Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome (eBook)

Dedication 6
Preface 8
Series Editor Preface 10
Contents 12
1: Pathophysiology of Type-2 Diabetes 18
Etiology 18
Natural History of Type-2 Diabetes 19
Pathophysiology 21
The Natural History of Type-2 Diabetes 22
Summary 29
References 29
2: Guidelines and Classifications 32
Classes of Diabetes 32
Type-1 Diabetes (Insulin Dependent Diabetes) 32
Type-2 Diabetes (Non-Insulin Dependent Diabetes) 33
Diabetes Associated with Other Risk Factors 37
Diagnosing Diabetes 40
Screening Recommendations [14] 41
Efficacy of Diets and Medications 44
Gestational Diabetes 45
Malnutrition Associated Diabetes 46
References 47
3: Exercise 50
Introduction 50
Guidelines for Exercise 54
Precautions 55
Effects and Timing of Exercise 55
Stress Testing 55
Types of Stress Tests 57
Summary 62
References 62
4: Nutrition 64
Introduction 64
Diabetes and Carbohydrates [3] 65
Diabetes and Protein [9] 69
Diabetes and Fats [13] 70
References 80
5: Obesity and the Metabolic Syndrome 83
Introduction 83
The Metabolic Syndrome 84
Obesity 95
Summary 105
References 105
6: Oral Agents for Type-2 Diabetes 109
Introduction 109
Oral Agent Classes 113
Sulfonylureas 113
The Meglitinides (Glinides) 115
The Biguanides 116
The Alpha-Glucosidase Inhibitors [19] 118
The Thiazolidinediones 119
DPP-IV Inhibitors (Gliptins) 123
Bile Acid Sequestrants (Colesevelam) 126
Oral Agent Combinations [12] 127
Metformin and Sulfonylurea 127
Metformin and Thiazolidinediones 128
Metformin and Repaglinide 128
Metformin and Nateglinide 128
Repaglinide and Thiazolidinedione 129
Sulfonylurea and Thiazolidinedione 129
Alpha-Glucosidase Inhibitors and Sulfonylurea 129
DPP-IV Inhibitors and Metformin and/or Thiazolidinediones 130
Combinations with Bile Acid Sequestrants 130
Multiple Oral Agent Therapy 130
Summary 135
References 135
7: Insulin Use 139
Introduction 139
Indications for Insulin Therapy 142
Human Insulin Preparations 145
Insulin Analogs [17] 146
Intermediate-Acting Insulins 152
Pre-Mixed (Biphasic) Insulins 152
Multiple Daily Injections 154
Continuous Subcutaneous Insulin Infusion Pumps [40] 157
General Therapeutic Principles 158
Novel Therapies 159
Summary 161
Case 1 162
Case 2 162
Case 3 163
Case 4 163
Case 5 164
References 165
8: Non-Insulin Injectables 168
Introduction 168
GLP-1 Receptor Agonists (Incretin Mimetics) 171
Exenatide (Byetta) (Exendin-4) 171
Pharmacokinetics 171
Clinical Trials 171
Liraglutide (Victoza) 175
Pharmacokinetics 176
Toxicology 176
Clinical Trials 176
Pramlintide (Symlin) 177
Amylin Physiology 177
Pharmacokinetics 180
Clinical Trials 180
Summary 182
References 182
9: Macrovascular Disease 184
Introduction 184
Coronary Artery Disease 184
Peripheral Arterial Disease 192
Cerebral Arteriosclerotic Vascular Disease 197
Summary 199
References 199
10: Microvascular Disease 202
Introduction 202
Diabetic Neuropathy 207
Diabetic Nephropathy 216
Pathophysiology of Diabetic Nephropathy 217
Summary 224
References 224
11: Diabetic Dyslipidemia 227
Introduction 227
Pathogenesis of Diabetic Dyslipidemia 227
Risk Assessment 230
Clinical Impact of Diabetic Dyslipidemia 232
Statins-Hmg-CoA Inhibitors (3-Hydroxy-3 Methylglutaryl-Coenzyme A Reductase Inhibitors) 234
Niacin (Nicotinic Acid) 235
Bile Acid Sequestrants 235
Fibrates Selective Cholesterol Absorption Inhibitors 236
Omega-3 Acid Ethyl Esters (Fish Oils) (Omega-3 Fatty Acids) 237
Summary 249
References 249
12: Hypertension in Diabetics 253
Introduction 253
Classification of Hypertension (Table 1) 254
Pathophysiology of Hypertension in Obesity and Type-2 Diabetes 254
Treatment for the Hypertensive Type-2 Diabetic (Table 2) 258
The Role of Combination Therapy 267
Summary 276
References 276
13: The Pathophysiology and Metabolic Impact of Hyperglycemia 280
Introduction 280
Pathophysiology of Hyperglycemia 281
Clinical Impact of Hyperglycemia 283
Summary 291
References 291
14: Risk Reduction in the Diabetic Patient 294
Introduction 294
Glycemic Control 295
Lipid Control 302
Primary Prevention 302
Secondary Prevention 303
Hypertension 310
Thrombosis Prevention 315
Multiple Risk Factor Reduction 318
Summary 323
References 323
15: Diabetes in Special Populations 329
Mental Health and Type-2 Diabetes 329
Type II Diabetes in Children 332
Diabetes in Women 333
Background 333
Prevention of Type-2 Diabetes 335
Gestational Diabetes 335
Macrovascular Disease 336
Screening for Coronary Heart Disease 338
Other Complications of Diabetes in Women 339
Infections 339
Gynecological Abnormalities 339
Risk Reduction in the Female Diabetic Patient 340
Pregnancy and Diabetes 341
Summary 347
The Geriatric Patient 347
Type-2 Diabetes and Acquired Immune Deficiency Syndrome (AIDS) 351
Type-2 Diabetes and Hemodialysis 352
Foot Problems in the Diabetic Patient 354
Perioperative and Postoperative Glucose Control 355
Skin Disorders in Type-2 Diabetes 356
Resources 358
References 361
Index 368