Clinical Dilemmas in Diabetes

Description:

Clinical Dilemmas in Diabetes answers the clinical questions commonly encountered when diagnosing, treating, and managing patients with diabetes and its associated complications. Designed to support informed, evidence-based care, this authoritative clinical guide includes contributions from leading endocrinologists and diabetes researchers that discuss a diverse range of recent developments. Concise and focused chapters cover prediabetes, diabetes diagnosis, initial evaluation and management, disease complications, and cardiovascular disease and risk factors.

Now in its second edition, Clinical Dilemmas in Diabetes contains extensively reviewed and revised information throughout. New and updated chapters examine prediction, diagnosis, and management of early Type 1 diabetes, ophthalmic complications, screening asymptomatic patients for cardiovascular disease, new agents for treatment of dyslipidemia, closed loop systems in Type 1 diabetes, upper gastrointestinal manifestations, managing hyperglycemia in critically ill patients, and more. Edited by Dr. Vella at the Mayo Clinic, this highly practical resource:

Encourages evidence-based clinical decision-making, rather than algorithm-based approaches

Provides clear guidance on common problematic areas, especially in cases where conflicts in treatment for the disease and the complications occur

Emphasizes the importance of translating the results of clinical trials to individual care and management of diabetes

Contains effective learning and revision tools, including Learning Points, chapter introductions and summaries, tables and figures, color diagrams and charts, and full references

Part of the popular Clinical Dilemmas series, Clinical Dilemmas in Diabetes is a must-have guide for anyone involved in the treatment of patients with diabetes, particularly endocrinologists, diabetes specialists and consultants, cardiologists, residents, fellows, specialist nurses, and general practitioners with an interest in diabetes.

PART I: Prediabetes and the Diagnosis of Diabetes

1 “Is Prediabetes a Risk Factor or Is It a Disease?”

What is prediabetes?

Rationale for the diagnostic criteria for diabetes mellitus and prediabetes

Epidemiology of prediabetes

Pathogenesis of impaired fasting glucose and impaired glucose tolerance

Screening recommendations for prediabetes

Risk of progression from prediabetes to diabetes mellitus

Microvascular complications associated with prediabetes

Macrovascular complications and mortality associated with prediabetes

Management of prediabetes

Conclusion

References

2 Early Diagnosis of Type 1 Diabetes – Useful or a Pyrrhic Victory?

Introduction

Pathogenesis of T1D: An Update in View of Defining Preventive Tools

Prediction of T1D as the Basis for Disease Prevention

Prevention of T1D: Current Status

Conclusions

Acknowledgments

References

3 Reclassifying or Declassifying Diabetes? Can Clinical Characteristics Guide Classification and Treatment?

The pathophysiology of hyperglycemia – type 1 vs type 2 diabetes

Genetic and environmental influences on disease presentation

Measuring insulin secretion

Autoantibodies

“Atypical” diabetes, glucose toxicity and the honeymoon period

Cystic fibrosis‐related diabetes

Novel approaches to reclassifying diabetes

Conclusions

Bibliography

4 How Should Secondary Causes of Diabetes Be Excluded?

Introduction

Hereditary haemochromatosis

Cystic fibrosis‐related diabetes

Pancreatic‐cancer‐associated diabetes

Diabetes due to hormone excess

Post‐transplantation diabetes mellitus (PTDM)

Diabetes associated with atypical antipsychotic drug use

Diabetes associated with HIV infection and its treatment

Diabetes secondary to immunotherapy

Monogenic forms of diabetes

References

5 How to Screen Appropriately for Monogenic Diabetes

Maturity onset diabetes of the young (MODY)

Differentiating monogenic diabetes from type 1 diabetes

Differentiating monogenic diabetes from type 2 diabetes

When to screen for monogenic diabetes?

Common forms of monogenic diabetes

Conclusions

References

PART II: Initial Evaluation and Management of Diabetes

6 Managing Gestational Diabetes During and After Pregnancy

Introduction

GDM diagnosis

GDM management

Conclusion

References

7 What Is the Role of Self‐Monitoring in Diabetes? Is There a Role for Postprandial Glucose Monitoring? How Does Continuous Glucose Monitoring Integrate into Clinical Practice?

Self‐monitoring of blood glucose

SMGB in type 1 DM and insulin‐requiring T2DM patients

SMBG in non‐insulin‐requiring T2DM

Postprandial SMBG

Continuous glucose monitoring systems

Flash glucose monitoring systems

References

8 Does HbA1c Remain the Most Important Therapeutic Target in Outpatient Management of Diabetes?

The glucose hypothesis and vascular risk

Measuring glycemic control in the clinical management of diabetes

Additional therapeutic targets to consider for hyperglycemia in the outpatient management of diabetes

