Primary care
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The management of diabetes in clinical practice has many challenges: quickly interpreting a large volume of self-monitoring of blood glucose data, ensuring safe and accurate titration of basal insulin, managing patients on insulin pump therapy, and synthesizing glycemic data into actionable reports to improve patient outcomes. Technological advancements are emerging as a solution to some of these challenges. This article reviews mobile applications for insulin dosing, continuous glucose monitoring, insulin pump therapy, and smart insulin pens available for patients with type 1 and type 2 diabetes.
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Diabetes-related microvascular complications include diabetic neuropathy (eg, diabetic symmetric polyneuropathy (DSPN), cardiac autonomic neuropathy, gastroparesis, enteropathy, erectile dysfunction, female sexual dysfunction, and hypoglycemia unawareness), diabetic kidney disease (DKD), and diabetes-related eye disease (eg, diabetic retinopathy (DR) and cataract). Both diabetes duration and degree of glycemic control strongly correlate with the development of microvascular complications. The development of diabetes-related microvascular complications interferes with the patient's quality of life and poses higher health system costs. This article will discuss a practical approach to effectively minimize/delay and manage the most common diabetes-related microvascular (DSPN, DKD, and DR).
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Diabetes influences other chronic medical conditions and is influenced by each in turn through multifactorial pathways. These comorbid conditions have a direct relationship with diabetes and can increase the severity of diabetes and the risk of various complications. ⋯ Recent research has shown that diabetic medications may play a direct role in treating some of these comorbidities. This article focuses on the best-known comorbid diseases associated specifically with type 2 diabetes and their co-management.
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Because macrovascular complications of diabetes are the leading cause of mortality and decreased quality of life for individuals with diabetes, prevention and risk reduction are paramount. Besides lifestyle management, contemporary therapies can significantly reduce risk for cardiovascular events in diabetes. For primary prevention, most individuals should be on statin therapy, whereas those at high atherosclerotic cardiovascular disease risk should also be on glucagon-like peptide 1 receptor agonists (GLP1RA) or sodium/glucose cotransporter-2 inhibitors (SGLT2i) at any hemoglobin A1c. For secondary prevention, addition of GLP1RA or SGLT2i, PCKS9i, rivaroxaban, and/or icosapent ethyl should be considered in addition to a statin and low-dose aspirin.