Showing papers by "Richard Kahn published in 2007"

'Computer modeling of diabetes and its complications: A report on the Fourth Mount Hood Challenge Meeting'

Abstract: Computer simulation models are mathematical equations combined in a structured framework to represent some real or hypothetical system. One of their uses is to allow the projection of short-term data from clinical trials to evaluate clinical outcomes and costs over a long-term period. This technology is becoming increasingly important to assist decision making in modern medicine in situations where there is a paucity of long-term clinical trial data, as recently acknowledged in the American Diabetes Association Consensus Panel Guidelines for Computer Modeling of Diabetes and its Complications. The Mount Hood Challenge Meetings provide a forum for computer modelers of diabetes to discuss and compare models and identify key areas of future development to advance the field. The Fourth Mount Hood Challenge in 2004 was the first meeting of its kind to ask modelers to perform simulations of outcomes for patients in published clinical trials, allowing comparison against "real life" data. Eight modeling groups participated in the challenge. Each group was given three of the following challenges: to simulate a trial of type 2 diabetes (CARDS [Collaborative Atorvastatin Diabetes Study]); to simulate a trial of type 1 diabetes (DCCT [Diabetes Control and Complications Trial]); and to calculate outcomes for a hypothetical, precisely specified patient (cross-model validation). The results of the models varied from each other and for methodological reasons, in some cases, from the published trial data in important ways. This approach of performing systematic comparisons and validation exercises has enabled the identification of key differences among the models, as well as their possible causes and directions for improvement in the future. © 2007 by the American Diabetes Association.

Metabolic Syndrome Is It a Syndrome? Does It Matter?

Abstract: To provide useful answers to the title questions, the first issue to resolve is what is meant by the term “metabolic syndrome.” If it is supposed to refer to a loose clustering of signs that are associated with cardiovascular disease (CVD) and type 2 diabetes mellitus, which can largely be ascribed to what we conceptually call “insulin resistance,” then the term may have some utility. However, if the term represents a very specific algorithm that should be used to diagnose a unique disease, it is highly misleading and ineffective. Unfortunately, many proponents of the term write about and discuss it as if both meanings are interchangeable, and as a result, they effectively blur all the problems that have arisen when referring to the term, confuse practitioners who are unable to easily understand the distinction, and do clinical medicine a great disservice. Let’s look closely at the issues. Response by Beaser and Levy p 1811 For several decades, we have had many terms that represented a clustering of signs related to CVD and diabetes mellitus that seemed to occur more often than chance would dictate. Certainly, an aggregate of signs associated with a morbid process that together constitute the picture of a disease may be rightly called a syndrome. In the early days, many investigators put a name to the condition that reflected its “metabolic”1–3 or “insulin resistance”4 origin. At that time, the cluster referred to the presence of obesity, hyperglycemia, hypertension, hyperlipidemia, and sometimes hyperuricemia. Reaven, in his now classic publication,5 provided an elegant explanation for how insulin resistance and its compensatory hyperinsulinemia could predispose individuals to the above conditions and thus was the underlying cause of much CVD and, of course, diabetes mellitus. Among its many attributes, Reaven’s publication opened the door to considerably more research …

Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes

Abstract: Obesity is an important risk factor for cardiometabolic dis-eases, including diabetes, hypertension, dyslipidemia, and cor-onary heart disease (CHD). Several leading national and inter-national institutions, including the World Health Organizationand the National Institutes of Health, have provided guidelinesforclassifyingweightstatusbasedonbodymassindex(BMI;inkg/m

Консенсус группы организаций Здоровья Америки: Ассоциации по профилактике ожирения и коррекции мас$ сы тела, Северо$Американской ассоциации по изучению ожирения, Общества по ожирению, Американского обще$ ства по проблемам питания и Американской диабетологической ассоциации. Waist Circumference and Cardiometabolic Risk A Consensus Statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association

Abstract: Ожирение является важнейшим фактором рискасердечнососудистых заболеваний и болезней обменавеществ, включая сахарный диабет, артериальную гипертензию, дислипидемию и ишемическую болезньсердца (ИБС). Целый ряд ведущих мировых институтов и обществ признают Классификацию массытела, основанную на индексе массы тела (ИМТ), такие как всемирная организация здравоохранения(ВОЗ) и Национальный институт здоровья [1, 2]. Согласно эпидемиологическим исследованиям имеетсяпрямая корреляция между ИМТ, риском осложненийи смертностью [см. 3, 4]. Мужчины и женщины с ИМТ,превышающим 30 кг/м