Aace Clinical Conversation Series - Podcast

In this conversation, two pediatric endocrinology specialists, David Cook, MD, FACE and Dr. Laurence Katznelson, MD, join Dr. Carlos Hamilton, Jr. to discuss Therapeutic Goals of Acromegaly.

In this conversation, two pediatric endocrinology specialists, David Cook, MD, FACE and Dr. Laurence Katznelson, MD, join Dr. Carlos Hamilton, Jr. to discuss Therapeutic Goals of Acromegaly.

Within the last decade, there have been major advances in the understanding of growth hormone deficiency and its impact on stature, especially short stature. Experts suggest that up to 75% of the cases of growth hormone (GH) deficiency may be reversible. Physicians and endocrinologists now recognize that the growth effects of GH are mediated by a substance called insulin-like growth factor 1 (IGF-1). IGF-1, a potent growth and differentiation factor, stimulates the multiple processes leading to statural growth and is normally secreted in response to stimulation by GH.

In this conversation, two pediatric endocrinology specialists, Dr. Naomi Neufeld and Dr. Paul Saenger, join Dr. Carlos Hamilton, Jr. to discuss current issues surrounding the role of IGF-1 in the treatment of growth failure.

In this conversation, two endocrinologists, Dr. Joseph Torre and Dr. Addison Taylor, join Dr. Carlos Hamilton, Jr. to discuss current issues surrounding the management of hypertension in diabetic patients.

Dr. Paul Jellinger, Dr. Joseph Torre and Dr. Vijay Nambi, join Dr. Carlos Hamilton, Jr. to discuss current issues primarily surrounding the non-pharmacological management and control of hyperlipidemia in diabetic patients.

Dr. Joseph Torre and Dr. Addison Taylor, join Dr. Carlos Hamilton, Jr. to discuss current issues surrounding the effects of renal disease in the management of diabetes.

Dr. Paul Jellinger, Dr. Joseph Torre and Dr. Vijay Nambi, join Dr. Carlos Hamilton, Jr. to discuss current issues primarily surrounding the prevention of vascular complications in diabetic patients.

According to estimates, at least 15% to 30% of hospitalized patients have hyperglycemia or diabetes. A full 2/3 of critical care patients fall into this category, as do 1/3 of cardiac surgery patients. Hyperglycemia is associated with poor outcomes in the inpatient setting, including a higher rate of infection, delayed healing, and more procedure-related complications.

The standard treatment paradigm for newly diagnosed patients with diabetes is counseling the patient about diet and exercise and starting them on an oral agent.

Optimizing glycemic control in the inpatient setting is critical. In the ICU, target blood glucose (BG) levels should be less then 110 mg/dL. In the non-ICU inpatient setting, the level may vary, since patients are likely to be eating

There is a great deal of evidence that tight glycemic control in the intensive care unit after surgery, especially cardiovascular surgery, shortens the duration of hospitalization and prevents complications.

For newly diagnosed patients with type 1 or type 2 diabetes, education about diabetes is critical and should start immediately. For the clinician, the major tasks are to provide key information in the context of a "partnership" approach to treatment without overwhelming the patient.

Treatment of type 2 diabetes begins with efforts to improve lifestyle factors, including diet and exercise. However, lifestyle intervention alone has had limited long-term success in maintaining glycemic goals for most patients with type 2 diabetes, and the majority of patients with type 2 diabetes will require medication over the course of their diabetes.

Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Oral monotherapy is often initiated as first-line therapy, though insulin may be indicated ...

Diabetes mellitus is a chronic condition that can lead to complications over time. The long-term complications of diabetes result from the effects of hyperglycemia on blood vessels, causing microvascular and macrovascular disease. Fortunately, many complications can be prevented or minimized with a combination of regular medical care and tight blood glucose monitoring.

Diet and physical activity are critically important in the treatment of type 1 and type 2 diabetes. Basic principles of nutritional management, however, are often poorly understood, both by both clinicians and their patients.

Current recommendations of the American Diabetes Association (ADA), which have been used predominantly in the United States, present goals for fasting/preprandial and bedtime glucose levels but do not define a target for postprandial glucose. The ADA guidelines also present a glycated hemoglobin (A1C) goal of less than 7%. The International Diabetes Federation (IDF) and the American College of Endocrinology (ACE) have each published guidelines that define targets for both fasting/preprandial and 2-h postprandial blood glucose and present 6.5% as their A1C goal for glycemic control.