The successful treatment of diabetes depends on the education of the patient to manage their own diabetes, and is therefore considered the cornerstone of the treatment plan. Essentially, the success that patients gain in treating their diabetes stems from their ability to learn and appropriately practice self-care. While healthcare providers see patients only episodically, usually every three to six months, it is the patient who needs to manage their diabetes on a day-to-day basis.
The successful treatment of diabetes depends on the education of the patient to manage their own diabetes, and is therefore considered the cornerstone of the treatment plan. Essentially, the success that patients gain in treating their diabetes stems from their ability to learn and appropriately practice self-care. While healthcare providers see patients only episodically, usually every three to six months, it is the patient who needs to manage their diabetes on a day-to-day basis. Business Briefing: US Endocrine Review 2005 begins with an excellent contribution dealing with the importance of self-care in diabetes. The hemoglobin A1C test (now referred to as A1C) is seen as a critical test in the management of diabetes. While the blood glucose testing that patients carry out on a daily basis gives the patient and provider an excellent picture of the variation of blood glucose levels during the course of the day and over a number of days, the A1C gives a picture of the average blood glucose value over the preceding two to three months. In combining the data gathered by a patient’s self blood glucose testing and the A1C obtained periodically, an excellent picture of how the patient is progressing with regard to glycemic control can be gained. Given the importance of this test, Business Briefing: US Endocrine Review 2005 includes a discussion of the value of the A1C test.
Diabetes is now considered to not only be a significant risk factor for cardiovascular disease (CVD) but the equivalent of a past history of CVD. Given this understanding, the goals for the treatment of patients with diabetes became identical to those for the patient who had a past history of CVD. Cardiovascular (CV) risk reduction now has become the standard of care for the treatment of diabetes itself. We speak of the ‘ABC’s of diabetes care’. In this mnemonic ‘A’ signifies A1C, the measure of glycemic control,‘B’ stands for blood pressure, and ‘C’ stands for cholesterol, by which we generally mean low-density lipid (LDL) cholesterol. The American Diabetes Association (ADA) recommends that A1C levels should be less then 7%, blood pressure should be less than 130/80, and the LDL cholesterol level should be less than 100mg/dl. In keeping with the approach that diabetes needs to be seen as intimately related to CVD, a number of editorials appear throughout Business Briefing: US Endocrine Review 2005. Contributions dealing with the use of fibrates, an important medication class for the treatment of dyslipidemia, and the management of triglyceride levels to reduce CV risks, as well as discussions regarding the treatment and prevention of heart failure (HF), and the mechanisms of cardiac function in long-standing diabetes, are included.
The chronic complications of diabetes are described as microvascular (relating to disorders of the small blood vessels) or macrovascular (relating to disorders of the large blood vessels). CVD, cerebrovascular disease and peripheral arterial disease (PAD) are the major macrovascular complications of diabetes.Within the category of microvascular complications, one typically thinks of retinopathy, nephropathy, and neuropathy. Business Briefing: US Endocrine Review 2005 includes discussions of diabetes and chronic kidney disease (CKD), including the pharmacologic treatment of diabetic nephropathy and the recognition and treatment of hyperparathyroidism.With regard to diabetic neuropathy, there is a section dealing with the early diagnosis and treatment of the diabetic neuropathies, including the management of the painful peripheral neuropathies. Lastly, also typically included in the category of microvascular disease, the subject of erectile dysfunction is highlighted. Within Business Briefing: US Endocrine Review 2005 you will find sections dealing with the treatment of erectile dysfunction with PDE5 inhibitors as well as vacuum therapy.
While much of Business Briefing: US Endocrine Review 2005 is devoted to diabetes, its treatment, and the prevention and treatment of its complications, there are also sections dealing with other important endocrinology topics. Topics discussed include pituitary disorders, the use of thyroid sonography, the management of thyroid nodules and the diagnosis and treatment of thyroid cancer, and the diagnosis of 12 male hypogonadism and use of testosterone replacement therapy.■