Primary care
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Insulin is an important treatment in diabetes, and understanding insulin pharmacokinetics is vital to clinical practice. The primary care physician should be knowledgeable about the decision for use, initiation of treatment and titration as well as common pitfalls such as hypoglycemia and cost.
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The incidence and prevalence of diabetes are increasing significantly globally and within the United States. Many individuals with diabetes are undiagnosed. The underlying causes of diabetes vary widely and are different in type 1 diabetes, type 2 diabetes, atypical diabetes, and gestational diabetes. It is important for clinicians to recognize the signs and symptoms of diabetes and use the proper diagnostic tools to diagnose diabetes.
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Diabetes-related microvascular complications include diabetic neuropathy (eg, diabetic symmetric polyneuropathy (DSPN), cardiac autonomic neuropathy, gastroparesis, enteropathy, erectile dysfunction, female sexual dysfunction, and hypoglycemia unawareness), diabetic kidney disease (DKD), and diabetes-related eye disease (eg, diabetic retinopathy (DR) and cataract). Both diabetes duration and degree of glycemic control strongly correlate with the development of microvascular complications. The development of diabetes-related microvascular complications interferes with the patient's quality of life and poses higher health system costs. This article will discuss a practical approach to effectively minimize/delay and manage the most common diabetes-related microvascular (DSPN, DKD, and DR).
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The landscape of diabetes treatment has evolved significantly in recent years. While metformin remains first-line for the treatment of type 2 diabetes, 2 new classes of medications (sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide agonists) are becoming mainstays in therapy. These classes boast strong efficacy and desired long-term outcomes, offering cardiovascular and renal protection, as well as other benefits such as weight loss and low risk of hypoglycemia. Most recent guidelines have highlighted the importance of using shared decision making and patient-centered choices when determining medication outcomes.
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Management of diabetes in hospitalized patients requires interdisciplinary, coordinated care that includes communication between physicians in the hospital and primary care providers. As the clinical condition of hospitalized patients can change quickly, insulin dosing must be altered in a timely manner to avoid adverse events.