Оглавление
Группа авторов. Clinical Dilemmas in Diabetes
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Clinical Dilemmas in Diabetes
List of Contributors
Preface
1 “Is Prediabetes a Risk Factor or Is It a Disease?”
LEARNING POINTS
What is prediabetes?
Rationale for the diagnostic criteria for diabetes mellitus and prediabetes
Epidemiology of prediabetes
Pathogenesis of impaired fasting glucose and impaired glucose tolerance
Screening recommendations for prediabetes
Reproducibility, sensitivity, and specificity of glycemic measurements and the role of oral glucose tolerance testing in clinical practice
Risk of progression from prediabetes to diabetes mellitus
Microvascular complications associated with prediabetes. Retinopathy
Nephropathy
Neuropathy
Macrovascular complications and mortality associated with prediabetes
Management of prediabetes
Diabetes prevention program
Da Qing study
Pharmacologic therapy for the prevention or delay of diabetes mellitus
Bariatric surgery for the prevention or delay of diabetes mellitus
Exercise and diet for the prevention or delay of diabetes mellitus
American diabetes association 2020 guideline recommendations for the management of prediabetes
Conclusion
References
2 Early Diagnosis of Type 1 Diabetes – Useful or a Pyrrhic Victory?
LEARNING POINTS
Introduction
Pathogenesis of T1D: An Update in View of Defining Preventive Tools
What Are the Environmental Factors Triggering Type 1 Diabetes?
The Role of Cow's Milk
The Role of Vitamin D Deficiency
Prediction of T1D as the Basis for Disease Prevention
Prevention of T1D: Current Status
Primary Prevention
Secondary Prevention
European Nicotinamide Diabetes Intervention Trial (ENDIT)
DPT‐1 Trials
Type 1 Diabetes Prediction and Prevention Study (DIPP)
Tertiary Prevention
Immune Intervention Therapies at Diagnosis of T1D
Incretin‐based Therapies
Conclusions
Acknowledgments
References
3 Reclassifying or Declassifying Diabetes? Can Clinical Characteristics Guide Classification and Treatment?
LEARNING POINTS
The pathophysiology of hyperglycemia – type 1 vs type 2 diabetes
Genetic and environmental influences on disease presentation
Measuring insulin secretion
Autoantibodies
“Atypical” diabetes, glucose toxicity and the honeymoon period
Cystic fibrosis‐related diabetes
Novel approaches to reclassifying diabetes
Conclusions
Bibliography
4 How Should Secondary Causes of Diabetes Be Excluded?
LEARNING POINTS
Introduction
Hereditary haemochromatosis
Clinical Vignette:
Natural history of haemochromatosis
The case for screening
Cystic fibrosis‐related diabetes
Natural history of CFRD
A comparison with other forms of diabetes
The case for screening
Pancreatic‐cancer‐associated diabetes
Diabetes due to hormone excess
Post‐transplantation diabetes mellitus (PTDM)
Clinical features
The case for screening
Diabetes associated with atypical antipsychotic drug use
Natural history
The case for screening
Diabetes associated with HIV infection and its treatment
Diabetes secondary to immunotherapy
Monogenic forms of diabetes. Case Vignette:
References
5 How to Screen Appropriately for Monogenic Diabetes
LEARNING POINTS
Maturity onset diabetes of the young (MODY)
Differentiating monogenic diabetes from type 1 diabetes
Differentiating monogenic diabetes from type 2 diabetes
When to screen for monogenic diabetes?
Common forms of monogenic diabetes. GCK mutations
HNF1A mutations
HNF4A mutations
Conclusions
References
6 Managing Gestational Diabetes During and After Pregnancy
LEARNING POINTS
Introduction
GDM diagnosis
GDM management. Glycemic goals
Lifestyle modification
Insulin therapy
Oral glucose‐lowering agents
Gestational weight gain
Fetal monitoring
Glucocorticoid therapy
Intrapartum management
Postpartum neonatal care
Postpartum maternal care
Future directions
Conclusion
References
7 What Is the Role of Self‐Monitoring in Diabetes? Is There a Role for Postprandial Glucose Monitoring? How Does Continuous Glucose Monitoring Integrate into Clinical Practice?
