RESUMO
Glycemic management is central in prevention of small vessel and cardiovascular complications in type 2 diabetes. With the plethora of newer medications and recommendations for a patient centered approach, more information is necessary to match the proper drug to each patient. We showed that BARI 2D, a five-year trial designed to compare two different glycemic treatment strategies, was suitable for assessing different responses according to different phenotypic characteristics. Treatment with insulin sensitizing medications such as thiazolidinediones and metformin was more effective in improving glycemic control, particularly in the more insulin resistant patient, when compared to the insulin provision strategy using insulin and or sulfonylureas. Triglyceride and high density lipoprotein ratio (TG/HDL-cholesterol ratio) was found to be a readily available and practical biomarker that helps to identify the insulin resistant patient. These results support the concept that not all medications for glycemic control work the same in all patients. Thus, tailored therapy can be done using phenotypic characteristics rather than a "one-size-fits-all approach."
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hiperlipidemias/prevenção & controle , Hipolipemiantes/uso terapêutico , Resistência à Insulina , Lipoproteínas HDL/sangue , Triglicerídeos/sangue , Idoso , Biomarcadores/sangue , Estudos de Coortes , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Angiopatias Diabéticas/cirurgia , Feminino , Seguimentos , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/epidemiologia , Masculino , Metformina/uso terapêutico , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Fatores de Risco , Tiazolidinedionas/uso terapêuticoAssuntos
Coriocarcinoma/metabolismo , Gonadotropina Coriônica Humana Subunidade beta/metabolismo , Hipertireoidismo/etiologia , Síndromes Endócrinas Paraneoplásicas/diagnóstico , Neoplasias Testiculares/metabolismo , Biomarcadores/metabolismo , Coriocarcinoma/complicações , Coriocarcinoma/diagnóstico , Humanos , Hipertireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Síndromes Endócrinas Paraneoplásicas/complicações , Neoplasias Testiculares/complicações , Neoplasias Testiculares/diagnósticoRESUMO
OBJECTIVES: To demonstrate that pharmacists working with physicians and other providers in an ambulatory care setting can improve glucose, blood pressure, and lipid control for patients with type 2 diabetes and to report patient adherence to screening and general preventive measures. DESIGN: Prospective, randomized, clinical practice study. SETTING: Burlington, MA, between January 2001 and August 2003. PATIENTS: 164 patients patients with type 2 diabetes older than 18 years with glycosylated hemoglobin (A1C) greater than 8%. INTERVENTION: Pharmacist-patient clinic visits included obtaining a comprehensive medication review; performing targeted physical assessment; ordering laboratory tests; reviewing, modifying, and monitoring patients' medication therapy and providing detailed counseling on all therapies; facilitating self-monitoring of blood glucose; and providing reinforcement of dietary guidelines and exercise. MAIN OUTCOME MEASURE: Effect of clinical pharmacists working with physicians in an ambulatory setting on health measures (e.g., A1C, blood pressure, cholesterol) of patients with diabetes. RESULTS: Baseline characteristics were similar between the two groups. After 1 year, significant improvements occurred for A1C and low-density lipoprotein (LDL) cholesterol in the intervention group compared with the control group (A1C, 7.7% vs. 8.4%; LDL, 93.7 vs. 105.1 mg/dL; P < 0.05). Systolic blood pressure improved for all study patients without a difference between the two groups. Diastolic blood pressure improved significantly in the intervention group compared with the control group (73.4 mm Hg vs. 77.6 mm Hg, P < 0.05). Significantly more intervention patients were screened for retinopathy, neuropathy, and microalbuminuria than control patients ( P < 0.05). CONCLUSION: For all indices measured, this study demonstrated that collaborative diabetes management with a clinical pharmacist can improve overall care.
Assuntos
Assistência Ambulatorial/organização & administração , Diabetes Mellitus Tipo 2/terapia , Equipe de Assistência ao Paciente/organização & administração , Cooperação do Paciente , Farmacêuticos , Idoso , Idoso de 80 Anos ou mais , Glicemia , Pressão Sanguínea , Dieta , Exercício Físico , Feminino , Hemoglobinas Glicadas , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Papel Profissional , Estudos ProspectivosAssuntos
Carcinoma Medular/diagnóstico , Tontura/etiologia , Neoplasias da Glândula Tireoide/diagnóstico , Idoso , Biópsia por Agulha Fina , Calcitonina/sangue , Carcinoma Medular/complicações , Carcinoma Medular/patologia , Carcinoma Medular/cirurgia , Humanos , Masculino , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
Preview What causes subclinical hypothyroidism? How prevalent is it? When is it likely to progress to overt disease? Are clinical abnormalities sometimes present? Answers to these questions, as well as a discussion of treatment approaches, are found in this overview.