fasting blood sugar levels chart in hindi

^^ fasting blood sugar levels chart in hindi 14 Jul 2020 How To Cure [Best Treatment]. [fasting blood sugar levels chart in hindi] fasting blood sugar levels chart in hindi [].

fasting blood sugar levels chart in hindi Treatment of the type1 diabetes mellitus does not considerably spoils the normal life structure of a patient if the patient is aware of the usage, the dosage, the ...

News & Perspective
Drugs & Diseases
CME & Education
Academy
Video
Edition: ENGLISH
Log In
Sign Up It''overview''clinical''workup''treatment''medication''s clinical circumstances must guide selection. [149]

In a meta-analysis of 20 publications comprising 13,008 cancer patients with concurrent type 2 diabetes, Yin et al found that patients treated with metformin had better overall and cancer-specific survival than those treated with other types of glucose-lowering agents. [95, 96] These improvements were observed across cancer subtypes and geographic locations.

fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for Risk reduction was significant among patients with prostate, pancreatic, breast, colorectal and other cancers, but not for lung cancer. [96] However, it remains unclear whether metformin can modulate clinical outcomes in cancer patients with diabetes.

Sulfonylureas

Sulfonylureas (eg, glyburide, glipizide, glimepiride) are insulin secretagogues that stimulate insulin release from pancreatic beta cells and probably have the greatest efficacy for glycemic lowering of any of the oral agents. However, that effect is only short-term and quickly dissipates. Sulfonylureas may also enhance peripheral sensitivity to insulin secondary to an increase in insulin receptors or to changes in the events following insulin-receptor binding.

Sulfonylureas are indicated for use as adjuncts to diet and exercise in adult patients with type 2 diabetes mellitus. They are generally well-tolerated, with hypoglycemia the most common side effect. The first-generation sulfonylureas are acetohexamide, chlorpropamide, tolazamide, and tolbutamide; the second-generation agents are glipizide, glyburide, and glimepiride. The structural characteristics of the second-generation sulfonylureas allow them to be given at lower doses and as once-daily regimens.

One study exonerated the sulfonylurea group of oral agents as the chief cause of cardiovascular death in diabetic patients admitted with acute myocardial infarction. However, even though sulfonylureas were safer in general, within the group, the use of glyburide was associated with highest mortality (7.5%) compared with other sulfonylureas, such as gliclazide and glimepiride (2.7%). [150] This raises an important concern about whether the use of glyburide should be avoided.

Meglitinide derivatives

Meglitinides (eg, repaglinide, nateglinide) are much shorter-acting insulin secretagogues than the sulfonylureas are, with preprandial dosing potentially achieving more physiologic insulin release and less risk for hypoglycemia. [151] Although meglitinides are considerably more expensive than sulfonylureas, they are similar in their glycemic clinical efficacy.

Meglitinides can be used as monotherapy; however, if adequate glycemic control is not achieved, then metformin or a thiazolidinedione may be added. Meglitinides may be used in patients who have allergy to sulfonylurea medications. They have a similar risk for inducing weight gain as sulfonylureas do but possibly carry less risk for hypoglycemia.

Alpha-glucosidase inhibitors

These agents delay sugar absorption and help to prevent postprandial glucose surges. Alpha-glucosidase inhibitors prolong the absorption of carbohydrates, but their induction of flatulence greatly limits their use. They should be titrated slowly to reduce gastrointestinal (GI) intolerance.

Thiazolidinediones

TZDs (eg, pioglitazone [Actos], rosiglitazone [Avandia]) act as insulin sensitizers; thus, they require the presence of insulin to work. They must be taken for 12-16 weeks to achieve maximal effect.

These agents are used as monotherapy or in combination with sulfonylurea, metformin, meglitinide, DPP-4 inhibitors, GLP-1 receptor agonists, or insulin. They are the only antidiabetic agents that have been shown to slow the progression of diabetes (particularly in early disease).

In the Canadian Normoglycemia Outcome and Evaluation (CANOE) trial, glycemic parameters and insulin sensitivity improved in patients taking rosiglitazone and metformin in year 1 but deteriorated in the years thereafter, as in the placebo arm. Beta-cell function remained relatively stable in both groups for the first 2 years but then deteriorated progressively in subsequent years. The investigators attributed the lower rate of incident diabetes in the rosiglitazone/metformin group to the early effect of treatment. [152]

In a study by DeFronzo et al, pioglitazone was found to reduce the progression to frank diabetes by 72% in patients with IGT. [153] However, the drug was associated with significant edema and weight gain.

In the Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) trial, rosiglitazone reduced the incidence of diabetes by 62%. It also improved the achievement of normoglycemia by 70% in patients with IFG and by 64% in patients with both IFG and IGT. [154]

A study by Phung et al investigated oral agents used for prevention of type 2 diabetes and found that TZDs resulted in a greater risk reduction than biguanides. Sulfonylureas and glinides had no benefit. [155]

TZDs generally decrease triglyceride levels and increase HDL cholesterol levels. They increase LDL cholesterol, but this increase may involve large, buoyant LDL, which may be less atherogenic.

Pioglitazone in patients unresponsive to combination therapy

fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for Charpentier et al concluded that the early addition of pioglitazone in patients who are not responding to dual therapy is beneficial, decreasing HbA1c, as well as improving FPG levels and other surrogate markers. [156] In this study, patients (n=299) with type 2 diabetes mellitus uncontrolled by combination therapy with metformin and a sulfonylurea or a glinide were randomly assigned to receive add-on therapy with either pioglitazone 30 mg daily or a placebo.

fasting blood sugar levels chart in hindi 👍how to fasting blood sugar levels chart in hindi for Among patients with a baseline HbA1c level of less than 8.5%, 44.4% of patients in the pioglitazone group achieved an HbA1c level of less than 7% after 7 months, compared with only 4.9% of patients in the placebo group. In patients with a baseline HbA1c level of 8.5% or greater, 13% of those in the pioglitazone group achieved an HbA1c level of less than 7%, while no patients in the placebo group saw the same reduction. [156]

Adverse effects

While TZDs have the 1 last update 2020/07/14 many desirable effects on inflammation and the vasculature, edema (including macular edema) and weight gain may be problematic adverse effects, especially when TZDs are administered with insulin or insulin secretagogues. [157] These effects may induce or worsen heart failure in patients with left ventricular compromise and occasionally in patients with normal left ventricular function. TZDs have not been tested in patients with New York Heart Association class III or IV heart failure.While TZDs have many desirable effects on inflammation and the vasculature, edema (including macular edema) and weight gain may be problematic adverse effects, especially when TZDs are administered with insulin or insulin secretagogues. [157] These effects may induce or worsen heart failure in patients with left ventricular compromise and occasionally in patients with normal left ventricular function. TZDs have not been tested in patients with New York Heart Association class III or IV heart failure.

Fluid retention from TZDs has been considered resistant to treatment with loop diuretics, because of upregulation of renal epithelial sodium channels. However, a randomized, double-blind, placebo-controlled, crossover study by Rennings et al found that response to the loop the 1 last update 2020/07/14 diuretics furosemide and amiloride were preserved in rosiglitazone-treated subjects with insulin resistance. [158] Fluid retention from TZDs has been considered resistant to treatment with loop diuretics, because of upregulation of renal epithelial sodium channels. However, a randomized, double-blind, placebo-controlled, crossover study by Rennings et al found that response to the loop diuretics furosemide and amiloride were preserved in rosiglitazone-treated subjects with insulin resistance. [158]

The use of pioglitazone for more than 2 years is weakly associated with an increased bladder cancer risk, with the highest risk among patients who took pioglitazone the longest and at the highest cumulative doses. [159, 160, 161] Constant surveillance and vigilance is needed. Ninety-five percent of these cases were detected in early stage. The US Food and Drug Administration (FDA) currently recommends not prescribing pioglitazone for patients with active bladder cancer and using it with caution in patients with a history of bladder cancer.

A meta-analysis indicated that in women with type 2 diabetes, long-term (ie, 1 y or longer) use of TZDs doubles the risk of fracture. [162] Although in this study, TZDs were not found to have significantly increased fracture risk among men with type 2 diabetes, risk of fracture in males has since been reported.

fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for Rosiglitazone restrictions

In response to data suggesting an elevated risk of myocardial infarction in patients treated with rosiglitazone, the FDA has restricted access to this drug. [163] The use of rosiglitazone is limited to patients already being successfully treated with this agent and to patients whose blood sugar cannot be controlled with other antidiabetic medicines and who do not wish to use pioglitazone, the only other TZD currently available.

Health-care providers and patients must be enrolled in the Avandia-Rosiglitazone Medicines Access Program in order to prescribe and receive rosiglitazone. Patients who are enrolled in the access program receive their medicine by mail order through certified pharmacies that participate in the program.

fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for Glucagonlike peptide–1 agonists

GLP-1 agonists (ie, exenatide, liraglutide, albiglutide, dulaglutide) mimic the endogenous incretin GLP-1; they stimulate glucose-dependent insulin release, reduce glucagon, and slow gastric emptying. The use of a GLP-1 in addition to metformin and/or a sulfonylurea may result in modest weight loss. Animal data suggest that these drugs prevent beta-cell apoptosis and may in time restore beta-cell mass. The latter property, if proven in humans, would have tremendous therapeutic potential.