LEARNING POINTS
Self‐monitoring of blood glucose
SMGB in type 1 DM and insulin‐requiring T2DM patients
SMBG in non‐insulin‐requiring T2DM
Postprandial SMBG
Continuous glucose monitoring systems
Flash glucose monitoring systems
References
8 Does HbA1c Remain the Most Important Therapeutic Target in Outpatient Management of Diabetes?
LEARNING POINTS
The glucose hypothesis and vascular risk
Measuring glycemic control in the clinical management of diabetes. Hemoglobin A1c: Discovery and integration into clinical practice
HbA1c: Role in predicting micro‐ and macrovascular complications
Clinical utility of HbA1c
Limitations of HbA1c measurement
Traditional measures of blood glucose and glucose exposure
Self‐monitored blood glucose (SMBG)
Additional therapeutic targets to consider for hyperglycemia in the outpatient management of diabetes
Post prandial glucose (PPG)
Continuous glucose monitoring (CGM) and glycemic control
CGM and hypoglycemia
Utility of CGM metrics in the management of diabetes
Metric 1: Duration of CGM use
Metric 2: Time in range (TIR)
Metric 3: Glycemic variability
Summary
References
9 Technology Issues: Continuous Glucose Monitoring, Insulin Pumps, and Closed Loop Control for Patients with Diabetes
LEARNING POINTS
Introduction
Continuous Glucose Monitoring (CGM) for Diabetes Care
Impact of CGM in Patients on MDI or CSII
Impact in a Higher Risk Population: Patients with T1D and Impaired Hypoglycemia Awareness
Efficacy of CGM in the Elderly: The WISDM Study
CGM in Pregnancy
Implantable CGM
Currently Approved CLC for T1DM
MiniMed 670G
FLAIR trial
780G pivotal trial
Post‐marketing Studies. SmartGuardTM Auto‐mode enabled MiniMedTM 670G System
The t:slim X2TM Insulin Pump with Control IQ Technology
Ongoing Pivotal Studies/Anticipated Closed Loop System. HorizonTM Pivotal study (Omnipod HorizonTM)
Patch Pump Series: Diabeloop Generation 1 (DBLG1) Hybrid Closed Loop
Closed Loop Control Initiation at Onset of T1D
CLC is Being Tested in Specific Subgroups with Type 1 Diabetes at Present. T1D Pregnancy
Closed Loop in Adults Prone to Hypoglycemia (DCLP2)
Cost of Diabetes Technologies
Insulin Pump Use for People With T2DM
Conclusion
References
10 Optimizing Diet in Patients with Diabetes
LEARNING POINTS
Clinical pearl
Clinical pearl
Clinical pearl
Clinical pearl
Clinical pearl
Summary
References
11 Are Insulin Sensitizers Useful Additions to Insulin Therapy?
LEARNING POINTS
Insulin sensitizers
Biguanides
Mechanism of action
Pharmacokinetics
Efficacy of combination therapy
Case
Questions
Additional indications. Polycystic ovary syndrome
Contraindications
Adverse effects. Lactic acidosis
Gastrointestinal
Thiazolidinediones
Mechanism of action
Pharmacokinetics
Efficacy of combination therapy
Additional indications. Nonalcoholic fatty liver disease
Polycystic ovary syndrome
Lipid lowering
Lipodystrophies
Carotid intima‐media thickness
Contraindications
Adverse effects
Discussion
References
12 Incretin‐Based Therapy for the Management of Type 2 Diabetes
LEARNING POINTS
Introduction
The incretin effect
Early development of GLP‐1 RA therapy
Clinical benefits and side effects of GLP‐1 RAs
The evidence for GLP‐1 ras in management of type 2 diabetes. Exenatide
Liraglutide
Lixisenatide
Dulaglutide
Semaglutide
The role of DPP‐4 inhibitors in type 2 diabetes management
Cardiovascular outcomes with incretin‐based therapies for type 2 diabetes
Incorporating incretin‐based therapy into clinical practice
Conclusions
Key points
References
13 Screening Patients with Prediabetes and Diabetes for Cardiovascular Disease
LEARNING POINTS
Introduction
Guidelines
Hyperglycemia and risks of CVD
Traditional risk factors
Diabetes‐specific clinical risk predictors of CVD
Nontraditional risk factors
Screening tools. Coronary artery calcium score
Coronary computed tomography angiography
Stress testing – Myocardial perfusion imaging
Stress testing – Echocardiogram for CAD
Carotid ultrasound and endothelial function studies
Screening for HF
Risk calculators
Summary
References
14 Choosing Medications for Type 2 Diabetes – What Weighting Should Be Given to Cardiovascular Risk Reduction?
LEARNING POINTS
Diabetes and cardiovascular risk: how does it affect therapeutic goals?
Metformin
Sulfonylureas
Thiazolidinediones
Acarbose
Colesevelam
Pramlintide
Bromocriptine
Glucagon‐like peptide‐1‐based therapy
SGLT‐2i
Conclusions
References
15 Choosing Medications for Weight Loss in Type 2 Diabetes Mellitus
LEARNING POINTS
Introduction: Prevalence and relationship of obesity and type 2 diabetes
Therapeutic classes for the treatment of type 2 Diabetes and their effects on weight
Insulin
Sulfonylureas
Biguanides/Metformin
Thiazolidinediones
Alpha‐glucosidase Inhibitors
Amylin Mimetics
GLP‐1 Receptor agonists
DPP‐4 inhibitors
SGLT‐2 inhibitors
Use of diabetic medications for weight loss in patients without diabetes
Metformin
GLP‐1 Receptor agonists
SGLT‐2 inhibitors
A Practical Guide to Choosing medication for type 2 diabetes with weight loss in mind
References
16 Are Statins the Optimal Therapy for Cardiovascular Risk in Patients with Diabetes? What Newer Agents Are There for the Treatment for Dyslipidemia in Diabetes? Are Triglycerides an Important Risk Factor for Diabetes?
