Diabetes care

452 articles · Since 2004

Articles, page 10

Despite positive trends, diabetes care has a long way to go

May 6, 2014May 6, 20145

The danger of diabetes is not only the immediate risk of very high blood sugar. Diabetes also has many dreaded long-term complications. (In this post I am referring to both type 1 and type 2 diabetes mellitus.) Diabetes greatly increases the risk of stroke, heart attack, and amputation. In the US it is the leading cause of kidney failure and of blindness in adults.

A study performed by researchers at the …

Conditions and diseases

MKSAP: 59-year-old woman with type 2 diabetes mellitus and hyperlipidemia

mksap

March 22, 2014Mar 22, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well.…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin.

Physical examination findings and vital signs are normal. BMI is 27.

Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an …

Health policy

Let’s learn from No Child Left Behind: Measuring quality in healthcare

Luis Collar, MD

January 20, 2014Jan 20, 201421

As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality assurance as if healing were an industrial process, a process similar to those that yield cars, air conditioners, or even cheeseburgers.

But in an age where science, technology, and health policy …

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Physician voices

Pizza or insulin: What does our society value more?

Vipan Nikore, MD

January 11, 2014Jan 11, 20148

Recently, I treated a young patient with diabetes in the hospital. Throughout her young life she had struggled with glucose control, and on this day her struggle left her in a state of diabetic ketoacidosis (DKA). DKA is a life-threatening condition that diabetics often face when their body is unable to uptake enough glucose, leading to utilization of fat and consequential build up of acidic ketones, which cause blood levels …

Physician voices

How many patients can a doctor safely see a day?

Luis Collar, MD

December 31, 2013Dec 31, 201334

Today’s question is a simple one. How many patients can a physician see in one day and still be thorough? Don’t get me wrong; I’m all for efficiency. But we need to recognize when efforts at efficiency become “medical sloppiness”…

With health care policy and insurance reimbursement what they are today, it’s not uncommon to encounter physicians seeing forty, fifty, and even sixty or more patients a day …

Physician voices

You can’t legislate doctor-patient relationships

J. Russell Strader, MD

December 8, 2013Dec 8, 20132

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn't recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I…

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok. She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.

She went on to tell …

Conditions and diseases

Diabetes: More than a word, much more than a diagnosis

Bernadette Sheridan, MD

November 30, 2013Nov 30, 2013

As a family doctor based in Brooklyn, New York, who has served the needs of my community since completing residency in 1982, I find myself with a unique privilege and opportunity to observe disease and wellness, the effects of lifestyle, policy and the collective efforts of myself and others, as we attempt to keep our patients well and affect the statistical bottom line. I’m typing this as I also think …

Conditions and diseases

Diabetes raise special concerns in the homeless

Duc Chung, MD

November 25, 2013Nov 25, 2013

Diabetes is an emerging national crisis. It is the leading cause of heart disease and stroke and the 7th leading cause of death in the United States. According to recent data from the Centers for Disease Control and Prevention (CDC), an estimated 25.8 million people are affected with diabetes with a staggering 79 million more living at high risk for the disease, a stage known as pre-diabetes. Unfortunately, about a third …

Conditions and diseases

How young eyes are devastated by diabetes

Erin K. Walsh, MD

November 16, 2013Nov 16, 2013

Children who live with diabetes, like all children with chronic diseases, learn to grow up rather quickly. In order to survive, they must learn how to manage a disease with which most adults struggle. In particular, not only must children completely change their diet, but they also have to deal with checking blood sugars daily, time and dose insulin shots, all while trying to fit into a world where they …

Patient voices

Are patients marginalized at health conferences?

