MD Conference Express ADA 2012 - (Page 28)
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Special situations include the switch from intravenous continuous insulin infusion to subcutaneous insulin therapy and patients who receive enteral or parenteral nutrition or glucocorticoid therapy. He noted that hyperglycemia during total parenteral nutrition is associated with a greater risk of hospital mortality [Pasquel FJ et al. Diabetes Care 2010]. Dr. Umpierrez stressed that MNT is an essential component of the glycemic management program for all hospitalized patients with diabetes and hyperglycemia and that providing meals with a consistent amount of carbohydrates can be useful in coordinating doses of rapid-acting insulin to carbohydrate ingestion. He also reviewed the risks of hypoglycemia in the hospital setting. According to the guidelines, an in-hospital glycemic control program should include: administrative support for an interdisciplinary steering committee using a systems approach to improve care of inpatients with hyperglycemia and diabetes; a uniform method of collecting and evaluating point-of-care testing and insulin use data as a way of monitoring the safety and efficacy of the glycemic control program; and the provision of accurate devices for glucose measurement at the bedside with ongoing staff competency assessments. Dr. Umpierrez also specified methods and goals for educating patients and professionals. These include diabetes self-management education that focuses on short-term survival goals; identification of community resources to provide continued support to patients; and ongoing staff education to update diabetes knowledge in general and whenever an adverse event that is related to diabetes management occurs.
in women, with 3 studies having a particular impact on the current guidelines for the prevention of CVD in women. The Women’s Health Initiative (WHI) [Rossouw JE et al. JAMA 2002] and the Heart and Estrogen/Progestin Replacement Study [Hulley S et al. JAMA 1998] were, in large part, responsible for the recommendation that hormone therapy not be used for the primary or secondary prevention of CVD, as it is not effective and may be harmful [Mosca L et al. Circulation 2007, 2011]. Aspirin is one of the least expensive and most frequently used preventive therapies for cardiovascular events; however, the Women’s Health Study (WHS), which evaluated the use of low-dose aspirin as primary prevention for CVD in women, provided evidence of a sex-based response to aspirin therapy. Among the women in the WHS, aspirin therapy resulted in a significant (p=0.04) overall reduction in stroke (RR, 0.83; 95% CI, 0.69 to 0.99) and a nonsignificant overall 9% reduction in cardiovascular events, a slight increase in the risk of hemorrhagic stroke (RR, 1.24; 95% CI, 0.82 to 1.87; p=NS), and no benefit on myocardial infarction (MI; RR, 1.02; 95% CI, 0.84 to 1.25). To assess for the effect of gender, the authors conducted a gender-specific on aspirin therapy randomeffects meta-analysis of data from 6 trials that showed a reduction in risk for MI and no influence on stroke among men but no effect on MI in women and a reduction in the incidence of stroke [Ridker PM et al. N Engl J Med 2005]. Aspirin resistance is present in up to 40% of patients with diabetes, and the prevalence of resistance increases with decreasing metabolic control [McGuire D. Braunwald’s Heart Disease: A Textbook Of Cardiovascular Medicine 2012. Elsevier]. Large RCTs are currently evaluating if higher doses of aspirin might overcome the effects of resistance, but the 2011 American Heart Association guidelines state that aspirin (75 mg/day to 325 mg/day) should be used in women with coronary heart disease unless contraindicated and that this therapy is reasonable in women with diabetes unless contraindicated. Signals of an increased risk of MI among younger women and risks for bleeding led to the recommendation against routine use of aspirin in healthy women aged <65 years to prevent MI [Mosca L et al. Circulation 2011]. Finally, although statin therapy greatly lowers cardiovascular risk, in the WHI study, the incidence of new-onset diabetes mellitus was associated with statin use among postmenopausal women [Culver AL et al. Arch Intern Med 2012]. The underpinnings of the recently scrutinized relationship between statin use and new-onset diabetes mellitus are unknown. Although the data generally support similar treatment responses in women and men and although there is no clear evidence that diabetes alters treatment benefit of
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CVD Prevention and Treatment in Women With Diabetes
Written by Phil Vinall
Cardiovascular disease (CVD) is the number one killer of women in westernized countries. Its connection to diabetes, a particularly strong risk factor that disproportionately affects women, has been well established. In a session that was devoted to the implications for CVD prevention and the treatment of women with diabetes, L. Kristin Newby, MD, Duke University Medical Center, Durham, North Carolina, USA, discussed differences in current diabetes treatment that are related to gender. Major randomized controlled trials (RCTs) over the past 1 to 2 decades have changed the practice of CVD prevention
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August 2012
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Table of Contents for the Digital Edition of MD Conference Express ADA 2012
MD Conference Express ADA 2012
Contents
ORIGIN Trial Results
New Lessons in Hypertension and Diabetes
Closed-Loop Insulin Therapy in Young Children
The Precocious “AGE’ing” Effect of Type 1 Diabetes in Children
Abatacept in Patients with New-Onset Type 1 Diabetes: One-Year Follow-Up
Explaining the UKPDS Legacy Effect
Insulin and Cancer
Insulin Analogs
Dyslipidemia
Insulin Therapy
Incretin Therapies
Diabetes and Chronic Kidney Disease Guidelines Update
Managing Hyperglycemia in Hospitalized Patients
CVD Prevention and Treatment in Women With Diabetes
China Da Qing Study: Lifestyle Change in Women With IGT Extends Life
Markers of Macrovascular Complications in Pediatric Diabetes
Nonoperative Management of the Infected Diabetic Foot
Diabetic Retinopathy: Changing Prevalence and Severity Require Flexible Interventions
New ADA/EASD Position Statement Endorses a Patient-Centered Approach
MD Conference Express ADA 2012
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