recommended skin care. The booklet concludes with contact information for resource organizations and a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). The booklet is illustrated with black-and-white line drawings and includes a brief pronunciation guide for some of the medical terms used. 17 figures.

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Prevent Diabetes Problems: Keep Your Kidneys Healthy. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 18 p.

Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about kidney disease associated with diabetes, or diabetic nephropathy. Topics include daily diabetes care to stay as healthy as possible; the anatomy and function of the kidneys; how to prevent diabetes-related kidney problems; the need to protect one’s kidneys during special x-ray tests; how diabetes can damage the kidneys; the symptoms of kidney failure; how kidney problems are diagnosed; and some treatment options, including hemodialysis and peritoneal dialysis. The booklet includes a pronunciation guide for the medical terms used, a brief list of recommended websites to visit, a list of the titles in the patient education series called “Prevent Diabetes Problems,” and the contact details for four resource organizations that can help patients obtain additional information. The booklet concludes with a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). The booklet is illustrated with black-and-white line drawings. 12 figures.

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Prevent Diabetes Problems: Keep Your Nervous System Healthy. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 27 p.

Diabetes is a disease in which blood glucose levels are above normal. People who have diabetes often experience complications due to these high blood glucose levels, including in the heart, blood vessels, eyes, and kidneys. This booklet, written in nontechnical language, answers common questions about nerve problems that can be caused by diabetes. Topics covered include daily activities that can help a person with diabetes stay healthy; foot care; the physiology of the nervous system; how diabetes can affect the peripheral, autonomic, and cranial nerves; the symptoms of nerve damage; and where to get additional information about diabetes nerve problems, including the contact information for resource organizations. The booklet concludes with a section that briefly summarizes the activities of the National Diabetes Information Clearinghouse (NDIC). The booklet is illustrated with black-and-white line drawings and includes a brief pronunciation guide for some of the medical terms used. 14 figures.

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Preventing Long Term Complications of Diabetes. 4th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).

This DVD program explains the long-term complications of diabetes, including atherosclerosis and other cardiovascular diseases, kidney disease, eye disease, and neuropathy. Viewers are reminded of the importance of a self-management plan for keeping diabetes under control and preventing or minimizing these complications. The management plan outlined includes patient education, healthy eating, physical activity and exercise, medications, self-monitoring of blood glucose (SMBG), and the glycosylated hemoglobin (A1C) test used for longer term monitoring of blood glucose levels. The video depicts a variety of people who share their experiences with complications and diabetes management. 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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Shock and Awesome. Diabetes Forecast. 61(2): 52-56. February 2008.

This article shares the story of actress Elizabeth Perkins, who was diagnosed with type 1 diabetes at age 44, after more than a decade of feeling constantly run down. In an interview style, Perkins, a mother of four, speaks about handling diabetes in Hollywood, why she is looking forward to getting an insulin pump, and how her diagnosis changed her life for the better. She details some of the frustrations and challenges in dealing with a chronic illness and how she has learned to focus on the consistency required for good diabetes control. 3 figures.

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Standards of Medical Care in Diabetes: 2008. Diabetes Care. 31(Suppl 1): S12-S54. January 2008.

This section 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.” These standards of care 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. Standards of care are categorized into 11 sections: classification and diagnosis; testing for pre-diabetes and diabetes in asymptomatic patients; detection and diagnosis of gestational diabetes mellitus (GDM); the prevention or delay of type 2 diabetes; diabetes care, including medical nutrition therapy (MNT) and diabetes self-management education (DSME); the prevention and management of diabetes complications, including hypertension, cardiovascular disease, dyslipidemia, nephropathy, retinopathy, neuropathy, and foot care; diabetes care in specific populations, including children, adolescents, and older adults; diabetes care in specific settings, such as hospitals, schools, daycare settings, diabetes camps, and correctional institutions; hypoglycemia and employment/licensure; third-party reimbursement for diabetes care, self-management education, and supplies; and strategies for improving diabetes care. 15 tables. 332 references.

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What I Need to Know About Physical Activity and Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. 15 p.

Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about the role of physical activity and exercise in a complete diabetes management program. Topics include the benefits of a physically active lifestyle, the kinds of physical activity that may be appropriate, cautions for some types of physical activity, the interrelationship between exercise and low blood glucose levels, how to get started on an exercise program, and how to stay motivated to maintain a physically active lifestyle. Suggestions are provided for incorporating exercise into everyday activities, for making sure that aerobic exercise is included, and for stretching and strength training. A sidebar lists tips for treating low blood glucose episodes. The booklet includes contact details for resource organizations where readers can get more information. A final section summarizes the activities of the National Diabetes Information Clearinghouse. The booklet is illustrated with black-and-white line drawings. 6 figures.

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What is Diabetes? (Type 2) 4th ed. Timonium, MD: Milner-Fenwick. 2008. (DVD).

This DVD program explains the differences between type 1 and type 2 diabetes. The program focuses on type 2 diabetes, covering the symptoms, risk factors, long-term complications, and treatment approaches. Viewers are reminded of the impact of excess weight on the development of diabetes. The program discusses insulin resistance, target ranges of blood glucose, healthy food choices, the diabetes food guide pyramid, carbohydrate counting, fats, portion sizes, the role of physical activity, blood glucose monitoring, and the use of medications to help keep diabetes under control. The video depicts a variety of people with type 2 diabetes and shares their experiences with diagnosis and diabetes management. 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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Acute Complications of Diabetes. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 63-68.

This chapter about the acute complications of diabetes is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter discusses hypoglycemia, diabetic ketoacidosis, and hyperosmolar nonketoacidotic coma. The chapter offers full-color photographs and figures representing these same topics, including the symptoms of hypoglycemia in diabetes, brain activation in patients with hypoglycemia, the biochemical features of diabetic ketoacidosis, the causes of death in diabetic ketoacidosis, and the biochemical features of diabetic hyperosmolar nonketotic coma. 5 figures. 5 references.

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Advances and Emerging Opportunities in Type 1 Diabetes: A Strategic Plan. Nephrology News & Issues. 21(3): 28-31. February 2007.

Type 1 diabetes develops as a consequent of the body’s failure to produce insulin and is associated with an array of microvascular complications such as kidney and eye disease, macrovascular complications such as cardiovascular and peripheral vascular disease, and neuropathy. The National Institutes of Health (NIH) recently announced the Type 1 Diabetes Research Strategic Plan (www.T1Diabetes.nih.gov/plan), designed to guide research in type 1 diabetes for the next decade. This article reviews this plan, describing the key objectives that will guide NIH efforts to achieve six goals: identify the genetic and environmental causes of type 1 diabetes, prevent or reverse type 1 diabetes, develop cell replacement therapy, prevent or reduce hypoglycemia in type 1 diabetes, prevent or reduce the complications of type 1 diabetes, and attract new talent and apply new technologies to research on type 1 diabetes. The author notes that, as the leading cause of kidney failure and blindness in the United States and a major contributor to cardiovascular disease and early death, diabetes is a disease deserving of further intensive research to identify its causes, prevention, management, and, ultimately, its cure. 2 references.

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American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus. Endocrine Practice. 13(Suppl 1): 3-68. May-June 2007.

In 2001, the American College of Endocrinology (ACE) launched the first in a series of conferences to address the important and growing epidemic of diabetes mellitus in the United States and worldwide. This article from the American Association of Clinical Endocrinologists (AACE) provides clinicians with clear and accessible evidence-based guidelines for the care of patients with type 1 or type 2 diabetes mellitus. Topics include screening and diagnosis, the prevention of type 2 diabetes mellitus, glycemic management, hypertension management, lipid management, nutrition and diabetes, microvascular complications, diabetes and pregnancy, diabetes management in the hospital setting, and patient safety in diabetes care. Each topic section contains a general overview of information necessary to interpret the specific recommendations, an executive summary of graded recommendations based on clinical evidence and various subjective factors, and evidence base and clinical considerations that include detailed discussion of the supportive clinical evidence and specific subjective factors. 1 figure. 21 tables. 567 references.

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American Diabetes Clinical Practice Recommendations 2007. Diabetes Care. 30 (Suppl 1): S1-S103. January 2007.

This supplement to the Diabetes Care journal contains the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes, the major position statement of the organization. In addition, this issue includes selected position statements on certain topics not adequately covered in the Standards of Medical Care in Diabetes. The introductory materials explain the differences between a position statement, an ADA statement, a technical review, and a consensus statement. The position statements included are: Standards of Medical Care in Diabetes, 2007; the Diagnosis and Classification of Diabetes Mellitus; Nutrition Recommendations and Interventions for Diabetes; Diabetes Care in the School and Day Care Setting; Diabetes Care at Diabetes Camps; Diabetes Management in Correctional Institutions; Hypoglycemia and Employment or Licensure; and Third-Party Reimbursement for Diabetes Care, Self-Management Education, and Supplies. The supplement also includes a list of technical reviews, committee reports and consensus statements, a list of position statements and ADA statements, and the National Standards for Diabetes Self-Management Education. Each standard includes a statement of the problem, and then lists recommendations; relevant references are also included.

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Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 126 p.

This atlas of diabetes mellitus offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. Diabetes requires a multidisciplinary care team, but many clinicians may not be familiar with some of the less common manifestations of the disease. The atlas begins with a brief overview of the diagnosis, pathogenesis, and treatment of diabetes with special reference to the complications of diabetes and the treatment of children and adolescents. Eleven chapters cover these topics plus diabetes and surgery, the acute complications of diabetes, the chronic complications of diabetes, diabetic dyslipidemia, diabetes and pregnancy, living with diabetes, and future developments in diabetes care. Each chapter includes full-color and black-and-white photographs and charts. The latest information about diagnostic tests, monitoring of blood glucose levels, drug therapies, and patient education recommendations is provided. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. Each chapter concludes with a list of readings, and a subject index concludes the volume.

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Case Study: Diagnostic Dilemma in a Patient With Insulinoma. Clinical Diabetes. 25(4): 152-154. Fall 2007.

This article presents a case study of a diagnostic problem in a person with insulinoma. The patient was a 70-year-old woman who was referred to the diabetes clinic for work-up for hypoglycemia. She had known coronary artery disease (CAD) and had had a coronary artery bypass graft. Her symptoms included fatigue and some depression. Despite very low blood glucose levels, the woman had hypoglycemia unawareness. The authors describe the various diagnostic tests used to evaluate this woman, including the need for three fasting studies and repeated drug screens. A magnetic resonance imaging (MRI) and angiogram of the abdomen finally showed a 1.6 centimeter enhancing mass at the head of the pancreas. Surgical excision was recommended for curative treatment, and the surgical pathology was consistent with insulinoma. In follow-up, the woman had mild hyperglycemia, suggesting that the insulinoma may have been masking mild type 2 diabetes. The authors review the symptoms of hypoglycemia, offer suggestions for the work up of hypoglycemia, consider why one of the sulfonylurea drug screen came back positive in this woman, and discuss the best imaging modalities for the diagnosis of insulinoma. 2 tables. 8 references.

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Childhood Obesity: Practical Considerations for Prevention and Management. Diabetes Spectrum. 20(3): 148-153. Summer 2007.

This article from a series on the art and science of obesity management offers practical considerations for the prevention and management of childhood obesity. The authors encourage health care providers to take a proactive role when treating children by focusing on the prevention of obesity rather than waiting until the condition exists. After a review of the complications and comorbidities of childhood obesity, the authors discuss how to make an appropriate and thorough assessment of a child’s lifestyle and behaviors and how to implement interventions that will result in improved health. Few medications for childhood obesity are approved for treatment, and then only for specific indications and with close follow-up. However, many of the environmental factors that give rise to childhood obesity are correctable or modifiable. The authors stress that the emphasis should be placed on changing the person’s behaviors through increased awareness and ongoing support of the family. 2 tables. 30 references.

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Chronic Complications of Diabetes. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 69-108.

This chapter about the chronic complications of diabetes is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter discusses the symptoms, prevalence, pathology, prognosis, and management of diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, major vascular disease, hypertension, the diabetic foot, erectile dysfunction, nonalcoholic steatohepatitis, skin disorders, and rare manifestations, including diabetic cheiroarthropathy, Dupuytren’s contracture, and adhesive capsulitis of the shoulder. The chapter offers full-color photographs and figures representing examples of each of these same topics. The photographs have brief captions that focus on clinical treatment for the problem depicted. 5 figures. 71 references.

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Clinical Diagnosis of Diabetic Neuropathy. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 275-292.

This chapter on the clinical diagnosis of diabetic neuropathy is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of this diabetes complication. The authors stress that the clinical assessment of diabetic neuropathies typically involves evaluation of both subjective symptoms and neurological deficits; an alteration in the former does not necessarily reflect an improvement in nerve function. The authors discuss clinical screening devices including the Semmes-Weinstein monofilament, graduated Rydel-Seiffer tuning fork, tactile circumferential discriminator, and Neuropen; other techniques discussed include quantitative sensory testing, electrophysiology, amplitude, F waves, distribution of velocities, the axon reflex, nerve biopsy, skin biopsy, magnetic resonance imaging (MRI), corneal confocal microscopy, and assessing risk of ulceration. The authors conclude that recent advances have included improved treatments for painful diabetic neuropathies, but treatment for the underlying pathology is still lacking. 3 figures. 4 tables. 66 references.

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Could Global Standardization of AIC Help it Become the Preferred Diabetes Screening Method?. Review of Endocrinology. 1(2): 59-61. June 2007.

This article considers the use of A1c, glycated hemoglobin, as a preferred diabetes screening method. The tests most widely used in clinical practice today are the fasting plasma glucose screening test (FPG) for type 2 diabetes and the confirmatory oral glucose tolerance test (OGTT). The glycated hemoglobin test is currently used for monitoring purposes after a diabetes diagnosis has been made. The authors contend that A1c tests have practical advantages over FPG or OGTT: blood sample collection can be performed more quickly, capillary blood samples are suitable, and sample stability is better than for blood glucose. In addition, A1c results reflect the 2- to 3-month average of blood glucose concentrations in the patient rather than a one-time snapshot as provided by the blood glucose tests. The authors discuss problems with consistencies in how the A1c results are reported, making it difficult to compare results across studies and populations. A final section recommends global reporting standards that could encourage the more widespread use of A1c testing as a diabetes screening test. A1c could then become more widely available as a screening tool, particularly in resource-poor populations where diabetes is an emerging public health issue but laboratory facilities are limited. 25 references.

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Dealing Day-to-Day With Diabetes: A Whole Family Experience. Today’s Dietitian. 9(11): 44-48. November 2007.

This article reminds dietitians of the importance of considering the whole family when working with a child who has been diagnosed with diabetes. The author begins with a description of what families of children with diabetes go through as they cope with the diagnosis and their “new normal.” Parents of children newly diagnosed with diabetes are given all the facts about managing diabetes from a clinical standpoint but are left with many questions about the social and emotional aspects of diabetes. The author uses the story of one family’s journey through diagnosis and adjustment to their son’s diabetes as a case example of the positive role that a dietitian can play on the patient’s care team. The mother of the family under discussion is a dietitian herself, and she speaks clearly to her readers. She shares her feelings of being overwhelmed by how much she had to learn about her young son’s disease and about diabetes management. Two sidebars outline a typical day in the family’s busy life and list readings recommended by the dietitian mother, some of which focus on coping with diabetes in the school setting. Another sidebar lists strategies that parents can use to help educate school personnel. 2 references.

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Diabetes And Pregnancy. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 111-114.

This chapter about diabetes and pregnancy is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter focuses on the potential adverse consequences of pregnancy for both the mother and fetus. The authors recommend close supervision of the patient during pregnancy by a multidisciplinary team familiar with both diabetes and obstetrics. Topics include mortality among diabetic mothers, uncontrolled diabetes and fetus loss, maternal hyperglycemia during pregnancy, recommended diagnostic and monitoring tests, pregnancy in patients with type 2 diabetes, and the problem of gestational diabetes. 11 references.

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Diabetes And Surgery. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 61-62.

This chapter about diabetes and surgery is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter discusses problems with regular diabetes care during hospitalization, protocols for the management of diabetes before, during, and after surgery, and the importance of preoperative assessment. The chapter also discusses the different care required for patients who are on insulin therapy compared with those who are not on insulin.

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Diabetes and Your Kidneys: Taking Control. Kidney Beginnings. 5(6): 6-7, 22-23, 28. February 2007.

This cover story article provides readers with an in-depth explanation of the interplay between diabetes mellitus and kidney function. The authors caution that diabetes is the leading cause of kidney failure in the United States and that nearly one of every two people treated with dialysis or a kidney transplant has diabetes. The authors summarize diabetes and how it affects different organ systems in the body, outline the two main types of diabetes, and describe how and when diabetes affects the kidneys. Topics include the complications associated with high blood glucose levels, the importance of early diagnosis, microalbuminuria, kidney function tests including glomerular filtration rate (GFR), the role of the hormone erythropoietin, anemia, risk factors for getting diabetes, and diabetes prevention and treatment. A final section focuses on glycosylated hemoglobin and why it is important. One table summarizes the recommended medical check-ups for people with diabetes, including glucose control, blood pressure, eye exams, foot exams, lipid checks, urine protein, vaccinations, and aspirin use counseling. 3 figures. 4 tables. 3 references.

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Diabetes Dictionary: What Every Person With Diabetes Needs to Know. Alexandria, VA: American Diabetes Association. 2007. 150 p.

This dictionary helps people with diabetes understand the constantly growing vocabulary associated with diabetes research and treatment. The pocket-sized book includes more than 500 entries and provides straightforward definitions of diabetes terms and concepts that patients need to successfully manage their disease. The dictionary includes pronunciation guides for every entry, quick browsing with lettered tabs, and the most current diabetes medications. The dictionary concludes with a list of common acronyms and abbreviations, a description of some of the other titles available from the American Diabetes Association (ADA), and a summary of the activities and contact information for various components of the ADA.

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Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. 706 p.

Although they receive an average of only 4 hours of professional training on diabetes, primary care physicians manage 90 percent of the patients with diabetes in the United States. This textbook offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. The author addresses all aspects of outpatient and hospital-based diabetes care for various age groups and focuses on behavioral interventions for enhanced patient adherence. After an introductory chapter, the text includes 12 chapters that cover diagnosing and managing metabolic syndrome: polycystic ovary syndrome; managing type 2 diabetes in adults; physiologic insulin replacement therapy; insulin pump therapy; assessing glycemic control; the managing diabetes in pregnancy; childhood and adolescence; lifestyle interventions for patients with diabetes; in-patient management of patients with diabetes; the screening, diagnosis, and management of diabetes-related complications; amylin; glucagon-like peptic-1 receptor antagonists and dipeptidyl peptidase IV (DPP-IV); and managing mental illness in patients with diabetes. Each chapter begins with a list of “take home points” that outline the concepts to be covered in that chapter and ends with a summary and an extensive list of references. A detailed subject index concludes the volume.

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Diabetes: Magnitude and Mechanisms. Clinical Diabetes. 25(1): 25-28. Winter 2007.

This article is the first in a new series focusing on the fundamentals of diabetes care for physicians-in-training. The overall goal is to provide doctors in internships and residency programs with important information regarding diabetes and the care of patients who have it. This first article highlights the scope of diabetes and the key pathophysiological attributes of the four common types of diabetes: type 1 diabetes, type 2 diabetes, gestational diabetes mellitus (GDM), and other specific forms, including diseases of the exocrine pancreas that result in diabetes. The author stresses that understanding these categories, which are based on the etiology of the disease, is vital to provide appropriate patient care. The article also provides epidemiological information about diabetes in the United States from 1999 to 2002, discussing risk factors, ethnic groups, increasing obesity, and aging populations. A brief section about the economic impact of diabetes is also included. 25 references.

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Diabetic Dyslipidemia. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 109-110.

This chapter about diabetic dyslipidemia is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter defines lipid disorders associated with diabetes and outlines the research studies that have been conducted to increase knowledge in this area. Studies discussed include the Scandinavian Simvastatin Survival Study (the 4S Trial), the Cholesterol and Recurrent Events Trial (CARE), the Veterans Affairs HDL Intervention Trial (VA-HIT), and the Collaborative Atorvastatin Diabetes Study (CARDS). Practical clinical strategies that can be gleaned from each of these studies are discussed. 9 references.

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Diabetic Ketoacidosis.. Pediatric Diabetes. 8: 28-43. 2007.

This article presents information from the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines (2006–2007) on diabetic ketoacidosis (DKA). DKA is characterized by low serum insulin and high counter-regulatory hormone concentrations which results in an accelerated catabolic state, hyperglycemia and hyperosmolality, and ketonemia and metabolic acidosis. Despite their dehydration, patients with DKA continue to maintain normal blood pressure and have considerable urine output until extreme volume depletion leads to a critical decrease in renal blood flow and glomerular filtration. This article reviews the clinical manifestations of DKA, the biochemical criteria for a diagnosis of DKA, the frequency of DKA, emergency assessment, supportive measures for patients diagnosed with DKA, clinical and biochemical monitoring, insulin therapy, potassium replacement, phosphate, acidosis, the introduction of oral fluids and transition to subcutaneous insulin injections, morbidity and mortality associated with DKA, and cerebral edema. A final section considers the prevention of recurrent DKA. A detailed patient care algorithm is included. 2 figures. 3 tables. 146 references.

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Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. 516 p.

This comprehensive textbook provides general practitioners details about the latest techniques for the clinical management of diabetic neuropathy. The text offers 28 chapters, covering the historical aspects of diabetic neuropathies, epidemiology, genomics, hyperglycemia-initiated mechanisms, neuronal and Schwann cell death, animal studies, the structure and function of the spinal cord in diabetes mellitus, diabetic encephalopathy, microangiopathy, the peripheral nervous system, the pathogenesis of human diabetic neuropathy, clinical features of diabetic polyneuropathy, microvascular disease, macrovascular disease, clinical diagnosis of diabetic neuropathy, punch skin biopsy, the use of aldose reductase inhibitors, other therapeutic agents, the pathophysiology of neuropathic pain, treatment of painful diabetic neuropathy, focal and multifocal diabetic neuropathy, hypoglycemia and the autonomic nervous system, cardiovascular autonomic neuropathy, postural hypotension and anhidrosis, gastrointestinal syndromes due to diabetes mellitus, genitourinary complications, and the management of diabetes-related foot complications. Each chapter includes a summary, a list of key words, and an extensive list of references. A subject index concludes the volume.

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Diagnosing and Managing the Metabolic Syndrome in Adults, Children, and Adolescents. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 43-87.

The term “metabolic syndrome” refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is believed to be related to insulin resistance. This chapter about diagnosing and managing metabolic syndrome in adults, children, and adolescents is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author briefly reviews the history of understanding metabolic syndrome, including its epidemiology, and then covers the risk factors; the role of obesity; treatments that focus on behavioral and lifestyle interventions; drug therapy, particularly for risk reduction intervention; the role of primary care physicians; and the importance of early recognition of symptoms and aggressive behavioral intervention. The author concludes by reiterating that health care providers should screen all at-risk children and adolescents for components of metabolic syndrome while promoting healthy lifestyle interventions with both the parents and the patient. The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 6 figures. 16 tables. 118 references.

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Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 30 (Suppl 1): S42-S47. January 2007.

This supplement to the Diabetes Care journal contains the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes, the major position statement of the organization. This section of the supplement presents a position statement on the Diagnosis and Classification of Diabetes Mellitus. The position statement includes a definition and description of diabetes mellitus; the classification of diabetes mellitus and other categories of glucose regulation, including type 1 diabetes, type 2 diabetes, genetic defects of the beta cell, genetic defects in insulin action, diseases of the exocrine pancreas, endocrinopathies, drug-induced or chemical-induced diabetes, gestational diabetes mellitus (GDM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG); and the diagnostic criteria for diabetes mellitus, which is also summarized in a table. 1 figure. 3 tables. 4 references.

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Disordered Eating: Identifying, Treating, Preventing, and Differentiating it From Eating Disorders. Diabetes Spectrum. 20(3): 141-148. Summer 2007.

This article, from a series on the art and science of obesity management, defines disordered eating (DE), differentiates it from eating disorders (ED), and provides information that can aid in the diagnosis and treatment of DE among people with diabetes. The authors demonstrate how to apply these concepts to diabetes education to assist patients in reaching and maintaining normal eating behaviors and proper diabetes management. The authors note that DE is prevalent among people with diabetes and can significantly increase diabetes mortality and morbidity. A trained multidisciplinary team is vital in the diagnosis and treatment of DEs. Treatment must begin with emphasis on nutrition rehabilitation, weight restoration, and adequate diabetes control. The insulin regimen must be monitored, and education about diabetes management and potential complications must be provided to patients and families. The authors conclude by encouraging diabetes educators to educate themselves about DE behaviors and to adopt positive approaches for the prevention and treatment of these behaviors. One side bar offers a list of related Internet resources. 2 tables. 58 references.