LEARNING POINTS
Introduction
Dyslipidemia in type 2 diabetes mellitus
Treatment of dyslipidemia in type 2 diabetes mellitus
Box 16.1 NCEP guidelines for diagnosis of the metabolic syndrome
Evidence that PSCK 9 is associated with increased CVD risk
Evidence linking hypertriglyceridemia to CVD risk in diabetes mellitus
Evidence that treating hypertriglyceridemia will decrease CVD risk in DM
Discussion
References
17 New Agents for Treatment of Dyslipidemia
LEARNING POINTS
Introduction
PCSK9 and regulation of LDL‐Cholesterol levels
PCSK9 inhibitors: Efficacy and safety
PCSK9 inhibitors: Cardiovascular outcome trails
PCSK9 inhibitor use in patients with diabetes
PCSK9 inhibitors: Clinical use and future perspectives
Other novel lipid‐lowering therapies
Conclusions
References
18 The Role of Bariatric Surgery in Obese Patients with Diabetes: Primary or Rescue Therapy?
LEARNING POINTS
Introduction
Possible Mechanisms by Which Bariatric Surgery Improves T2DM. Effect of Weight Loss
Effect of Incretins
Role of Bariatric Surgery in T2DM: First‐line Therapy or Rescue Therapy When Medical Options Fail?
Gastric Banding or Gastric Bypass?
Role of Weight Loss Surgery in the Treatment of Patients with T2DM and BMI < 35 kg/m2
New Techniques that can be an Option in the Future
References
19 Treatment Strategies in Patients with Diabetes Mellitus and Ischemic Heart Disease
LEARNING POINTS
Introduction
Role of medical therapy and glucose control
Antiplatelet therapy
Management of hyperglycemia
Coronary revascularization
Symptom control for stable patients despite medical therapy
Prolonging life and preventing subsequent MI in stable patients
Trials for patients with diabetes and cardiovascular disease
Subgroup analysis of patients with diabetes
Biomarkers for risk stratification
Acute coronary syndromes
Coronary artery bypass grafting
Percutaneous coronary intervention
Why is coronary artery bypass grafting more effective?
Conclusions
References
20 Diabetes Management in Patients with Critical and Non‐Critical Illness
LEARNING POINTS
Introduction
Mechanisms Mediating Adverse Effects of Hyperglycemia During Critical Illness
Large Intervention Studies. Background
General Findings (Tables 20.1and20.2)
Role of Hypoglycemia in Interpretation of Study Results (Table 20.3)
Methodology for Glucose Testing
The Role of Nutritional Support in Results of Trials
Conclusions
Acknowledgments
References
21 Diagnosis and Management of Ophthalmic Complications of Diabetes
LEARNING POINTS
Introduction
Risk Factors for Diabetic Retinopathy
Screening
Prevention. Glycemic Control
Blood Pressure Control
Lipid‐lowering Strategies
Fenofibrate
Statins
Aspirin and anticoagulation
Diet
Ocular Complications. Diabetic Retinopathy
Treatment of Diabetic Retinopathy. Non‐proliferative Diabetic Retinopathy
Proliferative Diabetic Retinopathy
Laser Photocoagulation
Anti‐VEGF
Combination Treatment
Surgical Treatment/Vitrectomy
Retinal Vein Occlusion
Neovascular Glaucoma
Diabetic Macular Edema
Treatment of DME. Macular Laser
Corticosteroid
Anti‐VEGF Therapy
Choice of the agent
Efficacy over other treatments
Side effects
Surgery
Future Directions
DME – Summary
Cornea
Treatment
Cataract
Orbital Disease
Note
References
22 Upper Gastrointestinal Manifestations of Diabetes
LEARNING POINTS
Introduction
Epidemiology
Mechanisms and pathophysiology underpinning upper gastrointestinal symptoms in diabetes mellitus
Pathophysiology of diabetic gastroparesis: insights from animal studies
Pathophysiology of gastric dysfunctions in humans with diabetes
Upper gastrointestinal manifestations associated with diabetes. Dysphagia and heartburn. Clinical features
Diagnosis
Gastroparesis and other upper gastrointestinal symptoms. Clinical features
Diagnosis
Abdominal Pain
Management of gastroparesis and dyspepsia
Nutritional support
Prokinetics
Endoscopic and device therapies
Conclusion
References
Index
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