SMA partner Constellation Quality Health welcomes Lisa Graham, RN, CDCES, BC-ADM, as our ECHO session’s didactic and case presenter on Community-Based Programs for Diabetes Education and Management.
Objectives: Biliary dyskinesia and gastroparesis are associated with upper abdominal discomfort and dyspeptic symptoms in the absence of structural abnormalities. We hypothesized that the similarity in symptoms would trigger testing and surgical treatment for biliary abnormalities in a significant number of patients, with refractory symptoms ultimately demonstrating impairment of gastric…
Objectives: Aspirin is recommended for cardiovascular disease (CVD) prevention in patients who are at high risk for CVD. The objective of this study was to compare agreement between two American Diabetes Association–endorsed CVD risk calculators in identifying candidates for aspirin therapy. Methods: Adult patients with diabetes mellitus (n = 238)…
The prevalence of gout and hyperuricemia has increased dramatically during the last several decades, to the point that gout is the most common inflammatory arthritis in the United States, affecting approximately 8 million Americans. Patients with gout frequently have multiple comorbidities, including hypertension, chronic kidney disease, cardiovascular disease, obesity, diabetes,…
Abstract: Just when vitamin deficiencies were thought to be a “thing of the past” a new vitamin deficiency-that of vitamin D has developed over the past 20 years. Vitamin D works like a hormone being produced primarily in one organ (the kidney) before circulating through the bloodstream to multiple organs…
Management of obesity-associated comorbidities costs about $60 billion/year, about 5% of total US healthcare expenditure. Bariatric surgery is the only proven effective weight loss therapy for severely obese patients with a BMI ≥35 kg/m2. Bariatric surgery produces long-term weight loss, improves quality of life, and reduces the number of sick…
Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and…
Abstract:The objective of this study was to compare rates of use of medications for diabetes, hypertension, and hypercholesterolemia between 1988–1994 and 2001–2006 and determine whether increased medication use may be partly attributable to nonadherence to healthy lifestyle habits. This study analyzed and compared data from two different time periods in…
Abstract:Peripheral arterial disease (PAD) is defined as an arterial brachial index (ABI) of ≤0.90 in the lower extremities and results from a narrowing of the arteries as a result of progressive atherosclerosis. PAD affects 12–20% of Americans aged 65 years or older; however, most are asymptomatic and many do not…
Abstract:Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other…
Abstract:We present a case of methicillin-sensitive Staphylococcus aureus metastatic endophthalmitis (SAME) that developed from a bacteremia. We compare this to a literature review of similar cases and report unique characteristics of SAME. We discuss important considerations in the work-up and treatment of endogenous endophthalmitis.
Abstract:Bullosis diabeticorum, or diabetic bullae, is a non-inflammatory blistering condition that is virtually diagnostic of diabetes. Diabetic bullae most often present as painless, tense, superficial bullae that occur in an acral distribution and commonly heal in 2–6 weeks without scarring, but complications such as secondary bacterial infection or hemorrhage may…
Abstract:Diabetic neuropathic cachexia is characterized by bilateral, painful neuropathy usually involving the anterior thighs, with dramatic weight loss. The cause is unknown. Most patients to date have been middle-aged type 2 diabetics on oral agents, and it has rarely been reported in patients with type 1 diabetes. Most patients recover…
Abstract:Increasing evidence supports the importance of postprandial glucose (PPG) in glycemic control with regard to the development of complications in patients with diabetes. PPG plays a critical role in determining overall glycemic control, particularly in patients who are close to their glycemic goals. Data also indicate that postprandial hyperglycemia may…
Objectives: Adhesive capsulitis is characterized by a progressive and painful loss of shoulder motion of unknown etiology. Previous studies have found the prevalence of adhesive capsulitis to be slightly greater than 2% in the general population. However, the relationship between adhesive capsulitis and diabetes mellitus (DM) is well documented, with…
Intensive treatment has been shown to improve glycemic control and reduce the risk of diabetic complications in controlled clinical trials; however, glycemic control has substantial room for improvement in the diabetic population. Management strategies have traditionally focused on achieving A1c targets, with fasting glucose levels serving as the primary measure…
Hispanics experience a higher rate of diabetes than non-Hispanic whites and tend to have worse glycemic control and a greater risk of diabetes-related complications. Once oral antidiabetic agents become insufficient, insulin plays an important role in achieving glycemic goals. However, many Hispanic patients are resistant to initiating insulin therapy or…
A 45-year-old man with paranoid schizophrenia with delusions was transferred from a group home for treatment of diabetic ketoacidosis (DKA). Six months before this episode, he had been hospitalized in an inpatient psychiatric institution and treated with valproic acid and quetiapine 400 mg with normal blood sugars recorded. The patient…
Chronic kidney disease (CKD), which is becoming increasingly prevalent in the US and worldwide, eventually progresses to end-stage renal disease (ESRD), requiring renal replacement therapy. Diabetes and hypertension, the two leading causes of CKD, are themselves reaching near epidemic proportions. Hypertension can cause both the development and progression of CKD,…
Iatrogenic hypoglycemia is the main factor limiting aggressive and optimal diabetes management. Rather than being an inevitable consequence of optimal glycemic control, however, hypoglycemia is avoidable and generally straightforward to manage when it occurs. Professional caregivers, patients, and their families are often fearful of hypoglycemia, even though most episodes are…
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