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Eye on Diabetes: Keeping Your Diabetes Under Control. Kidney Beginnings. 7(3): 7-8. October 2007.

This article reminds readers of the importance of good diabetes control to prevent complications, including diabetic retinopathy, the medical term for damage to the tiny blood vessels that nourish the retina in the eye. The author notes that these blood vessels are often affected by high blood glucose levels, resulting in fluid leakage in the retina, closure of blood vessels, or even the development of new blood vessels, which can reduce vision. Other factors that can cause retinopathy to worsen include malnutrition, pregnancy, smoking, and poorly controlled blood pressure. The author briefly reviews the symptoms of diabetic retinopathy, the importance of regular screening tests to monitor eye health, and the most common treatments for diabetic retinopathy: laser treatment, eye injections, and surgery. The article concludes with five recommended steps for readers to follow to reduce the risk of vision loss.

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Facts About Diabetic Nephropathy. Diabetes Wellness News. 13(11): 5-7. November 2007.

This article, from a wellness newsletter for people with diabetes, reminds readers of the basic facts about diabetic nephropathy, kidney disease associated with diabetes. The author reviews the anatomy and physiology of the kidneys and discusses the role of the kidneys in filtering and processing the blood, maintaining the proper amount of sodium, phosphorus, and potassium, and controlling the hormones that stimulate red blood cell production and calcium balance. The author explains how diabetes affects the kidneys, the risk factors for kidney disease, tests that may be conducted to diagnose and monitor kidney disease, the use of the glomerular filtration rate (GFR) as a monitoring test, symptoms of kidney disease, the stages of chronic kidney disease (CKD), the use of peritoneal dialysis and hemodialysis to treat diabetic nephropathy, the role of transplantation for people with kidney disease, and strategies that may help prevent diabetic nephropathy. Readers are referred to the National Kidney Foundation’s website at www.kidney.org and the National Kidney Disease Education Program’s website at http://nkdep.nih.gov for more information. 3 figures. 1 table.

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Facts About Diabetic Retinopathy. Diabetes Wellness News. 13(8): 4-5. August 2007.

Diabetic retinopathy is a sight-threatening, long-term complication of diabetes caused by raised glucose levels on the small blood vessels in the retina of the eye. This article, from a patient education newsletter for people with diabetes, describes how diabetic retinopathy develops, how it can be treated, how its progress can be slowed, and why it is important for people with diabetes to have a yearly eye exam. Topics include background retinopathy, retinal hemorrhages, proliferative diabetic retinopathy, diabetic maculopathy, laser treatment, self-care strategies that can help reduce one’s risks of developing diabetic retinopathy, screening for diabetic retinopathy, and the importance of getting screening before symptoms develop. The author concludes by briefly describing some of the other effects diabetes can have on the eye, including open angle glaucoma, vascular occlusions, and cataracts. 3 figures. 2 references.

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Focal and Multifocal Diabetic Neuropathy. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 367-378.

This chapter on focal and multifocal diabetic neuropathy is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of this diabetes complication. The vast majority of people with clinical diabetic neuropathy have a distal symmetrical form, but occasionally people with diabetes develop focal and multifocal neuropathies, including cranial nerve involvement and limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age and mostly in patients with long-standing diabetes mellitus. The focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self-limited, sometimes after a relapsing course. The author reminds readers that other causes of neuropathies must be excluded in people with diabetes with focal neuropathies. Treatable causes must always be sought in people with diabetes with disabling motor deficits. 3 tables. 56 references.

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Gastrointestinal Syndromes Due to Diabetes Mellitus. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 433-452.

This chapter on gastrointestinal (GI) symptoms due to diabetes mellitus is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of diabetic neuropathy. The author cautions that disturbances may manifest as symptoms and metabolic changes that can, in turn, impinge in the management of the patient with diabetes. Diet therapy is an important component of diabetes management for all people with diabetes. The author describes the pathophysiology, clinical findings, and management options for dealing with the main clinical syndromes associated with disturbances of GI physiology in people with diabetes. These disturbances include esophageal dysfunction, gastroparesis, diarrhea, constipation, fecal incontinence, and irritable bowel syndrome (IBS). The author provides advice about indications and interpretations of various diagnostic tests used to confirm these conditions. Treatment strategies are outlined and reviewed. 4 figures. 3 tables. 95 references.

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Genitourinary Complications. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 453-472.

This chapter on genitourinary complications is from a textbook on diabetic neuropathy. The authors note that disturbances in bladder emptying or storage are often asymptomatic to the patient, particularly in the beginning of this diabetes complication. However, sexual dysfunctions are readily perceived by the patient. Topics covered include the physiology of micturition, the pathophysiology and clinical symptomatology of the diabetic bladder, a diagnostic approach and treatment options for micturition disturbances, the epidemiology of erectile dysfunction (ED), the physiology and pathophysiology of erection, treatment strategies for ED, other sexual problems in men with diabetes, and female sexual dysfunction. The authors stress that impairment of bladder storage and emptying as well as sexual dysfunction may have severe organic and psychosocial consequences, so their existence should be systematically screened for in the routine diabetes clinic. 3 figures. 3 tables. 74 references.

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Gestational Diabetes And the Importance of Postpartum Management. Today’s Dietitian. 9(11): 14-20. November 2007.

This article helps dietitians work with clients who have had gestational diabetes mellitus (GDM) during their pregnancies. The author reminds readers that GDM places women at risk for developing postpartum type 2 diabetes. The author reviews the risk factors for developing GDM, screening and diagnosis during pregnancy, clinical outcomes of GDM, the risk prediction for developing type 2 diabetes subsequent to GDM, postpartum blood glucose testing, postpartum weight management, lifestyle intervention, and strategies to prevent type 2 diabetes in women who have had GDM. Tables summarize the nutrition recommendations for GDM and metabolic assessments recommended after GDM. Forms are provided for an eating behavior diary and a framework for outlining behavioral goals for health improvement. The author concludes that postpartum educational interventions offering continued support for healthy eating, regular physical activity, weight reduction, and breastfeeding are of high importance after delivery for all mothers who had GDM . 1 figure. 4 tables.

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Hypoglycemic Disorders. IN: Gardner, D.; Shoback, D., eds. Greenspan's Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007 . pp 748-769.

This chapter on hypoglycemic disorders is from a textbook on endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors note that, under the usual metabolic conditions, the central nervous system is completely dependent on plasma glucose and counteracts declining blood glucose concentrations with a carefully programmed response. Topics discussed include the pathophysiology of the counterregulatory response to neuroglycopenia; the maintenance of euglycemia in the postabsorptive state, that is, longer than 4 to 6 hours after a meal; the role of the kidney; the classification of hypoglycemic disorders into symptomatic and asymptomatic hypoglycemia; the clinical presentation of hypoglycemia; the documentation of low plasma glucose values; the reversibility of symptoms with treatment; specific hypoglycemia conditions, including insulin reaction, sulfonylurea overdose, surreptitious insulin or sulfonylurea administration, autoimmune hypoglycemia, pentamidine-induced hypoglycemia, and pancreatic beta cell tumors; symptomatic fasting hypoglycemia that presents without hyperinsulinism, including that due to ethanol and to nonpancreatic tumors; nonfasting hypoglycemia, also called reactive hypoglycemia, including postgastrectomy alimentary hypoglycemia, postgastric bypass hypoglycemia, functional alimentary hypoglycemia, pancreatic islet hyperplasia in adults, and late hypoglycemia, also called occult diabetes; and congenital hyperinsulinism. 3 figures. 5 tables. 43 references.

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Impaired Fasting Glucose and Impaired Glucose Tolerance: Implications for Care. Diabetes Care. 30(3): 753-759. March 2007.

The availability of interventions that have been shown to decrease the development of diabetes has stimulated consideration as to whether such interventions should be recommended and implemented, in whom, and under what circumstances. To address these issues, the American Diabetes Association (ADA) convened a consensus development conference in October 2006, focusing on the prediabetes states of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). This article reports on the answers to some of the questions that the consensus development conference addressed. Topics include definitions of IFG and IGT and their natural history; the pathogenesis of these conditions; how to alter the natural history of IFG and IGT; interventions that prevent the progression from IFG/IGT to diabetes and whether these interventions can also prevent the worsening of diabetes-related risk factors, including those connected to cardiovascular disease; the data that supports interventions undertaken to prevent or delay diabetes in people who have IFG/IGT; and patient selection for screening, methods for screening, and strategies to delay the adverse consequences of IFG/IGT. 1 figure. 2 tables. 59 references.

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Integrating Depression Care with Diabetes Care in Real-World Settings: Lessons from the Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Spectrum. 20(1): 10-16. Winter 2007.

This article describes the implementation of models of patient care geared toward treating patients with diabetes who also have depression. The authors note that depression is a common comorbidity in patients with diabetes and these conditions together pose challenges for health care providers, patients, and health care systems. The authors focus on models of care that are designed to treat patients with both illnesses in a coordinated manner in primary care and community settings serving disadvantaged and ethnic minority populations. Nine of these community sites used the PHQ-9, a short version of the Patient Health Questionnaire, as a screening tool for depression for all patients with diabetes who were enrolled in the Robert Wood Johnson Foundation Diabetes Initiative. The authors then report aggregate screening data found across the nine sites, describe models of treatment developed by the projects, and highlight key themes that emerged from this initiative. The results of this data collection showed that the proportion of patients with diabetes who had moderate to severe depression ranged from 30 to 70 percent. Treatment strategies that emerged included enhancements of primary care, integrated mental health services, group therapy, and approaches emphasizing cultural traditions and mind-body focus. 1 table. 29 references.

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Introduction to Diabetes. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 1-42.

Although they receive an average of only 4 hours of professional training on diabetes, primary care physicians manage 90 percent of the patients with diabetes in the United States. This introductory chapter is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. The author addresses all aspects of outpatient and hospital-based diabetes care for various age groups and focuses on behavioral interventions for enhanced patient adherence. In this chapter, the author reviews the rationale and importance of primary care intervention for people with diabetes and pre-diabetes, also called metabolic syndrome. The author notes that most patients with diabetes require pharmacologic regimens that are well-established, widely used, and safe, allowing primary care physicians to provide care for many of their own patients and refer more complex cases to specialists. Patients with chronic, poorly controlled hyperglycemia may have multiple complications that require the coordination and management skills of their health care provider. The author concludes the expertise in behavioral change and disease self-management is central to the successful care of any chronic disease, especially diabetes. 4 figures. 6 tables. 25 references.

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Introduction. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 1-9.

This brief introductory chapter is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter presents a definition of diabetes and discusses the diagnostic criteria for the disease, the classification of diabetes, and the epidemiology of both type 1 and type 2 diabetes. The chapter includes black-and-white photographs and colorful charts and figures. 7 figures. 9 references.

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Little Diabetes Book You Need to Read. Philadelphia, PA: Running Press Book Publishers. 2007. 256 p.

This diabetes handbook focuses exclusively on the person with diabetes, rather than on the disease itself. The authors emphasize the need for patients to understand and accept an active role in the design and implementation of their care by learning about diabetes and themselves. The authors describe a simple, four-step approach patients can use to optimize their diabetes self-care. The four steps are: learn all you can about diabetes and yourself; identify three guiding principles of role, flexibility, and targets; formulate a self-management plan; and experiment with and evaluate the plan. The first section of the book, Learning, has three chapters: the fundamentals of diabetes as a disease; how to select and work with the right health care professionals; and how to understand one's own wants, needs, and capabilities as they relate to diabetes management. The second section, Doing, also has three chapters: how to build a self-care plan, how to determine which principles and strategies will best fit into that plan, and how to incorporate this plan into every day life. The last section, What Now?, offers tips about how to stay motivated and briefly summarizes the latest research efforts in the field of diabetes. The book is written in nontechnical language and presented in large-print type.

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Living With Diabetes. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 115-116.

This brief chapter about living with diabetes is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter considers how diabetes mellitus, like any chronic medical condition, has an impact on quality of life. The author discusses some of the psychological adjustments required after diagnosis, the problem with depression in people with either type 1 or type 2 diabetes, concerns about driving an automobile after a diagnosis of diabetes, problems with employment associated with the disease, and health insurance concerns. 1 reference.

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Management of Diabetic Foot Complications. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 473-506.

This chapter on the management of diabetic foot complications is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of diabetic neuropathy. The author explains that diabetic foot complications are the result of an interplay between impaired wound healing, peripheral vascular disease, and neuropathy. The peripheral neuropathy seen with diabetes affects sensory, motor, and autonomic neurons and results in increased susceptibility to pathology. The most common problem is the presence of wounds that are difficult to heal. Therefore, the prevention of the formation of these wounds is of the highest importance in managing patients who are at risk for forming these wounds. Treatment involves a multidisciplinary approach and requires adequate perfusion, proper wound care, and appropriate protection of the wound from pressure of offloading. The author considers neuro-osteoarthropathy, or Charcot's disease of the foot, a common problem caused by neuropathy, which can result in the musculoskeletal disruption of the architecture of the foot and lead to severe deformity. 9 figures. 2 tables. 125 references.

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Managing Type 2 Diabetes In Adults. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 118-191.

Type 2 diabetes is a metabolic disorder characterized by abnormalities at multiple organ sites, including the pancreatic beta cells, skeletal muscles, adipose tissue, and liver. The successful management of type 2 diabetes requires an understanding of the pathophysiology of insulin resistance, a strategy to promote lifestyle modifications, surveillance for identifying and preventing long-term lifestyle modifications, knowledge of intensive pharmacologic interventions, and professional skills for providing patient education. This lengthy chapter about diagnosing and managing type 2 diabetes in adults is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author stresses that pursuing an aggressive approach to diabetes management can lead to positive treatment outcomes and improvement in the quality of life for these patients. The author also notes that because most patients with type 2 diabetes will eventually require insulin therapy, physicians should not hesitate to discuss this possibility during the early stages of the disease. Doing so will likely make the transition from oral agents to injectable therapy more acceptable to the patient. The author guides readers from diagnosis through patient care strategies, patient education, and monitoring for disease progression and complications. Readers are reminded that type 2 diabetes is not a “mild” form of diabetes. Physicians should screen high-risk patients for this disease, initiate aggressive treatment immediately after the diagnosis is confirmed, and advance the therapeutic interventions as needed to maintain as near normal A1C levels as possible to prevent long-term diabetes-related complications. The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 13 figures. 18 tables. 183 references.

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Mom? Dad? Meet Diabetes: Expert Advice on Life after Diagnosis. Diabetes Forecast. 60(10): 42-44. September 2007.

This patient education article, from a magazine for people with diabetes, offers advice for parents whose child has been recently diagnosed with diabetes. The author describes the growing incidence of diabetes, including type 2 diabetes, in children. The author reminds readers that diabetes education is an ongoing process and they will have time to learn as they go along. Parents who have been through the process share their tips and experiences in the article; they emphasize the importance of support groups, grieving, and working closely in tandem with health care providers. The author encourages parents to maintain their regular routines and to learn different approaches to achieving the appropriate care for their child. A sidebar lists three online information resources for parents. 2 figures.

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Other Complications and Associated Conditions. Pediatric Diabetes. 8: 171-176. 2007.

This article presents information from the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines (2006–2007) on other complications and associated conditions in children with diabetes. Topics covered include impaired growth and development; associated autoimmune conditions, such as hypothyroidism, hyperthyroidism, celiac disease, vitiligo, and primary adrenal insufficiency (Addison disease); lipodystrophy; necrobiosis lipoidica diabeticorum; limited joint mobility; and edema. The authors briefly review the literature on which their discussion is based and then summarize with a set of recommendations. They stress that monitoring of growth and physical development and the use of growth charts are essential elements in the continuous care of children and adolescents with type 1 diabetes. Screening of thyroid function and screening for celiac disease is recommended at the diagnosis of diabetes and thereafter, every second year. Routine clinical examination should be undertaken for skin and joint changes. There is no established therapeutic intervention for lipodystrophy, necrobiosis lipoidica, or limited joint mobility. 81 references.

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Pancreatic Hormones And Diabetes Mellitus. IN: Gardner, D.; Shoback, D., eds. Greenspan's Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 661-747.

This chapter on pancreatic hormones and diabetes mellitus is from a textbook on endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. Topics discussed include the endocrine pancreas, introduction, anatomy and histology, hormones of the endocrine pancreas, classification, clinical features of diabetes mellitus, laboratory findings in diabetes mellitus, diagnosis of diabetes mellitus, treatment of diabetes mellitus, acute complications of diabetes mellitus, chronic complications of diabetes mellitus, surgery in the diabetic patient, diabetes mellitus and pregnancy, and prognosis for patients with diabetes mellitus. The authors conclude by stressing the importance of excellent patient education and patient participation in their own health care as vital to the success of coping with diabetes and preventing its complications. A list of abbreviations is provided. 10 figures. 30 tables. 147 references.

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Pathogenesis. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 9-32.

This chapter about pathogenesis is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes, its diagnosis, and its treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter discusses type 1 diabetes; type 2 diabetes; other types of diabetes, including maturity-onset diabetes of the young (MODY); the obesity epidemic; and prevention of the different types of diabetes. The chapter offers full-color photographs of specific presentations of diabetes in conjunction with other diseases and genetic disorders, including Cushing’s syndrome, Prader-Willi syndrome, obesity, acromegaly, Addison’s disease, hemochromatosis, Klinefelter’s syndrome, Turner’s syndrome, myotonic dystrophy, and Rabson-Mendenhall syndrome. Additional illustrations present the biochemical consequences of insulin deficiency, mechanisms of glucose production and stimulation, histology of the pancreas and beta cells, and pathology of the pancreas. 44 figures. 20 references.

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Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment. Clinical Diabetes. 25(2): 57-62. Spring 2007.

Gestational diabetes mellitus (GDM) affects approximately 7 percent of all pregnancies and is defined as carbohydrate intolerance during gestation. This review article addresses screening recommendations, diagnosis, and treatment of GDM. The authors stress that it is important to detect women with GDM because the condition can be associated with several maternal and fetal complications, including macrosomia, birth trauma, cesarean section, and problems in the newborn, such as hypocalcemia, hypoglycemia, and hyperbilirubinemia. The authors discuss several treatment options as well as the need for long-term risk modification and postpartum follow-up care. Several agents that are both effective and safe can be used to treat women with GDM if diet and exercise alone are not enough; these include human insulin, insulin analogs, and glyburide. Patients who have experienced GDM during their pregnancy have a higher risk of developing type 2 diabetes in the future, so it is important to continue screening these patients and to educate them about their risk factors. 3 tables. 58 references.

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Phases of Diabetes. Pediatric Diabetes. 8: 44-47. 2007.

This article presents information from the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines (2006–2007) on the phases of type 1 diabetes: preclinical diabetes, presentation of diabetes, partial remission or the honeymoon phase, and the chronic phase characterized by lifelong dependency on administered insulin. In each phase, the article outlines the symptoms, diagnostic tests, and treatment strategies recommended; emergency and non-emergency presentations are reviewed. A final section addresses how to differentiate between type 1 and type 2 diabetes at the time of diagnosis in children and adolescents. 28 references.

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Polycystic Ovary Syndrome. IN: Unger, J. Diabetes Management in Primary Care. 2007. p. 88-117.

Polycystic ovary syndrome (PCOS) is one of the most common causes of menstrual irregularity and infertility in the United States. In addition, women with PCOS constitute the largest group of women at risk for developing cardiovascular disease (CVD) and diabetes. This chapter on PCOS is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author begins with a discussion of the prevalence and pathogenesis of PCOS and then covers diagnosis, clinical evaluation, the links between PCOS and metabolic syndrome, cancer risks associated with PCOS, and treatment strategies. The author notes that early recognition of this disorder may reverse the physical signs associated with the disease while correcting the metabolic abnormalities that can pose a significant health risk for untreated individuals. The use of insulin sensitizers can improve ovulatory function, lower insulin resistance, lower androgen levels, and increase the likelihood of becoming pregnant. The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 9 figures. 7 tables. 76 references.

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Pre-Diabetes: What You Need to Know. [Prediabetes: Lo Que Debe Saber]. Bethesda, MD: National Diabetes Information Clearinghouse. 2007. 4 p.

This fact sheet, printed in both English and Spanish, reviews the condition of pre-diabetes, defined as blood glucose levels that are higher than normal but not high enough to be called diabetes. Glucose is a form of sugar the body uses for energy and too much glucose in the blood can damage the body over time. Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The fact sheet answers questions about pre-diabetes, including how to know if pre-diabetes is present, who should be tested for the condition, risk factors, and treatment options, notably weight loss. Readers are referred to the National Diabetes Education Program (NDEP) and the National Diabetes Information Clearinghouse (NDIC) for more information about pre-diabetes and preventing diabetes. The same information is printed in Spanish on the second two pages of the document.

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Prediabetes. Chevy Chase, MD: Hormone Foundation. 2007. 1 p.

This brief fact sheet reviews pre-diabetes, a condition in which the body becomes resistant to the effects of insulin. Insulin is a hormone produced by the pancreas that helps the body take sugar from the bloodstream and carry it to cells where it is used for energy. The fact sheet answers common questions about pre-diabetes, discussing the risk factors for the disease, possible symptoms, diagnostic and screening tests used to monitor and diagnose pre-diabetes, complications associated with pre-diabetes, how to prevent and treat pre-diabetes, and how readers can best use the information provided in the fact sheet. One figure lists the diagnostic results of fasting blood glucose (FBG) and oral glucose tolerance (OGT) tests in the categories of normal, pre-diabetes, and diabetes. Readers are referred to the Hormone Foundation’s website at www.hormone.org and other resources for more information. The fact sheet is also available in Spanish. 1 figure. 4 references.

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Probe to Bone: What Do the Data Tell Us?. Review of Endocrinology. 1(2): 20-21. June 2007.

This article considers the importance of and techniques used for diagnosing osteomyelitis in people with diabetes who present with foot ulcers. The authors caution that diabetic foot ulcers frequently become infected and, if left untreated, can involve bones and joints and may progress to amputation. Osteomyelitis may be present in up to 60 percent of severe and 20 percent of mild-to-moderate infected wounds. The authors review the importance of early detection, the use of probe-to-bone (PTB) testing, the research that supports the value of PTB testing, and possible limitations of the technique. If the clinician can probe to bone with a sterile, blunt, stainless steel probe, there is an 89 percent positive predictive value for osteomyelitis. The authors conclude that the PTB test has limitations, but it also has value in assisting the clinician. In particular, a negative test may exclude the diagnosis of osteomyelitis. 11 references.

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Punch Skin Biopsy in Diabetic Neuropathy. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 293-312.

This chapter on the use of punch skin biopsy in diabetic neuropathy is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of this diabetes complication. The author describes the measurement of unmyelinated C and A delta nociceptors through punch skin biopsy as an important development in this area over the past decade. Clinically, the punch biopsy technique is most often used to define a length-dependent peripheral neuropathy, but it can also be used to follow patients longitudinally over time. Epidermal nerve fibers are often lost early in diabetes or even in impaired glucose tolerance and can be the only objective measure of neuropathy in these patients. The author concludes that the superficial nature of epidermal nerve fibers allows repeated sampling of these nerves in a relatively noninvasive fashion, permitting earlier diagnosis of neuropathy and a way to measure changes over time or in response to treatment. 7 figures. 44 references.

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Standards of Medical Care in Diabetes-2007. Diabetes Care. 30 (Suppl 1): S4-S41. January 2007.

This supplement to the Diabetes Care journal contains the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes, the major position statement of the organization. This section of the supplement presents the Standards of Medical Care in Diabetes (2007) in the areas of Classification and Diagnosis; Screening for Diabetes; Detection and Diagnosis of Gestational Diabetes Mellitus; the Prevention or Delay of Type 2 Diabetes; Diabetes Care; the Prevention and Management of Diabetes Complications; Diabetes Care in Specific Populations, including children and adolescents, preconception care, and older individuals; Diabetes Care in Specific Settings, including the hospital, school and day care settings, diabetes camps, correctional institutions, and emergency and disaster preparedness; Hypoglycemia and Employment or Licensure; Third-Party Reimbursement for Diabetes Care; and Strategies for Improving Diabetes Care. Each standard includes a statement of the problem, and then lists recommendations; relevant references are also included. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided with the standards. The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. 1 figure. 11 tables. 234 references.

