Clinical Gems

  Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   The most common cause of type 1 diabetes (over 90% of cases) is T cell-mediated autoimmune destruction of the islet beta cells leading to a failure of insulin production. The exact aetiology is complex and still imperfectly understood. However, it …

Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Islet structure and function Insulin is synthesized in and secreted from the β-cells within the islets of Langerhans in the pancreas. The normal pancreas has about 1 million islets, which constitute about 2-3% of the gland’s mass. All of the islet …

  Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Impact on healthcare expenditure Diabetes is an expensive disease. About 75% of the direct costs are absorbed by the long-term complications, rather than the management of diabetes itself. In the USA in 2002, the annual economic burden of diabetes was …

Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Diabetes mellitus is diagnosed by identifying chronic hyperglycemia. The World Health Organization (WHO) and the American Diabetes Association (ADA) have used a fasting plasma glucose (FPG) of 126mg/dL.(7 mmol/L) or higher to define diabetes (Table 3.1 ). This originated from epidemiological …

Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Diseases with the clinical features of diabetes have been recognised since antiquity. The Ebers papyrus, dating from 1550 BC, describes a polyuric state that resem­bles diabetes. The word ‘diabetes’ was first used by Aretaeus of Cappadocia in the second century AD. …

Richard S. Beaser, MD This week’s excerpt covers the following topics: What drugs restore incretin function How to titrate GLP-1 agonists Learn the contraindications and precautions for the DPP-IV inhibitors The typical doses for the different DPP-IV’s….

Richard S. Beaser, MD Medications that Increase Insulin Secretion: SULFONYLUREAS CLASS SUMMARY: Action: Insulin secretagogues. Initial effects are to increase insulin secretory capacity. With establishment of long-term glucose control, this increase may not persist and other extrapancreatic effects, either direct or indirect, may also occur. Required for efficacy: Some remaining …

Richard S. Beaser, MD This week’s excerpt covers the following topics: What drugs block glucose absorption How to titrate this class of drugs Learn the contraindications and precautions for the glucose blocking drugs Discover which other drugs can cause serious side effects when used with drugs that block glucose absorption   …

Richard S. Beaser, MD This week’s excerpt covers the following topics: Drug interactions with potential for clinical significance for metformin Contraindications and precautions for metformin Class contraindications and precautions for TZD’s Which TZD interactions are serious and how it is metabolized  

Richard S. Beaser, MD This week’s excerpt covers the following topics: The disadvantages of triple therapy Which abnormality of the metabolic syndrome to treat first When to start triple therapy Why we need to be more aggressive in treating type 2 diabetes Achieving a Proper Balance When initiating and titrating …