Cardiovascular complications constitute the major cause of morbidity and mortality in patients with diabetes. The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) provided consistent evidence that intensive glycemic control prevents the development and progression of microvascular complications in patients with type 1 or type 2 diabetes. However, whether intensive glucose lowering also prevents macrovascular disease and major cardiovascular events remains unclear. Extended follow-up of participants in these studies demonstrated that intensive glycemic control reduced the long-term incidence of myocardial infarction and death from cardiovascular disease. By contrast, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, and Veterans Affairs Diabetes Trial (VADT) results suggested that intensive glycemic control to near normoglycemia had either no, or potentially even a detrimental, effect on cardiovascular outcomes. This article discusses the effects of intensive glycemic control on cardiovascular disease, and examines key differences in the design of these trials that might have contributed to their disparate findings. Recommendations from the current joint ADA, AHA, and ACCF position statement on intensive glycemic control and prevention of cardiovascular disease are highlighted.
The advances in recombinant DNA technology have led to an improvement in the properties of currently available long-acting insulin analogs. Insulin degludec, a new generation ultra-long-acting basal insulin, currently in phase 3 clinical trials, has a promising future in clinical use. When compared to its rival basal insulin analogs, a longer duration of action and lower incidence of hypoglycemic events in both type 1 and type 2 diabetic patients has been demonstrated.1,2 Its unique mechanism of action is based on multihexamer formation after subcutaneous injection. This reportedly allows for less pharmacodynamic variability and within-subject variability than currently available insulin analogs, and a duration of action that is over 24 hours.3 The lack of proof of carcinogenicity with insulin degludec is yet another factor that would be taken into consideration when choosing the optimal basal insulin for a diabetic individual.4 A formulation of insulin degludec with insulin aspart, Insulin degludec 70%/aspart 30%, may permit improved flexibly of dosing without compromising glycemic control or safety.5
A behavioral intervention with a low-energy diet including 5 meal replacements and 5 servings of fruits or vegetables enabled obese individuals to lose 13 kg more than control subjects over a 24-week period.
This study demonstrates the benefits of lifestyle intervention using meal replacements and increased physical activity with resultant modest weight loss in long-standing, poorly controlled type 2 diabetes. RSG did not impede weight loss and, in fact, amplified some of the positive benefits of lifestyle intervention.
The emergence of a "critical medical anthropology" offers a perspective that can complement and enrich the explanatory model (EM) approach, particularly in the case of illnesses that are polysemic and have political and economic implications. Repetition strain injury (RSI), an occupational illness which became epidemic in Australian industry in the early 1980s, became the focus of multiple and disparate biomedical EMS. We argue that the biomedical debates about the etiology of RSI can be understood in terms of the ideological role of medicine in reducing RSI to a physiological or a psychological phenomenon, individualizing the problem, disenfranchising (or blaming) the injured worker, and dejiecting attention from those structural conflicts endemic in the workplace (and exacerbated by economic stringencies) which fostered injury, pain, and disability.xplanatory models (EMS) of occupational illnesses have their genesis in social and clinical contexts which are permeated by conflicting interests E and inequities in power and access to resources. Such illnesses take on significance not only for sufferers, their families, and their doctors, but for employers, unions, insurers, company clinicians, and government agencies. This is especially true of chronic work-related afflictions of uncertain etiology, insidious onset, ambiguous signs, and variable symptoms, such as work-related cancers, lung disease, back injuries, occupational radiation sickness, and poisonings. If, as is usually the case, an illness or injury deemed to be work-related is compensable, the models invoked to explain etiology, symptoms, pathophysiology , course, and treatment (Kleinman 1978) become significant not only in the clinical setting but in public discourse as it relates to the legitimation (or not) of the condition as job related.The subject of this study is an occupational epidemic of musculoskeletal pain which occurred throughout Australia in the early 1980s. The condition became widely known as repetition strain injury or "RSI." Here we examine some of the explanatory models advanced for RSI, with particular attention to certain medical writers whose views gained importance beyond the clinic. We examine the "outbreak" of RSI against the background of industrial, medical, and social circumstances in Australia at the time. 162
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