Scott Strange

October 20, 2013Oct 20, 201336

Recently, I was bemoaning the fact that while the first conference specifically addressing diabetes and depression was a good start, there really wasn’t a significant patient presence. Lots of experienced professionals in the field, but startling few people who had…

While this format will surely offer a lot of information from the professionals viewpoint, it seems that it would be a bit …

Drugs and prescribing

Stop mandating narrow studies of cardiovascular and diabetes drugs

Harlan M. Krumholz, MD

October 18, 2013Oct 18, 2013

The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo. I am not kidding. The New England Journal of Medicine published two trials, each…

The state of diabetes drugs has gotten to the point where it is good news that a drug does not produce worse outcomes than a placebo.

I am not kidding.

The New England Journal of Medicine published two trials, each testing whether a diabetes drug increased the risk of heart attacks and death from heart disease. The trials are a result of FDA guidance for companies to assess the cardiovascular safety of new …

Drugs and prescribing

Remember the side effects of needed drugs that go untaken

David L. Katz, MD

September 12, 2013Sep 12, 20136

You probably already know that what you do know about your medicine could kill you. You may not know that what you don't know could do so as well. Hold that somber thought -- we'll get back to it. You,…

You probably already know that what you do know about your medicine could kill you. You may not know that what you don’t know could do so as well. Hold that somber thought — we’ll get back to it.

You, and I, and everyone else has seen those direct-to-patient drug ads that Big Pharma runs on primetime television. Invariably, they feature a person skipping through butterflies and wildflowers, demonstrating …

Conditions and diseases

A 15 minute office visit cannot dispel a year’s worth of confusion

Karan Chhabra

September 8, 2013Sep 8, 201312

Minutes from melting in the summer heat, I dumped my stuff at a table and homed in on the hospital café’s soda display for something -cold. The gentleman at the next table glanced my way and said, "Are you in…

“Yes sir, I’m a medical student.”

He eyed my drink and asked, “Did you hear that diet soda can increase your risk of diabetes by 70%? Even just a few …

Physician voices

The hubris of medicine has to end

John Mandrola, MD

September 3, 2013Sep 3, 201340

I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat. That’s not…

That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at …

Read more…

The hubris of medicine has to end

Health policy

Quality is a word that lacks universal meaning

Hans Duvefelt, MD

July 9, 2013Jul 9, 20135

In 2009 I wrote a post titled “Quality or Conformity," where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients…

In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.

That phenomenon is called …

Drugs and prescribing

Protect patients from the effects of biased research

Kenneth Lin, MD

June 23, 2013Jun 23, 2013

Approval from the U.S. Food and Drug Administration to market a new drug is a critical waypoint along the path to profits for pharmaceutical manufacturers. Unfortunately, recent case studies have illustrated that FDA approval does not necessarily provide assurances of…

In last month’s Georgetown University Health Policy seminar, we discussed two examples, anemia drugs and the diabetes drug rosiglitazone (Avandia), which were …

Conditions and diseases

The racial disparity of cancer screening and preventive medicine

Sindhura Kodali

June 13, 2013Jun 13, 2013

Like many other Millenials who grew up in the age of Lara Croft and Brangelina, I greeted Angelina Jolie’s announcement that she had undergone a preventative mastectomy and reconstruction last month with sadness for her loss and admiration for her heroic decision and very public disclosure. I hope her story will lead other women to undergo screening and potentially save lives, but real improvement in women’s health outcomes requires …

Physician voices

The soul of our vocation is to heal our patients

Rose Kumar, MD

June 7, 2013Jun 7, 20136

As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could …

Medical education

Can group visits be an ideal way to practice primary care?

Joshua St. Louis

March 16, 2013Mar 16, 20136

After a long day on the internal medicine ward at St. Elizabeth’s Medical Center, I rushed across town to lead that evening’s two-hour group diabetes visit at Union Square Family Health Center in Somerville, MA. So when my preceptor asked…

Although we had discussed taking our Brazilian patients …

Conditions and diseases

MKSAP: 67-year-old woman with severe muscle weakness

mksap

February 24, 2013Feb 24, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …

Diabetes care

Articles, page 10

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