Diabetes & metabolism
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Mucormycosis is a life-threatening invasive fungal infection that arises particularly in diabetic patients with or without other underlying conditions such as haematological malignancies or the need for solid-organ transplantation. Rhino-orbito-cerebral involvement is the primary site of mucormycosis, but the paucity of signs may be a cause of delayed diagnosis. Thus, any case of documented non-bacteriological sinusitis in diabetic patients, even without ketoacidosis, should prompt suspicion of a mucormycosis diagnosis. To optimalize information for clinicians in charge of diabetic patients, this extensive review of the literature was carried out to provide an overview of mucormycosis specificities, epidemiology and pathophysiology in the setting of diabetes.
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Diabetes & metabolism · Jun 2012
Relative accuracy of arterial and capillary glucose meter measurements in critically ill patients.
As optimizing glucose control in critically ill patients remains a challenge for intensive-care physicians, this study aimed to determine the accuracy of glucose measurements. ⋯ In critically ill patients, glucose measurements from capillary and arterial blood by glucose meter are inaccurate, and can potentially lead to inappropriate use of insulin-infusion protocols and failure to achieve glycaemic targets.
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Diabetes & metabolism · Apr 2012
ReviewDPP-4 inhibitors in the management of type 2 diabetes: a critical review of head-to-head trials.
Dipeptidyl peptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes. Direct comparisons with active glucose-lowering comparators in drug-naive patients have demonstrated that DPP-4 inhibitors exert slightly less pronounced HbA(1c) reduction than metformin (with the advantage of better gastrointestinal tolerability) and similar glucose-lowering effects as with a thiazolidinedione (TZD; with the advantage of no weight gain). In metformin-treated patients, gliptins were associated with similar HbA(1c) reductions compared with a sulphonylurea (SU; with the advantage of no weight gain, considerably fewer hypoglycaemic episodes and no need for titration) and a TZD (with the advantage of no weight gain and better overall tolerability). ⋯ Clearly, more trials of direct comparisons between different incretin-based therapies are needed. Because of their pharmacokinetic characteristics, pharmacodynamic properties (glucose-dependent glucose-lowering effect) and good overall tolerability profile, DPP-4 inhibitors may have a key role to play in patients with renal impairment and in the elderly. The role of DPP-4 inhibitors in the therapeutic armamentarium of type 2 diabetes is rapidly evolving as their potential strengths and weaknesses become better defined mainly through controlled clinical trials.
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Diabetes & metabolism · Apr 2012
Insulin therapy for diabetes mellitus: treatment regimens and associated costs.
To describe insulin therapy in patients with diabetes, to determine treatment costs and to compare costs among treatment regimens. ⋯ Considerable heterogeneity is found in insulin treatment regimens used in everyday diabetes care. Payers should consider the full costs associated with the use of insulin rather than the cost of insulin alone. Treatment algorithms to harmonize insulin therapy should help to improve care, while encouraging patients to self-inject insulin should help to reduce costs.
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In order to help a patient with a chronic disease motivate himself, caregivers spontaneously make use of reason with a view to having the patient share the caregivers' point of view, in other words, to some extent, transforming the care recipient into a caregiver. However, it is not unusual for a caregiver suffering from the disease in which he specializes not to treat himself in compliance with the rules he recommends to his patients. Man is a trinity with three instances of the self. ⋯ While progressing in that direction, the patient will modify his representation of the disease and its treatment, and enhance his understanding of who he is and how he functions (metacognition). This is the objective of therapeutic education. However, it is necessary for caregivers to demonstrate real empathy that is not only cognitive but also emotional.