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OBJECTIVE To evaluate over 108 weeks the effect of phentermine and topiramate extended release (PHEN/TPM ER) treatment on progression to type 2 diabetes and/or cardiometabolic disease in subjects with prediabetes [...]

In patients with coronary artery disease (CAD), left ventricular (LV) function, the number of diseased vessels, and the severity of myocardial ischemia are important determinants of survival. These factors can be used to identify subsets of high-risk patients who are candidates for aggressive intervention. Among patients with LV dysfunction, those with left main CAD, three-vessel disease, and one- or two-vessel disease with inducible ischemia are at highest risk. Highrisk subsets among those with preserved LV function include patients with left main CAD and those with inducible ischemia and either three-vessel disease or two-vessel disease with involvement of the proximal left anterior descending coronary artery. Thus, exercise testing, assessment of ventricular function and, in selected patients, coronary angiography to determine coronary anatomy are valuable tools in risk stratification. In the primary-care setting, patient characteristics such as gender, race, age, and concomitant medical conditions may also be most useful in identifying high-risk patients. Although women in general have some primary protection against premature CAD, especially prior to the menopause, coronary risk in women who have experienced a cardiovascular event is similar to that in men. Coronary mortality is increased in minority populations, and the presence of other risk factors, such as diabetes and hyperlipidemia, can further increase this risk. Up to 80% of diabetic patients die of cardiovascular disease, 75% of which is CAD. The risk in this population is exacerbated by the abnormalities in lipid metabolism associated with the diabetic state. CAD mortality increases with aging, but it is recommended that elderly patients with CAD also receive risk factor intervention, such as cholesterol-lowering therapy. Consideration of the impact of such therapy on quality of life is especially important in initiating such interventions in the older population.

Cigarette smoking, obesity, and sedentary lifestyle are known to increase risk of coronary and other vascular disease. Yet eliminating, or reducing, these risk factors through lifestyle modifications is a significant challenge to patients and their physicians. To help meet this challenge in patients with coronary and other vascular disease, physicians should use an approach similar to that followed in other treatment plans: First, help the patient understand the value of the therapy; second, discuss the way in which treatment will evolve and set appropriate goals; third, follow up by monitoring and encouraging the patient's progress and identifying any barriers or adverse effects. When applying this paradigm to exercise, physicians can motivate patients by making them aware of the benefit of even moderate levels of activity, outlining a specific exercise program and setting appropriate goals, and following up on their patients' progress. Studies show that physicians can have a major positive impact on smoking cessation merely by asking patients whether they smoke and advising smokers to quit. Physicians can further assist smokers by providing educational materials, referring patients to counseling groups when needed, and prescribing nicotine replacement therapy when appropriate. Again, follow-up is essential. Dietary intervention should be tailored to individual patients, their food preferences and ethnic backgrounds. Individuals should be encouraged to try a wide variety of nonfat and low-fat foods and incorporate those they find acceptable into their diet in place of higher-fat alternatives. Educational materials are helpful in motivating patients to modify their eating habits and in providing additional ideas for food substitutions.

In older type II diabetics, complications progress more rapidly than in younger diabetics for any given degree of hyperglycemia. Therefore, it is important to closely monitor blood glucose levels. When their sugars are controlled, older diabetics will have less nocturia and polyuria; fewer infections; better wound healing; a decrease in the rate of progression of cataracts, diabetic retinopathy, and nerve and renal disease; and better control of dyslipidemia. To learn some useful tips for managing older patients with type II diabetes, GERIATRICS reader David B. Jack, MD, interviewed Nancy J.V. Bohannon, MD, for this 'Ask the Expert' article. Bohannon NJV, Jack DB. Type II diabetes: Tips for managing your older patients. Geriatrics 1996; 51(March):28-35., Mrs. Powell, age 71, with type II diabetes (NIDDM), awaits your visit in the next exam room. While thumbing through the chart, you note that your standard therapy seems to [...]

Sixty subjects (pts.) participated in an open lable, 4 month cross-over study to compare insulin lispro to Humulin Regular (HR) insulin during intensive insulin therapy in both Type 1 (N=32) [...]

Onychomycosis is a risk factor for amputations in diabetics (DMs). The presense of onychomycosis (OM) is associated with athlete's foot, foot ulcers and increased hospitalizations and patients with diabetes have [...]

The FreeStyle (FS) glucose meter was designed to be used on non-finger lancing sites in order to decrease the amount of pain associated with routine glucose monitoring. Because those sites [...]

We have developed a finger-stick ([is less than or equal to] 10[micro]L) test for hemoglobin A1c (HbA1c) for rapid quantitative testing at the point of care. This test (DRx-HbA1c) incorporates [...]

This cookbook was developed by a husband-wife team after Ron, 'a great dessert lover,' developed type II diabetes. However, the recipes are not truly sugar-free, since they do contain fruit [...]