Exenatide

A comparison by Bunck et al of 1 year''s safety and efficacy was assessed by the GetGoal program, which included 13 clinical trials of adults with type 2 diabetes mellitus (n >5000). The primary efficacy endpoint, HbA1c reduction, was achieved by all of the GetGoal studies. [182, 183]

The ELIXA study demonstrated that in patients with type 2 diabetes who had had a recent acute coronary syndrome, cardiovascular adverse events did not increase in those taking lixisenatide compared with patients taking placebo. The study included 6068 adults with type 2 diabetes, 39% of whom had a recent non–ST-segment-elevation myocardial infarction, 43% of whom had ST-segment-elevation myocardial infarction, and 17% of whom had unstable angina. At a median of 25 months, the investigators found that cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina had occurred in 13.4% of the lixisenatide patients and 13.2% of the control patients. [184]

A study to assess efficacy and safety of lixisenatide monotherapy in type 2 diabetes found a once-daily dose of the drug improved glycemic control. Once-daily monotherapy significantly lowered postprandial glucose and was for 1 last update 2020/07/14 well tolerated by patients with type 2 diabetes. [185] A study to assess efficacy and safety of lixisenatide monotherapy in type 2 diabetes found a once-daily dose of the drug improved glycemic control. Once-daily monotherapy significantly lowered postprandial glucose and was well tolerated by patients with type 2 diabetes. [185]

Semaglutide

In December 2017, the FDA approved once-weekly semaglutide SC (Ozempic), a GLP-1 receptor agonist, as a glycemic control–improvement agent in adults with type 2 diabetes. It is administered as a subcutaneous injection once weekly. Meant as an adjunct to diet and exercise, semaglutide was approved following eight phase 3a studies (the SUSTAIN trials). 

Semaglutide SC gained FDA approval in January 2020 for risk reduction of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and heart disease. Results from the 2-year randomized study SUSTAIN 6 (Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes) led to approval for for 1 last update 2020/07/14 the new indication. In the trial, 3297 adults with type 2 diabetes and established cardiovascular disease (CVD) received either injectable semaglutide or placebo, in addition to stand-of-care therapy. [186, 187] Semaglutide SC gained FDA approval in January 2020 for risk reduction of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and heart disease. Results from the 2-year randomized study SUSTAIN 6 (Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes) led to approval for the new indication. In the trial, 3297 adults with type 2 diabetes and established cardiovascular disease (CVD) received either injectable semaglutide or placebo, in addition to stand-of-care therapy. [186, 187]

Risk for the primary composite outcome—first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke—for patients treated with semaglutide SC was a significant 26% below that for placebo patients. However, cardiovascular risk reduction primarily resulted from declines in nonfatal stroke (39%) and nonfatal myocardial infarction (26%), with cardiovascular death rates being similar between the semaglutide and placebo patients. [186, 187, 188]

In September 2019, the FDA approved the first oral GLP-1 receptor agonist, a form of semaglutide available under the brand name Rybelsus. It is administered as a once-daily oral tablet. Approval of the oral tablet was based on results from the phase 3 PIONEER trials (n=9543). The trials included head-to-head studies of oral semaglutide compared with sitagliptin (DP4 inhibitor), empagliflozin (SGLT2 inhibitor), and liraglutide 1.8 mg (GLP-1 agonist). A1c reduction was found with oral semaglutide, as well as, via a secondary endpoint, body weight reduction. [189, 190, 191]

In January 2020, the FDA updated the clinical studies section of Rybelsus’s prescribing information, with results added from the randomized, placebo-controlled study PIONEER 6 (Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects With Type 2 Diabetes), which were released in June 2019. The report found oral semaglutide to be associated with a nonsignificant 21% reduction in three-component MACE. The information added to Rybelsus’s label related to cardiovascular safety, not benefit. [192, 187]

Dipeptidyl peptidase IV inhibitors

DPP-4 inhibitors (eg, sitagliptin, saxagliptin, linagliptin) are a class of drugs that prolong the action of incretin hormones. DPP-4 degrades numerous biologically active peptides, including the endogenous incretins GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). DPP-4 inhibitors can be used as a monotherapy or in combination with metformin or a TZD. They are given once daily and are weight neutral.

A study comparing the efficacy and safety of monotherapy with sitagliptin or metformin in treatment-naive patients with type 2 diabetes found no statistical differences between the 2 drugs in terms of decreases in HbA1c and fasting glucose levels. The 1050 participants in the study had baseline HbA1c levels of 6.5-9% and received sitagliptin (100 mg qd) or metformin (1000 mg bid) for 24 weeks. [193]

fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for In this study, the incidence of adverse GI effects was lower with sitagliptin than with metformin (11.6% vs 20.7%). Specifically, diarrhea (3.6% vs 10.9%) and nausea (1.1% vs 3.1%) were significantly less common with sitagliptin. [193]

A study by Vilsboll et al in patients receiving stable-dose insulin therapy (with or without concomitant metformin) found that the addition of sitagliptin produced a greater reduction in FPG (by 15 mg/dL [0.8 mmol/L]) and 2-hour postprandial glucose (by 36.1 mg/dL [2 mmol/L]) than did placebo. Sitagliptin reduced HbA1c by 0.6%, while no reduction was seen with placebo. In addition, 13% of patients attained an HbA1c level of less than 7% with sitagliptin, compared with 5% with placebo. [194]

A study by Pérez-Monteverde et al found that a combination of sitagliptin and metformin was associated with improved glycemic control and less weight gain when compared with pioglitazone in the treatment of patients with type 2 diabetes mellitus. [195]

fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Adding linagliptin to treatment in patients with type 2 diabetes mellitus that has been inadequately controlled with a metformin and sulfonylurea combination improves glycemic control. Because it has predominantly nonrenal excretion and is a clinically nonrelevant substrate for cytochrome-450 isoenzymes, this drug possesses the benefits of having a low risk of drug-drug interaction and of being safe to use in patients with renal insufficiency. [196]

Upper respiratory tract infections have been increasingly reported among users of DPP-4 inhibitors compared with users of other antidiabetic drugs. [197] However, further research is needed to evaluate the scope and underlying mechanisms of this phenomenon. On the other hand, a meta-analysis suggested that treatment with DPP-4 inhibitors could reduce the risk of bone fractures. [198]

Selective sodium-glucose transporter-2 inhibitors

fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Canagliflozin is the first SGLT-2 inhibitor approved in the United States. [199, 200] SGLT-2 inhibition lowers the renal glucose threshold (ie, the plasma glucose concentration that exceeds the maximum glucose reabsorption capacity of the kidney). Lowering the renal glucose threshold results in increased urinary glucose excretion. A second SGLT-2 inhibitor, dapagliflozin (Farxiga), was approved by the FDA in January 2014, [201, 202] and another, empagliflozin, approved in August, 2014. [203, 204]

Dosage adjustments are required for canagliflozin in patients who have renal impairment (ie, estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2). Dapagliflozin should not be used if eGFR is < 60 mL/min/1.73 m2. Also consider lowering the dose of insulin or insulin secretagogues to reduce the risk of hypoglycemia when coadministered with SGLT-2 inhibitors.

FDA approval of canagliflozin was based on global phase 3 clinical trials that included over 10,000 patients. [199, 200] In a trial evaluating canagliflozin monotherapy efficacy and safety in 584 adults with type 2 diabetes mellitus inadequately controlled with diet and exercise, treatment for 26 weeks with canagliflozin 100 or 300 mg daily resulted in a statistically significant improvement in HbA1C with both doses compared with placebo. [205]

Canagliflozin add-on combination therapy to metformin and/or sulfonylureas showed a reduction in fasting glucose and for 1 last update 2020/07/14 a greater proportion of patients achieving an HbA1C level less than 7%. [206] Add-on therapy to insulin and comparative data to thiazolidinediones and to dipeptidyl peptidase-IV inhibitors have also shown improved postprandial glucose levels and HbA1C levels. [206] Canagliflozin add-on combination therapy to metformin and/or sulfonylureas showed a reduction in fasting glucose and a greater proportion of patients achieving an HbA1C level less than 7%. [206] Add-on therapy to insulin and comparative data to thiazolidinediones and to dipeptidyl peptidase-IV inhibitors have also shown improved postprandial glucose levels and HbA1C levels. [206]

In October 2019, canagliflozin received FDA approval for the treatment of diabetic kidney disease (DKD) and, in patients with type 2 diabetes and DKD, reduction in the risk of hospitalization for heart failure. Approval stemmed from the outcome of the phase 3 CREDENCE study, which found that at median 2.62-year follow-up, the risk of renal failure and cardiovascular events was lower in patients with type 2 diabetes and kidney disease who were treated with canagliflozin than in patients on placebo. [207]

Dapagliflozin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. [201, 202]  It can be employed as monotherapy, as initial therapy with metformin, or as an add-on to other oral glucose-lowering agents, including metformin, pioglitazone, glimepiride, sitagliptin, and insulin. [208, 209, 210, 211]  

In October 2019, dapagliflozin gained an indication to reduce hospitalization for heart failure in adults with type 2 diabetes and cardiovascular risk. FDA approval was based on the Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE-TIMI 58) study, in which 17,160 patients were evaluated (median 4.2-year follow-up). The investigators found that in patients on dapagliflozin, the rate of cardiovascular death or hospitalization for heart failure was 4.9%, compared with 5.8% for patients on placebo. [212]  

Like dapagliflozin, empagliflozin is also approved as an adjunct to diet and exercise to improve glycemic control. The drug’s safety and effectiveness were evaluated in 7 clinical trials with 4480 patients with type 2 diabetes. The pivotal trials showed that empagliflozin improved hemoglobin A1c levels compared with placebo. [203, 204]  In late 2016, the FDA also approved empagliflozin for a new indiction, specifically, the prevention of cardiovascular disease–related death in adults with type 2 diabetes who also have cardiovascular disease. [213, 214]  The new approval was based on results from the (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME), which included more than 7000 patients. [215]

