Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement.

Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.

Characterization of HbA1c Levels in a Subsample of Hispanic Adults Living in the San Juan Metropolitan Area.

OBJECTIVE: To determine the mean levels of glycated hemoglobin (HbA1c) in a subsample of non-diabetic Hispanic Puerto Ricans living in the San Juan metropolitan area (SJMA) and to assess the sensitivity and specificity of HbA1c as a diagnostic test for prediabetes. RESEARCH DESIGN AND METHODS: This was a secondary data analysis of the parent study, Burden of Diabetes and Hypertension in the Adult Population of the San Juan Metropolitan Area of Puerto Rico. Based on their HbA1c and fasting plasma glucose (FPG) values, 370 adults (147 males; 223 females) were classified as non-diabetics. An additional analysis of sensitivity, specificity, and predictive values for this subsample examined the association between FPG and HbA1c. RESULTS: The mean HbA1c among the non-diabetic population was 5.38% (±0.23). Sensitivity, specificity, and the area under the receiving operating characteristic curve were 56.8%, 74.2%, and 84.3%, respectively, for the diagnosis of prediabetes, using HbA1c as the sole diagnostic test (P<0.001). CONCLUSION: This study demonstrated that HbA1c levels among the non-diabetic Hispanic population residing in the SJMA were very similar to those of non-Hispanic whites living in the US. Our results are consistent with those of other studies that have shown that the sensitivity of the HbA1c test is too low to be used in the diagnosis of prediabetes.

TRANSCULTURALIZATION RECOMMENDATIONS FOR DEVELOPING LATIN AMERICAN CLINICAL PRACTICE ALGORITHMS IN ENDOCRINOLOGY--PROCEEDINGS OF THE 2015 PAN-AMERICAN WORKSHOP BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) convened their first Workshop for recommendations to optimize Clinical Practice Algorithm (CPA) development for Latin America (LA) in diabetes (focusing on glycemic control), obesity (focusing on weight loss), thyroid (focusing on thyroid nodule diagnostics), and bone (focusing on postmenopausal osteoporosis) on February 28, 2015, in San Jose, Costa Rica. A standardized methodology is presented incorporating various transculturalization factors: resource availability (including imaging equipment and approved pharmaceuticals), health care professional and patient preferences, lifestyle variables, socio-economic parameters, web-based global accessibility, electronic implementation, and need for validation protocols. A standardized CPA template with node-specific recommendations to assist the local transculturalization process is provided. Participants unanimously agreed on the following five overarching principles for LA: (1) there is only one level of optimal endocrine care, (2) hemoglobin A1C should be utilized at every level of diabetes care, (3) nutrition education and increased pharmaceutical options are necessary to optimize the obesity care model, (4) quality neck ultrasound must be part of an optimal thyroid nodule care model, and (5) more scientific evidence is needed on osteoporosis prevalence and cost to justify intervention by governmental health care authorities. This 2015 AACE/ACE Workshop marks the beginning of a structured activity that assists local experts in creating culturally sensitive, evidence-based, and easy-to-implement tools for optimizing endocrine care on a global scale.

[Metabolic correction: a biochemical option against diseases]. / Corrección metabólica: Una opción bioquímica contra las enfermedades.

Human development and its physiology depends on a number of complex biochemical body processes, many of which are interactive and codependent. The speed and the degree in which many physiological reactions are completed depend on enzyme activity, which in turn depends on the bioavailability of co-factors and micronutrients such as vitamins and minerals. To achieve a healthy physiological state, organism need that biochemical reactions occur in a controlled and specific way at a particular speed and level or grade fully completed. To achieve this, is required an optimal metabolic balance. Factors such as, a particular genetic composition, inadequate dietary consumption patterns, traumas, diseases, toxins and environmental stress all of these factors rising demands for nutrients in order to obtain optimal metabolic balance. Metabolic correction is a biochemical and physiological concept that explains how improvements in cellular biochemistry of an organism can help the body achieve metabolic and physiological optimization. We summarize the contribution of several pioneers in understanding the role of micronutrients in health management. The concept of metabolic correction is becoming a significant term due to the presence of genetic variants that affect the speed of reactions of enzymes, causing metabolic alterations that enhance or promote the state/development of multiple diseases. Decline in the nutritional value of the food we eat, the increase in demand for certain nutrients caused by normal development, diseases and medications induce, usually, nutrients consumption. These nutritional deficiencies and insufficiencies are causing massive economic costs due to increased morbidity and mortality in our society. In summary, metabolic correction improves the enzymatic function, which favors the physiological normal functions, thus, contributing to improving health and the welfare of the human being. The purpose of this paper is to describe and introduce the concept of optimal metabolic correction as a functional cost-effective mechanism against disease, in addition, to contribute to diseases prevention and regeneration of the body and health.

