Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.53
S. Kalra
W hile efficacy and safety are proven for all modern glucose-lowering drugs, their tolerability may vary. This is especially true in terms of weight gain. This communication proposes a váro-centric model of diabetes care. This approach helps choose appropriate glucose-lowering therapy, based upon weight (body mass index). The váro-centric model suggests a weight-centric approach to selection of drugs. While respecting the tenets of patient-centred care and good clinical sense, it serves as a clinical and teaching tool for rational prescription in diabetes.
{"title":"Váro-centric Diabetes Management","authors":"S. Kalra","doi":"10.17925/USE.2017.13.02.53","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.53","url":null,"abstract":"W hile efficacy and safety are proven for all modern glucose-lowering drugs, their tolerability may vary. This is especially true in terms of weight gain. This communication proposes a váro-centric model of diabetes care. This approach helps choose appropriate glucose-lowering therapy, based upon weight (body mass index). The váro-centric model suggests a weight-centric approach to selection of drugs. While respecting the tenets of patient-centred care and good clinical sense, it serves as a clinical and teaching tool for rational prescription in diabetes.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"75 1","pages":"53"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.57
S. Twigg, M. Kazemi, M. Craig
{"title":"Flash Continuous Glucose Monitoring and its IMPACT to REPLACE Blood Glucose Monitoring in the Management of Type 1 and Type 2 Diabetes","authors":"S. Twigg, M. Kazemi, M. Craig","doi":"10.17925/USE.2017.13.02.57","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.57","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"13 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.01.17
M. Marcovecchio
{"title":"Complications of acute and chronic hyperglycemia","authors":"M. Marcovecchio","doi":"10.17925/USE.2017.13.01.17","DOIUrl":"https://doi.org/10.17925/USE.2017.13.01.17","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"13 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.75
G. Priya, S. Kalra, V. Bhambri
T here is an unmet need for adjunctive non-insulin-based therapies in type 1 diabetes (T1D). Weight gain, recurrent hypoglycemia and suboptimal glycemic control remain significant challenges. Sodium-glucose co-transporter-2 (SGLT2) inhibitors and dual inhibitors of sodium-glucose co-transporter-1 (SGLT1) and SGLT2 may have a potential role as an add-on therapy to insulin. The benefits include improved glycemic control, weight reduction, and reduced insulin dose requirement. However, the risk of diabetic ketoacidosis with SGLT2 inhibitors is significant and the diagnosis may be delayed due to absence of significant hyperglycemia. At present, SGLT2 inhibitors are not approved for use in T1D, and the risks should be discussed at length with the patient. We propose strategies to minimize the risk of diabetic ketoacidosis associated with off-label use of SGLT2 inhibitors in T1D.
{"title":"Sodium-glucose Co-transporter-2 Inhibitors in Type 1 Diabetes—a Dangerous Ally","authors":"G. Priya, S. Kalra, V. Bhambri","doi":"10.17925/USE.2017.13.02.75","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.75","url":null,"abstract":"T here is an unmet need for adjunctive non-insulin-based therapies in type 1 diabetes (T1D). Weight gain, recurrent hypoglycemia and suboptimal glycemic control remain significant challenges. Sodium-glucose co-transporter-2 (SGLT2) inhibitors and dual inhibitors of sodium-glucose co-transporter-1 (SGLT1) and SGLT2 may have a potential role as an add-on therapy to insulin. The benefits include improved glycemic control, weight reduction, and reduced insulin dose requirement. However, the risk of diabetic ketoacidosis with SGLT2 inhibitors is significant and the diagnosis may be delayed due to absence of significant hyperglycemia. At present, SGLT2 inhibitors are not approved for use in T1D, and the risks should be discussed at length with the patient. We propose strategies to minimize the risk of diabetic ketoacidosis associated with off-label use of SGLT2 inhibitors in T1D.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"13 1","pages":"75"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.99
L. Darki, S. Beydoun
I ntroduction: Multifocal motor neuropathy (MMN) is a rare, treatable, immune-mediated neuropathy often associated with multifocal conduction block (CB). The hallmark electrodiagnostic feature is the presence of CB occurring at non-entrapment sites. However, MMN without CB has also been described and can be diagnosed, even in the absence of CB. Therefore, it is crucial to diagnose and identify MMN cases without CB, as it is a treatable disorder. Case presentation: We present a case with progressive symptoms of asymmetric distal upper and lower extremity weakness with no sensory deficits. Intravenous immunoglobulin (IVIG) therapy was initiated, as the patient fulfilled the criteria for probable MMN, despite the absence of CB. The patient’s symptoms demonstrated a relative plateau phase in response to IVIG. Although the patient lost follow-up visits, repeated electrodiagnostic study, conducted 11 years after initial presentation, revealed new CB in nerve segments that previously did not show any evidence of CB. Conclusion: This case emphasizes the importance of early diagnosis and respectively initiating early IVIG treatment in MMN, in order to maintain the clinical function. Underdiagnosis of clinically suspected MMN, based on absence of CB, will result in denial of treatment to potential IVIG responders.