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Talk T With Your Male Patients: AADE Takes a Fresh Look at Low T and Diabetes in Men. Diabetes Educators Handbook. p. 7-8. July 2007.

This article, part of a special supplement to Endocrine Today, encourages diabetes educators to talk with men who have diabetes about their potential risk for low testosterone levels. The author describes a program from the American Association of Diabetes Educators (AADE) called “Take Charge. Talk T.” This program includes educational opportunities for diabetes educators and other professionals, a consumer website at www.TalkLowT.org, and a larger presence at diabetes patient events. The author encourages readers to remember that low testosterone levels are easily diagnosed with a simple blood test and treatable with gels like AndroGel (Solvay Pharmaceuticals), patches, and injections. In addition, free Spanish and English pamphlets are available in packs of 50 by emailing talkt@aadenet.org.

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Treatment of Children And Adolescents With Diabetes. IN: Scobie, I.N. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 59-60.

This brief chapter on treatment options for children and adolescents is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter discusses the importance of incorporating knowledge of child development into the care for diabetes because a variety of behavioral, physiologic, psychologic, and social factors operate in different ways in children and in adolescents. Most children and their parents rapidly become confident with insulin injections and self-monitoring of blood glucose (SMBG). The chapter briefly reviews the typical insulin needs of a younger child, noting that these dosages will change as the child moves into adolescence. 3 references.

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Treatment. IN: Scobie, I.N.. Atlas of Diabetes Mellitus. 3rd ed. New York, NY: Informa Healthcare USA. 2007. pp 33-58.

This chapter about treatment options is from an atlas of diabetes mellitus that offers text and pictures to familiarize clinicians with the most current information about diabetes and its diagnosis and treatment. The volume portrays the wide and varied expressions of diabetes and its complications as an aid to their more ready recognition in clinical practice. This chapter discusses dietary treatment for type 1 diabetes, dietary treatment for type 2 diabetes, the role of exercise, insulin regimens for type 1 diabetes, blood glucose monitoring, the importance of patient education and self-care, the assessment of glycemic control, drugs and insulin treatment used for type 2 diabetes, and the use of islet and pancreatic transplantation. The chapter offers full-color photographs and illustrations of these same topics, including the equipment used for self-monitoring of blood glucose (SMBG) and for insulin infusion, injection site complications, and the dosage ranges for common diabetes medications. 31 figures. 21 references.

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Ultrasound Surveillance in Pregnancy Complicated by Diabetes. Diabetes Spectrum. 20(2): 89-93. Spring 2007.

This article evaluates the clinical relevance of ultrasonography during pregnancy complicated by diabetes. Ultrasonography may be used for fetal surveillance, assessment of diabetes impact, guidance of diabetes treatment, and obstetric management. The authors discuss the role of the obstetrician, the ecological system of the maternal-fetal metabolic unit, assessment of fetal metabolic status, sonographic estimation of fetal development and growth, fetal body composition, fetal macrosomia and obstetrical management, Doppler sonography, fetal surveillance, and ultrasound-guided therapeutic management of maternal glycemic control. The authors conclude that although ultrasound has improved, its effect on reduction of perinatal morbidity and mortality remains to be proven, and its use in detecting large-for-gestational-age fetuses is unreliable. Indeed, clinical decisions based on birth weight prediction by sonography are often in error. The authors note that measurement of the insulin-sensitive fetal fat layer and fetal abdominal circumference may better reflect the impact of diabetes on the fetus. 37 references.

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What is Gestational Diabetes?. Diabetes Care. 30(Suppl 2): S105-S111. July 2007.

This article brings readers up to date on the basics of diagnosis and patient care management for women with gestational diabetes mellitus (GDM). GDM is defined as glucose intolerance with onset or first recognition during pregnancy. GDM is usually diagnosed with routine glucose tolerance screening. The authors review the use of population screening for glucose intolerance, the physiology of glucose regulation in pregnancy and GDM, GDM and autoimmune beta cell dysfunction, GDM and monogenic diabetes, and the role of GDM as an opportunity for the study of evolving diabetes and, potentially, for diabetes prevention. The authors conclude that GDM may result from a spectrum of existing metabolic abnormalities but were only detected by the screening process. In many, and perhaps most, women with GDM, the abnormalities appear to be chronic in nature, detected by routine glucose screening in pregnancy. They are frequently progressive, leading to rising glucose levels and eventually to diabetes. 4 figures. 65 references.

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Acute Illness in Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 103-198.

This chapter on acute illness in diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include recommended instructions for patients with diabetes who are coping with an acute illness at home, changes to be made to insulin regimens during periods of an acute illness, and the indications for hospital admission. The author stresses that instructions for patients must be individualized and instructions will vary depending on factors such as the type of diabetes; the kind of therapy, pills or insulin; the presence of complications; and the type of acute illness. The chapter presents two case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 3 references.

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Cardiac Autonomic Neuropathy. Practical Diabetology. 25(1): 34-38. March 2006.

Diabetes is one of a number of diseases that can affect the autonomic control of the heart and the vascular system. This article discusses the known forms of cardiac autonomic dysfunction and their clinical manifestations, with emphasis on diabetes-associated cardiac autonomic neuropathy (CAN). The authors review the clinical manifestations and differential diagnosis, prevalence and implications, diagnosis, and monitoring and patient care management. CAN should be considered in all patients with diabetes who have peripheral neuropathy or other forms of autonomic neuropathy, or in those who exhibit no respiratory variation of heart rate during physical examination. The symptom of CAN that most affects everyday life is orthostatic hypertension and lightheadedness; these can be treated with certain drugs, and steps to prevent salt and fluid loss. 2 figures. 4 tables. 4 references.

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Cheating Destiny: Living with Diabetes, America’s Biggest Epidemic. Boston, MA: Houghton Mifflin Company. 2006. 307 p.

This book offers a comprehensive look at the diabetes epidemic that combines history, reporting, advocacy, and patient memoir. The author offers revealing views of the diabetes subculture, the urge toward secrecy that many people with diabetes feel, the glycemic roller-coaster they constantly ride, and the remarkable perseverance required for survival. The author is a journalist and best-selling author who has lived with type 1 diabetes for 29 years; his brother is a diabetologist who also has type 1 diabetes, as does the author’s son, recently diagnosed at age 5. The author describes the science behind the disorder, the impact of diabetes care on the economy and on society, the history of diabetes care and insulin, research that supports the use of tight metabolic control to prevent complications, the psychosocial aspects of living with diabetes, the perspective of parents caring for children with diabetes, and alternative models of health care. The author uses numerous, real-life examples to illustrate the concepts under discussion. The book concludes with a lengthy bibliography and subject index.

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Diabetes And Driving. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 311-318.

This chapter on diabetes and driving is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include assessing driving risks in patients with diabetes, who should advise patients about driving, pregnancy and an increased risk of hypoglycemia, hypoglycemia unawareness and its impact on driving safety, and European and British guidelines for commercial drivers with diabetes. The chapter presents four detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. One table summarizes the British regulations on the driving licenses of individuals with diabetes mellitus. 1 table. 8 references.

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Diabetes And Old Age. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. . Somerset, NJ: John Wiley & Sons. 2006. pp 147-158.

This chapter on diabetes in patients older than 65 is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the frequency of diabetes mellitus (DM) in older adults, the etiology of DM development in older adults, the consequences of DM in older adults, chronic complications of DM, and general and specific patient care management approaches. The author notes that the appropriate targets for the management of DM and its various complications in older patients are not the same for all patients. In general, health care providers must consider the life expectancy of the patient, the ability and willingness of the patient and his or her family to follow the health care team’s advice, financial and other resources, and the presence of other coexistent medical problems. The chapter presents three case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 7 references.

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Diabetes And the Young. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 141-146.

This chapter on diabetes and the young is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the psychosocial consequences of receiving a diagnosis of a chronic disease, the process of adjusting to a diagnosis of diabetes in a child or adolescent, parent-child interactions and sharing of self-care, and coping with changes of adolescence. Parent and patient education strategies should cover insulin injections, hypoglycemia, hyperglycemia, self-monitoring of blood glucose (SMBG), nutrition, exercise, and rules for days of acute illness. The chapter presents five case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 2 references.

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Diabetes in Clinical Practice: Questions And Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. 467 p.

This book deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. The book offers 30 chapters, beginning with an introduction to diabetes and followed by topics including the pathophysiology of type 1 and type 2 diabetes, glycemic control, hypoglycemic, diabetic coma, surgery in diabetes, acute illness in diabetes, diabetes and exercise, diabetes and pregnancy, diabetes and the young, diabetes and old age, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, microangiopathy in diabetes, diabetic foot, skin disorders in diabetes, sexual function in diabetes, musculoskeletal system and diabetes, infections in diabetes, hypertension and diabetes, lipids and diabetes, diabetes and driving, diabetes and travel, nutrition, oral medications, insulin, new therapies, and the prevention of diabetes. Each chapter presents three to six case studies, which are individually discussed, and relevant questions are posed and answered. Each chapter concludes with a list of references for further reading. Some chapters are illustrated with black-and-white photographs. A detailed subject index concludes the text.

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Diabetes, Psychiatric Disorders, and the Metabolic Effects of Antipsychotic Medications. Clinical Diabetes. 24(1): 18-24. Winter 2006.

Antipsychotic medications, widely used to treat a variety of psychiatric conditions, are also associated with diabetes. This article explores the complex relationship among psychiatric disorders, antipsychotic medications, and risk factors for metabolic syndrome and diabetes (including obesity, hyperglycemia, and dyslipidemias). The authors focus on the atypical, or second-generation, antipsychotics and their current uses. They examine the relationship between diabetes and two of the most frequent indications for use of these medications, schizophrenia and the behavioral and psychological symptoms of dementia. One section discusses the importance of screening for diabetes among patients taking atypical antipsychotics; for example, many patients with schizophrenia may have diabetes, elevated lipids, and hypertension and be unaware of it. The authors conclude that diabetes risk reduction, including nutritional and physical activity counseling, control of blood pressure, lowering of cholesterol and triglyceride levels, weight loss, and increased physical activity, can have a positive impact on both diabetes and the psychiatric illnesses and can be successfully utilized in patients with schizophrenia. 2 tables. 55 references.

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Diabetes. IN: Blueprint for Men's Health: A Guide to a Healthy Lifestyle. Sudbury, MA: Jones and Bartlett Publishers, Inc. June 2006. pp. 39-40.

This chapter on diabetes is from a booklet that reviews a wide spectrum of health issues, focusing on health promotion and prevention for men. In this chapter, the author reviews the basics of diabetes, a condition characterized by a lack of enough insulin to handle the normal blood glucose resulting from digestion. The chapter covers type 1 diabetes, type 2 diabetes, diagnostic approaches, the symptoms of diabetes and which symptoms should trigger a visit to a health care provider, risk factors for diabetes, and living a healthy life while managing diabetes. The keys to prevention and treatment of diabetes include weight loss, blood pressure control, exercise, and a healthy, balanced diet. Readers are encouraged to talk with their health care provider about any concerns they may have in these areas.

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Diabetic Coma. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 81-92.

This chapter on diabetic coma is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include a definition of diabetic ketoacidosis (DKA), the diagnosis and treatment for diabetic ketoacidosis, hyperosmolar nonketotic hyperglycemic coma (HNKHC) and how it is diagnosed and treated, the risks for developing HNKHC, and lactic acidosis. The chapter presents three case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 5 references.

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Diabetic Eye Disease: An Educator's Guide (en ingles y espanol). Bethesda, MD: National Eye Institute. 2006. (CD-ROM)

Diabetes is a leading cause of blindness among working-age adults in the United States. With early detection and timely treatment, diabetic eye disease (diabetic retinopathy) can be controlled. The key is to get a dilated eye exam at least once a year. This CD-ROM program, which includes both English and Spanish language versions, offers patient education tools for health professionals and community-based educators who work with people who have diabetes. Topics covered include the importance of vision care, the risks of diabetes to vision, who tends to develop diabetic retinopathy, how diabetes damages the eyes and causes vision loss, why the dilated eye exam is so important, what to expect during and after a dilated eye exam, steps to take to protect one’s vision, treatment strategies for diabetic retinopathy (notably laser surgery), and low vision training options. The program reminds readers to take their medications, reach and maintain a healthy weight, add exercise to their daily routine, control their blood sugar, and stop smoking. The CD features modules patients can use on their own, a PowerPoint slide presentation, and English and Spanish presentations that can be printed in PDF format. The web site address for National Eye Institute programs is provided (www.nei.nih.gov).

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Diabetic Foot. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 217-242.

This chapter on the diabetic foot is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the frequency of ulcers of the feet and their significance, which diabetes patients are most at risk for developing a foot ulcer, monitoring and screening patients at risk for ulcer formation, patient care management strategies, decompression of the ulcer area, the classification system used for the severity of foot ulcers, antimicrobials used for ulcers with infection, the indications for hospitalization of a patient with a foot ulcer, osteomyelitis, surgical and nonsurgical debridement of foot ulcers, other factors that can accelerate healing of foot ulcers, and the diagnosis and patient management of Charcot arthropathy. The chapter presents four detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. The chapter is illustrated with black-and-white photographs of various types of foot ulcers. 10 figures. 6 tables. 11 references.

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Diabetic Ketoacidosis and Hypersmolar Hyperglycemic State. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 312-320.

This chapter on diabetic ketoacidosis and the hyperosmolar hyperglycemic state (HHS) is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the triad of hyperglycemia, acidemia, and ketonemia that define diabetic ketoacidosis (DKA); the symptoms of HHS, including hyperglycemia, hyperosmolarity, and altered mental status; mortality rates for DKA and HHS; the role of infection in triggering DKA and HHS; the role of nonadherence to insulin therapy as a cause of DKA and HHS, a problem that is the most common precipitant of DKA and HHS in urban African-Americans; the role of volume depletion in the development of HHS, as severe hyperglycemia develops when fluid intake fails to compensate for fluids lost through osmotic diuresis; treatment strategies, including administration of intravenous fluid to correct dehydration and hyperosmolarity, administration of insulin to reverse hyperglycemia and ketoacidosis (in DKA), correction of electrolyte abnormalities, identification of precipitants, and frequent patient monitoring; the complications of treatment, including hypoglycemia, hypokalemia, and cerebral edema (rare); and the American Diabetes Association recommendations for the diagnosis and treatment of DKA and HHS. The chapter concludes with a lengthy list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 1 figure. 1 table. 5 references.

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Diabetic Nephropathy. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 173-186.

This chapter on diabetic nephropathy is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Diabetic nephropathy is defined as the decline in kidney function due to diabetes mellitus; it manifests clinically with proteinuria, usually several years after the onset of hyperglycemia. Topics covered include the frequency of nephropathy in diabetes; factors that contribute to the pathogenesis of nephropathy; diagnostic tests used to confirm the condition; other conditions that can cause microalbuminuria; the significance of microalbuminuria in diabetes; the natural history of diabetic nephropathy; treatment options including glycemic control, control of arterial hypertension, and diet; the role of renal transplantation in people with diabetes; and the use of antihypertensive medications in patients with diabetic nephropathy. The chapter presents one detailed case study, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case study presented. 16 references.

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Diabetic Neuropathy. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 187-198.

This chapter on diabetic neuropathy is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the symptoms of neuropathy, how to diagnose peripheral neuropathy in patients with diabetes, the frequency of neuropathy in diabetes, factors that contribute to the pathogenesis of nephropathy, diagnostic tests used to confirm the condition, and treatment options including drug therapy. The author comments on the sometimes paradoxical nature of symptoms in peripheral neuropathy; the presence of painful symptoms does not necessary mean normal sensation. A combination of painful and yet insensitive feet indicates great risk for development of foot ulcerations, with the subsequent risk for amputation. The chapter presents five detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 2 tables. 4 references.

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Diabetic Peripheral Neuropathy. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 333-350.

This chapter on diabetic peripheral neuropathy (nerve disease) is from a comprehensive textbook on obesity and diabetes. The authors note that there is growing evidence that neuropathy may be associated with glucose intolerance and may even be the presenting symptom of diabetes. The authors discuss chronic diabetic polyneuropathy, pathogenesis, the diagnosis and evaluation of neuropathy, the management of chronic diabetic polyneuropathy, acute diabetic polyneuropathy, proximal diabetic neuropathy, and diabetic radiculopathies and mononeuropathies. The most common form, chronic diabetic polyneuropathy is characterized by neuropathic pain in the feet, numbness and paresthesias in the toes, fee, and lower legs, and mild distal weakness of the lower extremities. The management of diabetic neuropathy begins with treatment of hyperglycemia; strict control of blood glucose in both type 1 and type 2 diabetes is beneficial, including for management of the pain associated with neuropathy. 3 tables. 124 references.

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Diabetic Retinopathy. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 291-318.

Diabetes mellitus is the leading cause of blindness in people between the ages of 20 and 74 in the United States, and diabetic retinopathy (DR) will eventually affect most people with type 1 diabetes. DR encompasses a wide spectrum of manifestations from mild to profound vision loss, and early screening and appropriate treatment determine prognosis. This chapter on diabetic retinopathy is from a comprehensive textbook on obesity and diabetes. The authors discuss the two types of DR, their prevalence and incidence, pathophysiology (including vascular remodeling and angiogenesis, chronic inflammation, apoptosis, platelets, vascular permeability factor), risk factors, screening and diagnostic considerations, complications of DR and the mechanisms of vision loss, prevention strategies, and treatment (both conventional as well as emerging and experimental treatments). The authors conclude that tight glycemic (blood glucose) control is the mainstay of current medical management. Appropriate surgical therapy with photocoagulation or vitrectomy can delay progression of the disease and preserve vision. 5 figures. 213 references.

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Diabetic Retinopathy. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 159-172.

This chapter on diabetic retinopathy (DR) is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. DR is a form of microvascular disease that affects the vascular net of the retina. Topics covered include the characteristics of DR, the frequency of DR occurrence, factors that affect the progression of DR, increased capillary permeability in diabetes mellitus, the cause of microvascular obstructions of the retina, damage caused by hypoxia of the retina, diagnostic tests used to confirm the presence of DR, diabetic maculopathy, treatment options for DR, the relationship between cataract and diabetes, acute glaucoma in patients with diabetes, and diabetes as a cause of reversible haziness of the lens. The chapter presents one detailed case study, with relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management process for the case study presented. 3 figures. 10 references.

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Diagnosing Obesity, Diabetes Mellitus and the Insulin Resistance Syndrome. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 129-154.

Obesity is a disease state that has reached epidemic proportions, with increasing prevalence and serious health care consequences. This chapter on diagnosing obesity, diabetes mellitus, and insulin resistance syndrome is from a comprehensive textbook on obesity and diabetes. In the first part of the chapter, the authors present criteria for the diagnosis of overweight and obesity and for evaluation of the obese and overweight patient. The authors emphasize the importance of determining the specific type of obesity and the possible presence of other risk factors in obese individuals. The authors also review obesity-screening recommendations and rationale. They caution that obesity increases the risk of developing several comorbidities, including type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD), arthritis, sleep apnea, and some tumors. Screening procedures for type 2 diabetes mellitus are necessary because of the well-known association of diabetes with increased morbidity and mortality from acute and chronic complications and because as many as 50 percent of the diabetic population remains undiagnosed, at any given time. Insulin resistance is a state of decreased sensitivity of issues to insulin; also called the metabolic syndrome, insulin resistance is usually considered an intermediate state between diabetes and normality. 5 figures. 9 tables. 113 references.

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Dyslipidemia Associated with Diabetes and Insulin Resistance Syndromes. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 193-212.

In addition to having markedly increased risk of coronary heart disease (CHD), patients with type 2 diabetes have much worse outcomes after a major cardiovascular event. An understanding of the pathophysiology and treatment of modifiable metabolic abnormalities that often cluster with type 2 diabetes may help reduce the incidence of and mortality from CHD in this population. This chapter on dyslipidemia associated with diabetes and insulin resistance syndromes is from a comprehensive textbook on obesity and diabetes. The authors focus primarily on the dyslipidemia associated with type 2 diabetes and obesity as part of the insulin-resistant metabolic syndrome. The authors first provide an overview of the major lipoproteins and lipoprotein metabolism, then present the characteristics and mechanisms of dyslipidemia associated with diabetes and obesity. The authors review the lipid goals according to the American Diabetes Association (ADA) and Adult Treatment Panel III (ATP III) criteria and discuss lipid-lowering treatment options. Topics include the benefits of lifestyle modification, the mechanisms of action of the lipid-lowering medications available in the United States, and clinical trial data relevant to the management of patients with diabetes and the metabolic syndrome. The chapter includes a brief discussion of dyslipidemia associated with type 1 diabetes and with insulin-resistant states including human immunodeficiency virus (HIV) and polycystic ovary syndrome (PCOS). 4 figures. 3 tables. 77 references.

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Erectile Dysfunction. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 363-376.

This chapter on erectile dysfunction (ED) is from a comprehensive text on obesity and diabetes. ED is defined as the consistent or recurrent inability to attain or maintain a penile erection sufficient for sexual intercourse. ED is a common sexual dysfunction, especially among men with diabetes. Diabetes mellitus, hypertension, hyperlipidemia, and coronary artery disease are known to increase the likelihood of having ED. The author discusses a definition and epidemiology of ED, its pathophysiology, the diagnostic evaluation, treatment options, and the costs of various treatments. Vascular impairment in diabetes will lead to ED from large-vessel disease, but more important, from problems with intrapenile blood flow. Diagnostic components should include the patient's history, a physical examination, and diagnostic testing, including tests that measure nocturnal penile activity and patient symptom surveys. Treatment options include optimizing glycemic control, oral medications, injectable therapy, transurethral therapy, vacuum assistance devices, constriction rings, and penile implants. 1 figure. 5 tables. 35 references.

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Genetic Basis of Maturity-Onset Diabetes of the Young. Endocrinology and Metabolism Clinics of North America. 35(2): 371-384. June 2006.

Type 2 diabetes mellitus is a heterogeneous metabolic disease occurring with concomitant or interdependent defects of insulin secretion and action. This article investigates the genetic basis of maturity-onset diabetes of the young (MODY), defined as a genetic defect in beta-cell function with subclassification according to the gene involved. The authors note that type 2 diabetes seems to be composed of subtypes wherein genetic susceptibility is strongly associated with environmental factors at one end of the spectrum (common, polygenic forms of type 2 diabetes) and highly genetic forms at the other end. MODY is considered a monogenetic form of diabetes. The authors focus on the molecular genetics of MODY, discussing glucokinase mutations, mutations in the transcription factor genes, other candidate genes for familial diabetes, and the contribution of MODY genes to multifactorial forms of type 2 diabetes. The authors conclude that less than 15 percent of the genetic determinants of type 2 diabetes have been identified; however, it is likely that other genes contributing to the genetic risk for type 2 diabetes will soon be discovered. This identification can improve the understanding of the molecular mechanisms that maintain glucose homeostasis and of the precise defects leading to chronic hyperglycemia. The identification of these genes can also lead to the timely identification of high-risk individuals who might benefit from early behavioral or medical intervention for preventing the development of diabetes. 2 tables. 69 references.

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Glycaemic Control. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 59-69.

This chapter on glycemic control is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the role of self-monitoring of blood glucose (SMBG) with a glucose meter in people with type 1 diabetes mellitus (DM) and in people with type 2 DM, the use of urine glucose determination to monitor glycemic control, glycosylated hemoglobin (HbA1c) measurement and its use as a monitoring tool, problems with HbA1c measurement, and factors that can affect the HbA1c value. The chapter presents one case study, through which relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case study presented. 4 tables. 11 references.

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Hypertension And Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 277-292.

This chapter on hypertension and diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the definition of hypertension in diabetes mellitus (DM) and recommended treatment targets, the frequency of hypertension in patients with DM, the pathogenetic mechanism for the development of hypertension in DM, complications associated with hypertension in this patient population, recommendations for the monitoring of blood pressure levels, diagnostic and other tests recommended for determining cardiovascular risk, treatment options for hypertension in people with diabetes, and recommended first-line antihypertensive agents. The chapter presents two detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 1 table. 7 references.

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Hypoglycaemia. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 71-80.

This chapter on hypoglycemia is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. The author notes that episodes of hypoglycemia are usually perceived and treated by the patients themselves. However, if not detected early enough, hypoglycemia can lead to serious problems, including coma. Topics covered include the effects of hypoglycemia in type 1 and type 2 diabetes, the causes of hypoglycemia in a person with diabetes, the symptoms of hypoglycemia, the indications for hospitalization for episodes of hypoglycemia, and posthospitalization patient care and follow-up. The chapter presents five case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 3 references.