Metabolic correction: a functional biochemical mechanism against disease--Part 2: mechanisms and benefits.

A healthy physiology depends on a plethora of complex interdependent biochemical reactions. In order for these reactions to occur suitably, the enzymes and cofactors that regulate their flow must be present in the proper balance. The term metabolic correction is used to describe a biochemical-physiological process that improves cellular biochemistry as a means to an individual's achieving metabolic or physiological optimization. Part 2 discusses how metabolic correction, through the increase of cofactors, can supply unmet enzyme needs and compensate for nutritional deficiencies induced by improper nutritional intake or by the increased demand for nutrients caused by genetics, health conditions, medications, or physical or environmental stressors. Nutrient insufficiencies are causing an increase in morbidity and mortality, at great cost to our society. In summary, metabolic correction improves enzymatic function and satisfies the increasing demand for nutrients. Metabolic correction can have a significant impact on the reduction of morbidity and mortality and their financial cost to our society and contribute to improving health and well-being.

Metabolic correction: a functional biochemical mechanism against disease--Part 1: concept and historical background.

Human physiology depends on countless biochemical reactions, numerous of which are co-dependent and interrelated. The speed and level of completion of reactions usually depend on the availability of precursors and enzymes. The enzymatic activity depends on the bioavailability of micronutrient cofactors such as vitamins and minerals. In order to achieve a healthy physiological state, the organism requires that biochemical reactions occur at a controlled rate. To achieve this state it is required that metabolic reactions reach what can be considered an optimal metabolic equilibrium. A combination of genetic makeup, dietary patterns, trauma, disease, toxins, medications, and environmental stressors can elevate the demand for the nutrients needed to reach this optimal metabolic equilibrium. In this, part 1, the general concept of metabolic correction is presented with an elaboration explaining how this concept is increasing in importance as we become aware of the presence of genetic variants that affect enzymatic reactions causing metabolic disturbances that themselves favor or promote the disease state. In addition, part 1 reviews how prominent scientists have contributed in fundamental ways to our understanding of the importance of micronutrients in health and disease and in the development of the metabolic correction concept.

Adipocytes and cardiometabolic risk.

To describe the link between adipocytes and cardiometabolic risk and present mechanisms by which obesity contributes to dysglycemia, dyslipidemia, hypertension, and a prothrombotic, inflammatory state favoring atherogenesis. Review of relevant literature compiled via a literature search (PUBMED) of English-language literature publications between 1994 and 2010. Cardiometabolic risk is a term that includes a series of conditions and factors, which contribute to increased risk of developing atherosclerosis. Cardiometabolic risk encompasses traditional coronary risks factors such as smoking, arterial hypertension, diabetes, obesity, elevated cholesterol, old age, male gender, and a positive family history of early coronary events plus additional contributing factors such as insulin resistance, atherogenic dyslipidemia, physical inactivity, unhealthy eating, inflammation, and hypercoagulable state. Adipocyte accumulation and dysfunction contribute to most, if not all, of the cardiometabolic risk factors. A number of different pathologic mechanisms through which adipocytes contribute to cardiometabolic risk and promote atherosclerosis are reviewed. Dysfunctional adipocytes are associated with the development of insulin resistance, hyperglycemia, atherogenic dyslipidemia and arterial hypertension, and favor a prothrombotic and proinflammatory state. Adipocytes dysfunction increases cardiometabolic risk through a variety of mechanisms.

Women and the metabolic syndrome: an overview of its peculiarities.

