Current medical research and opinion
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Diabetes mellitus is a chronic disease that is monitored by measurement of haemoglobin A1c (A1C) as an index of glycaemic control. The limitations of using A1C, given the consensus clinical practice recommendations made by the American Diabetes Association, need to be better understood by clinicians. ⋯ Laboratories need to report current values and the analyse six internal quality control specimens for each analytical run. 'Delta check' criteria ought to be applied and results reported to highlight acute deviations in A1C. Such procedures will aid the attainment of the clinical quality requirements and give appropriate results for audit purposes.
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Measurement of glycosylated hemoglobin (HbA1c) remains the gold standard for the assessment of glycemic control in patients with type 2 diabetes. Recent investigations have studied the correlations between HbA1c levels and other aspects of glucose metabolism, specifically, postprandial glucose (PPG) and fasting plasma glucose (FPG). The results suggest that PPG is also important to overall glycemic control and may be a better index of glucose regulation than FPG. ⋯ Many patients receive combination therapy, thereby benefiting from multiple mechanisms of glucose control, although in most cases insulin must later be added to the regimen in order to effectively suppress FPG. Thus, all aspects of glucose metabolism appear to be clinically relevant and should be monitored for effective diabetes management. Further study will more precisely define the clinical significance of PPG.
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Clinical Trial
Clinical effect of combination therapy of pioglitazone and an alpha-glucosidase inhibitor.
This study evaluated the efficacy of adding pioglitazone 30 mg to the therapy of patients with type 2 diabetes mellitus whose glycaemic control was poor on an alpha-glucosidase inhibitor (alpha-GI) alone or in combination with a sulphonylurea (SU). The patients (n = 20) had a HbA(1c) level between 7.0 and 12.0% and the fasting plasma glucose was 7.8 mmol/l or higher. They were treated with 30 mg pioglitazone once daily for 16 weeks. ⋯ Five patients experienced adverse drug reactions, such as oedema, hypoglycaemia and increased creatine phosphokinase (CK), all of which were mild in severity. The addition of pioglitazone in diabetics whose glycaemic control was poor on a alpha-GI alone or with a alpha-GI and SU combination resulted in a significant decrease in HbA1c, and the treatment was well-tolerated. Our findings also suggest that leptin levels could be useful for assessing responders to pioglitazone.
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Depression is a chronic, recurrent illness carrying a heavy burden for the health service and the community. Current evidence suggests that the majority of patients with depression will experience recurrent episodes of illness, although there is extensive evidence that continuation therapy with antidepressant drugs will prevent relapse. Two surveys were designed and distributed in the UK in 2002 to compare the expectations of patients and GPs in the management of relapse in depression. ⋯ The findings suggest that discontinuation and non-compliance of therapies is associated with recurrent depression. Continuation therapy is now standard treatment to avoid recurrent depression; however, the majority of GPs questioned, continued therapy for less than the 6 months after acute treatment response as advised by the British Associated of Psychopharmacologists. Although depression is generally managed well at primary care level, this survey highlights the major worries of depression sufferers concerning further episodes of depression and the need to prevent relapse and recurrence through safe and effective therapies with which these patients are happy to comply.