Glycemic Management of Type 2 Diabetes

Nathan, David M.

doi:10.1001/archinte.168.19.2064

Cited by 7 publications

(1 citation statement)

References 21 publications

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“…However, the use of insulin is associated with weight gain (2-4 kg), probably related to glycemic level correction and subsequent reduction in glycosuria, and increased risk of hypoglycemia, due to high glycemic control intensification, targeting HbA1c levels lower than 7%. As advised by the latest ADA/EASD consensus [139], basal insulin may be added to oral drugs (metformin or metformin and sulfonylurea). Treatment is generally initiated by administering a medium-acting insulin (NPH) or long-acting insulin analog (levemir or glargine) dose of 0.1-0.2 U/kg of weight before bedtime, and insulin dose adjustments must be made according to the fasting capillary glycemic levels, measured on a daily basis.…”

Section: Type 2 Diabetes In Children and Adolescentsmentioning

confidence: 99%

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Halpern

Mancini

Magalhães

et al. 2010

Diabetol Metab Syndr

137

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Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D. The earlier the appearance of the clustering of risk factors and the higher the time of exposure, the greater will be the chance of developing coronary disease with a more severe endpoint. The age when the event may occur seems to be related to the presence and aggregation of risk factors throughout life.The treatment in this age-group is non pharmacological and aims at promoting changes in lifestyle. However, pharmacological treatments are indicated in special situations.The major goals in dietary treatments are not only limited to weight loss, but also to an improvement in the quality of life. Modification of risk factors associated to comorbidities, personal satisfaction of the child or adolescent and trying to establish healthy life habits from an early age are also important. There is a continuous debate on the best possible exercise to do, for children or adolescents, in order to lose weight. The prescription of physical activity to children and adolescents requires extensive integrated work among multidisciplinary teams, patients and their families, in order to reach therapeutic success.The most important conclusion drawn from this symposium was that if the growing prevalence of overweight and obesity continues at this pace, the result will be a population of children and adolescents with metabolic syndrome. This would lead to high mortality rates in young adults, changing the current increasing trend of worldwide longevity. Government actions and a better understanding of the causes of this problem must be implemented worldwide, by aiming at the prevention of obesity in children and adolescents.

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Section: Type 2 Diabetes In Children and Adolescentsmentioning

confidence: 99%

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Halpern

Mancini

Magalhães

et al. 2010

Diabetol Metab Syndr

137

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GlaxoSmithKline responds to the consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes

Ambery

Cobitz

2009

Diabetologia

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Abbreviation FDA Food and Drug AdministrationTo the Editor: GlaxoSmithKline regrets the recommendation [1] of the recent consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes against the use of rosiglitazone for treatment of type 2 diabetes, because it is contrary to scientific evidence.The evidence regarding a possible association of rosiglitazone with increased risk of cardiovascular ischaemic morbidity remains inconclusive. Data from clinical trials assessing cardiovascular outcomes are inconsistent with hypotheses of increases in the rates of myocardial ischaemia or death that have arisen from meta-analyses. No long-term clinical trial has confirmed an increased risk of cardiovascular ischaemia with rosiglitazone. Moreover, data from two large head-to-head clinical trials-A Diabetes Outcome Progression Trial (ADOPT) [2] and the interim report of the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) trial [3]-show that, apart from the well-documented risk of heart failure with thiazolidinediones, rosiglitazone has a cardiovascular risk profile comparable to the recommended tier 1 glucose-lowering medicines, metformin and sulfonylurea.The consensus statement contains multiple unexplained inconsistencies regarding the evidence underlying its conclusions and recommendations. Data from long-term clinical trials, which provide gold-standard evidence, sometimes appear to receive less weight than conclusions from hypothesisgenerating meta-analyses. This circumstance is difficult to understand, particularly in light of a recent comment by the corresponding author of the consensus statement [4] that 'the vagaries of meta-analyses make them unreliable'.Furthermore, the consensus statement cites data in an inconsistent manner. Meta-analyses critical of rosiglitazone are mentioned repeatedly, while analyses reporting no increase in cardiovascular ischaemic risk with rosiglitazone versus other established glucose-lowering medications are overlooked (such as those performed by Lago et al. [5] and the US Food and Drug Administration [FDA] [6]). A metaanalysis [7] that reported a statistically significant increase in a composite endpoint of cardiovascular hospitalisation or mortality with the combination of sulfonylureas and metformin-a tier 1 recommended option-is not mentioned in the consensus statement.The authors of the consensus statement write that 'the overarching principle in selecting a particular intervention will be its ability to achieve and maintain glycaemic goals' [1]. Rosiglitazone has been shown to provide glycaemic control for up to 5 years-significantly longer than the most commonly used oral glucose-lowering medications, sulfonylurea and metformin [2]. GlaxoSmithKline strongly believes that rosiglitazone has a place in the therapeutic armamentarium for type 2 diabetes when used appropriately. Diabetologia (2009) 52:986-987

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The challenge of undiagnosed pre-diabetes, diabetes and associated cardiovascular disease

Gossain

Aldasouqi

2010

International Journal of Diabetes Mellitus

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Glycemic Management of Type 2 Diabetes

Cited by 7 publications

References 21 publications

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment

GlaxoSmithKline responds to the consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes

The challenge of undiagnosed pre-diabetes, diabetes and associated cardiovascular disease

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