Can J Diabetes
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We report a case of metformin-associated lactic acidosis (MALA) in the setting of normal renal function and review the relevant medical literature. A 77-year-old female diagnosed with type 2 diabetes mellitus previously treated with insulin and gliclazide MR was started on metformin. A few weeks later, she was found to have lactic acidosis. ⋯ MALA can occur in the absence of renal impairment, systemic hypoperfusion or severe liver disease. A possible mechanism is a genetically determined alteration in metformin pharmacokinetics. Metformin is beneficial and safe in patients with normal renal function, but the development of MALA, although rare, should be kept in mind to prevent potentially life-threatening toxicity.
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Examining the "Killer K" of Diabetic Ketoacidosis at a Tertiary Care Hospital: An Exploratory Study.
Hypokalemia, a frequently cited complication of diabetic ketoacidosis (DKA) treatment, can have critical implications, including arrhythmias and death. We assessed the prevalence of hypokalemia and its associated factors in patients with DKA at our tertiary-care centre and identified opportunities to improve care. ⋯ Hypokalemia occurs frequently during acute DKA management and is often preventable. Our findings suggest that interventions targeted at enhancing awareness of guidelines may reduce hypokalemia rates.
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To assess the current status of diabetes teaching in Canadian medical schools. ⋯ There has been an increased use of small group sessions in undergraduate diabetes education, in keeping with generalized changes in medical school curricula. Future study is warranted in assessing the impact of differing undergraduate teaching methods on eventual competency.
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Randomized Controlled Trial
Efficacy and Cardiovascular Safety of Linagliptin as an Add-On to Insulin in Type 2 Diabetes: A Pooled Comprehensive Post Hoc Analysis.
With the expanding armamentarium of noninsulin therapies for type 2 diabetes mellitus, the use of insulin with various oral agents is becoming more common. In this study, we assessed the efficacy and cardiovascular (CV) safety of the dipeptidyl peptidase-4 inhibitor linagliptin as add-on to insulin in patients with type 2 diabetes. ⋯ Linagliptin, when added to ongoing insulin treatment in patients with type 2 diabetes, improves glycemic control and has a neutral impact on major adverse CV events.
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Comparative Study
Diabetes Management in Long-Term Care: An Exploratory Study of the Current Practices and Processes to Managing Frail Elderly Persons with Type 2 Diabetes.
There is limited evidence for the management of diabetes in frail elderly residents living in long-term care (LTC) settings. The purpose of this study was to explore the current practices of glycemic management in frail elderly persons with diabetes living in LTC settings. ⋯ The findings of this study were triangulated with both the quantitative survey and the qualitative interviews. The implications of these findings suggest a disparity between what physicians feel should be achieved for diabetes management and what is actually done for frail elderly adults in LTC settings. Further research needs to be completed to assess the distinct needs and considerations of this unique population and healthcare setting.