Primary care
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The management of diabetes in clinical practice has many challenges: quickly interpreting a large volume of self-monitoring of blood glucose data, ensuring safe and accurate titration of basal insulin, managing patients on insulin pump therapy, and synthesizing glycemic data into actionable reports to improve patient outcomes. Technological advancements are emerging as a solution to some of these challenges. This article reviews mobile applications for insulin dosing, continuous glucose monitoring, insulin pump therapy, and smart insulin pens available for patients with type 1 and type 2 diabetes.
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Assessing glycemia over time remains a standard recommendation in the care of all people with diabetes. Glycemic assessment methods range from laboratory- and office-based methods to patient-based methods. ⋯ Continuous glucose monitoring (CGM) can also be used, especially via glucose management indicator or time-in-range, which can be useful especially when A1c might be impractical, unreliable, or inaccurate, or for glycemia assessment over a shorter interval. Other measures of glycemia, including hypoglycemia and glycemic variability, are becoming increasingly important in many cases and are also available via CGM.
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Because macrovascular complications of diabetes are the leading cause of mortality and decreased quality of life for individuals with diabetes, prevention and risk reduction are paramount. Besides lifestyle management, contemporary therapies can significantly reduce risk for cardiovascular events in diabetes. For primary prevention, most individuals should be on statin therapy, whereas those at high atherosclerotic cardiovascular disease risk should also be on glucagon-like peptide 1 receptor agonists (GLP1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i) at any hemoglobin A1c. For secondary prevention, addition of GLP1RA or SGLT2i, PCKS9i, rivaroxaban, and/or icosapent ethyl should be considered in addition to a statin and low-dose aspirin.
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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.