Standards of medical care in diabetes.
TL;DR: I would like to take issue with the use of the phrase “standards of medical care in diabetes,” which is used to describe diabetes care standards, in the recently updated and circulatedADA 2006 Clinical Practice Recommendations.
Abstract: I write in reference to the recently updated and circulated “Standards of Medical Care in Diabetes,” in particular part II, “Screening for Diabetes,” which were recently updated and published in the American Diabetes Association (ADA) 2006 Clinical Practice Recommendations (1). I would like to take issue with the use of the phrase “standards of medical care in diabetes,” which is used to …
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TL;DR: The goals of this new consensus are to provide an abbreviated document to focus on key aspects of diagnosis and management, and to update the information based on new publications and the newer guidelines, but not to add an extensive list of references.
7,099 citations
TL;DR: The pathophysiology seems to be largely attributable to insulin resistance with excessive flux of fatty acids implicated, and a proinflammatory state probably contributes to the metabolic syndrome.
5,810 citations
TL;DR: A unified working diagnostic tool for the metabolic syndrome that is convenient to use in clinical practice and that can be used world-wide so that data from different countries can be compared.
Abstract: 469 Abstract Aims To establish a unified working diagnostic tool for the metabolic syndrome (MetS) that is convenient to use in clinical practice and that can be used world- wide so that data from different countries can be compared. An additional aim was to highlight areas where more research into the MetS is needed. Participants The International Diabetes Federation (IDF) convened a workshop held 12-14 May 2004 in London, UK. The 21 participants included experts in the fields of diabetes, public health, epidemiology, lipidology, genetics, metabolism, nutrition and cardiology. There were participants from each of the five con- tinents as well as from the World Health Organization (WHO) and the National Cholesterol Education Program—Third Adult Treatment Panel (ATP III). The workshop was sponsored by an educational grant from AstraZeneca Pharmaceuticals. Consensus process The consensus statement emerged following detailed discussions at the IDF workshop. After the workshop, a writing group produced a consensus statement which was reviewed and approved by all participants. Conclusions The IDF has produced a new set of criteria for use both epidemio- logically and in clinical practice world-wide with the aim of identifying people with the MetS to clarify the nature of the syndrome and to focus therapeutic strategies to reduce the long-term risk of cardiovascular disease. Guidance is included on how to compensate for differences in waist circumference and in regional adipose tissue distribution between different populations. The IDF has also produced recommendations for additional criteria that should be included when studying the MetS for research purposes. Finally, the IDF has identified areas where more studies are currently needed; these include research into the aetiology of the syndrome. Diabet. Med. 23, 469-480 (2006)
5,612 citations
St George's Hospital1, New York University2, McMaster University3, Brown University4, Catholic University of the Sacred Heart5, Hebron University6, University of Manitoba7, Emory University Hospital8, Hebrew University of Jerusalem9, Sunnybrook Health Sciences Centre10, University of Pittsburgh11, Saint Thomas - West Hospital12, University College London13, Vanderbilt University Medical Center14, Keio University15, Memorial Hospital of South Bend16, Cooper University Hospital17, University of Mississippi Medical Center18, Rush University Medical Center19, University of Ulsan20, Federal University of São Paulo21, Regions Hospital22, St. Michael's Hospital23, Washington University in St. Louis24, Ottawa Hospital25, University of Sydney26, Mount Sinai Hospital27, University of New South Wales28, Fujita Health University29, Christiana Care Health System30, Stanford University31, King Abdullah University of Science and Technology32, University of Kansas33, Harvard University34, California Pacific Medical Center35, University of Amsterdam36, Houston Methodist Hospital37
TL;DR: Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
Abstract: To provide an update to “Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012”. A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.
4,303 citations
TL;DR: The final purpose is to improve patient care and awareness of the importance of NAFLD, and to assist stakeholders in the decision-making process by providing evidence-based data, which also takes into consideration the burden of clinical management for the healthcare system.
3,117 citations
References
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TL;DR: The prevalence and titers of insulin antibodies in insulin-treated patients have markedly decreased, but numerous patients still produce antibody levels that may alter insulin pharmacokinetics, leading to higher postprandial blood glucose levels and to an increased risk for delayed hypoglycemia.
Abstract: The prevalence and titers of insulin antibodies in insulin-treated patients have markedly decreased, mainly as a consequence of the improvements in the purity of insulin preparations and to a lesser degree because of the changes of species of insulin (human insulin). However, numerous patients still produce antibody levels that may alter insulin pharmacokinetics, leading to higher postprandial blood glucose levels and to an increased risk for delayed hypoglycemia. Although the effects of antibodies on long-term glycemic control are less clear, the metabolic consequences of altered pharmacokinetics are clinically evident in patients in whom near normoglycemia is the goal and who are treated predominantly with short-acting insulin. Lipoatrophy and immunological insulin resistance, which are also antibody-induced phenomena, have become rare. Whether pregnancies in diabetic mothers with antibodies carry an increased risk for serious or fatal complications is not clear; neonates of these mothers are probably at increased risk for neonatal hypoglycemia.
96 citations
TL;DR: Although several authors have previously shown that circulating anti-insulin antibodies do affect the pharmacokinetics and pharmacodynamics of injected insulin, Heise et al. as mentioned in this paper were unable to show that circulating antinulin antibodies affect injected insulin.
Abstract: Although several authors have previously shown that circulating anti-insulin antibodies do affect the pharmacokinetics and pharmacodynamics of injected insulin (1–4), Heise et al. (5) were unable to …
46 citations
TL;DR: Early glomerular hyperfiltration and the later development of nephropathy in Type i (insulin-dependent) diabetes mellitus and the accurate determination of tracer clearance rates and equilibrium distribution volume fi'om single injection plasma measurements using numerical analysis are described.
Abstract: 1. Mogensen CE (1971) Glomerular filtration rate and renal plasma flow in short-term and long-term juvenile diabetes mellitus. Scand J Clin Lab Invest 28:91-100 2. Ditzel J, Schwartz M (1967) Abnormally increased glomerular filtration rate in short-term insulin-treated diabetic subjects. Diabetes 16:264-267 3. Mogensen CE, Christensen CK (1984) Predicting diabetic nephropathy in insulin-dependent patients. N Engl J Med 311:89-93 4. Mogensen CE (1986) Early glomerular hyperfiltration in insulindependent diabetics and late nephropathy. Scand J Clin Lab Invest 46:201-206 5. Lervang HH, Jensen J, Brochner-Mortensen J, Ditzel J (1988) Early glomerular hyperfiltration and the later development of nephropathy in Type i (insulin-dependent) diabetes mellitus. Diabetologia 31:723-729 6. Veall N, Gibbs GP (1982) The accurate determination of tracer clearance rates and equilibrium distribution volume fi'om single injection plasma measurements using numerical analysis. In: Radionuclides in nephrology. Joekes AM, Constable AR, Brown NJM, Tauxe WN (eds) Academic Press, London. Grune and Stratton, New York, pp 125-130
6 citations