OBJECTIVE: The peculiarities of the Metabolic Syndrome in women regarding frequency, pathophysiology, manifestations and therapy will be analyzed. Recommendations will be given for prevention of metabolic syndrome and possible reduction of risks factors for cardiovascular disease. METHODS: A review of pertinent studies serves as the basis for the analysis and recommendations of therapeutic strategies in women with metabolic syndrome. RESULTS: Metabolic syndrome, a conglomerate of obesity, hypertension, hyperglycemia, low high density cholesterol and elevated triglycerides can be found frequently in women, especially with polycystic ovaries or in the post-menopausal period. Insulin resistance and its metabolic consequences can lead to an increased risk of cardiovascular disease. There are interventions that can reduce insulin resistance and the other components which may lessen this risk in women with the metabolic syndrome. CONCLUSION: This article summarizes the peculiarities of the metabolic syndrome in women, especially with polycystic ovaries or at postmenopause. Evidence-based medicine is reviewed and used together with the recommendations for therapy and for the prevention of cardiovascular disease in women with this condition.

The use of biochemical markers of bone turnover in osteoporosis.

OBJECTIVE: Present evidence-based recommendations on the use of biochemical markers of bone turnover in the management of osteoporosis. METHODS: The English literature from 1999 to 2005 was reviewed by using data sources from MEDLINE. RESULTS: Measurement of biochemical markers of bone turnover helps us identify a high bone turnover rate. Elevated levels of these markers points towards a pathology and at an accelerated loss of bone mass. Its main utility is in documenting the response to therapy. They have a limited role in the follow-up of patients with osteoporosis. To be useful, bone markers must be measured at baseline and periodically after the beginning of therapy. A fall of on fifty (50%) percent in the levels of resorption markers between the third and sixth month of therapy predicts a good response. Bone markers can not be used to establish the diagnosis of osteoporosis. Neither do they measure bone mass. Markers are not capable of predicting future loss of bone mass in an individual nor do they correlate with the occurrence of previous fractures. The greatest limitation of these measurements is not being able to measure bone remodeling in the individual subject. Bone resorption markers are more frequently used than those of formation. The levels of the markers can identify the failures to the therapy and responses to therapy. Lack of reduction in the resorption markers could indicate lack of compliance with therapy, problems of absorption of the medication or lack in response to treatment. There may be problems with the measurement and the interpretation of results of bone remodeling markers. Variability between individuals and intra-individual variability exist as well as inter-assay and intra-assay variability. CONCLUSION: Biochemical markers of bone turnover along with measurements of bone density can help optimize the management of osteoporosis. The use of the bone markers is not recommended in a routine form, but they can be of utility in situations of poor compliance with the therapy or when there are difficulties in the management of the treatment of osteoporosis.

Cardiovascular disease in women with diabetes mellitus: a review.

OBJECTIVE: To analyze cardiovascular disease (CVD) along wit it's contributing risk factors in women with diabetes mellitus (DM) and from this, to recommend prevention strategies. METHODS: A review of pertinent studies serves as the basis for the analysis and recommendations of prevention strategies in this group. RESULTS: Women with (DM) show a higher morbidity and mortality from CVD. The presence of DM confers these individuals the same risk of having a coronary event as present in a non-diabetic person who has suffered a previous myocardial infarction. Arterial hypertension, a characteristic dyslipidaemia (hypertrigliceridemia, low level of high density lipoprotein cholesterol and elevated low density lipoprotein cholesterol), obesity, microalbuminuria, platelet hyperaggregability and endothelial dysfunction converge conferring the women with DM a higher susceptibility to atherosclerosis. Recommendations include: lifestyle intervention weight reduction, increase in physical activity and smoking cessation. Women with DM should target to lower the LDL-C to a level below 100 mg/dl, the blood pressure level to below 130/80 mm Hg and triglycerides to less than 150 mg/dl. The goal is to raise HDL-C to a level over 45 mg/dl and reduce hemoglobin A1c (HbAlc) levels to below seven (7%) percent. Women with DM should use aspirin on a daily basis, unless contraindicated. These actions may lead to the reduction of the burden of CVD in women with DM. CONCLUSION: This article summarizes the recent salient features of CVD in women with DM with emphasis on preventive measures as well as on the understanding of prevailing guidelines established under the principles of evidence based medicine.