The American journal of medicine
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Diabetes mellitus is a chronic progressive disease that has profound consequences for individuals, families, and society. Despite clear glycemic control targets articulated by the major medical societies, patients and physicians still struggle to meet and maintain these goals, leading to shortfalls in delivery of care. Recent advances in the treatment of type 2 diabetes seek to address these shortfalls: Modern oral hypoglycemic agents may be used with or in place of traditional therapies. ⋯ Using these new classes of therapy, physicians should strive to help patients understand and reach the targets for control that we know to be beneficial for the majority of individuals. Such targets include those for glycosylated hemoglobin (HbA1c), but increasingly we also realize the central importance of maintaining postprandial glucose levels within recommended limits, and it is likely that the recent introduction of a serum marker for this purpose, 1,5-anhydroglucitol, will help improve patient outcomes. By intensifying therapy early during the course of the disease process, using the most effective and acceptable therapies available, and maintaining the lowest and safest HbA1c levels for as long as possible, we will be serving our patients well and living up to our responsibilities as diabetes care physicians.
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Comparative Study
Normal fasting plasma glucose and risk of type 2 diabetes diagnosis.
The study compares the risk of incident diabetes associated with fasting plasma glucose levels in the normal range, controlling for other risk factors. ⋯ The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range.
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The increasing incidence of hepatocellular carcinoma coupled with this cancer's high mortality is a public health problem. Delineating high-risk populations and cancer patterns can provide valuable information. This is necessary to broaden screening and surveillance guidelines related to early detection and prevention. ⋯ Marked differences in the incidence rates of hepatocellular carcinoma by sex, ethnicity, and age of diagnosis likely represent variations in risk factor distributions (eg, viral hepatitis) and possibly in host genetics or other environmental factors. An individualized approach tailored to specific risk profiles may more effectively identify treatable tumors than more general guidelines.