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Infections in Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 267-276.

This chapter on infections in diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include susceptibility to infections; the specific characteristics of common infections in people with diabetes, including respiratory tract infections, urinary tract infections, and soft tissue infections; infections that are observed with increased frequency in people with diabetes, including some fungal infections, malignant otitis externa, necrotizing fasciitis and myonecrosis, rhinocerebral mucormycosis, and emphysematous cholecystitis; and the indications for treatment of asymptomatic bacteriuria in diabetes patients. The chapter presents two detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 10 references.

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ISPAD Clinical Practice Consensus Guidelines 2006-2007: Definition, Epidemiology and Classification. Pediatric Diabetes. 7(6): 343-351. December 2006.

This article offers clinical practice guidelines for the definition, epidemiology, and classification of diabetes, a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The article includes the diagnostic criteria for diabetes in childhood and adolescence, impaired glucose tolerance and impaired fasting glycemia, the pathogenesis and epidemiology of type 1 diabetes, classifying the different types of diabetes, maturity onset diabetes of the young (MODY), neonatal diabetes, mitochondrial diabetes, cystic fibrosis and diabetes, drug-induced diabetes, and stress hyperglycemia. The article concludes with a list of recommendations, covering diagnostic tests used for diabetes and how to choose which patients should be tested or monitored with which tests. This article is a chapter in the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2006-2007. 1 figure. 3 tables. 80 references.

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Lipids And Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 293-310.

This chapter on lipids and diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include a definition of lipids and their physiologic function in the body, lipoproteins, the metabolism of lipids and lipoproteins, diabetic dyslipidemia and its causes, the treatment of dyslipidemia in patients with diabetes mellitus (DM), recommended targets for blood lipid levels in this patient population, and medicines that are used in the treatment of diabetic dyslipidemia. The author notes that blood lipid physiology in people with type 1 diabetes depends, for the most part, on glycemic control. Poor glycemic control is associated with hypertriglyceridemia and, in some cases, with increased levels of low density lipoprotein (LDL) cholesterol and reduced levels of high density lipoprotein (HDL) cholesterol. Typical dyslipidemia in type 2 DM includes a slight increase of triglycerides, low levels of HDL, and normal to slightly elevated levels of total cholesterol and LDL cholesterol. The chapter presents two detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 1 figures. 3 tables. 10 references.

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Macroangiopathy in Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 199-216.

This chapter on microangiopathy in diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. The author notes that the term diabetic macroangiopathy is used interchangeably with the more common term atherosclerosis. Unlike other complications of diabetes, macroangiopathy is not seen only in people with diabetes. However, various atherosclerotic problems tend to be more frequent, appear earlier, and progress faster in people with diabetes compared with those without the disease. Topics covered include the morbidity and mortality from macroangiopathy, epidemiology, symptoms, how to diagnose macroangiopathy in patients with diabetes, factors that contribute to the pathogenesis of macroangiopathy, diagnostic tests used to confirm the condition, patient care protocols, the metabolic syndrome and macroangiopathy, and treatment options. The chapter presents four detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 2 figures. 3 tables. 14 references.

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Medical Nutrition Therapy for GDM. Today's Dietitian. 8(12): 22-25. December 2006.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset or first recognition during pregnancy. This article discusses the role of medical nutrition therapy (MNT) as a treatment option for women with GDM. The author presents a broad overview of the MNT evidence-based guides for practice, which cover a recommended schedule of MNT visits, the nutrition assessment, nutrition diagnosis, specific nutrition interventions, and nutrition monitoring, evaluation, and documentation. At the initial visit, the registered dietitian performs a nutritional assessment that includes food intake, anthropometrics, clinical status, medications, patient self-care skills, behavior modification status, and individual considerations. The next step, nutrition diagnosis, is the identification and labeling that describes an actual occurrence, risk of, or potential for developing a nutritional problem. The nutrition intervention includes determining goals (such as weight gain, blood glucose, monitoring, urine ketone, and exercise), determining when insulin may need to be used, creating meal plans, and patient education. The registered dietitian must routinely monitor the effectiveness of the MNT by evaluating key indicators at every visit. Most of the information is provided in lists and table format. The guidelines were developed by registered dietitians within two groups of the American Dietetic Association. 5 tables.

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Metabolic Syndrome. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 155-168.

This chapter on the metabolic syndrome is from a comprehensive textbook on obesity and diabetes. The metabolic syndrome is a cluster of risk factors associated with the development of cardiovascular disease (CVD). Obesity, in particular visceral adiposity, insulin resistance, and some degree of abnormal glucose metabolism coupled with dyslipidemia and abnormal blood pressure (BP) are the hallmarks of the syndrome. The authors review the pathogenetic factors associated with metabolic syndrome and its association with disease. Topics include a definition of metabolic syndrome, pathophysiology of the components associated with metabolic syndrome, prevalence of metabolic syndrome, metabolic syndrome in children and early life determinants, the metabolic syndrome and cardiovascular disease, potential treatments, and the role of weight loss and exercise. The authors conclude that a large body of epidemiological data correlates the presence of metabolic syndrome with an increased risk of CVD and overall mortality. They note that although it is difficult to identify the precise mechanisms whereby lifestyle alterations (exercise and weight loss) improve outcomes, the effects are likely to include decreases in adiposity, insulin resistance, and nutrient fluxes; altered intramyocellular and intrahepatic metabolism; and increased adiponectin levels and skeletal muscle blood flow. The authors stress that because obesity is an increasing global burden, it is expected that the number of individuals with metabolic syndrome will increase, as will the rates of morbidity and mortality from CVD. 3 figures. 3 tables. 84 references.

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Metabolic Syndrome: Recognition, Etiology, And Physical Fitness as a Component. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. . Boca Raton, FL: CRC Press. 2006. pp 57-78.

This chapter about the metabolic syndrome is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors describe the metabolic syndrome as a clustering of metabolic abnormalities associated with increased risk of cardiovascular disease, diabetes, and hypertension. They provide an overview of current controversies with the definition of the metabolic syndrome, review cross-sectional studies of the importance of physical fitness and exercise to the diagnosis and etiology of metabolic syndrome, and then focus on exercise training and its impact on individual components of the metabolic syndrome, including blood pressure, triglycerides, HDL cholesterol, fasting plasma glucose, insulin sensitivity, and waist circumference. A final section provides the rationale for using cardiorespiratory fitness as a monitoring measurement in metabolic syndrome. The chapter includes black-and-white illustrations and a lengthy list of references. 3 figures. 4 tables. 89 references.

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Musculoskeletal System And Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 261-266.

This chapter on the musculoskeletal system and diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include cheiroarthropathy, Dupuytren syndrome and carpal tunnel syndrome, shoulder periarthritis, osteoarthritis, Charcot neuroarthopathy, diabetic osteopathy, ankylosing hyperostosis, stenotic tenosynovitis de Quervain, and osteoporosis. Readers are briefed on the diagnostic and patient care management process for the conditions noted. The chapter is illustrated with black-and-white photographs. 2 figures. 3 references.

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Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. 476 p.

This textbook highlights the link between the problems of obesity and diabetes mellitus. The editors present 23 chapters that examine all aspects of the relationship between nutritional status and the pathogenesis, diagnosis, and treatment of patients with the various illnesses that manifest themselves as diabetes. The book is intended to be a reference handbook for physicians, nutritionists, and other health care workers, as well as of value to public policy makers involved in formulating health policies, particularly in developing countries. The chapters cover neuroendocrine regulation of food intake; the enteroinsular axis; diet and exercise interventions for type 2 diabetes; the metabolic syndrome; metabolic alterations in muscle associated with obesity; the nonsurgical management of obesity; bariatric surgery for obesity; postoperative management of the bariatric surgery patient; the epidemiology, risks, and health care expenditures for diabetes and its complications; nutrient interactions and glucose homeostasis; type 2 diabetes in childhood; the management of obesity-associated type 2 diabetes; the management of type 2 diabetes in underrepresented minorities in the United States; management of diabetes in developing countries; diabetes in pregnancy; web-based simulations for dynamic variations in blood glucose concentration in patients with type 1 diabetes; oxidative stress in pancreatic beta cells; oxidative stress in type 1 diabetes; oxidative stress and glycemic control in type 2 diabetes; oxidative stress and vascular complications of diabetes mellitus; oxidative injury in diabetic neuropathy; diabetic nephropathy; and the pathophysiology and management of diabetic gastropathy. Each chapter includes black-and-white illustrations and a lengthy list of references. A subject index concludes the volume.

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Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. 555 p.

Obesity and diabetes are reaching epidemic proportions in developed countries and becoming more prevalent in developing countries. These disease states are closely linked with the development of serious complications, including cardiovascular disease and several malignancies, thus their impact from a public health perspective is enormous and continues to increase. As the population ages and becomes more sedentary, the morbidity and mortality associated with obesity and diabetes will continue to escalate. This text book presents a comprehensive review of both the research and clinical aspects of obesity and diabetes for both research scientists and practicing clinicians. The text begins with a review of the history and epidemiology of obesity and diabetes. The next section of five chapters focuses on the genetics and pathophysiology of obesity and diabetes, reviewing known mechanisms and interactions. The third section features 15 chapters on the diagnosis, clinical manifestations, and complications associated with obesity and diabetes. The final section offers 7 chapters on treatment (including lifestyle and pharmacological) of these conditions. Each of the 29 chapters is written by an expert in the field and each includes a summary outline and list of references. The text concludes with a list of relevant resources (government agencies and voluntary organizations) and a detailed subject index.

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Obesity and Renal Disease. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 319-332.

Obesity enhances the progression of renal function deterioration to end-stage renal disease (ESRD) in patients with known pre-existing kidney disease. Obesity is also associated with focal segmental glomerulosclerosis (FSGS). And, through its close association with type 2 diabetes and hypertension, obesity is now considered to be a major risk factor for the development of chronic kidney disease (CKD). This chapter on obesity and renal disease is from a comprehensive textbook on obesity and diabetes. The authors discuss the prevalence of renal disease in obesity, the pathophysiological basis of kidney dysfunction in obesity, renal functional and structural consequences of obesity, and patient care management strategies. The authors conclude that weight management is the most beneficial strategy for controlling blood pressure in obese hypertensive patients. It is also a key tool in the management of proteinuria and glomerulosclerosis of obesity. Weight management can be achieved by caloric restriction through diet, increased physical activity, or pharmacological and surgical interventions. 1 figure. 86 references.

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Obesity and Type 2 Diabetes Mellitus in Childhood and Adolescence. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 277-290.

Since the mid-1990s, an ever-increasing prevalence of obesity and diabetes in children has been observed. Childhood obesity is associated with substantial comorbidities and late complications, including cardiovascular, orthopedic, and psychosocial problems, whether or not obesity persists into adulthood. This chapter on obesity and type 2 diabetes mellitus in childhood and adolescence is from a comprehensive textbook on obesity and diabetes. The authors discuss epidemiology, genetic and environmental factors, clinical presentations (symptoms), screening procedures, a multidisciplinary treatment approach that includes the family, lifestyle and behavior modifications, counseling (individual, group, and family), exercise and physical activity, nutritional interventions, and drug therapy. The authors note that whereas diagnostic methods are clear and straightforward, treatment often remains difficult and frustrating for the patient, the family, and the multidisciplinary team providing health care. The authors caution that because of this reality, more attention must be paid to prevention and health promotion strategies. 2 figures. 3 tables. 77 references.

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Obesity, Diabetes and Hypertension. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 169-192.

Obesity is a serious and pervasive health problem in both the industrialized world and in developing countries. This chapter on obesity, diabetes mellitus, and hypertension is from a comprehensive textbook on obesity and diabetes. In this chapter, the authors review the current knowledge, trends, and research in the field of hypertension in relation to type 2 diabetes and obesity. the authors discuss the mechanisms, relationships, genetics, issues in management, and unique features of hypertension in persons with coexistent obesity and diabetes. Treatment options discussed include nonpharmacological treatment (weight loss and exercise), thiazide diuretics, ACE inhibitors and angiotensin II receptor blockers, calcium channel blockers, beta blockers, oral diabetes agents, and weight loss agents. The authors stress the importance of rigorous initial evaluation of a hypertensive patient with diabetes, focusing on his or her overall cardiovascular risk. 4 figures. 166 references.

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Overview of Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 1-21.

This introductory chapter is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered in this overview include a definition of diabetes mellitus (DM), the different types of DM, the incidence of DM, epidemiology, genetics, the indications for performing a glucagon test, contraindications for glucagon testing, diagnosing disturbances of glucose metabolism, the oral glucose tolerance test (OGTT), the symptoms of type 2 diabetes, the symptoms of type 1 diabetes, the importance of good glycemic control, and the difficulties in achieving and maintaining high levels of glycemic control. The chapter presents seven case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 6 tables. 11 references.

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Pathophysiology and Management of Diabetic Gastropathy. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 427-448.

This chapter about the pathophysiology and management of diabetic gastropathy is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors caution that the clinical presentation of diabetic gastropathy is not specific and may overlap with structural disorders and functional dyspepsia. The most common symptoms are nausea, vomiting, bloating, early satiety, postprandial fullness, and upper abdominal discomfort. After an introduction, the authors review the physiological basis for gastric smooth-muscle activity, the pathophysiology of diabetic gastropathy, symptoms, the evaluation of gastric emptying, diagnostic tests used to confirm problems with gastric emptying, and treatment strategies in diabetic gastropathy. Diagnostic methods discussed include upper gastrointestinal (GI) x-ray series, scintigraphic assessment, tracer methods, ultrasonography, magnetic resonance imaging (MRI), and electrogastrography (EGG). Treatment strategies include dietary and supportive therapy, glycemic control optimization, and drug therapy, including metoclopramide, erythromycin, cisapride, domperidone, and tegaserod. A brief section considers the problem of refractory gastropathy. 1 figure. 3 tables. 157 references.

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Pathophysiology of Type 2 Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 43-58.

This chapter on the pathophysiology of type 2 diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the main pathophysiologic characteristics of type 2 diabetes mellitus, the physiologic effects of insulin in the body, insulin resistance and how it is measured, the role of pancreatic beta cells, the role of genetic predetermination and environmental factors in the development of type 2 diabetes, insulin secretion from the beta cell, and the natural history of type 2 diabetes development. The chapter presents four case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 1 figure. 6 references.

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Polycystic Ovary Syndrome and its Metabolic Complications. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 255-276.

This chapter on polycystic ovary syndrome and its metabolic complications is from a comprehensive textbook on obesity and diabetes. Polycystic ovary syndrome (PCOS) is a complex disorder with multiple potential etiologies and variable clinical presentations whose pathogenesis remains poorly understood. PCOS is characterized by clinical and biochemical hyperandrogenism and chronic annovulation. The syndrome is also associated with insulin resistance, obesity, increased risk of diabetes mellitus, and, possibly, cardiovascular disease (CVD). The authors review the pathophysiology, metabolic complications, and treatment of PCOS. Treatment strategies discussed include weight loss, the use of antiandrogens (spironolocatone, flutamide), oral contraceptive agents, and insulin sensitizers (metformin, thiazolidinediones, d-chiro-inositol). The authors note that obesity is present is approximately half of the patients with PCOS and obesity contributes to the disorder by increasing the magnitude of hyperandrogenism and the rates of anovulatory cycles and infertility. Treatments directed at the reduction of hyperinsulinemia reduce symptoms of PCOS and restore normal ovarian function in obese women with PCOS. 2 figures. 4 tables. 153 references.

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Sexual Function And Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 251-260.

This chapter on sexual function and diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the repercussions of diabetes mellitus (DM) in sexual life, including erectile dysfunction and its management, and ejaculation disturbances; the role of vascular disease risk factors; sexual problems in women with diabetes; and the use of oral contraceptive pills in women with diabetes, including the risk of complications such as thrombophlebitis and pulmonary embolism. The chapter presents three detailed case studies, with relevant questions posed and answered. Readers are walked through the diagnostic and patient care management process for the case studies presented. 6 references.

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Skin Disorders in Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 243-250.

This chapter on skin disorders in diabetes is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered include the main skin manifestations of diabetes mellitus (DM), including diabetic dermopathy, necrobiosis lipoidica diabeticorum, diabetic bullae, periungual telangiectasia, and skin infections; cutaneous manifestations that are associated with chronic complications of DM, including skin infections and ulcers; cutaneous manifestations that occur in other endocrine and metabolic disorders that are related to DM, including acanthosis nigricans, eruptive xanthomata, and vitiligo; and skin disorders associated with complications of DM treatment, including reactions to insulin and oral antidiabetes medications. Readers are walked through the diagnostic and patient care management process for patients with skin manifestations associated with diabetes. The chapter is illustrated with black-and-white photographs. 7 figures. 4 references.

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Standards of Medical Care in Diabetes 2006, Part 2: Diabetes Care. Practical Diabetology. 25(2): 8-34. 2006.

This second installment of the Standards of Medical Care in Diabetes (American Diabetes Association, 2006) covers diabetes care, including initial evaluation, management, glycemic control, self-monitoring of blood glucose (SMBG), glycosylated hemoglobin testing (HbA1c), medical nutrition therapy, weight management, diabetes self-management education (DSME), physical activity, psychosocial assessment and care, referral for diabetes management, intercurrent illness, hypoglycemia recommendations, and immunization recommendations. MNT issues covered include dietary carbohydrate, dietary protein, dietary fats, optimal macronutrient mix, fiber, reduced-calorie sweeteners, antioxidants, chromium, and alcohol. In each section, the guidelines review the recommended health care and focus on the role of the members of the health care team, including the patient. 81 references.

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Standards of Medical Care in Diabetes: 2006. Practical Diabetology. 25(1): 20-31. March 2006.

The American Diabetes Association (ADA) updates the Standards of Medical Care for Diabetes on an annual basis. In most years, the revisions are relatively minor and are published in a supplement to the journal Diabetes Care in January. In 2006, several major sections have been added or have had major modifications, including the sections on Medical Nutrition Therapy (MNT), Exercise, Diabetes Self-Management Education, Point-of-Care assays for hemoglobin A1C, and Diabetic Neuropathy. This article presents the first four sections of the Standards of Medical Care (the remaining sections will be published throughout 2006): Classification and Diagnosis, Screening for Diabetes, Detection and Diagnosis of Gestational Diabetes Mellitus (GDM), and Prevention or Delay of Type 2 Diabetes. Each section lists recommendations and some sections have editorial comments appended. These standards of care 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. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. 4 tables. 17 references.

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Treatment of Onycholycosis in Diabetic Patients. Clinical Diabetes. 24(4): 160-166. Fall 2006.

Onychomycosis is a fungal infection of the nail that is estimated to cause up to 50 percent of all nail problems and 30 percent of all cutaneous fungal infections. Onychomycosis is more common in people with diabetes than in people without diabetes. The infection causes more than cosmetic problems and increases the risk of serious complications from the disease, including limb amputations. This article reviews the various diagnosis and treatment options available for onychomycosis with a focus on managing patients with diabetes who have this fungal infection. The authors note that patients with diabetes-related comorbidities are at especially increased risk of morbidity in onychomycosis. The authors discuss the clinical presentation and diagnosis, the differential diagnosis, laboratory tests that may be used to confirm diagnosis, topical antifungal creams, oral drug therapy, combination therapy, the use of nail removal and surgical avulsion, and the role of patient education. Currently, the most effective therapy is 250 milligrams of oral terbinafine daily for 12 weeks, possibly with concomitant topical therapy with a nail lacquer, such as amorolfine or ciclopirox. Patient education, including proper foot and toe examinations, is essential to prevent relapses and complications. One table summarizes the organisms targeted, dosage, length of treatment, common side effects, common drug interactions, and other concerns regarding the drugs used for treating onychomycosis, including griseofulvin, fluconazole, itraconazole, and terbinafine. 1 table. 61 references.

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Type 2 Diabetes in Childhood: Diagnosis, Pathogenesis, Prevention, And Treatment. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 177-204.

This chapter about type 2 diabetes in childhood is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The author discusses controversies related to the diagnosis of type 2 diabetes in childhood; delineates factors that play important roles in disease pathogenesis; describes potential complications that may arise in the short and long terms; and outlines approaches to disease prevention and treatment. Specific topics include the roles of dietary nutrients and exercise in the pathogenesis of type 2 diabetes; complications of type 2 diabetes, including symptoms and acute complications, hypertension, atherogenesis, and cardiovascular disease; prevention strategies, including lifestyle intervention, drugs that limit nutrient absorption, insulin suppressors and sensitizers; and drug therapies used to treat type 2 diabetes. The author notes that in obese subjects, moderate reductions in body-fat mass can reduce the risks of type 2 diabetes and cardiovascular complications. Even relatively small reductions of 5 to 10 percent of body mass index (BMI) may increase insulin sensitivity, enhance glucose tolerance, improve measures of cardiovascular health, and reduce the risk of progression to type 2 diabetes. The chapter includes black-and-white illustrations and a lengthy list of references. 5 figures. 4 tables. 90 references.

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Understanding Peripheral Neuropathy. Lupus Newslink. 18: 13-17. Summer 2006.

This article, from a newsletter for people with lupus erythematosus, describes peripheral neuropathy. Peripheral neuropathy (PN) is a failure of the nerves that carry information to and from the brain and spinal cord. This results in pain, loss of sensation, and inability to control muscles. The author discusses the causes, incidence and risk factors for PN (including diabetes mellitus), the typical symptoms, movement difficulties, autonomic symptoms (affecting involuntary or semi-voluntary functions such as control of internal organs and blood pressure), diagnostic tests that can be used to confirm the presence of PN, treatment strategies, safety issues, support groups, prognosis, and complications. The author concludes that all people can reduce the risk of neuropathy through a balanced diet, drinking alcohol only in moderation, and maintaining good control of diabetes and other medical problems. 2 figures. 1 table.

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What I Need to Know About Gestational Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse, 2006. 18 p.

Gestational diabetes is defined as diabetes that is diagnosed for the first time when a woman is pregnant. This booklet, written in nontechnical language, answers common questions about gestational diabetes. Topics covered include the causes, risk factors, when pregnant women usually undergo diagnostic tests for gestational diabetes, the tests used to confirm the condition, how gestational diabetes can affect mother and baby, treatment strategies, how to monitor blood glucose levels, other tests that can be done at home, what to expect after the baby is born, and how to prevent or delay getting type 2 diabetes later in life. The booklet concludes with contact details for resource organizations and publications where readers can get more information. A final section summarizes the activities of the National Diabetes Information Clearinghouse. The booklet is illustrated with black-and-white line drawings. 7 figures. 2 tables.

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American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. 190 p.

This guide provides a resource for health professionals involved in the care of women who develop diabetes during their pregnancy (gestational diabetes mellitus, or GDM). The guide helps readers to promote sound nutrition principles in GDM and achieve optimal outcomes for the woman and her infant. The book offers 10 chapters: historical background, the pathophysiology of GDM, classification, screening and diagnosis issues, maternal and fetal complications associated with GDM, maternal and fetal testing in pregnancy, medical nutrition therapy, medications and supplements, additional concerns in pregnancy complicated by GDM, cultural issues in diabetes management in pregnancy, and postpartum considerations. Each chapter notes a list of learning objectives, includes a summary of the concepts presented, and concludes with an extensive list of references. The book includes three appendixes: forms; case studies; and the energy, carbohydrate, protein, and fat content of selected foods. A glossary of terms and subject index conclude the volume.

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Care of Children and Adolescents With Type 1 Diabetes: A Statement of the American Diabetes Association. Diabetes Care. 28(1): 186-212. January 2005.

In caring for children with diabetes, professionals need to understand the importance of involving adults in the child's diabetes management. The education about how to care for a child or adolescent with diabetes must be provided to the entire family unit, emphasizing age and developmentally appropriate self-care and integrating same into the child's diabetes management. This American Diabetes Association Statement provides a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. However, relevant references are provided and current works in progress are indicated as such. The information provided is based on evidence from published studies whenever possible and, when not, supported by expert opinion or consensus. The Statement discusses and provides recommendations in the areas of diagnosis, initial care, diabetes education, identification (medical tags), appropriate self-management by age, glycemic control, insulin management of diabetes, blood glucose monitoring, nutrition, medical nutrition therapy (MNT), exercise, assessment of child and family risk factors at diagnosis, psychosocial issues, acute complications, immunization, chronic complications, associated autoimmune conditions, adjustment and psychiatric disorders, adolescence, adherence to self-management, and special situations, including sick day management, and diabetes care at school and day care. A final section considers risk behaviors, including use of tobacco and recreational drugs and unprotected sexual intercourse. 4 tables. 237 references.

