The American Diabetes Association 71st Scientific Sessions was held June 24-28, 2011 in San Diego. The features below highlight some of the news emerging from the meeting.
» Type 1 Diabetes Often Misclassified
» Computer-Based Diabetes Training
» Thyroid Screening Suboptimal in Type 2 Diabetes
» Glucose Metabolism Disorders in Acute Stroke Patients
» OSA, Peripheral Neuropathy, & Type 2 Diabetes
Type 1 Diabetes Often Misclassified [back to top]
The Particulars: The demographics and manifestations of pediatric diabetes are changing along with the rising prevalence of overweight and obesity. The overlapping clinical picture between type 1 and type 2 diabetes may lead to confusion and perhaps inappropriate treatment of pediatric patients.
Data Breakdown: An analysis of patients aged 17 or younger with an initial diagnosis of type 2 diabetes found that 61% maintained this diagnosis after an average of 7 years follow-up, but 38.8% were later diagnosed with type 1 diabetes. Older age at diagnosis was associated with increased risk of misclassification, whereas obesity was associated with decreased risk. Significantly higher risks of developing neuropathic and renal complications were seen in those who were misclassified. This group also had a 50 times greater risk of at least one incidence of diabetic ketoacidosis.
Take Home Pearl: Life-threatening but potentially preventable acute complications appear to be increased when type 1 diabetes is misdiagnosed as type 2 diabetes early in a patient’s management.
Computer-Based Diabetes Training [back to top]
The Particulars: Substandard training of hospital staff may be a reason as to why many hospitals have difficulty implementing guidelines from the American Diabetes Association for managing patients with diabetes.
Data Breakdown: Among internal medicine staff who completed a case-based computer training program that focuses on inpatient dia-betes, house-staff confidence increased significantly after receiving the intervention, rising from 31.6 (on a scale of 0-45) prior to training to 39.2. Knowledge increased from 16.4 to 19.8 on a scale of 0-22. After the program was administered, use of sliding scale insulin decreased while use of basal-bolus insulin regimens increased.
Take Home Pearl: In the management of hospitalized patients with diabetes, a computer-based training program for staff that focuses on inpatient diabetes appears to improve basal-bolus insulin regimen implementation.
Thyroid Screening Suboptimal in Type 2 Diabetes [back to top]
The Particulars: Thyroid disease screening is not routine in diabetes care despite the common presence of hypothyroidism signs (eg, weight gain, lethargy, hypercholesterolemia) in patients with type 2 diabetes.
Data Breakdown: Researchers conducted a study of screenings for thyroid disorders in 1,000 patients with type 2 diabetes. The authors found that just 18 patients knew they had a thyroid disorder; however, 17% showed abnormal thyroid-stimulating hormone (TSH) values, 14% had values suggestive of hypothyroidism, and 3% had values suggestive of hyperthyroidism. Significant links were seen between abnormal TSH values and female sex and age older than 60.
Take Home Pearls: Undiagnosed thyroid disorders appear to be highly prevalent in individuals with type 2 diabetes. These disorders may be missed easily, but regular screenings in patients with type 2 diabetes, particularly females aged 60 or older, may be beneficial.
Glucose Metabolism Disorders in Acute Stroke Patients [back to top]
The Particulars: Diabetes has long been recognized as a risk factor for stroke, but it is unknown how stroke impacts the incidence rates of diabetes.
Data Breakdown: In a study of patients diagnosed with acute stroke, 19.72% were found to have previously known diabetes and 12.67% had newly diagnosed diabetes, while 8.45% had both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Another 7.74% of acute stroke patients had IGT, 5.63% had IFG, and 9.15% had transient hyperglycemia. More than one-third of patients (36.61%) in the analysis had normal glucose tolerance.
Take Home Pearls: Compared with the general population, stroke patients appear to have a higher prevalence of type 2 diabetes. Clinicians should consider conducting oral glucose tolerance testing in stroke patients with no diabetes history.
OSA, Peripheral Neuropathy, & Type 2 Diabetes [back to top]
The Particulars: Research has shown that obstructive sleep apnea (OSA) is prevalent in patients with type 2 diabetes. With shared oxidative stress and inflammatory mechanisms among OSA and diabetes complications, OSA may be associated with diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes.
Data Breakdown: British investigators reviewed 270 participants in a study to assess the link between OSA, DPN, and diabetes. Of the study group, 54.9% had OSA and 42.7% had DPN. Among participants with DPN, 70% also had OSA. Of patients with OSA, 56.8% had DPN, compared with 29.3% of those without OSA.
Take Home Pearls: After adjusting for numerous factors, OSA appears to be independently associated with DPN. Whether OSA treatments are effective in impacting DPN is deserving of further research.