{"title":"Delayed Appearance of Conduction Block in Multifocal Motor Neuropathy—A Case Report","authors":"L. Darki, S. Beydoun","doi":"10.17925/USE.2017.13.02.99","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.99","url":null,"abstract":"I ntroduction: Multifocal motor neuropathy (MMN) is a rare, treatable, immune-mediated neuropathy often associated with multifocal conduction block (CB). The hallmark electrodiagnostic feature is the presence of CB occurring at non-entrapment sites. However, MMN without CB has also been described and can be diagnosed, even in the absence of CB. Therefore, it is crucial to diagnose and identify MMN cases without CB, as it is a treatable disorder. Case presentation: We present a case with progressive symptoms of asymmetric distal upper and lower extremity weakness with no sensory deficits. Intravenous immunoglobulin (IVIG) therapy was initiated, as the patient fulfilled the criteria for probable MMN, despite the absence of CB. The patient’s symptoms demonstrated a relative plateau phase in response to IVIG. Although the patient lost follow-up visits, repeated electrodiagnostic study, conducted 11 years after initial presentation, revealed new CB in nerve segments that previously did not show any evidence of CB. Conclusion: This case emphasizes the importance of early diagnosis and respectively initiating early IVIG treatment in MMN, in order to maintain the clinical function. Underdiagnosis of clinically suspected MMN, based on absence of CB, will result in denial of treatment to potential IVIG responders.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"13 1","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.01.30
F. Y. A. Slail, H. Rashid, S. Fadl, O. Kheir
Background: Diabetic Muslims who wish to fast are recommended to undergo medical counseling prior to fasting to prevent complications. This study assesses knowledge, attitudes, and practices, and identifies issues related to building capacity for physicians treating diabetic patients. Methods: We conducted a qualitative study based on focus group discussions with primary healthcare center (PHCC) doctors who manage diabetic patients in the Riyadh region. Results: There is a lack of knowledge of the classification system for risk assessment of diabetic patients who fast during Ramadan. All the responses showed that there were misconceptions regarding nitroglycerin tablets placed under the tongue to nullify fasting. Other issues addressed by respondents include the following: how to adjust the dose and subsequently convince the patient to follow a new regimen, loss of patient follow-up due to referral to the hospital, the refusal of some laboratories to perform examinations for patients referred from other PHCCs, and lack of patient medication compliance. Conclusion: The study reported a lack of knowledge among respondents regarding therapeutic and lifestyle management of diabetic patients during Ramadan. Other issues addressed by participants include lack of healthcare services at primary healthcare center facilities and services not working effectively. To empower physicians and improve knowledge, attitude, and practices for managing diabetic patients during Ramadan, experience, continuous training, as well as fully equipped healthcare centers (including both laboratory and pharmaceutical medical supplies) play a crucial role.
