duke 2014 diabetes

Posted on 31 Окт 201718

Executive function, adherence, and glycemic control in adolescents ...

Executive function, adherence, and glycemic control in adolescents ...
2014 Oct;14(10):532. doi: 10.1007/s11892-014-0532-y. Executive function, adherence, and glycemic control in adolescents with type 1 diabetes: a literature review. ... University, 707 SW Gaines Street, Portland, OR, USA, duke@ohsu.edu.

Additional prospective and controlled studies are necessary to fully understand the impact of EF on the ability of youth to independently manage type 1 diabetes. Interventions targeted at modifiable risk factors, such as smoking cessation and management of hypertension and dyslipidemia, reduce the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). Patients with diabetes have approximately a 2-fold increase in the risk for coronary heart disease, stroke, and death from vascular causes compared with patients who do not have diabetes. Conclusive evidence of CV risk reduction with glucose-lowering therapy is still lacking and scrutiny of additional agents is necessary.

Associate Professor of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC. The major conclusions of this review support the presence of an association between EF, adherence, and glycemic control. Interventions that focus on the management of CV risk factors and glucose lowering with medications that are not cardiotoxic represent an optimal and attainable treatment approach. Type 2 diabetes mellitus is a heterogeneous disease, for which patient-centered, individualized care, and goal-setting is appropriate. Results from the first trials designed to meet the recent CV regulatory requirements have shown no increased risk of major adverse CV events but also no CV benefit from dipeptidyl peptidase-4 inhibitor therapy, as well as a potentially increased risk of hospitalization for heart failure.

A review of the published research is presented with the objectives of reporting the following: (1) the associations between EF and adherence, (2) the associations between EF and glycemic control, (3) proposed methodological considerations needed to advance related research, (4) recommendations for future research, and (5) clinical recommendations. New glucose-lowering therapies are now subject to close scrutiny for CV safety before and after drug approval. Although initiation of intensive glycemic control early in the disease course may be associated with a reduction in the long-term risk of cardiovascular (CV) events, this approach in those with long-standing or complicated T2DM is not of clear benefit and may even be harmful in some. The aim of the present review was to examine and report findings from published research to date that has examined associations between executive function (EF), adherence, and glycemic control in youth with type 1 diabetes. Failure to mitigate risk with antihyperglycemic therapy and the potential for some treatments to increase CVD risk underlies a treatment paradox. Division of Psychology, Child Development and Rehabilitation Center, Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, USA, duke@ohsu. Paradoxically, large randomized studies have failed to conclusively show that intensively lowering glucose reduces CVD event rates in patients with T2DM, despite pathophysiologic and epidemiologic evidence suggesting that hyperglycemia contributes to CVD.

Bilateral Oophorectomy and the Risk of Incident Diabetes in - NCBI
5 Nov 2013 ... Diabetes Care. 2014;37(3):725-33. doi: 10.2337/dc13-1986. Epub 2013 ... (1) Corresponding author: Duke Appiah, d0appi01@louisville.edu.

17 Dec 2013 ... 2014 Mar-Apr;28(2):219-25. doi: 10.1016/j.jdiacomp.2013.08.002. ... (1) Department of Community and Family Medicine, Duke University ...

Type 2 diabetes mellitus is a heterogeneous disease, for which patient-centered, individualized care, and goal-setting is appropriate. Division of Psychology, Child Development and Rehabilitation Center, Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, USA, duke@ohsu. Interventions targeted at modifiable risk factors, such as smoking cessation and management of hypertension and dyslipidemia, reduce the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). A review of the published research is presented with the objectives of reporting the following: (1) the associations between EF and adherence, (2) the associations between EF and glycemic control, (3) proposed methodological considerations needed to advance related research, (4) recommendations for future research, and (5) clinical recommendations. Conclusive evidence of CV risk reduction with glucose-lowering therapy is still lacking and scrutiny of additional agents is necessary.

Interventions that focus on the management of CV risk factors and glucose lowering with medications that are not cardiotoxic represent an optimal and attainable treatment approach. New glucose-lowering therapies are now subject to close scrutiny for CV safety before and after drug approval. Additional prospective and controlled studies are necessary to fully understand the impact of EF on the ability of youth to independently manage type 1 diabetes. Paradoxically, large randomized studies have failed to conclusively show that intensively lowering glucose reduces CVD event rates in patients with T2DM, despite pathophysiologic and epidemiologic evidence suggesting that hyperglycemia contributes to CVD. Associate Professor of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC.

Failure to mitigate risk with antihyperglycemic therapy and the potential for some treatments to increase CVD risk underlies a treatment paradox. Although initiation of intensive glycemic control early in the disease course may be associated with a reduction in the long-term risk of cardiovascular (CV) events, this approach in those with long-standing or complicated T2DM is not of clear benefit and may even be harmful in some. Results from the first trials designed to meet the recent CV regulatory requirements have shown no increased risk of major adverse CV events but also no CV benefit from dipeptidyl peptidase-4 inhibitor therapy, as well as a potentially increased risk of hospitalization for heart failure. Patients with diabetes have approximately a 2-fold increase in the risk for coronary heart disease, stroke, and death from vascular causes compared with patients who do not have diabetes. The major conclusions of this review support the presence of an association between EF, adherence, and glycemic control. The aim of the present review was to examine and report findings from published research to date that has examined associations between executive function (EF), adherence, and glycemic control in youth with type 1 diabetes.

Nurse practitioner management of type 2 diabetes. - NCBI

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