In Brief Although aspirin has been empirically used to prevent cardiovascular disease since the 1940s, there remains disagreement regarding the specific use of aspirin in people with diabetes. Despite this disagreement, several organizations have provided guidelines and recommendations concerning patient selection when considering aspirin use for this purpose. This review provides a brief overview of currently available recommendations related to aspirin use in the prevention of cardiovascular events in people with and without diabetes.

In Brief PowerUp is a community-wide initiative to make better eating and physical activity easy and fun for youths and the entire community as part of an effort to prevent childhood obesity. PowerUp works in partnership and on multiple levels to change the food and activity environment, engage the community, deliver programs, and support clinical interventions throughout the health care system and the community. Early results show promise that the initiative is inspiring community-level change.

The prevalence of diabetes has increased dramatically world-wide in the past 30 years because of an increase in life expectancy, urbanization, changing population demographics, and increasing rates of obesity and physical inactivity.1–3 The disease is considered a world-wide epidemic and major chronic health problem.3,4 According to the International Diabetes Federation, the United States has 23.7 million people with diabetes (27.7% of whom are undetected), and undiagnosed cases are responsible for an additional $18 billion in annual health care costs. Diabetes is recognized as a silent disease, and in 70% of patients with type 2 diabetes, cardiovascular problems and coronary disease are the main cause of death.5,6 Improvements in blood pressure, lipids, and blood glucose management reduce the risk of diabetes-related micro- and macrovascular disease,7–9 with a potential legacy effect as demonstrated with the U.K. Prospective Diabetes Study, which showed a reduced incidence of myocardial infarction in the intensively treated group after 10 years of follow-up.10 Long-term complications are preventable with a multi-interventional strategy addressing blood glucose, blood pressure, and lipid management.11 Nevertheless, many patients experience difficulty achieving recommended care goals using the current approach. Multiple options for diabetes treatment are available for patients, including diet and exercise regimens and 11 different drug classes. Several strategies are required for better management of diabetes, including factors pertinent to patients, care providers, and the health care system, all of which affect the quality of diabetes care. Diabetes educators can support these care strategies by performing services such as counseling, medication management, monitoring of disease control and progression through self-monitoring of blood glucose (SMBG) results, and screening for microvascular complications, all of which can influence the delivery of health care to patients with diabetes.12 To evaluate the risk of …

Type 2 diabetes is a progressive disease involving multiple metabolic defects that requires timely intervention targeted to individual patients' therapeutic challenges. Current guidelines recommend that the medications used to achieve glycemic goals must be individualized for each patient with type 2 diabetes.1 Although many medications improve control of hyperglycemia in patients with type 2 diabetes, all have limitations. For example, metformin monotherapy is associated with decreased effectiveness over time;2 sulfonylureas are associated with hypoglycemia and weight gain;3 thiazolidinediones are associated with fractures, congestive heart failure, and edema;3,4 and insulin is associated with hypoglycemia and increased body weight and generally requires an increase in frequency of self-monitoring of blood glucose.5 In addition to the limitations of the medications themselves, patients may have difficulty adhering to diabetes medication dosing regimens.6 Medication acceptance and adherence have been shown to be influenced by regimen complexity.7 Moreover, studies conducted in patients with osteoporosis or depression found improved adherence with once-weekly oral medications, compared to more frequently dosed oral medications.8,9 Although there has not yet been a study to assess adherence among patients who receive exenatide once-weekly injections versus those who receive more frequently dosed injections, there is the potential that a once-weekly diabetes treatment regimen could improve adherence because fewer injections are required. A need exists for diabetes medications that improve glycemic control without some of the side effects common in other drugs and that may improve patient adherence. One medication that has demonstrated improvements in glycemic control and may positively influence patient adherence is an extended-release formulation of exenatide that is dosed every 7 days (exenatide once weekly). This medication is a line extension to exenatide twice daily, a glucagon-like peptide-1 (GLP-1) receptor agonist that has been available in the United States …

In Brief This article reviews the history of the postoperative nutrition recommendations for today's common bariatric (weight loss) surgery procedures. Discussion of the evolution of postoperative nutrition guidelines supports the proposal for a standardized postoperative diet for patients who undergo a Roux-en-Y gastric bypass or a laparoscopic adjustable gastric band procedure.

Diabetes self-management education is an integral part of the role of diabetes care practitioners. However, guiding patients with diabetes toward a path of better health is a growing challenge for a variety of reasons. Diabetes ranks as the seventh-leading cause of death, affecting 25.8 million people (8.3%) in the U.S. population. In addition, 35% of adults in the United States ≥ 20 years of age have prediabetes.1 For patients with diabetes or prediabetes, the diagnosis is frequently accompanied by other comorbidities, including hypertension, dyslipidemia, and obesity. This means treatment guidelines must focus not only on blood glucose management, but also on controlling lipids, blood pressure, and body weight.2 Although glycemic control is an important aspect of health and well-being for patients with diabetes, there are more pieces to the puzzle of effective diabetes management. Adults with diabetes have a risk of death from coronary heart disease that is two to four times higher than that of adults without diabetes. Yet, of people with diabetes ≥ 20 years of age, 67% have blood pressure readings of ≥ 140/90 mmHg or are taking prescription hypertension agents.1 These statistics make it clear that diabetes practitioners have an opportunity to support their patients in achieving improvements in areas commonly referred to as “the ABCs of diabetes management”: A1C, blood pressure, and cholesterol. Lifestyle modification is a cornerstone of management for diabetes and prediabetes. A multitude of guidelines exist regarding proper nutrition, especially with regard to managing chronic conditions such as diabetes, hypertension, and dyslipidemia. Unfortunately, consumers are also bombarded with mixed messages about nutrition from numerous sources. It can be difficult to decipher fact from fiction and to answer one of the simplest questions often asked by patients with diabetes: “What can I eat?” The Dietary Guidelines for Americans, most recently …