Indicated as an adjunct to diet and exercise, ertugliflozin therapy is aimed at improving glycemic control in the 1 last update 2020/07/14 adults with type 2 diabetes. Ertugliflozin''s earlier glycemic-control algorithm, the level of treatment depends on the initial hemoglobin A1c (HbA1c). (Lifestyle modification, including weight loss, is a component of all treatments.) Whereas the earlier algorithm recommended an HbA1c of 6.5% or lower as the goal for most patients, the current algorithm refines this advice, recommending an HbA1c of 6.5% or lower for healthy patients without concurrent illness and at low risk for hypoglycemia but individualized target HbA1c values greater than 6.5% for patients with concurrent illness and those who are at risk for hypoglycemia.Indicated as an adjunct to diet and exercise, ertugliflozin therapy is aimed at improving glycemic control in adults with type 2 diabetes. Ertugliflozin''s earlier glycemic-control algorithm, the level of treatment depends on the initial hemoglobin A1c (HbA1c). (Lifestyle modification, including weight loss, is a component of all treatments.) Whereas the earlier algorithm recommended an HbA1c of 6.5% or lower as the goal for most patients, the current algorithm refines this advice, recommending an HbA1c of 6.5% or lower for healthy patients without concurrent illness and at low risk for hypoglycemia but individualized target HbA1c values greater than 6.5% for patients with concurrent illness and those who are at risk for hypoglycemia.

Metformin

Metformin is the preferred initial agent for monotherapy and is a standard part of combination treatments. Advantages of metformin include the following:

  • for 1 last update 2020/07/14 EfficacyEfficacy

  • Absence of weight gain or hypoglycemia

  • fasting blood sugar levels chart in hindi 🔥how to fasting blood sugar levels chart in hindi for Generally low level of side effects

  • High level of patient acceptance

  • Relatively low cost

The dose of metformin is titrated over 1-2 months to at least 2000 mg daily, administered in divided doses (during or after meals to reduce gastrointestinal [GI] side effects). Exercise increases metformin levels and interferes with its glucose-lowering effect. [242]

Metformin may also decrease the risk of dementia associated with type 2 diabetes. In a 2013 observational study of 14,891 patients aged 55 years and older with type 2 diabetes, treatment with metformin signlificantly lowered the risk of developing dementia. [243] Only patients who initiated therapy with a single drug (metformin, sulfonylureas [SU], thiazolidinediones [TZDs], or insulin) during the study period were included.

During 5 years of followup, dementia was diagnosed in 1487 (9.9%) patients. [243] Compared with patients starting SU, those starting metformin had about a 20% reduced risk for dementia. Compared with patients starting TZD, those starting metformin had a 23% lower risk. [243]

Conversely, starting SU treatment (compared with metformin) was associated with a 24% increased risk for dementia; starting TZD treatment was associated with an 18% increased risk; and starting insulin treatment was associated with a 28% increased risk. [243]

fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Dual-drug therapy

If the patient fails to safely achieve or sustain glycemic goals within 2-3 months, another medication should be added. The choice should be guided by patient characteristics (eg, a DPP-4 inhibitor if both postprandial and fasting glucose levels are elevated; a GLP-1 agonist if postprandial glucose levels are strongly elevated; a TZD if the patient has metabolic syndrome and/or nonalcoholic fatty liver disease). [244]

Failure of initial therapy usually should result in addition of another class of for 1 last update 2020/07/14 drug rather than substitution. Reserve the use of substitution for cases in which patients experience intolerance to a drug because of adverse effects.Failure of initial therapy usually should result in addition of another class of drug rather than substitution. Reserve the use of substitution for cases in which patients experience intolerance to a drug because of adverse effects.

Considerable debate exists regarding which second agent to add to (or use initially in conjunction with) metformin. An outline of the therapeutic approach generally used by the author is presented in the first 2 images below. An idealized scheme for glucose and insulin patterns is presented in the third image below. The author finds that keeping such an idealized scheme in mind is helpful when treating and educating patients, even if the patient is trying to replicate it with less intensive insulin therapy.

Treatment of type 2 diabetes mellitus.
Simplified scheme for using insulin in treating patients with type 2 diabetes mellitus.
Simplified scheme of idealized blood glucose values and multiple dose insulin therapy in type 2 diabetes mellitus.

Because TZDs not infrequently cause weight gain and edema, the author usually reserves these agents for patients who cannot use metformin, as a result of intolerance or contraindications. Exceptions to this practice may include patients of relatively normal weight who have marked insulin resistance, such as patients of Asian heritage.

Before adding a second agent for a patient who is taking an insulin secretagogue, the clinician should warn the patient about the possibility that the second agent will induce hypoglycemia. If hypoglycemia occurs, the dose of the insulin secretagogue, not the newly added agent, should be reduced.

Triple-drug therapy

If 2 drugs prove unsuccessful after 2-3 months, the next step is triple therapy. The third drug may be an oral agent from a third class of antidiabetic drugs, basal insulin (typically at bedtime), or the injectable drug exenatide. The expense and adverse effect profile of TZDs make their use in an oral triple therapy approach less desirable.

fasting blood sugar levels chart in hindi 👍how to fasting blood sugar levels chart in hindi for The addition of exenatide to 1 or 2 oral agents (eg, metformin and/or a sulfonylurea) is attractive because of its simplicity (ie, only 2 possible doses of exenatide, with easy titration compared with insulin); although expensive, it avoids hypoglycemia. If basal insulin is used, the insulin dose is titrated to the fasting glucose concentration, which the patient can measure at home.

fasting blood sugar levels chart in hindi 👍how to fasting blood sugar levels chart in hindi for Glucose values

Some patients need reduction of their oral antidiabetic agent to prevent daytime hypoglycemia as the bedtime insulin is initiated or increased and the fasting glucose concentration decreases. If a GLP-1 agonist is used, the author monitors fasting and postprandial sugars, expecting a marked flattening of the postprandial rise in glucose concentrations.

Measurement of glucose patterns in patients with type 2 diabetes, particularly those who have central obesity and hepatic steatosis, often reveals that the highest preprandial glucose level of the day is before breakfast (because of disordered hepatic glucose production overnight), with a "" decrease during the day (after the usual postmeal rise). These higher-than-desired morning glucose values do not necessarily dictate abandonment of the current therapeutic regimen, provided that the HbA1c level is at target.

For patients trying to achieve near euglycemia, premeal glucose values of 80-120 mg/dL are the goal, with the patient going to sleep at night with a value at least 100 mg/dL. In patients with less stringent glycemic goals (eg, because of advanced age, advanced complications, or severe concomitant disease), preprandial glucose values of 100-140 mg/dL are desired. Because of the limitations of therapies, essentially no patient is able to achieve these goals all the time if, in fact, insulin is needed to treat their disease.

For patients who primarily have fasting hyperglycemia, basal insulin is the easiest way to correct this abnormality. Basal insulin is typically scheduled at bedtime but can be given at suppertime if that is more convenient for the patient.

The goal of a combined daytime oral agent plus once-a-day insulin is to lower the fasting glucose level to 100 mg/dL by titrating the insulin. When this target is achieved, the oral agents can be effective in maintaining preprandial and postprandial blood glucose levels throughout the day. If a regimen combining oral agents and insulin fails to lower glucose levels into the normal range, patients should be switched to a daily multiple-injection schedule with a premeal rapid-acting insulin and a longer-acting basal insulin.

Insulin regimens

fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for A necessary condition for twice-daily insulin to succeed is a regimented lifestyle, with mealtimes regularly spaced and insulin injections taken at essentially the same time every day, including weekends and holidays. Lack of regularity in the schedule is self-defeating for this approach to therapy.

The author limits the use of premixed insulin to patients who may have trouble mixing their insulins. The author prefers premixes containing regular insulin if the premix is administered to maintain better midday coverage. Premixes with rapid-acting medications can be used if the midday meal is small. A systematic review found that glycemic control with premixed insulin analogues (ie, mixtures of rapid-acting the 1 last update 2020/07/14 and intermediate-acting insulin analogues) is similar to that with premixed human insulin. [245] The author limits the use of premixed insulin to patients who may have trouble mixing their insulins. The author prefers premixes containing regular insulin if the premix is administered to maintain better midday coverage. Premixes with rapid-acting medications can be used if the midday meal is small. A systematic review found that glycemic control with premixed insulin analogues (ie, mixtures of rapid-acting and intermediate-acting insulin analogues) is similar to that with premixed human insulin. [245]

Multiple daily dosing

Conventional multiple daily dosing of insulin gives the patient the greatest flexibility. In this approach, long-acting insulin (eg, glargine, detemir) is generally given once daily as the basal insulin, and rapid-acting insulin (eg, aspart, glulisine, lispro) is administered just before each meal.

The basal component can be administered at any time of day as long as it is given at the same time each day. However, interpreting glucose patterns is probably easiest if the basal insulin is administered at or near bedtime. The basal insulin can then be titrated to the morning sugar, and the bolus premeal insulin can be titrated to the next premeal sugar and, in some cases, a postprandial (2 h) value.

All insulin injections should preferably be administered in the abdomen, although they can also be given in the thigh, hip, or buttock regions. Adiposity blunts the pharmacodynamics of the basal insulins NPH, glargine, and, especially, detemir. [246]

Insulin dosing can be safely reduced in patients with renal insufficiency without compromising glycemic control. [247] Dosing based solely on weight is not advisable in these patients, who have reduced lean body mass and water retention.

