Diabetes care

452 articles · Since 2004

Articles, page 11

Your EHR needs a population health management system

February 23, 2013Feb 23, 20133

Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don’t. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement …

Drugs and prescribing

MKSAP: 71-year-old man with new dyspnea on exertion

mksap

January 27, 2013Jan 27, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus…

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

A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide …

Drugs and prescribing

MKSAP: 67-year-old woman is transferred to the ICU

mksap

January 19, 2013Jan 19, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year…

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

A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year history of type 2 diabetes mellitus.

Her blood glucose level on arrival at the ICU is 289 mg/dL (16.0 mmol/L). Although no longer on a cardiopulmonary bypass pump, she remains intubated …

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Conditions and diseases

MKSAP: 68-year-old woman with type 2 diabetes mellitus

mksap

December 8, 2012Dec 8, 2012

A 68-year-old woman comes to the office for a follow-up evaluation. She has had type 2 diabetes mellitus for the past 13 years and has experienced two early-morning hypoglycemic episodes in the past 3 months. Although her self-monitoring of fasting…

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

Although her self-monitoring of fasting blood glucose levels over the past …

Conditions and diseases

MKSAP: 78-year-old man with poor glycemic control

mksap

November 11, 2012Nov 11, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery…

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

A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery ward for 3 weeks with a nonhealing foot ulcer.

The patient has an extensive history of arteriosclerotic cardiovascular disease, including peripheral vascular disease, and a 20-year history of type 2 diabetes …

Conditions and diseases

MKSAP: 45-year-old woman is seen for diabetes follow-up

mksap

July 14, 2012Jul 14, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride.…

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

A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride. A daily injection of insulin glargine was added to her regimen 1 year ago.

At present, her hemoglobin A_1c value is 8.1%. Mean blood glucose values derived from the past 4 …

Drugs and prescribing

Is there a harm to not seeing drug reps?

Matthew Mintz, MD

June 10, 2012Jun 10, 201234

Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …

Health technology

Mobile health apps don’t always follow conventional wisdom

Richard Meyer

May 22, 2012May 22, 2012

Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to a way to save billions of dollars in healthcare costs. There may be a future for mobile apps…

Last year I led some market research into mobile apps across all demographic segments and several disease conditions. While we did …

Conditions and diseases

MKSAP: 22-year-old man with type 1 diabetes mellitus

mksap

May 12, 2012May 12, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 22-year-old man comes for a routine evaluation. He has a history of type 1 diabetes mellitus and began taking insulin glargine and insulin…

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

A 22-year-old man comes for a routine evaluation. He has a history of type 1 diabetes mellitus and began taking insulin glargine and insulin lispro 8 years ago. Two days ago, he participated in a marathon race.

On physical examination, temperature is 36.4 °C (97.5 °F), blood …

Physician voices

Always treat your patient with compassion

Yann Meunier, MD

April 7, 2012Apr 7, 20122

Year: 1979 Setting: George Washington University Hospital Position: Intern In sharing my global health background, I would be remiss if I did not talk about some of my American experience. After all, Washington, D.C., is remote from Palo Alto and…

Year: 1979
Setting: George Washington University Hospital
Position: Intern

In sharing my global health background, I would be remiss if I did not talk about some of my American experience. After all, Washington, D.C., is remote from Palo Alto and Paris! I am in my late 20s and an intern at George Washington University as an exchange student from Brazil. My mentor, Stanley Talpers, MD, has organized a rotating program for the interns, …

Conditions and diseases

Improving diabetes and hypertension outcomes in Medicaid patients

Fred Johnson

March 7, 2012Mar 7, 20123

Medicaid patients with diabetes and hypertension need better outcomes. To achieve better outcomes, physicians need more consistent information on their patients’ real health behaviors. State legislators are pressing to get healthcare costs under control, while Medicaid administrators need to invest thinly stretched resources simultaneously in direct care and broad public health programs that will keep hospital readmissions down. As director of a network of managed primary care systems (Northern Piedmont Community Care) …

Conditions and diseases

MKSAP: 78-year-old woman is seen for management of her diabetes mellitus

mksap

February 11, 2012Feb 11, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient's blood glucose log shows levels…

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

A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient’s blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more than …

Conditions and diseases

3 best practices for both physicians and patients to treat diabetes

Alan L. Plummer, MD

February 1, 2012Feb 1, 20128

As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed…

With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based …

Physician voices

Quality indicators can harm the elderly

Ken Covinsky, MD

December 19, 2011Dec 19, 201112

Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators. The…

The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve …

Read more…

Quality indicators can harm the elderly

Physician voices

How political correctness interferes with healthcare

Dominic A. Carone, PhD

December 14, 2011Dec 14, 20117

Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity…

Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …

Conditions and diseases

MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery

mksap

December 4, 2011Dec 4, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin…

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

A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin is …

Conditions and diseases

A medical student becomes a diabetic and finds public disapproval

Atalanta

October 31, 2011Oct 31, 201125

Recently, our whole class was asked to "become" a diabetic to try and really understand what it is we’re diagnosing people with. Fantastic idea. Fantastic opportunity. Not so fantastic to carry out. I opted for the insulin-dependent, type I option,…

Recently, our whole class was asked to “become” a diabetic to try and really understand what it is we’re diagnosing people with. Fantastic idea. Fantastic opportunity.

Not so fantastic to carry out. I opted for the insulin-dependent, type I option, which meant I had to keep a diary of what I ate (including counting carbohydrates), regularly check my glucose level, and inject myself before meals. (We didn’t actually inject insulin or saline, …

Conditions and diseases

Steps you can take to prevent developing diabetes

James Haddad

October 14, 2011Oct 14, 2011

In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic. Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000. When you consider that type II diabetes has a strong genetic component – the risk for a …

Patient voices

Hospital discharge summaries are a health literacy issue

Hilary Seligman, MD

October 11, 2011Oct 11, 20114

A couple of years ago, a frail 88 year old Filipino woman came into the emergency department of my hospital complaining of confusion and weakness of her left arm. Her blood sugar level was extraordinarily low, so low that she…

The emergency room doctors treated her by injecting her with sugar, and then called the team of internists on call to admit …

Conditions and diseases

Control and be responsible for your diabetes

Trey Stephens

September 2, 2011Sep 2, 2011

Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic. Unlike the majority of the 360 million diabetics worldwide, I…

Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic.

Unlike the majority of the 360 million diabetics worldwide, I did not become a diabetic in my adult life. I became a type I diabetic at 14 months old. As a result, I have never had to change my way …

Diabetes care

Articles, page 11

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