Drugs online research references
geisinger.edu
OBJECTIVE: To describe outcomes associated with a health maintenance organization (HMO)-sponsored disease management program for diabetes. STUDY DESIGN: Descriptive study that compared outcomes of patients with diabetes before and after entry into a disease management program. PATIENTS AND METHODS: The study was conducted in a mixed-model HMO with 275,000 members. The disease management program included a Steering Committee, clinical guidelines, primary care site-based diabetes education, coverage of glucose meters and strips, simplified outcomes reporting, and support of clinical leadership. Data were obtained for 5332 continuously enrolled patients who voluntarily entered the disease management program; 3291 patients (61.7%) received 3 months or more of follow-up, and 663 (12.4%) received 1 year or more of follow-up. The primary outcomes were change from baseline of mean hemoglobin A1c (HbA1c) and medication use after 3 months and 1 year of follow-up. RESULTS: The mean baseline HbA1c for all program participants was 8.51% (standard deviation [SD] = 1.86%). At 3 months of follow-up, the mean HbA1c value for 2794 of 3291 participants (84.0%) had decreased to 7.41% (SD = 1.33%; P = .0001). At 1 year of follow-up, the HbA1c value, available for 605 of 663 patients (91.3%), had decreased from a mean baseline value of 8.76% (SD = 1.87%) to 7.41% (SD = 1.24%; P = .0001). Among 663 patients with 1 year of follow-up, insulin use increased from 30.0% to 31.6%, and sulfonylurea use decreased from 40.7% to 33.8%. Troglitazone and metformin use increased from 7.7% and 23.8%, respectively, to 16.4% and 28.8%, respectively. CONCLUSIONS: Our data suggest that a multifaceted disease management program for diabetes can result in significant short-term improvements in glycemic control in the managed care setting. While the improvement in the HbA1c was accompanied by an increase in the use of insulin, troglitazone, and metformin, we suggest the influence of disease management on glycemic control among our participants was significant and should be considered in future studies in this area.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11185847&dopt=Abstract
Exp Clin Endocrinol Diabetes. 2001;109 Suppl 2:S149-56.
Pathogenesis of type 2 diabetes mellitus.
Dostou J, Gerich J.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Type 2 diabetes mellitus is a heterogeneous disorder with genetic and acquired components. It is primarily due to impaired insulin secretion in that individuals with genetically impaired beta cell function cannot increase their insulin release sufficiently to compensate for insulin resistance. The resultant hyperglycemia is largely the consequence of excessive release of endogenous glucose due to increased gluconeogenesis. Nevertheless, clinical experience has demonstrated that therapies directed at improving beta cell function (sulfonylureas) and at improving hepatic (metformin) and muscle (thiazolidinediones) insulin sensitivity are effective treatments for the condition.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11460566&dopt=Abstract
Med Pregl. 2000 Jul-Aug;53(7-8):423-6.
[News in oral therapy of diabetes mellitus]
[Article in Croatian]
Ivkovic-Lazar T.
Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Institut za interne bolesti, Klinicki centar Novi Sad.
INTRODUCTION: Recent interest in regard to therapy of diabetes mellitus has focused on novelties in the field of insulin and other kinds of therapies disregarding the contemporary achievements in oral therapy. DIETARY PLANT FIBER: Dietary habits and food preferences in developed countries reveal lack of dietary plant fiber associated with the epidemiologic expansion of widespread noninfectious diseases (metabolic, cardiovascular and some malignant neoplasms). INHIBITORS OF INTESTINAL ALPHA-GLYCOSIDASES: These are substances which competatively and reversibly inhibit the intestinal alpha-glycosidases. The best known among them is acarbose, already in clinical usage for some time. Its wide application has been limited due to fairly distressing side effects. NEW ORAL HYPOGLYCEMIC AGENTS: Although metformin is not a new agent, it deserves attention because it is a novelty in our country. It is extremely useful in therapy of obese diabetics with insulin resistance and hyperinsulinemia. Furthermore, glimepiride--a new sulphonyluretic agent is also at disposal, being better than the previous due to not inhibiting vasodilatory reaction and so it can be used in treatment of some heart diseases. A completely new group of oral hypoglycemics is represented by thiazolidine agents which represent the so-called insulin sensitisers. Apart from that, they have a favourable effect on some lipid fractions and arterial blood pressure. SOME OTHER HYPOGLYCEMIC AGENTS: Among numerous substances with hypoglycemic effect it seems that in the future sulphonyluretic agents might be replaced by benzoic acid preparations.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11214490&dopt=Abstract
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