Continuous subcutaneous insulin infusion

The American Association of Clinical Endocrinologists and American College of Endocrinology released a consensus statement on insulin pump management: [248]

  • Based on currently available data, continuous subcutaneous insulin infusion (CSII) is justified for basal-bolus insulin therapy in patients with type 1 diabetes mellitus.

  • Only providers whose practice can assume full responsibility for a comprehensive pump management program should offer this technology.

  • The ideal CSII candidate is a patient with type 1 diabetes mellitus or intensively management insulin-dependent type 2 diabetes mellitus who is currently performing 4 or more insulin injections and 4 or more self-monitored blood glucose measurements daily; is motivated to achieve optima blood glucose control; is willing and able to carry out the tasks that are required to use this complex and time-consuming therapy safely and effectively; and is willing to maintain frequent contact with their health care team.

  • fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for Adult patients

    • At CSII initiation, the patient should have daily contact with the pump trainer. a return visit with the endocrinologist/diabetologist/advanced practice nurse is advised within 3-7 days after CSII initiation.

    • fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for Educational consults should be scheduled weekly or biweekly at first, then periodically as needed.

    • Specialist follow-up visits should be scheduled at least monthly until the pump regimen is stabilized, then at least once every 3 mo.

  • Pediatric patients

    • CSII the 1 last update 2020/07/14 is indicated for pediatric patients with elevated hemoglobin A1C (HbA1C) levels on injection therapy; frequent, severe hypoglycemia; widely fluctuating glucose levels; a treatment regimen that compromises lifestyle; and microvascular complications and/or risk factors for macrovascular complications.CSII is indicated for pediatric patients with elevated hemoglobin A1C (HbA1C) levels on injection therapy; frequent, severe hypoglycemia; widely fluctuating glucose levels; a treatment regimen that compromises lifestyle; and microvascular complications and/or risk factors for macrovascular complications.

    • Ideal pediatric candidates are those with motivated families who are committed to monitoring blood glucose 4 or more times per day and have a working understanding of basic diabetes management.

    • Patient age and duration of diabetes should not be factors in determining the transition from injections to CSII.

Intensified basal-bolus regimen

An intensified basal-bolus regimen of insulin glargine and insulin glulisine provides better glycemic control than does a standard, premixed insulin regimen, in patients with long-standing, insulin-treated type 2 diabetes mellitus, according to a study by Fritsche et al. In this open-label, randomized, multinational trial, an intensified insulin regimen combining insulin glargine (once daily) with premeal insulin glulisine (basal-bolus group; n=153) was compared with twice-daily conventional therapy with premixed insulin (n=157).

The mean decrease from baseline HbA1c was -1.31% for the basal-bolus group, versus -0.80% for the premix patients, with more patients in the basal-bolus group attaining HbA1c of 7% or less. Moreover, significantly lower blood glucose levels were observed in the basal-bolus group than in the premix group. [249] The mean decrease from baseline HbA1c was -1.31% for the basal-bolus group, versus -0.80% for the premix patients, with more patients in the basal-bolus group attaining HbA1c of 7% or less. Moreover, significantly lower blood glucose levels were observed in the basal-bolus group than in the premix group. [249]

Postprandial glycemic control

Glycemic control is a function not only of fasting and preprandial glucose values but also of postprandial glycemic excursions. Emphasis on postprandial glucose measurements has been fueled to some degree by the availability of short-acting insulin secretagogues, very-short-acting insulin, and alpha-glucosidase inhibitors, all of which target postprandial glycemia.

While postprandial glucose levels are a better predictor of macrovascular disease risk early in the course of loss of glucose tolerance, it remains to be seen whether targeting after-meal glucose excursions has a greater effect on the risk of complications than do more conventional strategies. A study by Siegelaar et al seriously questions the notion that targeting postprandial glucose variability favorably affects cardiovascular outcomes in patients after myocardial infarction. [250] Clearly, more studies are needed.

Intuitively, one would assume that therapies that normalize preprandial and postprandial glycemia (or that come close to normalizing them) would be optimal. Whether such a strategy can be achieved without untoward adverse effects and with further reductions in microvascular and macrovascular disease risk (compared with regimens used in the UKPDS) using newly available therapies is open to question. Practically speaking, most patients are fully occupied trying to handle conventional glucose monitoring and insulin dose adjustment.

Eating a high-protein prebreakfast snack, such as one with soy yogurt, is a simple way to achieve better postbreakfast glycemic control, according to a study by Chen et al; this study confirms a phenomenon observed in healthy humans nearly a century ago (Staub, 1921). [251]

Glycemic monitoring

Decisions about glycemic management are generally made on the basis of HbA1c measurements and the results of self-monitoring of blood glucose (SMBG). HbA1c is measured at least twice yearly in patients with stable glycemic control who are meeting treatment goals and quarterly in patients whose therapy has changed or who are not meeting treatment goals. [2]

fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for If a total glycated hemoglobin (GHb) measurement is used, the number is 1-2% higher. However, the laboratory should provide a correlation of GHb values with HbA1c values. [3, 70, 120]

Glycemic targets

A guideline from the American College of Physicians (ACP) recommends that an HbA1c target of less than 7% is appropriate for many patients. [252] Some organizations (eg, the American Association of Clinical Endocrinologists, [109] the International Diabetes Federation) recommend a glycemic target of less than 6.5% for HbA1c, although this is a general target that always has to be individualized according to patient characteristics and health conditions

The ACP advises, however, that an HbA1c of 7% may not be an appropriate target for all patients. [252] Goals should be tailored to the individual patient and should take the following considerations into account:

  • The patient''s 2013 shift from a systolic target of 130 mm Hg to 140 mm Hg.)

  • With regard to physical activity, the document now advises limiting the time spent sitting to no longer than 90 min.

  • The ADA does not support e-cigarettes as alternatives to smoking or to facilitate smoking cessation.

  • Immunization against pneumococcal disease is recommended.

  • A new HbA1c target of less than 7.5% for children is now the 1 last update 2020/07/14 recommended.A new HbA1c target of less than 7.5% for children is now recommended.

HDL cholesterol therapy

The benefits of raising HDL cholesterol levels in patients with type 2 diabetes remains uncertain. Some of the statin trials suggest that statin therapy eliminates some of the excess risk from low the 1 last update 2020/07/14 HDL cholesterol levels in patients with LDL cholesterol elevation at baseline.The benefits of raising HDL cholesterol levels in patients with type 2 diabetes remains uncertain. Some of the statin trials suggest that statin therapy eliminates some of the excess risk from low HDL cholesterol levels in patients with LDL cholesterol elevation at baseline.

The Veterans Administration HDL Intervention Trial (VA-HIT) showed an approximately 22% reduction in CHD events in patients with diabetes and known CHD when HDL cholesterol levels were increased by approximately 6% by gemfibrozil. [311] This was a population with low LDL cholesterol levels, however, so whether these same benefits would accrue in patients with elevated LDL cholesterol who are treated with a statin before their low HDL cholesterol is addressed is unclear.

Triglyceride therapy

An elevated triglyceride level is a common abnormality in type 2 diabetes mellitus. However, whether therapy to reduce triglycerides helps to reduce CHD events has not been determined from clinical end-point trials.

Revascularization

The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) study, which was conducted in 2368 patients with type 2 diabetes mellitus and heart disease, showed no significant difference in the rates of death and major cardiovascular events between patients undergoing prompt revascularization and those undergoing medical therapy with insulin or insulin-sensitizing drugs. [312] These data emphasize the need to customize therapy to the patient’s circumstances and therapeutic goals.

Previous
Next:

Management of Ophthalmologic Complications

Patients with established retinopathy should see an ophthalmologist at least once every 6-12 months, as necessary. Three-year retinal screening may be feasible for patients with mild diabetes and no retinopathy. [313]

Early background retinopathy may reverse with improved glycemic control. More advanced retinopathy does not regress with improved glycemia and may worsen, although rarely, with short-term marked improvements in glycemia. Hypertension control is of paramount importance in these latter patients. Results of the randomized, placebo-controlled DIRECT-Protect 2 trial suggested that treatment with the ARB candesartan may improve mild to moderate retinopathy in patients with type 2 diabetes. [314]

Macular edema has been reported in a proportion of patients who experience fluid retention as a side effect of TZDs. [315] Resolution typically follows cessation of the TZD, although diuretics have been prescribed in such cases.

Laser photocoagulation has markedly improved the ability of ophthalmologists to preserve sight in patients with diabetes and proliferative retinopathy or macular edema. Laser therapy is effective in decreasing macular edema and preserving vision but is less effective in restoring lost vision.

Diabetes can affect the lens, vitreous, and retina, causing visual symptoms that may prompt the patient to seek emergency care. Visual blurring may develop acutely as the lens changes shape with marked changes in blood glucose concentrations. This effect, which is caused by osmotic fluxes of water into and out of the lens, usually occurs as hyperglycemia increases, but it also may be seen when high glucose levels are lowered rapidly. In either case, recovery to baseline visual acuity can take up to a month, and some patients are almost completely unable to read small print or do close work during this period.

Patients with diabetes also tend to develop senile cataracts sooner than persons without diabetes. Development of senile cataracts is not related to the degree of glycemic control, however.

Previous
Next:

Management of Diabetic Neuropathy

Peripheral neuropathy is the most common complication observed in patients with type 2 diabetes in outpatient clinics. Patients may have paresthesias, numbness, or pain. The feet are involved more often than the hands.

