XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. 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. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Emotion-regulation strategies across psychopathology: A meta-analytic review.

The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) 

Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR) 

ABI
: ankle-brachial index

/pdf/2016-esc-eas-guidelines-for-the-management-of-dyslipidaemias-3oe2qnm09b.pdf

2016 ESC/EAS Guidelines for the Management of Dyslipidaemias

Inflammation is a biological response of the immune system that can be triggered by a variety of factors, including pathogens, damaged cells and toxic compounds. These factors may induce acute and/or chronic inflammatory responses in the heart, pancreas, liver, kidney, lung, brain, intestinal tract and reproductive system, potentially leading to tissue damage or disease. Both infectious and non-infectious agents and cell damage activate inflammatory cells and trigger inflammatory signaling pathways, most commonly the NF-κB, MAPK, and JAK-STAT pathways. Here, we review inflammatory responses within organs, focusing on the etiology of inflammation, inflammatory response mechanisms, resolution of inflammation, and organ-specific inflammatory responses.

/pdf/inflammatory-responses-and-inflammation-associated-diseases-1vf5a1j4st.pdf

Inflammatory responses and inflammation-associated diseases in organs

These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include (1) the replacement of the term “prehypertension” with the term “elevated blood pressure,” (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.

Transdiagnostic Polygenic Risk Scores in Youth With Bipolar Disorder

Bipolar disorder (BD) is a highly heritable illness that is associated with increased risk of premature cardiovascular disease (CVD). Prior studies have observed increased CVD risk factors in unaffected adult relatives of adults with BD. Here we examined metabolic syndrome (MetS) and its components in a controlled study of adults with BD and their offspring. 

Cardiometabolic risk in individuals with bipolar disorder and their offspring

Dyslipidemia is common and associated with mood symptom severity in adults with bipolar disorder (BD). However, there is a gap in knowledge on this topic in youth with BD. We set out to examine the associations of lipid levels with mood states and symptoms in youth with BD. 

28.2 Atherogenic Lipid Profiles Differ Across Mood States Among Youth With Bipolar Disorder

To examine the association between obesity and the course of pediatric bipolar disorder (BP). Subjects (N=323), 7-17 years old, were in the Course and Outcome of Bipolar Illness among Youth (COBY) study. Illness characteristics during 4 years of follow-up were examined as they relate to obesity at intake.

Compared to non-obese subjects, obese subjects spent a significantly greater proportion of follow-up weeks with syndromal symptoms, which was mainly accounted for by major depressive episodes. Obese subjects were significantly more likely to experience syndromal manic and depressive episodes. Obese subjects were more likely to demonstrate psychosis during follow-up, and there was a trend toward increased rates of psychiatric hospitalization. Obesity is associated with a more severe prospective longitudinal course of BP among youth.

Obesity and the longitudinal course of pediatric bipolar disorder

Youth with bipolar disorder are at high risk for suicide and have high rates of self-harm. Self-harm, defined as a history of suicide attempt and/or nonsuicidal self-injury, is one of the biggest risk factors for suicide, yet the mechanisms underlying the risk for self-harm and progression to suicide remain poorly understood. Neurocognitive impairment is well-established in youth with bipolar disorder. A prior study found that youth with MDD and a history of self-harm have altered risk-taking and decision-making performance compared to those without a history of self-harm. 

Benjamin I. Goldstein

Papers

Transdiagnostic Polygenic Risk Scores in Youth With Bipolar Disorder

Cardiometabolic risk in individuals with bipolar disorder and their offspring

28.2 Atherogenic Lipid Profiles Differ Across Mood States Among Youth With Bipolar Disorder

Obesity and the longitudinal course of pediatric bipolar disorder

2.101 Risk-Sensitive Decision Making and Self-Harm Among Youth With Bipolar Disorder