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Classification, Screening and Diagnosis. IN: Thomas, A.M.; Gutierrez, Y.M., eds. American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. pp. 17-26.

This chapter on the classification, screening, and diagnosis of gestational diabetes mellitus (GDM) is from a Guide that serves as a resource for health professionals involved in the care of women who develop diabetes during their pregnancy. The Guide helps readers to promote sound nutrition principles in GDM, to achieve optimal outcomes for the woman and her infant. The author of this chapter begins by summarizing the various classifications of diabetes during pregnancy. The author then outlines the risk factors associated with GDM, describes the differences between the glucose challenge test (GCT) and the oral glucose tolerance test (OGTT), compares the threshold glucose values of the American Diabetes Association and the World Health Organization (WHO) in the diagnosis of GDM, and evaluates the results obtained using the current recommended criteria for screening and diagnosing GDM. The author concludes by noting that there is controversy on the current practice of screening and diagnosing GDM. The author concludes that the recommendations of the American College of Obstetricians and Gynecologists (ACOG) be used: a screening test consisting of a 50-gram, 1-hour GCT at 24 to 28 weeks’ gestation; the test should be performed in a laboratory using plasma glucose. 1 figure. 4 tables. 46 references.

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Conversation About Your Sex Life: Is It Time to Talk?. Diabetes Vital. 1(3): 4. Fall 2005.

Sexual dysfunction is a common occurrence in diabetes, yet is not often talked about when discussing complications of the disease. This brief article describes how poorly controlled diabetes, blood glucose fluctuations, and medication side effects can affect sexual function and libido (desire). The author provides five simple tips to remember when talking with one's partner about sexual dysfunction. These are: choose the right moment, be open and honest, share responsibility, stay connected, and prepare together for any visits to health care providers to get help with sexual dysfunction. The author encourages readers to communicate openly with their partners as well as with their health care providers in addressing any concerns about sexual dysfunction.

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Cystic Fibrosis-Related Diabetes. Practical Diabetology. 24(2): 23-29. June 2005.

Cystic fibrosis (CF) is a common, lethal autosomal recessive disease that leads to the pathologic accumulation of thick secretions leading to progressive obstruction and destruction. However, as nutritional and respiratory treatments have improved, many people with CF are living well into adulthood and with this comes a greater chance of seeing complications related to CF, including CF-related diabetes (CFRD). The authors review the Pathophysiology of CFRD, criteria for diagnosis, screening recommendations, treatment strategies, management of acute and chronic complications, management of CFRD without fasting hyperglycemia, and management of impaired glucose tolerance (IGT). The treatment goals for CFRD include good glycemic control while maintaining or attaining body-weight goals. Treatment of CFRD with insulin is recommended, as this has been shown in several studies to improve pulmonary function and nutritional status, two factors strongly linked to morbidity and mortality in this population. 2 figures. 2 tables. 28 references.

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Diabetes and Kidney Failure: How Individuals with Diabetes Experience Kidney Failure. Nephrology Nursing Journal. 32(04): 502-509 p. September- October 2005.

This article reports on a qualitative study that used interpretive description methods to explore how individuals with diabetes experience kidney failure. The author begins with a review of the literature about the experiences of patients with both end-stage renal disease (ESRD) and diabetes mellitus. The data used in the study consisted of transcripts of in-depth interviews with seven participants diagnosed with both diabetes and kidney failure, and with a minimum of 2 years on dialysis. The analyses identified the dominant themes within the participant narratives, including diagnosis, illness intrusion, interactions with health care providers, learning to manage, finding a balance, and accepting illness. The author concludes that the constructs of compliance, denial, and control in adjusting to living with illness remain imperfectly understood. There also is a need for further research on the issue of hope for transplantation, particularly simultaneous kidney and pancreas transplantation. In a health care environment in which workload is a growing issue, nephrology nurses are challenged to create opportunities for clients to share their living situations and to provide patient access to adequate information and resources at times appropriate for each individual. The article includes the form with which readers can obtain continuing education credits. 4 tables. 58 references.

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Diabetes and Your Kidneys. Rockville, MD: American Kidney Fund. 2005. 26 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 issues that patients ought to discuss with their health care provider, make suggestions for ways to stay healthy, and discuss 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, HbA1c (glycosylated hemoglobin, a measure of blood glucose over time), blood pressure, urine tests, and glomerular filtration rate (a measure of kidney function). Other topics include the patient health care team, dietary strategies for managing diabetes, the role of medications including Angiotension Converting Enzyme (ACE) inhibitors, symptoms of early kidney disease, the importance of self-monitoring of blood glucose (SMBG), and the interaction of 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. 3 figures. 1 table.

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Diabetes Dictionary. Bethesda, MD: National Diabetes Information Clearinghouse. 2005. 41 p.

This dictionary defines words that are often used when people talk or write about diabetes. The dictionary is designed to assist those with diabetes and their families and friends. The words are listed in alphabetical order. Some words have many meanings; only those meanings that relate to diabetes are included. Words that appear in a definition in bold italics are defined elsewhere in the dictionary. Each term includes a pronunciation guide. The booklet concludes with a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). Some terms are illustrated with black-and-white line drawings. 19 figures.

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Diabetes, Heart Disease, and Stroke. Bethesda, MD: National Diabetes Information Clearinghouse. 2005. 11 p.

Having diabetes or pre-diabetes can result in an increased risk for heart disease and stroke. Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This fact sheet answers common questions about heart and blood vessel disease associated with diabetes. Readers with diabetes are encouraged to lower their risk of heart disease and stroke by keeping blood glucose, blood pressure, and blood cholesterol levels close to the recommended target numbers. Reaching these targets can also help prevent narrowing or blockage of the blood vessels in the legs, called peripheral arterial disease. The fact sheet reviews the disease of diabetes itself, then covers pre-diabetes; the connection between diabetes and cardiovascular disease; risk factors for heart disease and stroke in people with diabetes; metabolic syndrome and how it is linked to heart disease; strategies that can prevent or delay heart disease and stroke; tests that can monitor diabetes management programs including blood glucose, blood pressure, and blood cholesterol tests; coronary artery disease; cerebral vascular disease; stroke; heart failure; peripheral arterial disease; the symptoms of heart disease; treatment options for heart disease; the symptoms of stroke; the treatment options for stroke; and current research programs and studies in these areas. The booklet concludes with contact information for related resource organizations and a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). 2 figures. 4 tables.

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Diabetic Eye Disease: An Educator's Guide. Bethesda, MD: National Eye Institute. 2005. (flipchart).

Diabetes is a leading cause of blindness among working-age adults in the United States. With early detection and timely treatment, diabetic eye disease (diabetic retinopathy) can be controlled. The key is to get a dilated eye exam at least once a year. This flipchart, produced on heavy cardstock, is a patient education tool for health professionals and community-based educators who work with people who have diabetes. The desktop flipchart has text on one side to guide the discussion and illustrations on the patient side. Topics covered include the importance of vision care, the risks of diabetes to vision, who tends to develop diabetic retinopathy, how diabetes damages the eyes and causes vision loss, why the dilated eye exam is so important, what to expect during and after a dilated eye exam, steps to take to protect one’s vision, treatment strategies for diabetic retinopathy (notably laser surgery), and low vision training options. The flipchart uses the acronym TRACK to remind readers to Take your medications, Reach and maintain a healthy weight, Add exercise to your daily routine, Control your blood sugar, and Kick the smoking habit. The back cover of the chart is designed to serve as an easel for the desktop chart. The flipchart is available in Spanish; an accompanying CD-ROM of the flipchart is also available. The web site address for the National Eye Institute programs is provided (www.nei.nih.gov).

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Diabetic Neuropathies: A Statement by the American Diabetes Association. Diabetes Care. 28(4): 956-962. April 2005.

This article presents the American Diabetes Association (ADA) statement on diabetic neuropathies, complications of the nervous system attributed to diabetes mellitus. Most common among the neuropathies are chronic sensorimotor distal symmetric polyneuropathy (DPN) and the autonomic neuropathies. The statement covers definitions and classification; diagnostic criteria and brief clinical aspects, including sensory neuropathies, focal and multifocal neuropathies, autonomic neuropathy, cardiovascular autonomic neuropathy (CAN), gastrointestinal disturbances, and genitourinary problems; epidemiology; and management, including prevention, pathogenetic treatments, and symptomatic treatments. The final section presents recommendations for screening for and treatment of diabetic neuropathy, notably the role of tight glycemic control. The authors emphasize the need for early recognition and appropriate management of neuropathy in patients with diabetes. 1 figure. 5 tables. 22 references.

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Diagnosis and Treatment of Diabetic Cardiomyopathy. Practical Diabetology. 24(3): 6-10. September 2005.

Diabetic cardiomyopathy is a syndrome of impaired cardiac (heart) contractility or congestive heart failure with left ventricular hypertrophy (overgrowth), but without coronary artery disease. This syndrome occurs in both Type 1 and Type 2 diabetes. This article explains the characteristics of this syndrome, including its diagnosis, treatment, and possible prevention. Clinical findings discussed include abnormal contractility, structural abnormalities of the heart, metabolic abnormalities, vascular dysfunction, and cardiac autonomic neuropathy (nerve disease). Treatment considerations covered include blood glucose control, antihypertensive agents, and antioxidant and lipid-lowering therapy. The author concludes that aggressive treatment of hyperglycemia (high blood glucose levels) and hypertension (high blood pressure) is the mainstay of therapy and should be combined with strategies to prevent both microvascular and macrovascular disease. 7 references.

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Erectile Dysfunction. Clinical Diabetes. 23(3): 105-113. Summer 2005.

Erectile dysfunction (ED) affects approximately 30 million men in the United States to some extent. ED may indicate the presence of a serious underlying medical condition, such as cardiovascular disease, diabetes, or depression. ED can compromise multiple aspects of a patient's life, including overall quality of life and interpersonal relationships. This article reviews ED in men with diabetes. The incidence of ED in this patient population increases with advancing age, and it occurs at an earlier stage than age-matched counterparts without diabetes. Clinicians need to be aware of the underlying pathophysiology of ED in diabetes in order to ensure the best possible outcomes in managing this problem. Topics include prevalence and pathophysiology of ED, endothelial dysfunction, the International Index of Erectile Function, the significance of ED in patients with diabetes, ED management strategies, drugs used to treat ED, intracavernosal therapy, intraurethral prostaglandin therapy, vacuum-constriction devices, surgery, beta blockers, and androgen therapy. The authors also remind readers of the importance of screening for cardiovascular disease in patients who present with ED. Follow-up at regular intervals and reassessment of all patients receiving treatment for ED is highly recommended. 1 figure. 5 tables. 31 references.

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Eye Disease: Understanding Retinopathy. Diabetes Forecast. 58(12): 25-26. December 2005.

This article reviews the impact of diabetes mellitus on the eyes, focusing on diabetic retinopathy (damage to the light-sensing layer at the back of the eye). Diabetic retinopathy occurs when high blood glucose levels damage small blood vessels in the retina. Less blood may then flow to the eye, or the blood vessels may become weak. The author defines and discusses nonproliferative retinopathy, proliferative retinopathy, symptoms, diagnosis, and treatment options including laser therapy, cryotherapy, and vitrectomy. A final section reviews several steps that can reduce the risk of developing retinopathy or slow its progression, including keeping blood glucose levels, blood pressure, and cholesterol levels as close to normal as possible and having regular eye exams.

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Help Your Child Manage Diabetes: A Parent's Handbook. South Deerfield, MA: Channing Bete Company. 2005. 31 p.

This booklet is designed to help parents of a child newly diagnosed with diabetes understand the basics of caring for a child with diabetes. The booklet covers a description of diabetes, its causes and symptoms; the role of support and emotional health; a plan for diabetes management; blood glucose monitoring; general health approaches, including nutrition and physical activity; diabetes medications, including insulin and its administration and the role of diabetes pills; hypoglycemia and hyperglycemia; diabetes care in the school setting; foot care; and other safety tips. A summary page reminds parents to test the child?s blood glucose, follow a healthy meal plan, encourage the child to be physically active, make sure the child takes all medications, keep good records, and involve the whole family in eating better and staying healthy. The booklet includes a food and medications care chart, a list of resources, a wallet card for the child to carry, and plenty of blank space for individualizing recommendations and management strategies for the child and his or her family. The brochure is illustrated with black-and-white photographs of children and their families, as well as figures and charts designed to increase understanding of the material presented. 5 figures. 2 tables.

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I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians. Bethesda, MD: National Diabetes Information Clearinghouse, 2005. 16 p.

Although people with diabetes can prevent or delay complications by keeping blood glucose levels close to normal, preventing or delaying the development of type 2 diabetes in the first place is even better. This booklet, written in nontechnical language, answers common questions about type 2 diabetes and its prevention and management. The booklet begins with a letter from a Native American physician and a note that describes the results of the Diabetes Prevention Program, which demonstrated successful strategies for preventing diabetes in people at high risk for the condition. Topics include the different types of diabetes, the signs and symptoms of type 2 diabetes, the condition pre-diabetes, risk factors for type 2 diabetes, how to know if one should be tested for diabetes, and how to lower the risks for diabetes. Another section describes research that focused on a population of Pima Indian volunteers. Two forms are included for readers to keep track of their daily food and drink intake and their daily physical activities. A final section summarizes the activities of the National Diabetes Information Clearinghouse. 3 figures. 5 tables.

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Identification of Individuals With Insulin Resistance Using Routine Clinical Measurements. Diabetes. 54(2): 534-539. February 2005.

Insulin resistance is a precursor of type 2 diabetes and perhaps of cardiovascular disease as well. The latter association, which is independent of diabetes, may be partially a consequence of the relationship between insulin resistance and the metabolic syndrome (obesity; impaired glucose regulation; dyslipidemia; and hypertension). This article reports on a study undertaken to identify insulin-resistant patients. The authors developed decision rules from measurements of obesity, fasting glucose, insulin, lipids, blood pressure and family history from 2,321 individuals (2,138 without diabetes) using the euglycemic insulin clamp technique at 17 European sites, San Antonio, Texas, and the Pima Indian reservation. The authors report on three classification tree models developed from their results. The distribution of whole-body glucose disposal rates is bimodal. The authors conclude that the presence of bimodality facilitates the choice of a cut point for defining insulin resistance that has some basis in the underlying biology and is not wholly arbitrary. The results permit decision rules for identifying individuals with insulin resistance based on routine clinical measurements. 4 figures. 1 table. 28 references.

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Joslin's Diabetes Mellitus. 14th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. 1209 p.

The comprehensive diabetes textbook reflects the practice and experiences of the physicians of the Joslin Diabetes Center and updates the information presented in the last version of the text published 10 years ago. The text offers 70 chapters in eight sections: basic mechanisms of islet development and function; hormone action and the regulation of metabolism; the definition, genetics, and pathogenesis of diabetes; obesity and lipoprotein disorders; treatment of diabetes mellitus; biology of the complications of diabetes; clinical aspects of managing diabetic complications; and hypoglycemia and islet cell tumors. Specific topics include genetic regulation of islet function, insulin biosynthesis, insulinlike growth factors, glucagon and glucagonlike peptides, fat and protein metabolism in diabetes, maturity-onset diabetes of the young (MODY), syndromes of extreme insulin resistance, diabetes in minorities in the United States, lipid disorders in diabetes, medical nutrition therapy (MNT), psychological issues in diabetes, iatrogenic hypoglycemia, the economic and social costs of diabetes, diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, cardiovascular disease in diabetes, erectile dysfunction, diabetes and wound healing, and endocrine tumors of the pancreas. Each chapter is illustrated with tables and figures and includes a list of references; a subject index concludes the volume.

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Keeping the Insulin-Like Growth Factor System in Harmony. Journal of Neuropathic Pain and Symptom Palliation. 1(1): 3-6. 2005.

The precise biochemical mechanisms which lead to painful diabetic polyneuropathy are complex, multifactorial, and remain elusive. This article brings readers up-to-date on the role of insulin-like growth factor system (IGFS) in diabetic polyneuropathy (DPN). The authors note that early changes in nerve function may pre-date elevated serum glucose levels by years. It is conceivable that disturbances in the IGFS as well as the levels of insulin or C-peptide may play a role in contributing to the pain and neural dysfunction in patients with painful diabetic polyneuropathy. Improved blood glucose control significantly reduces the risk of DPN and delays the development and progression of microvascular complications, although even strict glycemic control does not fully prevent DPN. The authors conclude that restoring the balance of the IGFS may provide effective strategies in early efforts to prevent or treat DPN. 1 figure. 24 references.

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La Diabetes y Sus Rinones (Diabetes and Your Kidneys). Rockville, MD: American Kidney Fund. 2005. 26 p.

Diabetic kidney disease, also called diabetic nephropathy, can result when high blood glucose levels damage the filtering structures in the kidney. This Spanish language, large-print booklet helps readers recently diagnosed with diabetes understand risk factors that diabetes create for kidney disease. The authors outline that patients ought to discuss with their health care provider, make suggestions for ways to stay healthy, and discuss 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, HbA1c (glycosylated hemoglobin, a measure of blood glucose over time), blood pressure, urine tests, and glomerular filtration rate (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 of 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. 3 figures. 1 table.

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Managing Diabetes Your Way Workbook: Living with Type 2 Diabetes. Berkeley, CA: Ulysses Press. 2005. 164 p.

This book is designed to help readers newly-diagnosed with Type 2 diabetes understand how to monitor, track, and gain control of their disease. The book includes eleven chapters: an introduction with a brief explanation of diabetes; the role of team participation and team health care; understanding blood glucose results; medications for diabetes; diabetes and weight control; developing a food plan; the role of exercise; psychosocial factors; diabetes and cardiovascular (heart) considerations; working with the health care team to minimize complications; and sharing diabetes with others in one's family, friends, and workplace. The author includes four sections in each chapter, each marked with a graphic for ease of understanding: illumination, the facts one needs to know, without medical jargon; contemplation, understanding what those facts mean to one's health; application, the steps necessary to put a plan into action; and evaluation, or ways to track one's progress. The author emphasizes how factors such as diet and stress can produce unhealthy changes in the blood glucose and why simple steps such as proper exercise can have very positive results. The book includes blank charts and worksheets for readers to individualize their goals and progress. The book concludes with an annotated list of resources for implementing a diabetes plan, information about the references used to compile the book, an appendix of additional worksheets, and an author biography.

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Managing Prediabetes: Self-Care Handbook. South Deerfield, MA: Channing Bete Company. 2005. 31 p.

This booklet is designed to educate people who have been diagnosed with pre-diabetes, a condition in which the blood glucose levels are elevated, but not to such an extent that a diagnosis of diabetes is warranted. The booklet covers the dangers of prediabetes, the risk factors for diabetes, diagnostic tests and monitoring strategies that may be used, lifestyle changes, setting goals, determining a healthy weight, weight loss tips, nutrition basics, meal planning, the role of exercise, keeping records of food and activities, dealing with stress, and family considerations. The booklet is filled with charts and illustrations, places to record individualized information, and black-and-white photographs of a variety of people undertaking a variety of activities. A tear-out card is included that readers can bring with them to their health care appointments; the card includes room to record blood glucose test results and special instructions. The booklet concludes with a list of the answers to common questions about prediabetes, as well as a list of resource organizations through which readers can get more information. 5 figures. 5 tables.

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Metabolic Syndrome: Time for a Critical Appraisal: Joint Statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 28(9): 2289-2304. September 2005.

The term 'metabolic syndrome' refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathology is thought to be related to insulin resistance. In this review article, the authors examine the evidence for the definition and underlying pathogenesis of the metabolic syndrome, as well as analyze the evidence for the association between cardiovascular diseases and the metabolic syndrome. The authors also discuss the evidence for the goals and impact of treatment. The authors found that while there is no question that certain CVD risk factors are prone to cluster, the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. The authors conclude that too much critically important information is missing to warrant the designation as a 'syndrome.' Clinicians are advised to evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the metabolic syndrome. 2 figures. 3 tables. 168 references.

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National Diabetes Fact Sheet, United States, 2005. Phoenix, AZ: Centers for Disease Control and Prevention. 2005. 10 p.

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications. This lengthy fact sheet reviews the different types of diabetes, treatment strategies, the problem of prediabetes, the prevalence and incidence of diabetes in the United States (including differences between ethnic groups), the epidemiology of diabetes complications, and the importance of management and prevention approaches to minimize the impact of diabetes complications. The direct and indirect costs of diabetes are also estimated. The fact sheet concludes with a list of the web site addresses of organizations that collaborated in compiling the information for the fact sheet and with a glossary of related terms. 6 figures.

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Postpartum Considerations. IN: Thomas, A.M.; Gutierrez, Y.M., eds. American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. pp. 101-113.

This chapter on postpartum considerations in gestational diabetes mellitus (GDM) is from a Guide that serves as a resource for health professionals involved in the care of women who develop diabetes during their pregnancy. The Guide helps readers to promote sound nutrition principles in GDM, to achieve optimal outcomes for the woman and her infant. The authors of this chapter begin by discussing postpartum screening and diagnosis procedures for women with GDM. They focus on the uses of medical nutrition therapy (MNT) and other risk-reducing strategies for women with a history of GDM. Additional topics include the benefits of breastfeeding for women with GDM, the nutrition requirements of postpartum women with previous GDM, the long-term health risks associated with GDM, preconception counseling, and contraception. 1 figure. 2 tables. 70 references.

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Practical Management of Patients with Painful Diabetic Neuropathy. Diabetes Educator. 31(4): 523-540. July-August 2005.

This article provides diabetes educators with current and essential tools for painful diabetic neuropathy (PDN) assessment and management. The author notes that PDN has a significant impact on patients' quality of life, affecting sleep, mood, mobility, ability to work, interpersonal relationships, overall self-worth, and independence. Recent advancements in the assessment of neuropathic pain include identifying characteristics that distinguish between neuropathic and non-neuropathic pain. In the absence of treatment, research demonstrates that nerve damage may progress while pain diminishes. Many disease-modifying and symptom management treatment options are available. The author concludes that good glycemic control is the first priority for both prevention and management of PDN. However, even with good glycemic control, up to 20 percent of patients will develop PDN. PDN recognition and assessment are critical to optimize management. Combination therapy, including nonpharmacologic modalities, may be required. 2 tables. 70 references.

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Protecting Your Kidneys. Diabetes Self-Management. 22(2): 43-48. March-April 2005.

Diabetic nephropathy (kidney disease associated with diabetes mellitus) is the leading cause of kidney failure in the United States. This article helps readers with diabetes understand how to protect their kidneys and postpone or prevent kidney disease. The author first explains the anatomy and physiology of the kidneys, then reviews the kidney problems that can develop. Kidney damage is discussed in five levels: hyperfiltration, microalbuminuria, nephrotic syndrome (also called macroalbuminuria), advanced clinical nephropathy, and kidney failure. The author discusses screening for the earliest stages of diabetic nephropathy, then explains the treatment options, including lifestyle changes, drug therapy consisting of ACE inhibitors and ARBs (angiotensin-II receptor blockers), and dietary protein restriction. The author concludes that with proper screening and diagnosis, some lifestyle changes, and good control of blood glucose and blood pressure, patients can greatly reduce their chance of developing kidney diseases.

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Sailing on a Wave of New Research: Part 2. Diabetes Forecast. 58(11): 45-48. November 2005.

This article, the second in a two-part series, summarizes recent research findings that were reported at the American Diabetes Association's 65th Scientific Sessions, held in San Diego (2005). This article covers undiagnosed kidney disease in people with type 2 diabetes, diet soda and weight gain in both type 1 and type 2 diabetes, poor diabetes control and depression in children and adolescents with type 1 diabetes, the use of exercise to prevent gestational diabetes, and eye disease (retinopathy) that may develop before clinical diabetes develops. Some of the information reported is from the Diabetes Prevention Program (DPP), a study that showed that weight loss, exercise, or treatment with the diabetes drug metformin can cut the risk of developing diabetes in people with pre-diabetes.

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Screening for Asymptomatic Coronary Artery Disease in Diabetes. Practical Diabetology. 24(3): 12-17. September 2005.

