Insulin resistance is an increasingly common metabolic abnormality characterized by an impaired physiological response to insulin. The constellation of insulin resistance and several other metabolic and vascular disorders is known as the insulin resistance syndrome. The characteristic features of the insulin resistance syndrome include central obesity, hypertension, dyslipidemia, glucose intolerance and specific abnormalities of both endothelial cell and vascular function. Although insulin resistance can arise in response to aging, obesity and inactivity, there is a clear genetic component. Insulin resistance is not generally attributable to a single genetic defect. Indeed, it is very likely to be a polygenic disorder in most individuals. A genetic predisposition is suggested to be the demonstration of increased insulin resistance in first-degree relatives of patients with diabetes and by a high incidence of insulin resistance in specific populations. Epidemiological data have demonstrated a strong association between a clustering of specific factors and the risk of cardiovascular disease. The diagnosis of the insulin resistance syndrome remains a significant clinical challenge. At present, clinicians are faced with establishing a clinical diagnosis despite varying definitions of the disorder and controversy regarding how many components presage clinical events. A proposed approach to the management of patients with the insulin resistance syndrome is discussed.
Removing Barriers to Insulin Therapy D iabetes educators recognize that addressing psychosocial needs is one of their key responsibilities. Understanding patientoriented concerns is critical to helping patients overcome the psychological resistance to initiating insulin therapy. Calls for treating patients with insulin earlier in the course of type 2 diabetes to reach glycemic targets and improve long-term outcomes must be coupled with practical strategies for helping patients make the transition to insulin. This article identifies 10 reasons that patients resist starting insulin and presents strategies for supporting patients through the decision-making process. Because patients are often taught to fear insulin, an even more challenging imperative is to create a culture that is receptive to insulin therapy. As this article argues, diabetes educators are in a unique and powerful position to create and promote this cultural shift. Psychological Resistance to Insulin Selected Results of the DAWN Study The Diabetes Attitudes, Wishes, and Needs (DAWN) study is a global, cross-sectional survey that addresses psychosocial issues associated with diabetes. The study recruited more than 5000 adults with type 1 or type 2 diabetes and nearly 4000 health care providers, including primary care and diabetes specialist physicians and nurses. 1 Participants from 13 countries across North America, Europe, Asia, and Australia provided selfreported information based on structured interviews designed to identify patient and provider perceptions of diabetes and its management. An important goal of the study was to enhance the understanding of patient concerns and provider attitudes to lay the foundation for improved diabetes care. Results of the DAWN study illustrate the strong symbolism patients attach to insulin. Among patient participants,
Background Diabetes is a known risk factor for severe coronavirus disease 2019 (COVID-19). We conducted this study to determine if there is a correlation between hemoglobin A 1c (HbA 1c ) level and poor outcomes in hospitalized patients with diabetes and COVID-19. Methods This is a retrospective, single-center, observational study of patients with diabetes (as defined by an HbA 1c ≥ 6.5% or known medical history of diabetes) who had a confirmed case of COVID-19 and required hospitalization. All patients were admitted to our institution between March 3, 2020 and May 5, 2020. HbA 1c results for each patient were divided into quartiles; 5.1-6.7% (32-50 mmol/mol), 6.8-7.5% (51-58 mmol/mol), 7.6-8.9% (60-74 mmol/mol), and >9% (>75 mmol/mol). The primary outcome was in-hospital mortality. Secondary outcomes included admission to an intensive care unit, invasive mechanical ventilation, acute kidney injury, acute thrombosis, and length of hospital stay. Results Five hundred and six patients were included. The number of deaths within quartiles 1 through 4 were 30 (25%), 37 (27%), 34 (27%) and 24 (19%), respectively. There was no statistical difference in the primary or secondary outcomes between the quartiles except acute kidney injury was less frequent in quartile 4. Conclusions There is no significant association between HbA 1c level and adverse clinical outcomes in patients with diabetes who are hospitalized with COVID-19. HbA 1c should not be used for risk stratification in these patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.