Summary

References

9 Technology Issues: Continuous Glucose Monitoring, Insulin Pumps, and Closed Loop Control for Patients with Diabetes

Introduction

Continuous Glucose Monitoring (CGM) for Diabetes Care

Currently Approved CLC for T1DM

Post‐marketing Studies

Ongoing Pivotal Studies/Anticipated Closed Loop System

Closed Loop Control Initiation at Onset of T1D

CLC is Being Tested in Specific Subgroups with Type 1 Diabetes at Present

Cost of Diabetes Technologies

Insulin Pump Use for People With T2DM

Conclusion

References

10 Optimizing Diet in Patients with Diabetes

Summary

References

11 Are Insulin Sensitizers Useful Additions to Insulin Therapy?

Insulin sensitizers

Biguanides

Thiazolidinediones

Discussion

References

12 Incretin‐Based Therapy for the Management of Type 2 Diabetes

Introduction

The incretin effect

Early development of GLP‐1 RA therapy

Clinical benefits and side effects of GLP‐1 RAs

The evidence for GLP‐1 ras in management of type 2 diabetes

The role of DPP‐4 inhibitors in type 2 diabetes management

Cardiovascular outcomes with incretin‐based therapies for type 2 diabetes

Incorporating incretin‐based therapy into clinical practice

Conclusions

Key points

References

PART III: Diagnosis and Management of Cardiovascular Risk Factors and Cardiovascular Disease

13 Screening Patients with Prediabetes and Diabetes for Cardiovascular Disease

Introduction

Guidelines

Hyperglycemia and risks of CVD

Traditional risk factors

Diabetes‐specific clinical risk predictors of CVD

Nontraditional risk factors

Screening tools

Risk calculators

Summary

References

14 Choosing Medications for Type 2 Diabetes – What Weighting Should Be Given to Cardiovascular Risk Reduction?

Diabetes and cardiovascular risk: how does it affect therapeutic goals?

Metformin

Sulfonylureas

Thiazolidinediones

Acarbose

Colesevelam

Pramlintide

Bromocriptine

Glucagon‐like peptide‐1‐based therapy

SGLT‐2i

Conclusions

References

15 Choosing Medications for Weight Loss in Type 2 Diabetes Mellitus

Introduction: Prevalence and relationship of obesity and type 2 diabetes

Therapeutic classes for the treatment of type 2 Diabetes and their effects on weight

Use of diabetic medications for weight loss in patients without diabetes

A Practical Guide to Choosing medication for type 2 diabetes with weight loss in mind

References

16 Are Statins the Optimal Therapy for Cardiovascular Risk in Patients with Diabetes? What Newer Agents Are There for the Treatment for Dyslipidemia in Diabetes? Are Triglycerides an Important Risk Factor for Diabetes?

Introduction

Dyslipidemia in type 2 diabetes mellitus

Treatment of dyslipidemia in type 2 diabetes mellitus

Evidence that PSCK 9 is associated with increased CVD risk

Evidence linking hypertriglyceridemia to CVD risk in diabetes mellitus

Evidence that treating hypertriglyceridemia will decrease CVD risk in DM

Discussion

References

17 New Agents for Treatment of Dyslipidemia

Introduction

PCSK9 and regulation of LDL‐Cholesterol levels

PCSK9 inhibitors: Efficacy and safety

PCSK9 inhibitors: Cardiovascular outcome trails

PCSK9 inhibitor use in patients with diabetes

PCSK9 inhibitors: Clinical use and future perspectives

Other novel lipid‐lowering therapies

Conclusions

References

18 The Role of Bariatric Surgery in Obese Patients with Diabetes: Primary or Rescue Therapy?

Introduction

Possible Mechanisms by Which Bariatric Surgery Improves T2DM

Role of Bariatric Surgery in T2DM: First‐line Therapy or Rescue Therapy When Medical Options Fail?

Role of Weight Loss Surgery in the Treatment of Patients with T2DM and BMI < 35 kg/m2

New Techniques that can be an Option in the Future

References

19 Treatment Strategies in Patients with Diabetes Mellitus and Ischemic Heart Disease

Introduction

Role of medical therapy and glucose control

Coronary revascularization

Conclusions

References

PART IV: Management of Disease Complications

20 Diabetes Management in Patients with Critical and Non‐Critical Illness

Introduction

Mechanisms Mediating Adverse Effects of Hyperglycemia During Critical Illness

Large Intervention Studies

General Findings (Tables 20.1 and 20.2)

Role of Hypoglycemia in Interpretation of Study Results (Table 20.3)

Methodology for Glucose Testing

The Role of Nutritional Support in Results of Trials

Conclusions

Acknowledgments

References

21 Diagnosis and Management of Ophthalmic Complications of Diabetes

Introduction

Risk Factors for Diabetic Retinopathy

Screening

Prevention

Ocular Complications

Treatment of Diabetic Retinopathy

Retinal Vein Occlusion

Neovascular Glaucoma

Diabetic Macular Edema

Treatment of DME

Cornea

Cataract

Orbital Disease

References

22 Upper Gastrointestinal Manifestations of Diabetes

Introduction

Epidemiology

Mechanisms and pathophysiology underpinning upper gastrointestinal symptoms in diabetes mellitus

Upper gastrointestinal manifestations associated with diabetes

Management of gastroparesis and dyspepsia

Conclusion

References

Index

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