Cardiovascular disease remains the leading cause of death among patients with diabetes. This article explores the role of asymptomatic coronary artery disease (CAD) in cardiovascular mortality among patients with diabetes. The author focuses on the recent Detection of Ischemia in Asymptomatic Diabetics (DIAD) study; ischemia is a reduced flow of blood. The author defines asymptomatic CAD, then considers the diagnosis of this condition. The author then reviews the results found in the DIAD study, which was undertaken to identify patients with diabetes and asymptomatic CAD who may benefit from more aggressive primary prevention or revascularization procedures. Results showed that silent heart disease was found in more than 20 percent of asymptomatic patients with Type 2 diabetes aged 50 to 75 years. Abnormal perfusion studies were not reliably predicted by routine clinical and biochemical cardiac risk factors or by the number of classic or emerging risk factors. The author notes that the development of evidence-based guidelines for the surveillance of asymptomatic CAD has to be postponed until more research is completed. 4 tables. 7 references.

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Treating Type 2 Diabetes in Children. Diabetes Self-Management. 22(4): 80-83. July-August 2005.

This article explains the comprehensive plan of diabetes care that is involved in treating type 2 diabetes in children. The author first defines type 2 diabetes and discusses the increasing incidence of type 2 diabetes, along with an increasing incidence of obesity in children. The link between being overweight and diabetes is insulin resistance: overweight contributes to insulin resistance. Other topics include the diagnostic tests used to confirm type 2 diabetes; risk factors, in addition to obesity, for type 2 diabetes; treatment options, including diet and exercise, insulin and drugs, blood pressure control, blood lipid control, and regular checkups, including HbA1c tests (a blood test that measures blood glucose levels over time); the importance of taking a family-centered approach to diabetes management and lifestyle changes; and the importance of dealing with the psychosocial aspects of a diabetes diagnosis and ongoing care. The author concludes by encouraging parents to access the many resources available to help their family cope with diabetes.

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Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Treatment. Clinical Diabetes. 23(4): 181-185. Fall 2005.

Due to the current epidemic of obesity among children and adolescents, physicians can logically expect to encounter increasing numbers of young patients presenting initially with signs and symptoms associated with uncontrolled hyperglycemia (high blood glucose) and relatively advanced cases of diabetes. This article reviews the risk factors, diagnosis, and treatment of type 2 diabetes in children and adolescents. The authors use the case of a young adolescent (a 13-year-old Hispanic girl) with multiple risk factors for type 2 diabetes. The authors first discuss the role of family history and genetics, insulin resistance, criteria for diagnosis of diabetes, and classification of diabetes. One section covers some of the issues to consider when initiating a therapeutic regimen for this patient population, including illness severity and stage, anticipated adherence, developmental stage, and family socioeconomic status and level of support. Lifestyle changes that involve the entire family, including detailed attention to diet and exercise, constitute the foundation of an effective treatment plan. The authors also discuss drug therapy, including the use of insulin. Health care providers are encouraged to match a younger patient's level of commitment with an appropriately designed therapy, considering any possibilities to increase the likelihood of adherence and compliance to therapy. 2 figures. 27 references.

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Women, Polycystic Ovary Syndrome and Type 2: We Are Family. Diabetes Forecast. 58(12): 63-66. December 2005.

This article describes the impact that polycystic ovary syndrome (PCOS) can have on women with type 2 diabetes. PCOS is a reproductive and metabolic condition that is closely linked to diabetes and is associated with the interplay between insulin and androgens. The author discusses the symptoms of PCOS, the increased risk for women with PCOS of developing type 2 diabetes, insulin resistance, diagnostic tests used to confirm PCOS, treatment strategies, and the importance of early intervention. The author notes that lifestyle factors (keeping one's weight under control and exercising) are extremely effective for improving insulin sensitivity.

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35 Things Everyone Should Know About Diabetes. Santa Cruz, CA: Journeyworks Publishing. 2004. 2 p.

This brochure lists 35 facts about diabetes. Written primarily for the person recently diagnosed with type 2 diabetes, the brochure offers the facts in six categories: general physiology of insulin and diabetes; diagnostic considerations, including symptoms and diagnostic tests; the three main types of diabetes, i.e., type 1 diabetes, types 2 diabetes, and gestational diabetes; the risk factors for getting type 2 diabetes; the primary components of type 2 diabetes care, eating a healthy diet, getting enough physical activity, and monitoring blood glucose levels; and how to lower one's risk of developing type 2 diabetes. The brochure concludes by encouraging readers to talk with health care providers about diabetes. The web site of the National Diabetes Education Program is also provided (www.ndep.nih.gov). The brochure is illustrated with colorful line drawings.

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6 Good Ways to Lower Your Risk of Diabetes. Santa Cruz, CA: Journeyworks Publishing. 2004. 2 p.

Recent studies have shown that type 2 diabetes can be prevented or delayed by simple lifestyle changes. This brochure suggests strategies to lower one's risk of diabetes. Written primarily for the person at risk of type 2 diabetes, the brochure offers the suggestions in six categories: lose weight if necessary; eat a healthy diet; stay physically active; quit smoking; learn about risk factors, including the symptoms of diabetes or pre-diabetes; and talk with one's health care provider. The web site of the National Diabetes Education Program is provided (www.ndep.nih.gov). The brochure is illustrated with colorful line drawings.

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Am I at Risk for Type 2 Diabetes? Taking Steps to Lower the Risk of Getting Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse, 2004. 12 p.

Diabetes is a disease in which blood glucose levels are above normal. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. The amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about type 2 diabetes. Topics covered include the causes, risk factors, signs and symptoms, and prevention of type 2 diabetes. The booklet also addresses the tests used to confirm the condition and discusses pre-diabetes. A large section of the booklet walks readers through lifestyle changes that can prevent diabetes or reduce its impact. These changes include reaching and maintaining a reasonable body weight, making wise food choices most of the time, being physically active every day, and taking any prescribed medications. The publication concludes with a final section that briefly summarizes the activities of the National Diabetes Information Clearinghouse. 1 table.

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Ambulatory Blood Pressure Monitoring: A Practical Management Tool for Patients with Diabetes. Practical Diabetology. 23(4): 12-16. December 2004.

Hypertension (high blood pressure) is often a concern in patients with diabetes mellitus and thus is usually measured at every office visit and often by patients at home. However, this type of monitoring is not always accurate because the two methods may not always match in the patient's perception or in actuality. This article reports on the use of 24-hour ambulatory blood pressure monitoring (ABPM) in patients with diabetes to provide a more accurate picture of blood pressure values, which can then be used to verify a patient's diagnosis and guide management strategies. ABPM is a noninvasive procedure in which the patient wears an ambulatory blood pressure monitor for 24 hours, usually during a typical working day. Patients also keep a log of daily activities. The system records blood pressure every 15 to 20 minutes during the day and every 20 to 30 minutes during the night. The authors review the ABPM procedure, indications for ABPM (patient selection), ABPM versus clinic blood pressure measurements, tolerability of ABPM, and obstacles to ABPM, including reimbursement considerations. The authors mention white-coat hypertension, the phenomenon of blood pressure rise in the presence of a health care provider, and its implications in high risk this population. The authors conclude that although hypertension is a silent disease, ABPM can be used to give more data and thus a better prediction of cardiovascular risk than do clinic blood pressure values. 1 figure. 24 references.

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Complications of Diabetes Mellitus: Primary Care Implications. In: Hormel, A.P. and Mother, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 189-238.

By definition, diabetes is characterized by elevated blood glucose concentrations, however, the impact of diabetes, on both the health of individuals and on health care systems, resides almost entirely in the complications of the disease. This chapter on the primary care implications of these complications is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. This chapter considers the complications of diabetes in three separate categories: microvascular (small vessel) disease, the clinical manifestations of which are diabetic retinopathy (eye disease) and diabetic nephropathy (kidney disease); neuropathy (involvement of both the peripheral and autonomic nervous systems), the clinical manifestations of which can lead to various problems including foot and bone problems; and macrovascular (large vessel or atherosclerotic) disease, the clinical manifestations of which are angina and myocardial infarctions (heart attacks), cerebrovascular accidents (strokes), and peripheral vascular disease. 18 figures. 9 tables. 174 references.

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Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. 496 p.

This textbook provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. The book offers 12 chapters: the diagnosis, classification, and epidemiology of diabetes mellitus; general principles of treatment; nutrition and physical activity in diabetes; oral antidiabetes agents; insulin therapy; hyperglycemic and hypoglycemic emergencies; complications of diabetes mellitus, notably the implications for primary care settings; the emerging role of insulin resistance in the understanding of reducing cardiovascular risk in type 2 diabetes and the metabolic syndrome; office management of the patient with diabetes; diabetes management in children and adolescents; diabetes and pregnancy; and diabetes self-management education. Each chapter concludes with a list of references. One appendix lists resources for additional information and support. A detailed subject index concludes the text.

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Diabetes Screening in Children: When and How. Consultant. 44(13): 1609-1610. November 2004.

This article considers guidelines for screening in children from families where either Type 1 or Type 2 diabetes are already present. The authors discuss the two types of diabetes separately, contending that there are completely different issues at stake. In children with a strong family history of Type 1 diabetes, primary autoantibody screening is recommended to identify those who are at risk. Readers are reminded, however, that 85 percent of children with newly diagnosed Type 1 diabetes have no family history of the disease. They stress that for children in the general population, the newer strategy of primary genetic (HLA) screening at birth, followed by antibody screening in a research setting for those identified as high risk, makes more sense. The main determinants of Type 2 diabetes risk remain the triad of poor diet, insufficient exercise, and obesity. In children who are obese, who have physical evidence of insulin resistance (such as acanthosis nigricans), or who have a strong family history of Type 2 diabetes, screening for prediabetes and the metabolic syndrome is clearly indicated. The authors conclude that lifestyle changes that encourage weight loss and exercise are the most effective way to avoid the eventual development of diabetes in these children. However, early use of metformin can also help delay the onset of diabetes in children with impaired glucose tolerance. 1 reference.

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Diabetic Neuropathy: Early Clues, Effective Management. Consultant. 44(12): 1549-1556. October 2004.

This article guides physicians in a structured approach to the diagnosis and treatment of diabetic neuropathy (nerve disease associated with diabetes mellitus). The author stresses that the early signs of diabetic neuropathy can be detected during a routine clinical examination and annual surveillance for evidence of neuropathy and intensive diabetes management can reduce the incidence of complications. Physicians should inspect patients' feet for deformities and for sensory loss, which indicate risk of ulceration. Prolonged poor glycemic (blood glucose) control, alcohol abuse, and obesity increase the risk of amputation. Autonomic dysfunction, which can lead to sexual dysfunction and gastropathy (gastrointestinal problems), can be detected by measurement of heart rate and blood pressure. Electromyography and nerve conduction studies can be used to confirm a diagnosis of diabetic neuropathy. Improved metabolic control is the main goal of treatment. Analgesics, neuromodulators, and tricyclic antidepressants are effective for managing pain. 1 figure. 3 tables.

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Diabetic Retinopathy. Diabetes Care. 27(10): 2540-2553. October 2004.

Retinopathy is the most common microvascular complication of diabetes, resulting in blindness for over 10,000 people with diabetes per year. This article reviews the pathophysiology, screening, medical treatment, and future research for diabetic retinopathy. Several biochemical pathways have been proposed to link hyperglycemia (high blood glucose levels) and microvascular complications, including polyol accumulation, formation of advanced glycation end products (AGEs), oxidative stress, and activation of protein kinase C (PKC). These processes are through to modulate the disease process through effects on cellular metabolism, signaling, and growth factors. In the area of diagnosis, the authors discuss techniques for diabetic retinopathy screening, intervals for evaluating patients without any retinopathy, a new classification of diabetic retinopathy severity, and optical coherence tomography. The treatment section discusses glycemic control, blood pressure control, management of impaired renal (kidney) function, and serum lipid control. A final section considers future directions, in the areas of PKC inhibitors, Macugen (pegaptanib), Lucentis (ranibizumab), corticosteroids, and vitrectomy surgery. 5 tables. 134 references.

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Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 27(Supplement 1): S5-S10. January 2004.

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood glucose) resulting from defects in insulin secretion, insulin action, or both. This article presents the position statement of the American Diabetes Association on the diagnosis and classification of diabetes mellitus. Topics include a definition and description of diabetes mellitus; the classification of diabetes mellitus and other categories of glucose regulation; and the diagnostic criteria for diabetes mellitus. The authors caution that assigning a type of diabetes to an individual often depends on the circumstances present at the time of diagnosis, and many individuals with diabetes do not easily fit into a single class. 3 tables. 4 references.

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Diagnosis of Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2004. 6 p.

Diabetes is a disease in which blood glucose levels are above normal. People develop diabetes because the pancreas does not make enough insulin or because the cells in the muscles, liver, and fat do not use insulin properly. This fact sheet reviews the different types of diabetes and provides basic information for people who have just received a diagnosis of diabetes. Topics include type 1 diabetes; type 2 diabetes; gestational diabetes; pre-diabetes; diagnostic tests used to confirm diabetes; the fasting plasma glucose (FPG) test; the oral glucose tolerance test (OGTT); the random plasma glucose test; risk factors for type 2 diabetes; who should consider being tested for diabetes; steps that can delay or prevent type 2 diabetes; and management strategies for diabetes, notably meal planning, physical activity, and medications. The body mass index (BMI) tables are included in one chart. The booklet concludes with contact information for related resource organizations and a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). 4 tables.

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Diagnosis, Classification, and Epidemiology of Diabetes Mellitus. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 1-22.

Diabetes is a group of metabolic diseases that are characterized by hyperglycemia (high levels of blood glucose) resulting from defects in insulin secretion, insulin action, or both. The lack of effective insulin action leads to alterations in carbohydrate, fat, and protein metabolism. The chronic hyperglycemia of diabetes is associated with long term dysfunction and damage of organs, including the kidneys, eyes, nerves, heart, and blood vessels. This chapter on the diagnosis, classification, and epidemiology of diabetes mellitus is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. This chapter defines diabetes, then discusses diabetes as a local and global epidemic, the incidence and prevalence of diabetes among specific communities, current recommended criteria for the diagnosis of diabetes mellitus, alternative approaches to the diagnosis of diabetes, implications and importance of impaired glucose tolerance, the role of screening for diabetes, classification of diabetes, type 1 diabetes, type 2 diabetes, other specific types, and gestational diabetes. 5 tables. 155 references.

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Don't Lose Sight of Diabetic Eye Disease: Information for People With Diabetes. Bethesda, MD: National Eye Institute. 2004. 4 p.

Diabetes is a serious disease that can cause complications such as blindness, heart disease, kidney failure, and amputations. This brochure describes how diabetes-related eye disease (diabetic retinopathy) can be treated before vision loss occurs. Written in a question-and-answer format, the brochure defines diabetic retinopathy and then covers how diabetic retinopathy causes blindness, the symptoms of this condition, risk factors, diagnostic tests used to confirm diabetic retinopathy, treatment options (laser surgery), prevention strategies, risk factors for other eye diseases (cataracts and glaucoma), and research studies being undertaken in this area. The brochure concludes by reminding readers that excellent control of diabetes is the best way to prevent and reduce diabetic retinopathy. Readers with diabetes are encouraged to have a comprehensive, dilated eye examination at least once a year. 3 figures.

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Evaluation of SET-A New Device for the Measurement of Pain Perception in Comparison to Standard Measures of Diabetic Neuropathy. Diabetes Technology & Therapeutics. 6(5): 601-606. October 2004.

Early detection of sensory impairment and loss of protective pain sensation is of major importance for the prevention of neuropathic foot ulceration. This article reports on a study that evaluated a new handheld device (SET, a prototype developed by Dr. W. Henniges, Zülpich, Germany) for measurement of pain perception, in comparison with established methods for diagnosis of diabetic neuropathy. The study included sixty-one patients with diabetes mellitus (13 who had type 1 diabetes, 48 who had type 2; 42 men, 19 women; mean age 61.6 years plus or minus 11.6 years) underwent measurement of pain perception threshold using the new SET device and a measurement of light touch sensation, temperature sensation, and vibration sensation by the use of standard clinical devices. In addition, warm, cold, heat pain and vibration perception thresholds were determined by the use of a computer-based peltier thermode and a vibration stimulator (TSA 2001, Medoc, Ramat Yishai, Israel). Using the new SET device, patients with sensory impairment showed significantly elevated pain perception thresholds at the dorsum of the foot, while only a trend towards higher measurements could be observed at the plantar aspect of the foot. Compared with other qualities of sensory dysfunction, pain perception measurement with the SET device provided the highest sensitivity. The authors conclude that using the SET device for measurement of pain perception threshold is an easy and reliable method for identifying patients with impaired small nerve fiber function. 3 figures. 3 tables. 14 references.

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Gestational Diabetes Mellitus. Clinical Diabetes. 23(1): 17-24. December 2004.

Gestational diabetes mellitus (GDM) is a common condition characterized by glucose intolerance that begins or is first detected during pregnancy. GDM results from an increased severity of insulin resistance as well as an impairment of the compensatory increase in insulin secretion. This article reviews the diagnosis and care of GDM. The authors stress that the detection of GDM is important because of its associated maternal and fetal complications. The authors discuss the diagnostic criteria used for GDM, its pathogenesis, potential complications, screening guidelines, treatment options (glucose monitoring, medical nutrition therapy, exercise, insulin, oral agents), antepartum fetal assessment, peripartum considerations, and postpartum considerations. The authors conclude that treatment with medical nutrition therapy, close monitoring of glucose levels, and insulin therapy if glucose levels are above recommended levels can help to reduce these complications. In addition, certain types of exercise appear to have potential benefits in women without any contraindications. 1 table. 47 references.

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Hyperglycemic and Hypoglycemic Emergencies. In: Hormel, A.P. and Mother, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 147-187.

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are profound metabolic complications of diabetes and are among the most serious acute complications, along with severe hypoglycemia (low blood glucose levels). Both of the hyperglycemic (high blood glucose conditions) can occur in type 1 or type 2 diabetes, as can hypoglycemia. This chapter on hyperglycemic and hypoglycemic emergencies is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. This chapter addresses the pathophysiology, causes, signs, symptoms, and treatment of hyperglycemic emergencies, and outlines specific differences between DKA and HHS in these regards. The final section of this chapter focuses on hypoglycemia, its causes, manifestations, and management. 10 figures. 13 tables. 103 references.

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Medical Tests and Procedures for Finding and Treating Heart and Blood Vessel Disease. Alexandria, VA: American Diabetes Association. 2004. 2 p.

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. People with diabetes can reduce their cardiovascular disease risks by taking special care of their heart and blood vessels. This fact sheet on medical tests and procedures for finding and treating heart and blood vessel disease is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. In addition to regular checkups, the health care team can do special tests to check the condition of the heart and blood vessels. In patients who already have heart or blood vessel problems, the health care team can use special procedures to open up or bypass narrowed or blocked blood vessels. Choosing foods wisely, being physically active, and taking medications can also help patients to stay healthy. The fact sheet defines the angiogram (or arteriogram), angioplasty, ankle brachial index (ABI), cardiac catheterization, carotid artery surgery, chest x ray, coronary artery bypass graft, CT (computed tomography) scan, echocardiogram (ECG), electrocardiogram (ECG or EKG), exercise perfusion test, exercise stress test, Holter monitoring, magnetic resonance imaging (MRI), nuclear ventriculography, and PET (positron emission tomography) scan. 1 figure.

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Nutrition and Physical Activity in Diabetes. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 49-69.

Medical nutrition therapy (MNT) and physical activity have been considered the cornerstones of metabolic control in both type 1 and type 2 diabetes for decades. More recently, these lifestyle components have proven valuable in preventing type 2 diabetes. This chapter on nutrition and physical activity in diabetes mellitus is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. The author notes that the challenge for health professionals in implementing MNT and exercise guidelines is recognizing that the person with diabetes is responsible for 99 percent of the day-to-day management of diabetes, and ultimately makes the choice of what, when, and how much to eat and exercise. Helping patients prioritize strategies and develop critical thinking to problem solve around day-to-day hassles of diabetes is crucial to achieving metabolic control. Topics include healthy eating, glycemic control, body weight, minimizing weight gain, calorie restriction and weight, nutrient composition and weight, exercise and weight, carbohydrates, quantity of carbohydrate, type of carbohydrate and glycemic index, carbohydrate counting, physical activity and glycemic control, protein and renal (kidney) function, fat and cardiovascular risk, and alcohol. 1 figure. 3 tables. 106 references.

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Overview of Diabetes and Its Management. Timonium, MD: Available from Milner-Fenwick, Inc.. 2004. [CD-ROM Instructional Program]

This CD-ROM, recently updated to reflect the newest information about medications, pre-diabetes, diabetes and heart disease, and healthy behaviors, provides a 'lecture in a box,' designed to be used in diabetes education programs. The publication includes 112 full-color slides that cover ten important topic areas: introduction, diagnosis and goals, management, healthy food choices, physical activity, medications, short-term complications, sick day management, long-term complications, and diabetes and emotions. The CD-ROM includes leader's notes that are designed to help educators communicate key concepts to patients, community audiences, or healthcare professionals. The CD-ROM uses PowerPoint format, offering the flexibility to combine slides with other resources and create presentations for any setting. The leader's notes are provided in both a Word rich text format file and a PDF file. This program is available in either English or Spanish.

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Peripheral Arterial Disease in People with Diabetes. Clinical Diabetes. 22(4): 181-189. 2004.

Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities. This article presents the consensus statement of the American Diabetes Association for guidelines regarding the care of patients with both diabetes and PAD. The consensus statement addresses four areas: the epidemiology (incidence and prevalence) and impact of PAD in people with diabetes; how the biology of PAD is different in people with diabetes, including inflammation, risk factors for PAD, endothelial cell dysfunction in diabetes, and coagulation; recommended diagnostic methods for evaluating PAD in people with diabetes, including noninvasive evaluation, vascular lab evaluation, treadmill functional testing, and imaging studies; and the appropriate medical treatments for PAD in people with diabetes. Treatment options include treatment of systemic atherosclerosis associated with PAD, smoking cessation, glycemic (blood glucose) control, treatment of hypertension (high blood pressure), treatment of dyslipidemia (dysfunctional levels of blood lipids or fats), antiplatelet therapy, exercise rehabilitation, drug therapies, preventive foot care, treatment of the ischemic (reduced blood flow) foot, debridement, appropriate footwear, dressings, treatment of infection, and indications for revascularization procedures. The consensus statement concludes that PAD is a common cardiovascular complication in patients with diabetes. Diagnosis of PAD is vital to monitor symptoms, prevent disability and limb loss, and to identify patients at high risk of stroke and death. 4 tables. 37 references.

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Retinopathy in Diabetes. Diabetes Care. 27(Supplement 1): S84-S87. January 2004.

Diabetic retinopathy (eye disease associated with diabetes mellitus) is the most frequent cause of new cases of blindness among adults aged 20 to 74 years. This article presents the position statement of the American Diabetes Association on the diagnosis and management of retinopathy in people with diabetes. Topics include the natural history of diabetic retinopathy, risk factors and treatment, glycemic control, blood pressure control, aspirin treatment, laser photocoagulation, and evaluation of diabetic retinopathy. The guidelines conclude that glycemia and blood pressure control can prevent and delay the progression of diabetic retinopathy in patients with diabetes. Timely laser photocoagulation therapy can also prevent loss of vision in a large proportion of patients. A significant number of patients with vision-threatening disease may not have symptoms, so ongoing evaluation for retinopathy is a valuable and required strategy. 1 table. 10 references.

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Screening for Diabetes in an African-American Community: The Project DIRECT Experience. Journal of the National Medical Association. 96(10): 1325-1331. October 2004.

This article reports the results of a community-based screening program associated with Project DIRECT, a multi-year diabetes mellitus prevention and control project targeting African-American residents of southeast Raleigh, North Carolina. Between December 1996 and June 1999, 183 blood glucose screening events took place in community settings. Participants with a positive screen were referred for confirmatory testing and physician follow-up. Results showed that risk factors for diabetes were prevalent in this community, including ethnic minority race (88.2 percent), obesity (45.6 percent), and family history of diabetes (41.7 percent). In all, 197 persons had an elevated screening result; the prevalence of diabetes in the screened population that underwent follow-up testing was 1.7 percent. Despite persistent tracking efforts, 28 percent of the people with a high screening test received no final diagnosis. The authors conclude that their results support national recommendations against community-based screening. Community-based diabetes control efforts are likely better focused in other areas, such as increasing opportunistic screening during routine clinical care, improving quality of care, or increasing access to self-management education. 1 figure. 2 tables. 27 references.

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Standards of Medical Care in Diabetes. Diabetes Care. 27(Supplement 1): S15-S35. January 2004.

