Glycemic relapse in type 2 diabetes.

OBJECTIVE: To characterize the occurrence of glycemic relapse after initial improvement in blood glucose levels and to describe predictors of relapse in patients with type 2 diabetes. METHODS: Occurrence of glycemic relapse was analyzed in 393 consecutive patients with type 2 diabetes after participation in a 3-month intensive outpatient intervention. All patients had hemoglobin A1c (A1C) values (3)7% before the intervention and had achieved adequate glycemic control (nadir A1C<7%) afterward. The median follow-up time was 26.5 months. Relapse was defined as a subsequent increase in A1C to (3)7%. RESULTS: The probability of glycemic relapse was 45% at 1 year after the intervention and was 76% at 3 years. The median time to relapse was 15.2 months. Cox multivariate regression analysis indicated that treatment with insulin was associated with a greater risk of relapse-- hazard ratio=1.5 (95% confidence interval, 1.1 to 2.2), after controlling for the patient's age, sex, race, body mass index, duration of diabetes, weight change during the intervention, and nadir A1C value. Among those patients not treated with insulin at the end of the intervention, a shorter duration of diabetes and weight loss during the intervention period were significantly associated with decreased risk of relapse. CONCLUSION: The majority of study patients with type 2 diabetes who attained satisfactory glycemic control after intensive outpatient intervention had a relapse after the end of the intervention period. Patients receiving insulin therapy were at particular risk of glycemic relapse. Therefore, such patients should receive high priority for continuation of intensive care or for other relapse prevention measures.

Serendipitous detection of Cushing's disease by FDG positron emission tomography and a review of the literature.

A 70-year-old woman was referred for F-18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging of the brain to evaluate progressive dementia and neuropsychiatric symptoms. Although she had a history of hypertension and diabetes mellitus, she did not exhibit phenotypic features of Cushing's disease. The FDG-PET images revealed marked FDG uptake in the pituitary gland but no evidence of degenerative dementia. Two macroadenomas were confirmed by magnetic resonance imaging. Endocrinologic evaluation revealed Cushing's disease. After surgical resection of the tumors, the patient's symptoms decreased markedly.

Improving glycemic control in adults with diabetes mellitus: shared responsibility in primary care practices.

BACKGROUND: Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications METHODS: Primary care physicians referred patients with unsatisfactory glycemic control, frequent hypoglycemia, or inadequate self-management to an endocrinologist-directed team of nurse and dietitian educators for a 3-month program of intensive diabetes care. Patients had at least weekly contact with a diabetes educator and received changes in insulin and/or other medication, coupled with extensive individualized instruction. The main outcome measurement was change in glycosylated hemoglobin (HbA1c) level at 3 months. RESULTS: The first 350 patients who completed the program had overall mean decrease in HbA1c level of 1.7% (95% CI 1.4%-1.9%). CONCLUSIONS: Barriers to improving glycemic control may be overcome by establishment of a system of collaboration between primary care providers and endocrinologist-directed diabetes educators.