Improved glycemic control early may alleviate some of the symptoms, although sometimes symptoms actually worsen with lowering of blood glucose levels. Later symptomatic therapy largely is empirical and may include the following:

  • Low-dose tricyclic the 1 last update 2020/07/14 antidepressantsLow-dose tricyclic antidepressants

  • Duloxetine

  • Anticonvulsants (eg, phenytoin, gabapentin, carbamazepine)

  • Topical capsaicin

  • fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Various pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs)

Protection of the feet by applying lubricating agents (but not between the toes) and wearing appropriate footwear (shoes and socks or stockings) is important. Daily inspection of the feet after bathing is mandatory. In patients with advanced neuropathy, water temperature must be checked by a companion or with a thermometer. Soaking the feet generally is not recommended and may be harmful.

Gastroparesis is usually less of a problem in patients with type 2 diabetes mellitus than in those with type 1. Improved glycemic control, discontinuation of medications that slow gastric motility, and the use of metoclopramide may be helpful. Metoclopramide use preferably should be limited to a few days at a time, as long-term use has been linked to tardive dyskinesia. [316]

Autonomic neuropathy may manifest as orthostatic hypotension. Such patients may require volume expanders or adrenergic agents. Patients with cystopathy may benefit from cholinergic agents.

Acute-onset mononeuropathies in diabetes include acute cranial mononeuropathies, mononeuropathy multiplex, focal lesions of the brachial or lumbosacral plexus, and radiculopathies. It is important to consider nondiabetic causes for cranial nerve palsies, including intracranial tumors, aneurysms, and brainstem stroke. [317]

For more information see Diabetic Neuropathy and Diabetic Lumbosacral Plexopathy.

Previous
Next:

Management of Infections

fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Diabetes predisposes patients to a number of infectious diseases, including the following:

  • Malignant otitis for 1 last update 2020/07/14 externaMalignant otitis externa

  • Rhinocerebral mucormycosis

  • Bacteriuria

  • fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Pyuria

  • Cystitis

  • Upper urinary tract infection

  • Intrarenal bacterial infection

  • Skin and soft tissue infections

  • Osteomyelitis

For more information, see Infections in Patients with Diabetes Mellitus.

Previous
Next:

Management of Intercurrent Medical Illness

Patients with intercurrent illness become more insulin resistant because of the effects of increased counterregulatory (ie, anti-insulin) hormones. Therefore, despite decreased nutritional intake, glycemia may worsen.

Patients on oral agents may need transient therapy with insulin to achieve adequate glycemic control. In patients who require insulin, scheduled doses of insulin, as opposed to sliding scale insulin, are far more effective in achieving glycemic control. [318, 319]

Metformin is a special case. If patients taking metformin have any illness that leads to dehydration or hypoperfusion, the drug should be temporarily discontinued because of a possible increased risk of lactic acidosis.

Previous
Next:

Management of Critical Illness

fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for Standard practice in intensively ill patients has been to provide tight glycemic control through intensive insulin therapy. Research evidence, however, has called this practice into question.

fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for A meta-analysis found that in critically ill adult patients, tight glucose control is associated with an increased risk of hypoglycemia but not with significantly reduced hospital mortality. [320] A large, international, randomized trial among adults treated in an intensive care unit (ICU) found that intensive glucose control (target, 81-108 mg/dL) resulted in higher mortality than did a blood glucose target of 180 mg/dL or less. [321]

However, large, single-center studies using more accurate glucose measurements have shown a benefit to intensive glycemic control in critical illness. [322] This remains an area of important ongoing research.

Results of the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial suggested improved outcomes in patients with type 2 diabetes with acute myocardial infarction or stroke who receive constant IV insulin during the acute phase of the event to maintain blood glucose values of approximately 100-150 mg/dL. [323] However, these results were not confirmed in the follow-up trial, DIGAMI-2. [324]

A post-hoc analysis of the DIGAMI-2 study revealed that glucose-lowering drugs impact prognosis differently. Insulin may be associated with increased risk of nonfatal cardiac events, whereas metformin seems to be protective against risk of death. [325]

Previous
Next:

Pharmacologic Considerations in Surgery

Surgical patients may experience worsening of glycemia for reasons similar to those listed above for intercurrent medical illness. Patients on oral agents may need transient therapy with insulin to maintain blood glucose at approximately 100-180 mg/dL.

In patients who require insulin, scheduled doses of insulin (eg, glargine once daily plus glulisine before meals, as opposed to sliding-scale insulin, are far more effective in controlling glucose. Intensive glucose control in surgical ICU patients appears to reduce the risk of septicemia, but as with other critically ill patients, this may come at the cost of increased risk of hypoglycemia. [320]

A standardized protocol can be effective in transitioning patients who have diabetes and acute coronary syndrome to subcutaneous insulin once oral feeding has resumed. This is based on insulin requirement during the previous 12 hours. Half of the amount is given as basal insulin, and the remainder is given as prandial insulin. [326]

For patients who can eat soon after surgery, the time-honored approach of administering half of the usual morning dose of neutral protamine Hagedorn (NPH) insulin with 5% dextrose in the IV infusion is acceptable, with resumption of scheduled insulin (perhaps at reduced doses) within the first 1-2 days. With the availability of newer basal insulins (ie, glargine, detemir), options have expanded. A full dose of basal insulin can be given, and rapid-acting insulin can be administered when meals are consumed.

Patients receiving basal insulin can often receive their usual dose if they are given IV glucose during surgery, with appropriate intraoperative and postoperative monitoring of glucose. Oral antidiabetic agents can be restarted when the patient is stable and eating.

Insulin secretagogues should be used with caution in the hospital, since food intake may be interrupted by diagnostic tests and procedures. Metformin may have to be started at a lower dose and gradually titrated to full dose due to GI side effects. Since TZDs have such a long biologic effect, their omission in the hospital is usually inconsequential. The role of incretins in the hospital has not yet been defined.

For patients who require more prolonged periods without oral nutrition and for major surgery, such as coronary artery bypass grafting and major abdominal surgery, constant infusion IV insulin is preferred. Discontinue metformin temporarily after any major surgery until the patient is clearly hemodynamically stable and normal renal function is documented. Discontinuing metformin for at least 48 hours in this situation until proof of normal renal function is established is the current standard.

Previous
Next:

Prevention of Type 2 Diabetes Mellitus

Guidelines from the American College of Clinical Endocrinologists for the prevention of type 2 diabetes mellitus in patients at risk recommend the following measures:

  • fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for Weight reduction

  • Proper nutrition

  • Regular physical activity

  • Cardiovascular risk factor for 1 last update 2020/07/14 reductionCardiovascular risk factor reduction

  • Aggressive treatment of hypertension and dyslipidemia

Lifestyle improvement

The Diabetes Prevention Program (DPP) trial has shown that modest lifestyle changes (eg, 4-5% sustained weight reduction for approximately 3 y) reduce the risk for diabetes in patients at high risk by 58%. [327] Eight health-care facilities participated in an instructive study of group-based lifestyle intervention that should help other agencies/states emulate strategies used to affect positive lifestyle changes for the prevention of diabetes. [328]

In an 11-year, population-based cohort study of over 200,000 men and women for 1 last update 2020/07/14 without evidence of diabetes, heart disease, or cancer at baseline, good lifestyle decisions in combination significantly reduced the risk of developing diabetes. For each additional positive lifestyle factor (eg, with regard to diet, physical activity, or smoking) in the low-risk group, the odds for diabetes were 31% lower [329] In an 11-year, population-based cohort study of over 200,000 men and women without evidence of diabetes, heart disease, or cancer at baseline, good lifestyle decisions in combination significantly reduced the risk of developing diabetes. For each additional positive lifestyle factor (eg, with regard to diet, physical activity, or smoking) in the low-risk group, the odds for diabetes were 31% lower [329]

Yeh et al found that although cigarette smokers are at increased risk for type 2 diabetes, smoking cessation leads to higher short-term risk. [330] In this prospective cohort study in 10,892 middle-aged, nondiabetic adults, 1254 persons developed type 2 diabetes during 9 years of follow up.

The adjusted hazard ratio of incident diabetes among persons in the highest tertile of pack-years was 1.42, compared with persons who had never smoked. However, in the first 3 years after quitting smoking, the hazard ratio was 1.73; the risk then gradually decreased, disappearing completely at 12 years. Yeh et al recommended that smoking cessation in smokers at risk for diabetes be coupled with strategies for prevention and early detection of diabetes.

A significant inverse correlation has been found between the risk of diabetes and the intake of magnesium, which plays an important role in insulin action and glucose homeostasis. In a meta-analysis, the summary relative risk of for 1 last update 2020/07/14 type 2 diabetes for every 100 mg/day increment in magnesium intake was 0.86. [331] A significant inverse correlation has been found between the risk of diabetes and the intake of magnesium, which plays an important role in insulin action and glucose homeostasis. In a meta-analysis, the summary relative risk of type 2 diabetes for every 100 mg/day increment in magnesium intake was 0.86. [331]

Interest in the impact of phylloquinone intake on glucose tolerance and insulin sensitivity has a long history. A 2012 report suggests a beneficial role for phylloquinone in diabetes prevention in elderly subjects with high cardiovascular risk. However, caution is advised in patients who are concurrently being treated with anticoagulant drugs such as warfarin. [332]

Pharmacologic prevention

Drugs from several classes have been studied in the prevention of diabetes. However, the FDA has not approved any drug for the treatment of prediabetes or the prevention of type 2 diabetes. [333]

Metformin

The ADA recommends that, in addition to lifestyle counseling, metformin be considered in selected patients with prediabetes. [2] ADA criteria for preventive metformin therapy are as follows:

  • Obesity

  • Age younger than 60 years

  • Both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)

  • Other risk factors (eg, HbA1C >6%, hypertension, low HDL cholesterol, elevated triglycerides, or a family history of diabetes in a first-degree relative)

In the DPP, metformin 1700 mg daily was about half as effective as lifestyle intervention in reducing risk among subjects with elevated fasting and postload plasma glucose concentrations. [327] Over an average follow-up period of 2.8 years, the incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively.