Diabetes care is complex and requires that many issues, beyond glycemic (blood glucose) control, be addressed. This article presents standards of care from the American Diabetes Association that are intended to provide clinicians, patients, researchers, payors, and other interested persons with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. Topics include classification, diagnosis, and screening; initial evaluation; patient care management, including glycemic control, referral for diabetes management, and intercurrent illness; assessment of glycemic control; medical nutrition therapy (MNT); physical activity; prevention and management of diabetes complications, including cardiovascular diseases, high blood pressure (hypertension), smoking cessation, nephropathy (kidney disease) screening and treatment, diabetic retinopathy (eye disease), and foot care (including amputation prevention); preventive care, including preconception care and immunization; and special considerations for the care of older adults with diabetes, children and adolescents, and standards of care. 8 tables. 129 references.

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Treating High Blood Pressure in People with Diabetes. Alexandria, VA: American Diabetes Association. 2004. 2 p.

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. This fact sheet on treating hypertension (high blood pressure) in people with diabetes is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. The fact sheet stresses that having one's blood pressure check regularly and taking action to reach blood pressure targets can prevent or delay diabetes problems. The fact sheet defines hypertension and how it is measure, the recommended targets for blood pressure, the suggested timing for blood pressure checkups, and recommended treatment options, including lifestyle changes and medications. The treatment options are provided in checklist format for ease of understanding. Medications discussed include ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and diuretics. 1 figure.

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Treating High Cholesterol in People with Diabetes. Alexandria, VA: American Diabetes Association. 2004. 2 p.

Cardiovascular disease (CVD) is the leading cause of death among people with diabetes, accounting for at least two out of three diabetes-related deaths. This fact sheet on treating high cholesterol in people with diabetes is from a set of 26 reproducible patient education handouts on topics related to diabetes CVD. The fact sheet reminds readers that keeping their cholesterol and other blood lipids (fats) under control can help prevent diabetes problems. For most patients, treatment includes both lifestyle changes, such as choosing foods wisely, and medication. The fact sheet reviews the different kinds of blood lipids and their physiology, the interrelationship between diabetes and blood lipids, diagnostic tests to monitor blood lipids (and recommended target values for those tests), and recommended treatments. The treatment options are provided in checklist format for ease of understanding. Medications discussed include statins, fibric acid derivatives, nicotinic acid (niacin), cholesterol absorption inhibitors, and bile acid sequestrants. 1 figure.

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Trends in the Prevalence and Ratio of Diagnosed to Undiagnosed Diabetes According to Obesity Levels in the U.S. Diabetes Care. 27(12): 2806-2812. December 2004.

This article reports on a study undertaken to examine trends in the prevalence of diagnosed and undiagnosed diabetes and the proportion of total cases previously diagnosed, according to obesity status in the United States over the past 40 years. Data showed that in the U.S. population aged 20 to 74 years between 1976-1980 and 1999-2000, significant increases in the prevalence of diagnosed diabetes were accompanied by nonsignificant increases in undiagnosed diabetes. This resulted in an increase in total diabetes and a modest nonsignificant increase in the proportion of cases that were diagnosed. These trends varied considerably by BMI (body mass index) level. The proportion of total diabetes cases that were diagnosed increased from 41 percent to 83 percent among individuals with BMI greater than 35 (defined as obese). By comparison, changes in prevalence within BMI strata were modest and there was no increase in the percent of total cases that were diagnosed. The authors conclude that improvements in diabetes awareness and detection are most prominent in overweight and obese individuals. 1 figure. 2 tables. 38 references.

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What You Should Know About Diabetes. Parsippany, NJ: Female Patient. 2004. 2 p.

This article helps women understand the three main types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. For each type, the author discusses the symptoms and complications, the risk factors, who should be tested, the kinds of diagnostic tests that may be used to confirm a diagnosis, and prevention strategies. Diagnostic tests outlined include fasting blood glucose, random blood glucose, and the two-hour post glucose challenge test (oral glucose tolerance test). The author encourages all readers to incorporate healthy lifestyle techniques, including achieving and maintaining an ideal weight, stopping smoking, exercising regularly, controlling cholesterol levels, and controlling blood pressure. Readers are referred to a number of other websites for additional information.

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Adolescent with Type I Diabetes. In: Sperling, M.A. Type 1 Diabetes: Etiology and Treatment. Totowa, NJ: Humana Press Inc. 2003. p. 307-319.

Adolescence is a challenging and complex state in human development, involving major physical, hormonal, emotional, and psychological changes, which affect both the young person involved and members of his or her family. The addition of having to deal with a chronic disease such as diabetes at this time of life adds further to the potential for instability and turmoil. Diabetes affects most aspects of adolescence, including the physiologic processes of growth and puberty, and the emotional and social transitions into adulthood. This chapter on the management of the adolescent with type 1 diabetes is from a book in which well-recognized physicians and researchers review the latest thinking about the causes of type 1 diabetes and the best approaches to treating both its acute and chronic complications. Topics include insulin deficiency and resistance during growth and puberty, psychosocial issues, adherence, drugs, special requirements for education, and transition to adult care. 92 references.

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Children, Teenagers and Type 2 Diabetes. Los Angeles, CA: National Health Video, Inc. 2003. (videorecording).

Children and adolescents who are diagnosed with type 2 diabetes are often concerned about how the disease will affect their lives. This videotape program reassures these young people that diabetes is very common and that they can do a great deal toward taking care of themselves, achieving and maintaining good health, and preventing complications. Written and narrated by a diabetes educator and dietitian, Nicole Celona-Jacobs, the video describes the disease, explains the anatomy and physiology of the pancreas and how the body uses food as fuel, and outlines the use of diet therapy and exercise as approaches to managing type 2 diabetes. Viewers are encouraged to include their friends and family in their healthy strategies, to help with motivation and enjoying a new lifestyle. The video features interviews and footage with a variety of teens and adults, as well as colorful graphics supporting the physiology discussions. Specific tips for meal planning, food choices, food labels, and exercise strategies are provided.

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Chronic Complications of Diabetes: An Overview. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 43-64.

The diabetes educator can play a key role in the prevention of chronic complications of diabetes by providing information to patients about behaviors and nonpharmacologic options that may affect the development of complications. This chapter on the chronic complications of diabetes is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter covers both the modifiable and nonmodifiable risk factors of diabetes complications, to provide the background for the content in each subsequent complication-specific chapter in this handbook and to assist educators to present this information to persons with diabetes in a meaningful way. Topics include the modifiable risk factors for diabetes-related cardiovascular disease, neuropathy (nerve disease), nephropathy (kidney disease), and retinopathy (eye disease); the nonmodifiable risk factors in these same categories; glucose, lipid, and blood pressure goals for people with diabetes; and the impact of hyperglycemia (high blood glucose levels) on the long term complications of diabetes. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 3 tables. 68 references.

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Cooper Has Diabetes. Atlanta, GA: Pritchett and Hull Associates, Inc. 2003. 32 p.

This children's book shares the story of a little boy, Cooper, who has recently been diagnosed with diabetes. Cooper shares his experiences with not feeling well, going to the doctor and hospital for his diagnostic workup and to get stabilized, the role of the endocrinologist, the basic anatomy of the digestive tract, the role of the pancreas, the role of the diabetes educator, the glucose monitor, insulin injections, the dietitian, making good food choices, the equipment and supplies, staying healthy at school, and staying healthy during other activities, such as playing baseball. The story shows Cooper in colorful drawings, as he goes through the whole diagnostic procedure and learns about caring for his diabetes. The last five pages are line drawings of illustrations from earlier in the book; readers can color in the pictures for themselves. The book uses accurate medical language, with pictures and descriptions to make the information accessible to a youngster.

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Core Curriculum for Diabetes Education. 5th ed.: (Volume 1) Diabetes and Complications. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. 232 p.

This guidebook is one in a series of four handbooks in the CORE Curriculum, a project originally planned to help educators prepare for the Certified Diabetes Educators (CDE) exam. However, the use and scope of the CORE Curriculum has expanded; it is both a key reference for the Advanced Diabetes Management credential exam and an authoritative source of information for diabetes education, training, and management. This first volume covers diabetes and complications. Topics include pathophysiology of the diabetes disease state, hyperglycemia, an overview of the chronic complications of diabetes, diabetic foot care and education, skin and dental care, macrovascular disease, eye disease and adaptive diabetes education for visually impaired persons, nephropathy (kidney disease) and diabetic neuropathy (nerve disease). Each chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). The handbook concludes with a subject index.

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Core Curriculum for Diabetes Education. 5th ed.: (Volume 3) Diabetes Education and Program Management. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. 264 p.

This guidebook is one in a series of four handbooks in the CORE Curriculum, a project originally planned to help educators prepare for the Certified Diabetes Educators (CDE) exam. However, the use and scope of the CORE Curriculum has expanded; it is both a key reference for the Advanced Diabetes Management credential exam and an authoritative source of information for diabetes education, training, and management. This volume covers diabetes education and program management. Topics include applied principles of teaching and learning; psychosocial assessment; behavior change; cultural competence in diabetes education and care; teaching persons with low literacy skills; psychological disorders; management of diabetes education programs; and payment for diabetes education. Each chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). The handbook concludes with a subject index.

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Diabetes Sourcebook. 3rd ed. Detroit, MI: Omnigraphics. 2003. 621 p.

This book provides information for people seeking to understand the risk factors, complications, and management of type 1 diabetes, type 2 diabetes, and gestational diabetes. The book offers 67 chapters in seven sections: diabetes types and diagnosis; lifestyle and related diabetes management concerns; exercise and nutrition for diabetes management; medication management of diabetes; complications of diabetes; treatment of end stage renal disease (ESRD); and diabetes-related research and statistics. Specific topics include risk factors, impaired glucose tolerance (IGT), insulin resistance, HbA1c (glycosylated hemoglobin) testing, blood glucose testing, urine testing, SMBG (self monitoring of blood glucose), non-invasive blood glucose monitors, preventing complications, how stress affect diabetes, alternative therapies for diabetes, exercise, exchange lists, carbohydrate counting, eating at restaurants, insulin administration and dosage, oral medications, amputation, kidney disease (diabetic nephropathy), diabetic retinopathy (eye disease), diabetic neuropathy (nerve disease), gastroparesis (reduced motility of stomach contents), hypoglycemia (low blood glucose levels), hyperglycemia (high blood glucose levels), erectile dysfunction (ED formerly called impotence), research advances in diabetes, and diabetes in ethnic and racial groups. The book includes a glossary of related terms, information about locating financial help for diabetes care, and a list of resources, including organizations, recipes and cookbooks.

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Diabetic Foot Care and Education. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 65-86.

Teaching patients and health care professionals how to reduce the risk factors for lower-extremity complications is an important strategy in diabetes management. This chapter on diabetic foot care and education is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. The author of this chapter stresses that appropriate diabetes self-management education and preventive foot care are known to reduce lower-extremity complications. Topics include the effects of peripheral sensory neuropathy, autonomic neuropathy, and motor neuropathy on the functions of the foot; the signs of peripheral vascular disease in the lower extremities of people with diabetes; the basic elements of a diabetic foot screening examination; the findings from a foot examination that would cause a person with diabetes to be classified as high risk; treatment plans for the person with high-risk feet or a foot ulcer; and guidelines for teaching foot care to both low-risk and high-risk individuals. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 1 figure. 44 references.

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Diabetic Kidney Disease: Preventing Dialysis and Transplantation. Clinical Diabetes. 21(2): 55-62. April 2003.

Diabetic nephropathy (kidney disease associated with diabetes mellitus), characterized by proteinuria (protein in the urine) and progressive kidney failure, occurs more frequently when uncontrolled hyperglycemia (high blood glucose) and hypertension (high blood pressure) are present. Exaggerated cardiovascular risk is present in these patients, and early detection and treatment are imperative. Successful prevention and treatments are available, primarily based on aggressive blood glucose and blood pressure control. This article reviews strategies for preventing dialysis and transplantation in patients with diabetic kidney disease. Topics include epidemiology and costs of the problem, screening for diabetic nephropathy, definition and recognition of kidney failure, pathogenetic mechanisms, primary prevention (antihypertensives and blood glucose control), and treatment of diabetic nephropathy, primarily with drug therapy. The author concludes that early referral to a nephrologist when estimated creatinine clearance is less than 60 milliliters per minute is recommended to allow adequate time to prepare for renal replacement therapy, dialysis, or transplantation, resulting in lower overall morbidity and mortality. 1 figure. 1 table. 49 references.

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Diabetic Neuropathy. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 189-220.

Diabetes is the most common cause of peripheral neuropathy (nerve disease) in the Western world and is responsible for significant patient morbidity (related illness). This chapter on diabetic neuropathy is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. The authors of this chapter discuss the definition of diabetic neuropathy; the role of blood glucose control in the development and treatment of peripheral neuropathies; pharmacological (drug) and nonpharmacological treatments for peripheral neuropathy; the clinical manifestations of diffuse sensory neuropathy; the classifications and clinical manifestations of autonomic neuropathy; the primary symptoms for each of the focal neuropathies; and the information about neuropathy that should be taught to all patients with diabetes. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 3 tables. 86 references.

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Diabetic Retinopathy. Diabetes Care. 26(1): 226-229. January 2003.

Diabetic retinopathy (eye disease associated with diabetes) is the most frequent cause of new cases of blindness among adults aged 20 to 74 years. During the first two decades of disease, nearly all patients with type 1 diabetes and more than 60 percent of patients with type 2 diabetes have retinopathy. This article reviews the natural history of diabetic retinopathy, its risk factors and treatments, the role of glycemic (blood glucose) control, blood pressure control, the use of aspirin treatment, indications for laser photocoagulation, and the evaluation of diabetic retinopathy. The article notes that treatment modalities exist that can prevent or delay the onset of diabetic retinopathy, as well as prevent loss of vision, in a large proportion of patients with diabetes. The latter part of the article presents guidelines and recommendations for initial and subsequent ophthalmologic evaluation of patients with diabetes. 1 table. 10 references.

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Diabetic Retinopathy: What You Should Know. Bethesda, MD: National Eye Institute. 2003. 21 p.

This large-print booklet provides information for people with diabetic retinopathy and for their families and friends. The booklet discusses the causes and symptoms of this progressive eye disease. Written in a question and answer format, the booklet covers the stages of diabetic retinopathy, risk factors for the condition, how diabetic retinopathy causes vision loss, the symptoms that may be experienced, the symptoms of proliferative retinopathy when bleeding is involved, the detection of macular edema and diabetic retinopathy, treatment options for these two conditions, laser treatments, vitrectomy, the effectiveness of treatments for proliferative retinopathy, how to handle vision loss associated with diabetic retinopathy, current research in this area, steps to protect one’s vision, and questions or concerns to address with the eye care professional. The National Eye Institute encourages everyone with diabetes to have a comprehensive dilated eye exam at least once a year; people with diabetic retinopathy may need an eye exam more often. People with proliferative retinopathy can reduce their risk of blindness by 95 percent with timely treatment and appropriate follow up care. Readers are also reminded that better control of blood glucose levels slows the onset and progression of retinopathy. The booklet includes the contact information for the National Eye Institute, as well as for other resource organizations in the areas of diabetic retinopathy, diabetes, and low-vision programs. 6 figures.

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Diabetic Syndrome. In: Patel, A. Diabetes in Focus. 2nd ed. Lewisville, TX: Pharmaceutical Press. 2003. p. 5-10.

Diabetes mellitus is a common chronic disorder and represents a serious health care challenge. The prevalence of diabetes is increasing worldwide and considerable progress has been made in the understanding of diabetes management. This overview chapter on the diabetic syndrome is from a textbook that details the practical pharmaceutical care that pharmacists can provide for people with diabetes. In this chapter, the author presents the World Health Organization (WHO) diagnostic criteria, and the WHO classification criteria for type 1 diabetes mellitus, type 2 diabetes mellitus, and other specific types. One sidebar explains the oral glucose tolerance test. 6 references.

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Diagnosis and Management of Diabetes. In: Hall, J.E.; Nieman, L.K., eds. Handbook of Diagnostic Endocrinology. Totowa, NJ: The Humana Press, Inc. 2003. p. 157-177.

With the rapid development of new and more reliable diagnostic tests, and aided by the molecular and genetic approaches that continue to deepen the understanding of these diseases, the ability to diagnose patients with endocrine disease has dramatically increased. This chapter on the diagnosis and management of diabetes is from a book that explains the pathophysiology and clinical manifestations of endocrine disorders and surveys all the latest laboratory tests used in their diagnosis. Diabetes mellitus represents a heterogeneous group of metabolic disorders characterized by decreased insulin secretion, insulin action, or both. In this chapter, the author discusses the diagnosis of diabetes, impaired fasting glucose and impaired glucose tolerance, and gestational diabetes; monitoring glycemia (levels of blood glucose) in the patient with diabetes; protein glycation; and the diagnosis and monitoring of diabetes-related complications, including retinopathy (eye disease), neuropathy (nerve disease), nephropathy (kidney disease), and cardiovascular disease. The author stresses that because safe and effective medical therapies are available to improve metabolic control and large-scale clinical trials have demonstrated reduced complications with treatments for both types 1 and 2 diabetes, diagnostic procedures are vital. 5 tables. 50 references.

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Eye Disease and Adaptive Diabetes Education for Visually Impaired Persons. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 123-150.

Diabetes is a leading cause of vision impairment in the United States. This chapter on diabetes related eye disease and adaptive diabetes education is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. The authors of this chapter discuss the stages of diabetic retinopathy and appropriate treatments for each stage; six other ophthalmic conditions that may occur more commonly in people with diabetes than in the general population; factors for assessing function with vision loss; appropriate times for referral and the general services that are available for individuals with diabetes and visual impairment; ways to enhance interactions with individuals who are visually impaired; and how to adapt diabetes self-management skills for the visually impaired patient. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 2 figures. 5 tables. 48 references.

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Gestational Diabetes Mellitus. Diabetes Care. 26(2): 385-389. February 2003.

This article reports on a study undertaken to examine anxiety levels of women diagnosed with gestational diabetes mellitus (GDM) and to compare these with glucose-tolerant (GT) women at similar stages of pregnancy. The prospective longitudinal study was conducted on 50 women with GDM and 50 GT women. All women completed the Mental Health Inventory (MHI-5) forms and the Speilberger State-Trait Anxiety Inventory (STAI) at the beginning of the third trimester, antepartum, and 6 weeks postpartum. Women with GDM, compared with GT women, had a higher level of anxiety (state rather than trait) at the time of the first assessment. However, before delivery and in the postpartum period, there were no significant differences in anxiety scores between the two groups. Women in both groups were positive about being tested for GDM and wished to be tested during future pregnancies. The authors conclude that there were no sustained increased levels of anxiety for women diagnosed with GDM. Concerns expressed about causing sustained maternal anxiety by testing for GDM could not be substantiated. 3 tables. 20 references.

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Gestational Diabetes: Where Do We Look for It and How Do We Find It?. In: Hall, J.E.; Nieman, L.K., eds. Handbook of Diagnostic Endocrinology. Totowa, NJ: The Humana Press, Inc. 2003. p. 179-191.

With the rapid development of new and more reliable diagnostic tests, and aided by the molecular and genetic approaches that continue to deepen the understanding of these diseases, the ability to diagnose patients with endocrine disease has dramatically increased. This chapter on gestational diabetes is from a book that explains the pathophysiology and clinical manifestations of endocrine disorders and surveys all the latest laboratory tests used in their diagnosis. In this chapter, the author discusses the definition of gestational diabetes (GDM), clinical features of the disease, diagnostic strategies and the controversies around diagnosis, threshold glucose levels for perinatal morbidity (complications during the prenatal and postnatal period), and appropriate screening tests for GDM. The author concludes that selective screening is advocated with no screening necessary only in those women meeting all of the low risk characteristics. High risk women require glucose screening at the first clinical contact following diagnosis of pregnancy, with women of average risk being screened at 24 to 28 weeks gestation. 1 figure. 4 tables. 42 references.

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Handbook of Diagnostic Endocrinology. Totowa, NJ: The Humana Press, Inc. 2003. 360 p.

With the rapid development of new and more reliable diagnostic tests, and aided by the molecular and genetic approaches that continue to deepen the understanding of these diseases, the ability to diagnose patients with endocrine disease has dramatically increased. In this book, physicians concisely explain the pathophysiology and clinical manifestations of these disorders and survey all the latest laboratory tests used in their diagnosis. Topics range widely from an overview of the diagnosis of diabetes and the long-term monitoring of its complications to the evaluation of menstrual dysfunction. Other topics include the diagnosis of pituitary tumors, Cushing's syndrome, thyroid disease, and hypoglycemia; the evaluation of endocrine-induced hypertension; the assessment of dyslipidemia and obesity; new approaches to diagnosing hypercalcemia and hypocalcemia, osteoporosis, hypogonadism and erectile dysfunction, and hyperandrogenism in women. The authors review the complex physiological basis of the relevant endocrine processes and provide recommendations for the follow up and long term management of patients. Each chapter concludes with references and the text concludes with a subject index.

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Heart Disease and Diabetes. Clinical Diabetes. 21(1): 10. January 2003.

This brief fact sheet reminds readers of the connection between heart disease and diabetes. The fact sheet notes that many conditions that increase one's changes of getting heart disease are more common in people with diabetes. These conditions include cholesterol problems, high blood pressure (hypertension), overweight, and blood clotting problems. Heart attacks, known in the medical community as myocardial infarctions, are one of the most common heart conditions. For most people, a heart condition leads to symptoms such as chest pain or pressure, jaw pain, arm pain, shortness of breath, sweating, and pounding heartbeat. However, many people with diabetes and heart disease do not notice any symptoms at all. This is called silent ischemia. Silent ischemia is very dangerous because it may prevent patients with heart problems from seeking medical care and getting early treatment. The fact sheet lists common risk factors for heart disease, and encourages readers with those risk factors to be tested.

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Hyperglycemia. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 19-42.

This chapter on hyperglycemia (high blood glucose levels) is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter notes that prolonged hyperglycemia can lead to two types of acute metabolic crises: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Either of these life-threatening conditions may result in an altered mental state, loss of consciousness, or possibly death. Topics include the precipitating factors in DKA, the pathophysiology of DKA, the presenting signs and symptoms of DKA, possible variations in initial laboratory values, and goals for the treatment of DKA; the precipitating factors in HHS, the pathophysiology of HHS, the presenting signs and symptoms of HHS, and treatment for HHS; and the major differences between laboratory values found in DKA and HHS. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 3 figures. 2 tables. 18 references.

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Hypoglycemic Disorders. In: Hall, J.E.; Nieman, L.K., eds. Handbook of Diagnostic Endocrinology. Totowa, NJ: The Humana Press, Inc. 2003. p. 193-211.

With the rapid development of new and more reliable diagnostic tests, and aided by the molecular and genetic approaches that continue to deepen the understanding of these diseases, the ability to diagnose patients with endocrine disease has dramatically increased. This chapter on hypoglycemic (low blood glucose) disorders is from a book that explains the pathophysiology and clinical manifestations of endocrine disorders and surveys all the latest laboratory tests used in their diagnosis. The author discusses classification of hypoglycemic disorders, and then considers the tests available for their diagnostic evaluation. The author notes that a healthy-appearing patient with no coexisting disease who has a history of neuroglycopenic spells requires an approach quite different from that taken for a patient with concurrent illness or a hospitalized patient with acute hypoglycemia (low levels of blood glucose). Tests discussed include serum glucose levels, the prolonged (72 hour) fast, the mixed meal test, the C-peptide suppression test, insulin antibodies, glycated hemoglobin, and imaging studies. 6 figures. 4 tables. 84 references.

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Importance of Research. In: Franz, M.J., et al., eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 4) Diabetes in the Life Cycle and Program Management. Chicago, IL: American Association of Diabetes Educator (AADE). 2003. p. 245-270.

Diabetes educators practicing in all care settings are expected to provide quality care and education that reflects the translation of scientific research evidence and professional consensus into practice. This chapter on the importance of research is from a handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter provides an overview of the importance of research and outcome measures to daily clinical care. Topics include the differences between quantitative and qualitative approaches to research; different types of research studies; the general phases of the research process; the basic elements of a research report; experimental versus nonexperimental research; identifying and measuring diabetes outcomes; and strategies for participating in research opportunities. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 7 figures. 4 tables. 21 references.

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Insulin Resistance and Pre-Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2003. 8 p.