{"title":"Physician Awareness in Diabetes Management During Ramadan 2015—A Focus Group Discussion","authors":"F. Y. A. Slail, H. Rashid, S. Fadl, O. Kheir","doi":"10.17925/USE.2017.13.01.30","DOIUrl":"https://doi.org/10.17925/USE.2017.13.01.30","url":null,"abstract":"Background: Diabetic Muslims who wish to fast are recommended to undergo medical counseling prior to fasting to prevent complications. This study assesses knowledge, attitudes, and practices, and identifies issues related to building capacity for physicians treating diabetic patients. Methods: We conducted a qualitative study based on focus group discussions with primary healthcare center (PHCC) doctors who manage diabetic patients in the Riyadh region. Results: There is a lack of knowledge of the classification system for risk assessment of diabetic patients who fast during Ramadan. All the responses showed that there were misconceptions regarding nitroglycerin tablets placed under the tongue to nullify fasting. Other issues addressed by respondents include the following: how to adjust the dose and subsequently convince the patient to follow a new regimen, loss of patient follow-up due to referral to the hospital, the refusal of some laboratories to perform examinations for patients referred from other PHCCs, and lack of patient medication compliance. Conclusion: The study reported a lack of knowledge among respondents regarding therapeutic and lifestyle management of diabetic patients during Ramadan. Other issues addressed by participants include lack of healthcare services at primary healthcare center facilities and services not working effectively. To empower physicians and improve knowledge, attitude, and practices for managing diabetic patients during Ramadan, experience, continuous training, as well as fully equipped healthcare centers (including both laboratory and pharmaceutical medical supplies) play a crucial role.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"13 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.55
S. Kalra, Y. Balhara, M. Bathla
A lexithymia is a personality trait that refers to the inability to express emotions in words. Medical professionals have been criticized for being “alexithymic” by many observers. From a clinician’s perspective, an alexithymic diabetes care professional is one who is unable to empathize with the patient, or to understand the patient’s emotional status and needs. In overzealous attempts at being “patientcentric,” one often tends to undermine the importance of the fact that diabetes care is a two-way process. The diabetes care professional is as important a component of diabetology as the person with diabetes. Balanced models and constructs are available which highlight the equal importance of the physician and other stakeholders of the healthcare system as well. The term we propose is “eulexithymia,” which we define as a balanced ability to express one’s emotions and understand others’ feelings. When used to describe a diabetes care professional, a “eulexithymic” professional is one who understands and responds to a patient’s feelings in a balanced manner, without letting oneself be unduly and inappropriately affected by them.
{"title":"“Eulexithymia” and Diabetes Care Professionals","authors":"S. Kalra, Y. Balhara, M. Bathla","doi":"10.17925/USE.2017.13.02.55","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.55","url":null,"abstract":"A lexithymia is a personality trait that refers to the inability to express emotions in words. Medical professionals have been criticized for being “alexithymic” by many observers. From a clinician’s perspective, an alexithymic diabetes care professional is one who is unable to empathize with the patient, or to understand the patient’s emotional status and needs. In overzealous attempts at being “patientcentric,” one often tends to undermine the importance of the fact that diabetes care is a two-way process. The diabetes care professional is as important a component of diabetology as the person with diabetes. Balanced models and constructs are available which highlight the equal importance of the physician and other stakeholders of the healthcare system as well. The term we propose is “eulexithymia,” which we define as a balanced ability to express one’s emotions and understand others’ feelings. When used to describe a diabetes care professional, a “eulexithymic” professional is one who understands and responds to a patient’s feelings in a balanced manner, without letting oneself be unduly and inappropriately affected by them.","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"13 1","pages":"55"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.70
K. Zackowski
{"title":"Exercise as Medicine in Multiple Sclerosis—Moving Beyond Compensatory Benefits","authors":"K. Zackowski","doi":"10.17925/USE.2017.13.02.70","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.70","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"65 6 1","pages":"70"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USE.2017.13.02.72
G. Priya, V. Bhambri
{"title":"Diabetic Ketoacidosis in a Patient with Type 1 Diabetes on Sodium-glucose Co-transporter-2 Inhibitors—a Case Report","authors":"G. Priya, V. Bhambri","doi":"10.17925/USE.2017.13.02.72","DOIUrl":"https://doi.org/10.17925/USE.2017.13.02.72","url":null,"abstract":"","PeriodicalId":23490,"journal":{"name":"US endocrinology","volume":"14 1","pages":"72"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67603644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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