Thiazolidinediones

Analysis of available data from the DPP suggests that troglitazone was effective in preventing diabetes. This effect was also seen in the Troglitazone in Prevention of Diabetes (TRIPOD) study of Hispanic women with a history of gestational diabetes. After troglitazone was withdrawn from the market because of hepatotoxicity, the continuation of TRIPOD in the Pioglitazone in the Prevention of Diabetes Study demonstrated slowed progression of subclinical atherosclerosis with glitazone treatment. [334]

In the Diabetes Reduction Assessment With Ramipril and Rosiglitazone Medication (DREAM) trial, investigators concluded that rosiglitazone at 8 mg daily reduces the incidence of type 2 diabetes mellitus in patients with IFG and/or IGT. At the end of this prospective, multicenter study, composite outcome of diabetes or death from any cause was 11.6% in the rosiglitazone group the 1 last update 2020/07/14 versus 26% in the placebo group. [154] Ramipril did not produce significant reduction in the same composite outcome. [335] In the Diabetes Reduction Assessment With Ramipril and Rosiglitazone Medication (DREAM) trial, investigators concluded that rosiglitazone at 8 mg daily reduces the incidence of type 2 diabetes mellitus in patients with IFG and/or IGT. At the end of this prospective, multicenter study, composite outcome of diabetes or death from any cause was 11.6% in the rosiglitazone group versus 26% in the placebo group. [154] Ramipril did not produce significant reduction in the same composite outcome. [335]

Acarbose

Acarbose (100 mg three times a day) was shown in the Study to Prevent Non-Insulin Dependent Diabetes Mellitus (STOP-NIDDM) to reduce diabetes rates by approximately 25% in patients at high risk for the development of type 2 diabetes. [336] This 6-year, international, multicenter, double-blind, placebo-controlled, randomized investigation included 1,368 subjects with IGT.

Previous
Next:

Stroke Prevention in Diabetes

fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for The 2010 American Heart Association/American Stroke Association (AHA/ASA) guidelines for the primary prevention of stroke include the following recommendations for patients with diabetes:

  • Regular blood pressure screening

  • Physical activity; 30 minutes or more of moderate-intensity activity on a daily basis

  • A low-sodium, high-potassium diet to reduce blood pressure; a diet emphasizing consumption of fruits, vegetables, and low-fat dairy products (eg, the Dietary Approaches to Stop Hypertension [DASH] diet) may lower stroke risk

  • A blood pressure goal of less than 130/80 mm Hg

  • Drug therapy with ACE inhibitors or ARBs

  • Statin therapy, especially in patients with other risk factors; monotherapy with fibrates may also be considered to lower stroke risk

The AHA/ASA guidelines note that the benefit of taking aspirin for the reduction of stroke risk has not been fully demonstrated in diabetic patients.

Previous
Next:

Consultations

Primary care providers can care for patients with type 2 diabetes mellitus adequately. The multiple facets of disease treatment (eg, nutrition, exercise, smoking cessation, medications, complications monitoring) and data management (eg, glucose levels, blood pressure, lipids, complications monitoring) must be continually addressed.

Inability to achieve adequate glycemic (or blood pressure or lipid) control usually should be a clear indication to consult a diabetes specialist. When a patient has developed advanced complications, a diabetes specialist cannot be expected to be able to lessen the burden of these complications.

Previous
Guidelines
 
 
fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for
References
  1. [Guideline] Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan. 33 Suppl 1:S62-9. [Medline]. [Full Text].

  2. fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for [Guideline] American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012 Jan. 35 Suppl 1:S11-63. [Medline].

  3. U.S. Preventive Services Task Force. Screening for Type 2 for 1 last update 2020/07/14 Diabetes Mellitus in Adults. Available at http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm. U.S. Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults. Available at http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm.

  4. Keller DM. New EASD/ADA Position Paper Shifts Diabetes Treatment Goals. Medscape Medical News. Available at http://www.medscape.com/viewarticle/771989. Accessed: October 15, 2012.

  5. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012 Jun. 55(6):1577-96. [Medline].

  6. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012 Jun. 35(6):1364-79. [Medline]. [Full Text].

  7. Tucker ME. New diabetes guidelines ease systolic blood pressure target. December 20, 2012. Medscape Medical News. Available at http://www.medscape.com/viewarticle/776543. Accessed: January 8, 2013.

  8. [Guideline] American Diabetes Association Professional Practice Committee. American Diabetes Association clinical practice recommendations: 2013. Diabetes Care. January 2013. 36 (suppl 1):S1-S110. [Full Text].

  9. Report of the 1 last update 2020/07/14 the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003 Jan. 26 Suppl 1:S5-20. [Medline]. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003 Jan. 26 Suppl 1:S5-20. [Medline].

  10. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. 2017. Available at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

  11. Harrison P. Almost Half the US Population Has Diabetes or Its Precursor. Medscape Medical News. 2017 Jul 19. [Full Text].

  12. Unger RH, Orci L. Paracrinology of islets and the paracrinopathy of diabetes. Proc Natl Acad Sci U S A. 2010 Sep 14. 107(37):16009-12. [Medline]. [Full Text].

  13. Philippe MF, Benabadji S, Barbot-Trystram L, Vadrot D, Boitard C, Larger E. Pancreatic volume and endocrine for 1 last update 2020/07/14 and exocrine functions in patients with diabetes. Pancreas. 2011 Apr. 40(3):359-63. [Medline]. Philippe MF, Benabadji S, Barbot-Trystram L, Vadrot D, Boitard C, Larger E. Pancreatic volume and endocrine and exocrine functions in patients with diabetes. Pancreas. 2011 Apr. 40(3):359-63. [Medline].

  14. Bacha F, Lee S, Gungor N, Arslanian SA. From pre-diabetes to type 2 diabetes in obese youth: pathophysiological characteristics along the spectrum of glucose dysregulation. Diabetes Care. 2010 Oct. 33(10):2225-31. [Medline]. [Full Text].

  15. Hansen KB, Vilsboll T, Bagger JI, Holst JJ, Knop FK. Increased postprandial GIP and glucagon responses, but unaltered GLP-1 response after intervention with steroid hormone, relative physical inactivity, and high-calorie diet in healthy subjects. J Clin Endocrinol Metab. 2011 Feb. 96(2):447-53. [Medline].

  16. Wheeler E, Barroso I. Genome-wide association studies and type 2 diabetes. Brief Funct Genomics. 2011 Mar. 10(2):52-60. [Medline].

  17. fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for Billings LK, Florez JC. The genetics of type 2 diabetes: what have we learned from GWAS? Ann N Y Acad Sci. 2010 Nov;1212:59-77. [Full Text].

  18. Nielsen EM, Hansen L, Carstensen B, Echwald SM, Drivsholm T, Glumer C, et al. The E23K variant of Kir6.2 associates with impaired post-OGTT serum insulin response and increased risk of type 2 diabetes. Diabetes. 2003 Feb. 52(2):573-7. [Medline].

  19. Ukkola O, Sun G, Bouchard C. Insulin-like growth factor 2 (IGF2 ) and IGF-binding protein 1 (IGFBP1) gene variants are associated with overfeeding-induced metabolic changes. Diabetologia. 2001 Dec. 44(12):2231-6. [Medline].

  20. Lindgren CM, McCarthy MI. Mechanisms of disease: genetic insights into the etiology of type 2 diabetes and obesity. Nat Clin Pract Endocrinol Metab. 2008 Mar. 4(3):156-63. [Medline].

  21. Sladek R, Rocheleau G, Rung J, Dina C, Shen L, Serre D, et al. A genome-wide association study identifies novel risk loci for type 2 diabetes. Nature. 2007 Feb 22. 445(7130):881-5. [Medline].

  22. Sandhu MS, Weedon MN, Fawcett KA, Wasson J, Debenham SL, Daly A, et al. Common variants in WFS1 confer risk of type 2 diabetes. Nat Genet. 2007 Aug. 39(8):951-3. [Medline]. [Full Text].

  23. Saxena R, Hivert MF, Langenberg C, Tanaka T, Pankow JS, Vollenweider P, et al. Genetic variation in GIPR influences the glucose and insulin responses to an oral glucose challenge. Nat Genet. 2010 Feb. 42(2):142-8. [Medline]. [Full Text].

  24. Chiefari E, Tanyolac S, Paonessa F, Pullinger CR, Capula C, Iiritano S, et al. Functional variants of the HMGA1 gene and type 2 diabetes mellitus. JAMA. 2011 Mar 2. 305(9):903-12. [Medline].

  25. Wang TJ, Larson MG, Vasan RS, Cheng S, Rhee EP, McCabe E, et al. Metabolite profiles and the risk of developing diabetes. Nat Med. 2011 Apr. 17(4):448-53. [Medline]. [Full Text].

  26. Testa R, Olivieri F, Sirolla C, Spazzafumo L, Rippo MR, Marra M, et al. Leukocyte telomere length is associated with complications of type 2 diabetes mellitus. Diabet Med. 2011 Nov. 28(11):1388-94. [Medline].

  27. Krssak M, Winhofer Y, Gobl C, Bischof M, Reiter G, Kautzky-Willer A, et al. Insulin resistance is not associated with myocardial steatosis in women. Diabetologia. 2011 Jul. 54(7):1871-8. [Medline].