Diabetes is a systemic disease that has reached epidemic proportions worldwide during the past 30 years,1 and this trend shows no sign of slowing down. In the United States alone, it is estimated that almost 26 million people have diabetes, including 7 million not yet diagnosed.2 The statistics are even worse for prediabetes (impaired fasting glucose or impaired glucose tolerance), which is believed to affect 79 million Americans > 20 years of age.2 Risk factors for type 2 diabetes include, but are not limited to, family history, ethnicity, and obesity, whereas people with certain autoimmune conditions, pancreatic disease, and genetic predisposition are at increased risk for type 1 diabetes.3 Regardless of the type, individuals with diabetes experience abnormal carbohydrate metabolism because of a variety of factors, including impaired insulin secretion and insulin resistance. After carbohydrates were recognized as the macronutrient primarily responsible for increasing blood glucose, severe restriction was used to manage hyperglycemia before the discovery of insulin in 1922.4 Until the early 1970s, a lower-carbohydrate, higher-fat diet was considered appropriate for nutritional management of diabetes.5 In 1980, the first set of Dietary Guidelines for Americans included recommendations to adopt an eating pattern lower in fat to prevent chronic health conditions such as diabetes, cardiovascular disease (CVD), and hypertension.6 Although these guidelines state that they “do not apply to people who need special diets because of diseases or conditions,” many clinicians began recommending lower-fat eating patterns, and people with diabetes began adopting them. Although the American Diabetes Association (ADA) has recommended for more than 15 years that macronutrient composition and meal plans be based on individual preferences and needs, many clinicians continue to prescribe a low-fat meal plan for diabetes management. In terms of teaching carbohydrate consistency, a popular nutrition intervention used in …

Abstract Objective. The purpose of this article is to explore the relationships among polycystic ovarian syndrome (PCOS), diabetes, and cardiovascular (CV) risk and review the use of metformin and thiazolidinediones (TZDs) in reducing CV risk in women with PCOS. Methods. The authors conducted a search for and reviewed reports of clinical trials, meta-analyses, and controlled trials published from January 1998 to December 2012 included in the PubMed, Cochrane Collaborative, and Health and Psychosocial Instruments databases. Search terms included PCOS, polycystic ovary/ovarian syndrome, diabetes mellitus, hyperglycemia, cardiovascular, metformin, TZDs, thiazolidinediones, rosiglitazone, and pioglitazone. Results. The articles provided evidence that PCOS is associated with both metabolic syndrome and diabetes in women. Metformin is an effective treatment for diabetes with favorable effects on lipid abnormalities to reduce CV risk. TZDs demonstrate some benefit on clinical markers associated with PCOS. However, there is no evidence that TZDs provide a greater benefit than metformin in reducing CV risk in women with PCOS and diabetes. Additionally, there is concern that TZDs may increase patients' risk of adverse events. Conclusions. Based on evidence linking PCOS to diabetes and increased CV risks, clinicians should systematically screen women with diabetes for PCOS and direct appropriate treatment at minimizing related risks. Treatment with metformin appears to be more beneficial than TZDs and has been shown to lower triglycerides, increase HDL cholesterol, and favorably influence serum insulin levels.

Glycemic management in type 2 diabetes mellitus has become increasingly complex and, to some extent, controversial, with a widening array of pharmacological agents now available,1–5 mounting concerns about their potential adverse effects and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications.6–9 Many clinicians are therefore perplexed as to the optimal strategies for their patients. As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes. Several guideline documents have been developed by members of these two organizations10 and by other societies and federations.2,11–15 However, an update was deemed necessary because of contemporary information on the benefits/risks of glycemic control, recent evidence concerning efficacy and safety of several new drug classes,16,17 the withdrawal/restriction of others, and increasing calls for a move toward more patient-centered care.18,19 This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below). The document refers to glycemic control; yet this clearly needs to be pursued within a multifactorial risk reduction framework. This stems from the fact that patients with type 2 diabetes are at increased risk of cardiovascular morbidity and mortality; the aggressive management of cardiovascular risk factors (blood pressure and lipid therapy, antiplatelet treatment, and smoking cessation) is likely to have even greater benefits. View this table: Table 1. Properties of Currently Available Glucose-Lowering Agents That May Guide Treatment Choice in Individual Patients With Type 2 Diabetes Mellitus These recommendations should be considered within the context …