Insulin resistance is a silent condition that increases the changes of developing diabetes and heart disease. This fact sheet describes insulin resistance and pre-diabetes and how readers can make lifestyle changes to help prevent diabetes and other health problems. Topics include the role of insulin; the interplay between insulin resistance, prediabetes and type 2 diabetes; the causes of insulin resistance; symptoms; metabolic syndrome; diagnostic tests used to confirm the presence of diabetes and prediabetes, including fasting blood glucose tests, glucose tolerance test, and insulin measure; strategies to reverse insulin resistance, including physical activity, appropriate weight loss, control of blood pressure, control of cholesterol levels, and stopping smoking; and the drugs that are used to improve response to insulin. One additional section briefly reports on future research projects in this area. The fact sheet concludes with a brief description of the goals and activities of the National Diabetes Information Clearinghouse (NDIC).

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Lost In Darknes, Depression, Diabetes, And Heart Disease. Diabetes Forecast. 56(5): 44-46. May 2003.

This article helps readers with diabetes to understand the problem of depression and the risks that having a chronic disease may contribute to any likelihood of experiencing depression. The author notes that depression may occur as a reaction to illness and changing social circumstances, such as after the onset of type 1 diabetes or a divorce, but depression also seems to have a genetic basis in some patients. The author briefly reviews the biological basis of depression, stress hormones, diagnosing depression, and treatment options. Although depression causes severe dysfunction, many people can be successfully treated by a combination of medication and by tested forms of behavioral therapy such as cognitive behavioral therapy, which is a form of coaching. Regular physical exercise has been shown to reduce depressive symptoms; exercise also improves blood glucose control and cardiovascular function.

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Macrovascular Disease. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 96-122.

Among the many conditions associated with diabetes, cardiovascular diseases (CVD) are the most frequent, serious, lethal, and costly. This chapter on diabetes-associated macrovascular disease is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. The author of this chapter covers the types of macrovascular disease that occur among persons with diabetes mellitus; the contribution of macrovascular disease to the overall disease and economic burden associated with diabetes mellitus; special features of macrovascular disease in persons with diabetes, including pathogenesis, clinical manifestations, detection, and treatment; risk factors that may contribute to the prevalence, morbidity, and mortality of macrovascular disease in diabetes; and assessment and intervention strategies that can prevent or minimize macrovascular disease in diabetes mellitus. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 116 references.

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Macrovascular Risk and Diagnostic Criteria for Type 2 Diabetes. Diabetes Care. 26(2): 485-490. February 2003.

The use of fasting plasma glucose (FPG) levels (greater than 7.0 mmol per liter) leads to underdiagnosis of type 2 diabetes compared with the oral glucose tolerance test (OGTT). The OGTT is of limited use for population screening. Most of the increase in cardiovascular risk in relation to increasing blood glucose occurs before the threshold at which the diagnosis of type 2 diabetes is made. This article reports on a study that evaluated the use of HbA1c (glycosylated hemoglobin, a measure of glucose over time) and FPG as predictors of type 2 diabetes and cardiovascular risk and how they can be used to develop a rational approach to screening for abnormalities of glucose tolerance. OGTT and measurement of HbA1c and FPG levels were performed in 505 subjects screened for type 2 diabetes. The subjects were aged 19 to 88 years (mean 53.8 years). The incidence of type 2 diabetes was 10.4 percent based on the OGTT and 4 percent based on the FPG levels. HbA1c testing predicted with certainty the absence or presence of type 2 diabetes as defined by the OGTT. However, the majority (75 to 85 percent) of subjects in each case had intermediate values, which were therefore nondiagnostic. The authors conclude that measurement of FPG and HbA1c levels will diagnose or exclude type 2 diabetes with certainty in a minority (15 percent) of people. There is a continuous relationship between FPG and HbA1c and cardiovascular risk. The authors also present a cost-effective approach to screening patients. 2 figures. 1 table. 29 references.

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Mastering Your Diabetes (Before Diabetes Masters You). Alexandria, VA: American Diabetes Association. 2003. 123 p.

This book is written for patients newly diagnosed with diabetes mellitus. Written by a diabetes health care professional who has also lived with diabetes for more than 25 years, the book covers the emotional, physical, and practical aspects of living with diabetes. Fifteen chapters cover adjusting to a diagnosis of diabetes, definition of diabetes (including the different types), the physiology of diabetes, short-term complications of high glucose levels (hyperglycemia), monitoring blood glucose levels (SMBG), medications that are used to treat diabetes, diet therapy to help manage diabetes, hypoglycemia (low blood glucose), the role of exercise, general health care recommendations, sick days, the emotional side of diabetes, long-term complications of diabetes, and how to stay motivated to maintain healthy self-care strategies. A subject index concludes the book.

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NCEP-Defined Metabolic Syndrome, Diabetes, and Prevalence of Coronary Heart Disease Among NHANES III Participants Age 50 Years and Older. Diabetes. 52(5): 1210-1214. May 2003.

Although the individual components of the metabolic syndrome are clearly associated with increased risk for coronary heart disease (CHD), the authors of this study wanted to quantify the increased prevalence of CHD among people with metabolic syndrome. The authors used the Third National Health and Nutrition Examination Survey (NHANES III) to categorize adults over 50 years of age by presence of metabolic syndrome, with or without diabetes. Metabolic syndrome is very common, with approximately 44 percent of the United States population over 50 years of age meeting the criteria. In contrast, diabetes without metabolic syndrome is uncommon (13 percent of those with diabetes). Older Americans over 50 years of age without metabolic syndrome, regardless of diabetes status, had the lowest CHD prevalence. The prevalence of CHD markedly increased with the presence of metabolic syndrome. Among people with diabetes, the prevalence of metabolic syndrome was very high, and those with diabetes and metabolic syndrome had the highest prevalence of CHD. 2 figures. 4 tables. 31 references.

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Nephropathy. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 151-188.

The spectrum of renal (kidney) changes that occur in individuals with diabetes and that can not be ascribed to other causes is known as diabetic nephropathy. This chapter on diabetic nephropathy is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. The authors of this chapter discuss the epidemiology (incidence and prevalence) of diabetic nephropathy and end stage renal disease (ESRD); the basic functions of the kidney; the major stages in the progression of diabetic nephropathy; diagnostic tests used to assess and monitor renal function; treatment modalities for diabetic nephropathy; treatment options for renal replacement therapy; and prevention strategies and when they should be implemented. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 2 figures. 7 tables. 98 references.

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Pathophysiology of the Diabetes Disease State. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 1-18.

This chapter on pathophysiology of diabetes is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This first chapter focuses on the pathology and clinical manifestations of the multifaceted syndrome of diabetes mellitus. Topics include fuel metabolism and its hormonal control; the groups at risk for diabetes; the diagnostic criteria for diabetes mellitus; the differences among the various forms of diabetes mellitus; the stages of development of type 1 diabetes and the implications for early intervention and prevention; and the mechanisms by which type 2 diabetes occurs, the risk factors for its development, and mechanisms for potential prevention. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 2 tables. 22 references.

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Peripheral Arterial Disease in People with Diabetes. Diabetes Care. 26(12): 3333-3341. October 2003.

Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic (hardening of the arteries) occlusive disease of the lower extremities. While PAD is a major risk factor for lower-extremity amputation, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease. This article reviews the assessment and management of PAD in people with diabetes. The article reports on a Consensus Development Conference held in May 2003 on this topic. The conference addressed four topics: the epidemiology and impact of PAD in people with diabetes; how the biology of PAD differs in people with and without diabetes; the diagnosis and evaluation of PAD in people with diabetes; and appropriate treatments for PAD in people with diabetes. Patients with PAD and diabetes may present later with more severe disease and have a greater risk of amputation. In addition, the presence of PAD is a marker of excess cardiovascular risk. The authors stress that it is important to diagnose PAD in patients with diabetes, to elicit symptoms, prevent disability and limb loss, and identify a patient at high risk of myocardial infarction, stroke, and death. 37 references.

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Peripheral Arterial Disease: Diagnosis and Treatment. Totowa NJ: Humana Press. 2003. 368 p.

This textbook acquaints physicians with all aspects of peripheral arterial disease (PAD), defined as narrowing (stenosis) or blockage (occlusion) within the arteries of the lower extremities. PAD is caused by both modifiable (diabetes, smoking, hypertension) and nonmodifiable (family history, age, gender) factors. Due to the limitations of medical therapy, there is now a special emphasis on prevention of PAD and a special emphasis on risk factors and their treatment. The text includes seventeen chapters: the etiology and pathogenesis of atherosclerosis, the epidemiology and natural history of PAD, clinical evaluation of intermittent claudication, hemodynamics and the vascular laboratory, vascular imaging, chronic critical limb ischemia (lack of blood flow), acute limb ischemia, exercise rehabilitation for intermittent claudication, treatment of risk factors and antiplatelet therapy, pharmacotherapy for intermittent claudication, angiogenesis and gene therapy, endovascular therapy, surgical revascularization, perioperative cardiac evaluation and management for vascular surgery, special consideration for the diabetic foot, arterial vascular disease in women, atheromatous embolism, thromboangiitis obliterans (Buerger's disease), and large-vessel vasculitis. Each chapter concludes with extensive references and a subject index concludes the textbook.

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Preadolescent Child with Type I Diabetes. In: Sperling, M.A. Type 1 Diabetes: Etiology and Treatment. Totowa, NJ: Humana Press Inc. 2003. p. 293-305.

Results of the Diabetes Control and Complications Trial (DCCT) indicate that most patients with type 1 diabetes should receive intensive treatments aimed at lowering glucose and glycosylated hemoglobin (HbA1c, a measure of blood glucose over time) levels as close to normal as possible and as soon as possible in order to prevent and delay the development of microvascular complications of the disease. Among the pediatric age groups, the preadolescent child with type 1 diabetes is an ideal candidate for such therapy. This chapter on the management of the preadolescent child with type 1 diabetes is from a book in which well-recognized physicians and researchers review the latest thinking about the causes of type 1 diabetes and the best approaches to treating both its acute and chronic complications. Topics include the goals of treatment, insulin replacement, monitoring glucose control, glycosylated hemoglobin, diet, exercise, outpatient care, hypoglycemia (low blood glucose levels), sick-day rules, and the behavioral and psychosocial aspects of treatment. 3 figures. 1 table. 35 references.

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Prediabetes: Staying Healthy. Scotts Valley, CA: ETR Associates. 2003. 4 p.

Sometimes people have high blood glucose levels (high sugar) but it is not high enough to be considered diabetes. This condition is called prediabetes and includes a higher likelihood of getting diabetes or having a heart attack or stroke. This brochure helps readers with prediabetes understand how to lower blood glucose to a healthy level, prevent or delay getting diabetes, and lower the chances of having a heart attack or stroke. The brochure reviews risk factors, encourages readers to get tested for prediabetes, explains the test results for the fasting plasma glucose test (FPG) and the oral glucose tolerance test (OGTT), and notes the symptoms of diabetes. One sidebar lists strategies to help blood glucose stay at healthy levels: eat healthy foods more often, eat smaller servings of less-healthy foods, choose low-fat foods, cook in healthy ways, be active, achieve and maintain a healthy weight, and stop smoking. The brochure concludes with the contact information for the American Diabetes Association (800-342-2383 or www.diabetes.org). 1 figure. 1 table.

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Prediction and Prevention of Type 1 Diabetes. In: Sperling, M.A. Type I Diabetes: Etiology and Treatment. Totowa, NJ: Humana Press Inc. 2003. p. 55-70.

The increasing incidence of diabetes worldwide has prompted a rapid growth in the pace of scientific discovery and clinical understanding of this disease. This chapter on the prediction and prevention of type 1 diabetes is from a book in which well-recognized physicians and researchers review the latest thinking about the causes of type 1 diabetes and the best approaches to treating both its acute and chronic complications. The authors note that it is now possible to predict type 1A (the common immune type) diabetes in humans with reasonable accuracy. Prevention of diabetes is possible in animal models, and a major effort is underway to carry these observations from the 'bench' into the clinic in order to make prevention in humans a reality. The authors outline primary, secondary, and tertiary prevention strategies. 2 figures. 2 tables. 100 references.

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Prediction of Type 2 Diabetes Using Simple Measures of Insulin Resistance. Diabetes. 52(2): 463-469. February 2003.

This article reports on a study undertaken to determine and formally compare the ability of simple indices of insulin resistance (IR) to predict type 2 diabetes. The authors used combined prospective data that included well-characterized cohorts of non-Hispanic white, African-American, Hispanic American, and Mexican subjects with 5 to 8 years of follow up. Poisson regression was used to assess the ability of each candidate index to predict incident diabetes at the follow up examination (343 of 3,574 subjects developed diabetes). The authors found substantial differences between published IR indexes in the prediction of diabetes, with ISI 0,120 consistently showing the strongest prediction. This index may reflect other aspects of diabetes pathogenesis in addition to IR, which might explain its strong predictive abilities despite its moderate correlation with direct measures of IR. 6 tables. 28 references.

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Prevent Diabetes Problems: Keep Your Eyes Healthy. Bethesda, MD: National Diabetes Information Clearinghouse, 2003. 14 p.

Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about eye problems associated with diabetes, including diabetic retinopathy and other conditions. Topics include daily diabetes care to stay as healthy as possible; the anatomy and physiology of the eyes; how to prevent diabetes-related eye problems; diabetic retinopathy and how it progresses; how diabetes can damage the eyes; the symptoms of diabetic retinopathy; and other eye problems associated with diabetes, including cataracts and glaucoma. The booklet concludes with contact information for resource organizations and a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). The booklet is illustrated with black-and-white line drawings. 9 figures.

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Prevent Diabetes Problems: Keep Your Heart and Blood Vessels Healthy. Bethesda, MD: National Diabetes Information Clearinghouse. 2003. 17 p.

Diabetes is a disease in which blood glucose levels are above normal. Over time, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation. This booklet, written in nontechnical language, answers common questions about heart and blood vessel disease associated with diabetes, including diabetic angiopathy and other conditions. Topics include daily diabetes care to stay as healthy as possible, the anatomy and physiology of the heart and blood vessels, how to prevent diabetes-related heart disease and stroke, what can happen when blood vessels are clogged, the warning signs of a heart attack, how heart disease causes high blood pressure (hypertension), the warning signs of a stroke, how clogged blood vessels can hurt the legs and feet, and how to prevent or control peripheral vascular disease. The booklet concludes with contact information for resource organizations and a brief summary of the activities of the National Diabetes Information Clearinghouse (NDIC). The booklet is illustrated with black-and-white line drawings. 9 figures.

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Prevention of and Screening for Diabetes Mellitus. In: Patel, A. Diabetes in Focus. 2nd ed. Lewisville, TX: Pharmaceutical Press. 2003. p. 135-140.

Diabetes mellitus is a common chronic disorder and represents a serious health care challenge. The prevalence of diabetes is increasing worldwide and considerable progress has been made in the understanding of diabetes management. This chapter on the prevention of and screening for diabetes mellitus is from a textbook that details the practical pharmaceutical care that pharmacists can provide for people with diabetes. In this chapter, the author summarizes prevention strategies, implemented at three levels, that have been used in an attempt to reduce the incidence of morbidity and mortality from diabetes complications. The author focuses primarily on the primary prevention of the disease and population screening for early diagnosis of diabetes mellitus. Topics include risk factors, symptoms, and screening methods. 3 figures. 13 references.

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Quality of Care for Patients Diagnosed with Diabetes at Screening. Diabetes Care. 26(2): 367-371. February 2003.

Screening for diabetes has the potential to be an effective intervention, especially if patients have intensive treatment of their newly diagnosed diabetes and comorbid hypertension (high blood pressure). This article reports on a study undertaken to determine the process and quality of diabetes care for patients diagnosed with diabetes by systematic screening. A total of 1,253 patients of a Veterans Affairs Medical Center aged 45 to 64 years who did not report having diabetes were screened for diabetes with an HbA1c (glycosylated hemoglobin, a measure of blood glucose levels over time) test. All subjects with an HbA1c level greater than 6.0 percent were invited for follow up blood pressure and fasting plasma glucose (FPG) measurements. A case of unrecognized diabetes was defined as HbA1c greater than 7.0 percent. For each of the 56 patients for whom a new diagnosis of diabetes was determined, the authors notified the patient's primary care provider of the diagnosis. One year after diagnosis, the authors performed follow up and review of the patient's medical records. Among patients diagnosed with diabetes at screening, 34 of 53 (64 percent) had evidence of diet or medical treatment for their diabetes, 42 of 53 (79 percent) had HbA1c measured within the year after diagnosis, 32 of 53 (60 percent) had cholesterol measured, 25 of 53 (47 percent) received foot examinations, 29 of 53 (55 percent) had eye examinations performed by an eye specialist, and 16 of 53 (30 percent) had any measure of urine protein. The mean blood pressure decline over the year after diagnosis for patients with diabetes was 2.3 mmHg; this decline was similar to that found for 183 patients in the study without diabetes. The authors conclude that patients with diabetes diagnosed at screening achieve less tight blood pressure control than similar patients without diabetes. Primary care providers do not appear to manage diabetes diagnosed at screening as intensively as long-standing diabetes and do not improve the management of hypertension given the new diagnosis of diabetes. 3 tables. 18 references.

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Risk of Stillbirth in Pregnancies Before and After the Onset of Diabetes. Diabetic Medicine. 20(9): 703- 707. September 2003.

This article reports on a study undertaken to evaluate the risk of stillbirth in pregnancies before and after the onset of diabetes. The retrospective cohort and nested case-control study, undertaken in the United Kingdom, identified 913 women with diabetes who previously had a pregnancy; 10,000 subjects without diabetes were randomly chosen as control. Stillbirth was defined as death in utero after 20 weeks or with birth weight greater than 500 grams. The results showed that stillbirth rates were higher in prediabetes pregnancies (19.7 per 1,000), and in those occurring after the diagnosis of diabetes (33.7 per 1,000), compared with the non-diabetes population (5.5 per 1,000). In further analysis, stillbirths were matched to four live births by maternal age and year of birth. Prediabetic pregnancy and pregnancy after the onset of diabetes were strongly associated with stillbirth. The authors conclude that improvements are still needed in the care of diabetes patients in pregnancy if the goal of reducing perinatal mortality to the levels of the normal population is to be achieved. The authors hypothesize that the increased risk of stillbirth in prediabetes pregnancy may be due to undiagnosed and untreated gestational diabetes or due to other metabolic abnormalities associated with adult-onset diabetes. 2 tables. 31 references.

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Silent Ischemia in People With Diabetes: A Condition That Must Be Heard. Clinical Diabetes. 21(1): 5-9. January 2003.

Silent ischemia is the presence of objective findings (exercise testing or ambulatory monitoring demonstrating electrocardiographic changes) suggestive of myocardial ischemia (lack of or reduced blood flow to the heart) that is not associated with angina (chest pain) or related symptoms. This article considers the impact of silent ischemia in people with diabetes. The authors stress that cardiovascular disease remains the leading cause of death in patients with diabetes. The impact of silent ischemia in these patients is concerning because patients may not seek medical attention and therefore may not be evaluated, diagnosed, or treated in a timely manner. Autonomic nervous system dysfunction is believed to be the primary underlying mechanism for impaired recognition of ischemia in patients with diabetes. Myocardial imaging techniques, echocardiography, and nuclear myocardial perfusion imaging are alternative and more sensitive methods of testing than resting ECG for diagnosing coronary artery disease (CAD) in people with diabetes. 2 tables. 10 references.

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Skin and Dental Care. In: Franz, M.J., et al, eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 1) Diabetes and Complications. Chicago, IL: American Association for Diabetes Educators (AADE). 2003. p. 87-96.

Understanding the effect of diabetes on the health of the skin, oral mucosa, and teeth is important as educators work with patients with diabetes. This chapter on skin and dental care is from the first handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter covers the relationship between metabolic control and healthy skin; the elements of effective skin care; the risk associated with loss of metabolic control when infection occurs in people with diabetes; the relationship between metabolic control and overall dental health; the factors that contribute to periodontal disease in people with diabetes; and effective dental care practices. The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 12 references.

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Special Problems and Management of the Child Less Than 5 Years of Age. In: Sperling, M.A. Type 1 Diabetes: Etiology and Treatment. Totowa, NJ: Humana Press Inc. 2003. p. 279-292.

Diabetes in a child less than 5 years old is characterized by unstable glycemic (blood glucose) control, frequent and asymptomatic hypoglycemia (low blood glucose), and greater risk of severe hypoglycemia. Management of diabetes in young children is complicated by special age-related problems, including difficulties in administering and adjusting small doses of insulin and unpredictable behavior pattern or day-to-day variations in diet and physical activities. This chapter on the special problems and management of the child less than 5 years of age with type 1 diabetes is from a book in which well-recognized physicians and researchers review the latest thinking about the causes of type 1 diabetes and the best approaches to treating both its acute and chronic complications. Topics include the characteristics of type 1 diabetes in young children, treatment objects, and treatment means and strategy. The authors stress that a multidisciplinary approach by a specialized team available for frequent contacts and that gives children and parents an adapted continuing education and support is necessary. In case of severe hypoglycemia despite a well-conducted conventional therapy, a more physiological way of insulin treatment, such as continuous subcutaneous insulin infusion (CSII) has been shown to be well-tolerated by young children and allows achievement of good metabolic control without severe hypoglycemia under the supervision of a specialized team. 3 figures. 3 tables. 54 references.

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Type 1 Diabetes: A Healthier Life for Adults With Diabetes. San Bruno, CA: The StayWell Company. 2003. 16 p.

This booklet offers a friendly, graphics-intensive approach to learning about type 1 diabetes and its care. The booklet is designed to educate young adults who have just been diagnosed with type 1 diabetes. Topics include the causes of diabetes, the impact of diabetes on one's daily activities, emotions that can be expected with the diagnosis, the members of the patient care team, how insulin works in the body, how to monitor one's blood glucose (SMBG, self-monitoring of blood glucose), the equipment and supplies used (blood glucose meters, needles, insulin pen, insulin pump), hypoglycemia (low blood glucose) and its symptoms, hyperglycemia (high blood glucose) and its complications, the role of healthy eating, the importance of exercise, getting good medical care, handling sick days, and how to learn more about diabetes. The booklet offers the contact information for four resource organizations through which readers can get more information. The booklet is illustrated with cartoon figures, full-color photographs, and brightly colored graphics.

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Type 2 Diabetes. Yardley, PA: The StayWell Company: KRAMES Health and Safety Education. 2003. 13 p.

This booklet helps readers recently diagnosed with type 2 diabetes understand and manage the disease. Type 2 diabetes is a chronic and progressive condition that makes it hard for the body to break food down into energy. The booklet first describes the professionals who may be a part of the patient care team, including an endocrinologist, a registered dietitian, a diabetes educator, and a psychologist or social worker. The booklet then discusses the pathology of type 2 diabetes, the importance of managing the disease, how to check one's blood glucose (sugar), healthy eating, the role of physical activity and exercise, medications and drug therapy, treating high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia) levels, the need for regular doctor's visits, self care, preventive strategies (i.e., preventing hypoglycemia while driving, preparing for emergencies), preparing for special situations (sick days, travel), and where to find emotional support. The brochure is illustrated with full-color drawings of patients and health care providers. The brochure concludes with the contact information for four resource organizations that can provide assistance. The brochure is also available in Spanish. 39 figures.

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What You Should Know About Celiac Disease. Diabetes Self-Management. 20(1): 66,68-69,71-73. January-February 2003.

This article helps readers with diabetes understand celiac disease (gluten intolerance) and the interplay of diabetes and celiac disease in people who have both conditions. The author reviews celiac disease, its diagnosis, complications, and treatment, then discusses how to manage both diseases. In people with type 1 diabetes, malabsorption of nutrients from undiagnosed celiac disease can lead to frequent unexplained low or high blood glucose readings. Insulin needs are frequently lower during the time before diagnosis. Once treatment of celiac disease has begun and nutrients are better absorbed, insulin doses may need to be adjusted. Treating celiac disease should make it easier to keep diabetes under control. The article includes a table of the carbohydrate content of selected gluten-free foods, a list of manufacturers and retailers of gluten-free products, a list of books and other resources, and a description of four national support groups through which readers can obtain additional information. 1 figure. 1 table. 15 references.

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When More Than One Family Member Has Diabetes. Diabetes Self-Management. 20(1): 92-95. January-February 2003.

This article helps readers understand the issues and concerns that may arise when more than one person in a family has diabetes. The author notes that each person's diabetes is unique and may require different treatment approaches, there is a lot of work and responsibility accompanying diabetes management, and multiple diagnoses of diabetes in the family may also give rise to feelings of anger, fear, sadness, anxiety, or guilt among family members. The author discusses the role of heredity, emotional responses, parents' roles, remembering the individual, and keeping additional family members apprised of the situation. The author concludes with a few suggestions for strategies to address diabetes care as a family.

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