  28. Leiter LA, Lundman P, da Silva PM, Drexel H, Junger C, Gitt AK. Persistent lipid abnormalities in statin-treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidaemia International Study. Diabet Med. 2011 Nov. 28(11):1343-51. [Medline].

  29. Stern MP. Do non-insulin-dependent diabetes mellitus and cardiovascular disease share common antecedents?. Ann Intern Med. 1996 Jan 1. 124(1 Pt 2):110-6. [Medline].

  30. Haffner SM, D''Dea K, Sikaris KA, Shaw JE. A1C for screening and diagnosis of type 2 diabetes in routine clinical practice. Diabetes Care. 2010 Apr. 33(4):817-9. [Medline]. [Full Text].

  31. Lerner N, Shani M, Vinker S. Predicting type 2 diabetes mellitus using haemoglobin A1c: A community-based historic cohort study. Eur J Gen Pract. 2013 Nov 29. [Medline].

  32. fasting blood sugar levels chart in hindi 🔥how to fasting blood sugar levels chart in hindi for McCall B. Simple saliva swab and early HbA1c test predict diabetes. Medscape Medical News. February 11, 2014. [Full Text].

  33. Gerstein HC, Islam S, Anand S, Almahmeed W, Damasceno A, Dans A, et al. Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study. Diabetologia. 2010 Dec. 53(12):2509-17. [Medline].

  34. Suzuki S, Koga M, Amamiya S, Nakao A, Wada K, Okuhara K, et al. Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus. Diabetologia. 2011 Sep. 54(9):2247-53. [Medline].

  35. Wilson DM, Xing D, Cheng J, Beck RW, Hirsch I, Kollman C, et al. Persistence of individual variations in glycated hemoglobin: analysis of data from the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Randomized Trial. Diabetes Care. 2011 Jun. 34(6):1315-7. [Medline]. [Full Text].

  36. fasting blood sugar levels chart in hindi 🔥how to fasting blood sugar levels chart in hindi for American Diabetes Association. Standards of Medical Care in Diabetes-2015: Abridged for Primary Care Providers. Clinical Diabetes. 2015. 33(2):[Full Text].

  37. Colayco DC, Niu F, McCombs JS, Cheetham TC. A1C and cardiovascular outcomes in type 2 diabetes: a nested case-control study. Diabetes Care. 2011 Jan. 34(1):77-83. [Medline]. [Full Text].

  38. Gerstein HC, Miller ME, Genuth S, Ismail-Beigi F, Buse JB, Goff DC Jr, et al. Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med. 2011 Mar 3. 364(9):818-28. [Medline].

  39. Ng JM, Cooke M, Bhandari S, Atkin SL, Kilpatrick ES. The effect of iron and erythropoietin treatment on the A1C of patients with diabetes and chronic kidney disease. Diabetes Care. 2010 Nov. 33(11):2310-3. [Medline]. [Full Text].

  40. Morrison F, Shubina M, Turchin A. Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus. Arch Intern Med. 2011 Sep 26. 171(17):1542-50. [Medline].

  41. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12. 352(9131):854-65. [Medline].

  42. [Guideline] Busko M. HbA1c Below 8% in Diabetes for '' Says ACP, But Others Disagree. Medscape Medical News. 2018 Mar 5. [Full Text].

  43. [Guideline] Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1c Targets for Glycemic the 1 last update 2020/07/14 Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Ann Intern Med. 2018 Mar 6. [Medline]. [Full Text].[Guideline] Qaseem A, Wilt TJ, Kansagara D, et al. Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians. Ann Intern Med. 2018 Mar 6. [Medline]. [Full Text].

  44. Alfayez OM, Al Yami MS, Alshibani M, et al. Network meta-analysis of nine large cardiovascular outcome trials of new antidiabetic drugs. Prim Care Diabetes. 2019 Jan 31. [Medline].

  45. Scarpello JH, Howlett HC. Metformin therapy and clinical uses. Diab Vasc Dis Res. 2008 Sep. 5(3):157-67. [Medline].

  46. Bodmer M, Meier C, Krahenbuhl S, Jick SS, Meier CR. Metformin, sulfonylureas, or other antidiabetes drugs and the risk of lactic acidosis or hypoglycemia: a nested case-control analysis. Diabetes Care. 2008 Nov. 31(11):2086-91. [Medline]. [Full Text].

  47. Sun L, Xie C, Wang G, et al. Gut microbiota and intestinal FXR mediate the clinical benefits of metformin. Nat Med. 2018 Dec. 24 (12):1919-29. [Medline].

  48. Melville NA. Metformin''Incredibly Exciting''Aniello S, Evans M, Vora J, Pollak M. Long-term effects of insulin for 1 last update 2020/07/14 glargine on the risk of breast cancer. Diabetologia. 2011 Sep. 54(9):2254-62. [Medline]. Melville NA. Metformin''Incredibly Exciting''Aniello S, Evans M, Vora J, Pollak M. Long-term effects of insulin glargine on the risk of breast cancer. Diabetologia. 2011 Sep. 54(9):2254-62. [Medline].

  49. fasting blood sugar levels chart in hindi 👍how to fasting blood sugar levels chart in hindi for Johnson JA, Bowker SL, Richardson K, Marra CA. Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of the 1 last update 2020/07/14 potential detection bias. Diabetologia. 2011 Sep. 54(9):2263-71. [Medline]. Johnson JA, Bowker SL, Richardson K, Marra CA. Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of potential detection bias. Diabetologia. 2011 Sep. 54(9):2263-71. [Medline].

  50. fasting blood sugar levels chart in hindi 👍how to fasting blood sugar levels chart in hindi for Stefansdottir G, Zoungas S, Chalmers J, Kengne AP, Knol MJ, Leufkens HG, et al. Intensive glucose control and risk of cancer in patients with type 2 diabetes. Diabetologia. 2011 Jul. 54(7):1608-14. [Medline].

  51. Shyangdan DS, Royle P, Clar C, Sharma P, Waugh N, Snaith A. Glucagon-like peptide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2011 Oct 5. CD006423. [Medline].

  52. Handelsman Y, Goldberg RB, Garvey WT, Fonseca VA, Rosenstock J, Jones MR, et al. Colesevelam hydrochloride to treat hypercholesterolemia and improve glycemia in prediabetes: a randomized, prospective study. Endocr Pract. 2010 Jul-Aug. 16(4):617-28. [Medline].

  53. Rosenstock J, Fonseca VA, Garvey WT, Goldberg RB, Handelsman Y, Abby SL, et al. Initial combination therapy with metformin and colesevelam for achievement of glycemic and lipid goals in early type 2 diabetes. Endocr Pract. 2010 Jul-Aug. 16(4):629-40. [Medline].

  54. Sando KR, Taylor J. Bromocriptine: its place in type 2 diabetes Tx. J Fam Pract. 2011 Nov. 60(11):E1-5. [Medline].

  55. Gaziano JM, Cincotta AH, O''Souza S, D''Historic''s disease in Denmark. Diabetes Care. 2011 May. 34(5):1102-8. [Medline]. [Full Text].

  56. Cereda E, Barichella M, Pedrolli C, Klersy C, Cassani E, Caccialanza R, et al. Diabetes and risk of Parkinson''Riordan M. No CV risk with olmesartan in diabetics, says FDA review. Medscape Medical News. June 24, 2014. [Full Text].

  57. Parving HH, Brenner BM, McMurray JJ, de Zeeuw D, Haffner SM, Solomon SD, et al. Cardiorenal End Points in a Trial of Aliskiren for Type 2 Diabetes. N Engl J Med. 2012 Nov 3. [Medline].

  58. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of time the 1 last update 2020/07/14 of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care. 2011 Jun. 34(6):1270-6. [Medline]. [Full Text].Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care. 2011 Jun. 34(6):1270-6. [Medline]. [Full Text].

  59. Management of dyslipidemia in adults with diabetes. Diabetes Care. 2000 Jan. 23 Suppl 1:S57-60. [Medline].

  60. Bell DS, Bakris GL, McGill JB. Comparison of carvedilol and metoprolol on serum lipid concentration in diabetic hypertensive patients. Diabetes Obes Metab. 2009 Mar. 11(3):234-8. [Medline].

  61. Aspirin therapy in diabetes. Diabetes Care. 2000 Jan. 23 Suppl 1:S61-2. [Medline].

  62. Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008 Nov 12. 300(18):2134-41. [Medline].

  63. Saito Y, Morimoto T, Ogawa H, Nakayama M, Uemura S, Doi N, et al. Low-dose aspirin therapy in patients with type 2 diabetes and reduced glomerular filtration rate: subanalysis from the JPAD trial. Diabetes Care. 2011 Feb. 34(2):280-5. [Medline]. [Full Text].

  64. Okada S, Morimoto T, Ogawa H, Kanauchi M, Nakayama M, Uemura S, et al. Differential effect of low-dose aspirin for primary prevention of atherosclerotic events in diabetes management: a subanalysis of the JPAD trial. Diabetes Care. 2011 Jun. 34(6):1277-83. [Medline]. [Full Text].

  65. fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994 Nov 19. 344(8934):1383-9. [Medline].

  66. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002 Jul 6. 360(9326):7-22. [Medline].

  67. Sever PS, Dahlof B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003 Apr 5. 361(9364):1149-58. [Medline].

  68. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004 Aug 21-27. 364(9435):685-96. [Medline].

  69. fasting blood sugar levels chart in hindi 🔥how to fasting blood sugar levels chart in hindi for Preiss D, Seshasai SR, Welsh P, Murphy SA, Ho JE, Waters DD, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011 Jun 22. 305(24):2556-64. [Medline].

