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المصدر: Postgraduate Medicine. 130:653-659
مصطلحات موضوعية: Blood Glucose, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030209 endocrinology & metabolism, Type 2 diabetes, Disease, 030204 cardiovascular system & hematology, Drug Administration Schedule, Diabetes Complications, 03 medical and health sciences, 0302 clinical medicine, Insulin resistance, Meta-Analysis as Topic, Internal medicine, medicine, Humans, Hypoglycemic Agents, Insulin, In patient, Randomized Controlled Trials as Topic, Glycated Hemoglobin, Metabolic Syndrome, Disease trajectory, business.industry, Insulin deficiency, General Medicine, medicine.disease, Endocrinology, Diabetes Mellitus, Type 2, Insulin Resistance, business
الوصف: In patients with type 2 diabetes secondary to excess nutrients and energy balance, relative - not absolute - insulin deficiency plays a key role in disease development and progression. Although patients with type 2 diabetes who have features of insulin resistance would usually have hyperinsulinemia, insulin therapy remains recommended by guidelines particularly when patients fail to achieve glycemic goals. This approach does not prevent complications particularly macrovascular complications. This raises a controversial question regarding the benefit of using exogenous insulin for glycemic control in patients with type 2 diabetes who have features of insulin resistance. To address this concern, the authors performed a literature search looking for either randomized trials or meta-analyses directly comparing exogenous insulin to non-insulin therapy in the treatment of patients with type 2 diabetes. Our main outcomes of interest were effect on glycemic control and insulin resistance at various time points in the usual trajectory of type 2 diabetes. In trials investigating early short-term initiation of intensive insulin therapy, insulin therapy was beneficial in rapidly achieving glycemic control and reversing glucotoxicity. Following the initial 2 weeks to 3 months of adequate glycemic control in patients on intensive insulin therapy, there is little evidence that continuing insulin therapy provides greater glycemic control or improves insulin resistance beyond what can be achieved with other therapies. In conclusion, long-term insulin use appears neutral if not potentially harmful with respect to insulin resistance and cardiovascular outcomes. While this review has limitations and should be dealt cautiously, it raises questions regarding the benefit of insulin in patients with type 2 diabetes with features of insulin resistance. Further research is needed to confirm these findings.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::012be334ef1fa2d5ab0883cb37641f2fTest
https://doi.org/10.1080/00325481.2018.1533381Test -
2دورية أكاديمية
المؤلفون: Robert J. Tanenberg, Walter Pories
المصدر: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy ; page 281 ; ISSN 1178-7007
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المؤلفون: Kristen Springer Dreyfus, Michael J. Lewis, Christopher A. Newton, Robert J. Tanenberg, Doyle M. Cummings, Almond J. Drake
المصدر: Teaching and Learning in Medicine. 21:334-343
مصطلحات موضوعية: medicine.medical_specialty, education, Medically Underserved Area, Primary care, Diabetes education, Experiential learning, Education, Teaching hospital, Nursing, Diabetes mellitus, Diabetes Mellitus, North Carolina, medicine, Humans, Fellowships and Scholarships, Program Development, Curriculum, health care economics and organizations, Glycemic, Primary Health Care, business.industry, General Medicine, medicine.disease, Education, Medical, Graduate, Family medicine, Medicine, Educational Measurement, Training program, business, Program Evaluation
الوصف: Background: To address the need of caring for the growing number of patients with diabetes, East Carolina University implemented a 1-year fellowship in diabetes. Most of the region has been designated as Health Professional Shortage Areas. Description: The objective of the fellowship is to educate primary care physicians to serve as regional specialists in diabetes. The program is administered by physicians, educators, and representatives of the university's affiliated teaching hospital. The curriculum includes clinical, didactic, and experiential learning strategies in outpatient and inpatient settings. Adult and pediatric endocrinologists, obstetricians, and generalists mentor and evaluate the fellows. Evaluation: This innovative training program has improved the availability of high-quality diabetes care for underserved patients in the region. Mean glycemic control in fellows' patients improved and other clinical endpoints were also met. Conclusions: A 1-year diabetes fellowship is a replicable solutio...
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f781b7566cc253593440935e79cb38e3Test
https://doi.org/10.1080/10401330903228703Test -
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المؤلفون: null Robert J. Tanenberg, null Walter Pories
المصدر: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. :281
مصطلحات موضوعية: Pharmacology, Internal Medicine
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::d530314804d1a7edca71741f0701fa34Test
https://doi.org/10.2147/dmsott.s9981Test