  70. Tucker ME. Statins Up Type 2 Diabetes Risk, Overweight at Greatest Risk. Medscape Medical News. 2019 Mar 13. [Full Text].

  71. Ahmadizar F, OchoaRosales C, Glisic M, Franco OH, Muka T, Stricker BH. Associations of statin use with glycaemic traits and incident type 2 diabetes. Br J the 1 last update 2020/07/14 Clin Pharmacol. 2019 Mar 5. [Medline]. [Full Text].Ahmadizar F, OchoaRosales C, Glisic M, Franco OH, Muka T, Stricker BH. Associations of statin use with glycaemic traits and incident type 2 diabetes. Br J Clin Pharmacol. 2019 Mar 5. [Medline]. [Full Text].

  72. Tucker ME. ADA endorses ACC/AHA the 1 last update 2020/07/14 statin guidelines, with caveats. Medscape Medical News. Available at http://www.medscape.com/viewarticle/837138. Accessed: December 24, 2014.Tucker ME. ADA endorses ACC/AHA statin guidelines, with caveats. Medscape Medical News. Available at http://www.medscape.com/viewarticle/837138. Accessed: December 24, 2014.

  73. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med. 1999 Aug 5. 341(6):410-8. [Medline].

  74. Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009 Jun 11. 360(24):2503-15. [Medline]. [Full Text].

  75. Agardh E, Tababat-Khani P. Adopting 3-year screening intervals for sight-threatening retinal vascular lesions in type 2 diabetic subjects without retinopathy. Diabetes Care. 2011 Jun. 34(6):1318-9. [Medline]. [Full Text].

  76. Sjolie AK, Klein R, Porta M, Orchard T, Fuller J, Parving for 1 last update 2020/07/14 HH, et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet. 2008 Oct 18. 372(9647):1385-93. [Medline]. Sjolie AK, Klein R, Porta M, Orchard T, Fuller J, Parving HH, et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet. 2008 Oct 18. 372(9647):1385-93. [Medline].

  77. Oshitari T, Asaumi N, Watanabe M, Kumagai K, Mitamura Y. Severe macular edema induced by pioglitazone in a patient with diabetic retinopathy: a case study. Vasc Health Risk Manag. 2008. 4(5):1137-40. [Medline]. [Full Text].

  78. Food and Drug Administration. FDA Requires Boxed Warning and Risk Mitigation Strategy for Metoclopramide-Containing Drugs. U.S. Food and Drug Administration. Available at http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm149533.htm. Accessed: August 4, 2010.

  79. Chou KL, Galetta SL, Liu GT, Volpe NJ, Bennett JL, Asbury AK, et al. Acute ocular motor mononeuropathies: prospective study of the roles of neuroimaging and clinical assessment. J Neurol Sci. 2004 Apr 15. 219(1-2):35-9. [Medline].

  80. fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for Queale WS, Seidler AJ, Brancati FL. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med. 1997 Mar 10. 157(5):545-52. [Medline].

  81. Sawin CT. Action without benefit. The sliding scale of insulin use. Arch Intern Med. 1997 Mar 10. 157(5):489. [Medline].

  82. Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008 Aug 27. 300(8):933-44. [Medline].

  83. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26. 360(13):1283-97. [Medline].

  84. Van den Berghe G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006 Nov. 55(11):3151-9. [Medline].

  85. Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ. 1997 May 24. 314(7093):1512-5. [Medline]. [Full Text].

  86. Malmberg K, Ryden L, Wedel H, Birkeland K, Bootsma A, Dickstein K, et al. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005 Apr. 26(7):650-61. [Medline].

  87. Mellbin LG, Malmberg K, Norhammar A, Wedel H, Ryden L. Prognostic implications of glucose-lowering treatment in patients with acute myocardial infarction and diabetes: experiences from an extended follow-up of the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 Study. Diabetologia. 2011 Jun. 54(6):1308-17. [Medline].

  88. Avanzini F, Marelli G, Donzelli W, Busi G, Carbone S, Bellato L, et al. Transition from intravenous to subcutaneous insulin: effectiveness and safety of a standardized protocol and predictors of outcome in patients with acute coronary syndrome. Diabetes Care. 2011 Jul. 34(7):1445-50. [Medline]. [Full Text].

  89. fasting blood sugar levels chart in hindi 🔴how to fasting blood sugar levels chart in hindi for Knowler for 1 last update 2020/07/14 WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7. 346(6):393-403. [Medline]. [Full Text].Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7. 346(6):393-403. [Medline]. [Full Text].

  90. Vanderwood KK, Hall TO, Harwell TS, Butcher MK, Helgerson SD. Implementing a state-based cardiovascular disease and diabetes prevention program. Diabetes Care. 2010 Dec. 33(12):2543-5. [Medline]. [Full Text].

  91. Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A. Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med. 2011 Sep 6. 155(5):292-9. [Medline].

  92. fasting blood sugar levels chart in hindi ⭐️how to fasting blood sugar levels chart in hindi for Yeh HC, Duncan BB, Schmidt MI, Wang NY, Brancati FL. Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2010 Jan 5. 152(1):10-7. [Medline].

  93. Dong JY, Xun P, He K, Qin LQ. Magnesium intake and risk of type 2 diabetes: meta-analysis of prospective cohort studies. Diabetes Care. 2011 Sep. 34(9):2116-22. [Medline]. [Full Text].

  94. Ibarrola-Jurado N, Salas-Salvado J, Martinez-Gonzalez MA, Bullo M. Dietary phylloquinone intake and risk of type 2 diabetes in elderly subjects at high risk of cardiovascular disease. Am J Clin Nutr. 2012 Nov. 96(5):1113-8. [Medline].

  95. National Diabetes Information Clearinghouse. Insulin Resistance and Pre-diabetes. Available at http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/#medicines.

  96. Xiang AH, Hodis HN, Kawakubo M, Peters RK, Kjos SL, Marroquin A, et al. Effect of pioglitazone on progression of subclinical atherosclerosis in non-diabetic premenopausal Hispanic women with prior gestational diabetes. Atherosclerosis. 2008 Jul. 199(1):207-14. [Medline]. [Full Text].

  97. Bosch J, Yusuf S, Gerstein HC, Pogue J, Sheridan P, Dagenais G, et al. Effect of ramipril on the incidence of diabetes. N Engl J Med. 2006 Oct the 1 last update 2020/07/14 12. 355(15):1551-62. [Medline]. Bosch J, Yusuf S, Gerstein HC, Pogue J, Sheridan P, Dagenais G, et al. Effect of ramipril on the incidence of diabetes. N Engl J Med. 2006 Oct 12. 355(15):1551-62. [Medline].

  98. Chiasson JL. Acarbose for the prevention of diabetes, hypertension, and cardiovascular disease in subjects with impaired glucose tolerance: the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) Trial. Endocr Pract. 2006 Jan-Feb. 12 Suppl 1:25-30. [Medline].

  99. [Guideline] Jenkins K. ADA Updates Recommendations for Managing Hypertension in Diabetes. Medscape. 2017 Sep 4. [Full Text].

  100. [Guideline] de Boer IH, Bangalore S, Benetos A, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Sep. 40 (9):1273-1284. [Medline]. [Full Text].

  101. [Guideline] American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S7-S12. [Medline]. [Full Text].

  102. [Guideline] American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S13-S27. [Medline]. [Full Text].

  103. [Guideline] American Diabetes Association. 3. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S28-S37. [Medline]. [Full Text].

  104. [Guideline] American Diabetes Association. 4. Lifestyle Management: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S38-S50. [Medline]. [Full Text].

  105. [Guideline] American Diabetes Association. 5. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S51-4. [Medline]. [Full Text].

  106. [Guideline] American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S55-S64. [Medline]. [Full Text].

  107. fasting blood sugar levels chart in hindi ☑how to fasting blood sugar levels chart in hindi for [Guideline] American Diabetes Association. 7. Obesity Management for the Treatment of Type 2 Diabetes: Standards of the 1 last update 2020/07/14 Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S65-S72. [Medline]. [Full Text].[Guideline] American Diabetes Association. 7. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S65-S72. [Medline]. [Full Text].

  108. [Guideline] American Diabetes Association. 8. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S73-S85. [Medline]. [Full Text].

  109. [Guideline] American Diabetes Association. 9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S86-S104. [Medline]. [Full Text].

  110. [Guideline] American Diabetes Association. 10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S105-18. [Medline]. [Full Text].

  111. [Guideline] American Diabetes Association. 11. Older Adults: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S119-25. [Medline]. [Full Text].

  112. [Guideline] American Diabetes Association. 12. Children and Adolescents: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S126-36. [Medline]. [Full Text].

  113. [Guideline] American Diabetes Association. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S137-43. [Medline]. [Full Text].

  114. [Guideline] American Diabetes Association. 14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S144-51. [Medline]. [Full Text].

  115. [Guideline] American Diabetes Association. 15. Diabetes Advocacy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S152-3. [Medline]. [Full Text].

  116. [Guideline] Summary of Revisions: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan. 41 (Suppl 1):S4-S6. [Medline]. [Full Text].

  117. [Guideline] Tucker ME. ADA 2018 Standards Address Diabetes Drugs With CV Benefit. Medscape. 2017 Dec 8. [Full Text].

  118. [Guideline] Davenport L. ADA Releases Comprehensive Type 2 Diabetes Guidelines for Youth. Medscape Medical News. 2018 Nov 19. [Full Text].

  119. [Guideline] Davies MJ, D''Unprecedented''IMAGE''VIDEO''overview''clinical''workup''treatment''medication''proxima_nova_rgregular''6''3'>

    Recommended

Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. Share a Case