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Steven V Edelman

Publications and source records attributed to Steven V Edelman.

At least 19 recordsLinked to original sources
PubMed2005

Thiazolidinediones.

Explore the source record for details and available documents.

Diabetes Mellitus, Type 2↗
PubMed2005

Strategies for insulin therapy in type 2 diabetes.

Chronic hyperglycemia in type 2 diabetes is responsible for an array of microvascular and macrovascular complications that can lead to significant morbidity and mortality. Several well-conducted large clinical studies have shown that normalizing blood glucose levels can help prevent the onset and slow the progression of complications from diabetes. As many as 25% of patients treated with oral hypoglycemic agents require the addition of insulin therapy to compensate for the progression of beta-cell failure and an inability to maintain glycemic control. Various strategies incorporating the use of insulin early in the course of the disease have been developed to meet this goal, and include the use of basal-bolus insulin regimens as well as bedtime insulin injections. The pharmacokinetic properties of the new insulin analogs (eg, insulin lispro, insulin aspart, insulin glargine) offer significant advantages, such as improved control of nocturnal hypoglycemia with basal insulin glargine, and improved postprandial glucose control, with insulin lispro or insulin aspart.

Blood Glucose↗
PubMed2004

Skeletal muscle GLUT1 transporter protein expression and basal leg glucose uptake are reduced in type 2 diabetes.

To investigate the role of skeletal muscle tissue expression of the glucose transporter protein GLUT1 in mediating glucose disposal in the basal (fasting) state, skeletal muscle biopsies (vastus lateralis) were obtained from lean and obese nondiabetics and type 2 diabetic subjects. Basal and insulin-stimulated glucose uptakes were measured. Basal whole body glucose uptake was measured using isotope dilution, and arteriovenous catheterization limb balance was used to determine leg muscle glucose uptake. Basal (noninsulin-stimulated) whole body glucose uptake was higher in the type 2 group compared with the controls (2.26 +/- 0.17 vs. 1.83 +/- 0.15 mg/kg.min; P < 0.05). However, basal leg muscle glucose uptake was reduced in diabetic subjects (1.53 +/- 0.56 vs. 3.89 +/- 0.83 mg/100 ml.min; P < 0.025) despite basal hyperglycemia (230 +/- 13 vs. 94 +/- 2 mg/dl; P < 0.0005). Skeletal muscle GLUT1 protein expression was lower in the type 2 subjects (57 +/- 12 vs. 91 +/- 11 arbitrary units/10 microg protein; P < 0.05), although GLUT1 mRNA levels did not differ. In summary, 1) skeletal muscle tissue GLUT1 protein expression is reduced in type 2 diabetes and could contribute to impaired basal leg glucose uptake; and 2) elevated rates of basal whole body glucose uptake in type 2 diabetes are due to uptake in tissues other than skeletal muscle.

Diabetes Mellitus, Type 2↗
PubMed2004

Prognostic role of B-type natriuretic peptide levels in patients with type 2 diabetes mellitus.

OBJECTIVES: We hypothesized that B-type natriuretic peptide (BNP) levels can predict cardiac mortality in diabetic patients. BACKGROUND: Detection of cardiovascular disease in diabetics can be difficult until overt events occur. METHODS: A total of 482 diabetics (majority male with type 2 diabetes) at the Veterans Affairs Medical Center San Diego were divided into two groups: 1) referred patients for echocardiogram on the basis of clinical suspicion of cardiac dysfunction (referred [R], n = 180); 2) patients randomly selected from the diabetic clinic without any suspicion of cardiac dysfunction (not referred [N-R], n = 302). We examined cardiac events and all-cause mortality in relation to initial BNP levels during the follow-up. RESULTS: A total of 71 (14.7%) patients died during this period: 52 of 180 (29%) in the R group (30 of 52 [58%] cardiac, 10 of 52 [19%] non-cardiac, 2 of 52 [4%] renal, 10 of 52 [19%] unknown cause) and 19 of 302 (6%) in N-R group (6 of 19 [32%] cardiac). The median BNP level in the R and N-R groups who died of cardiac, non-cardiac, and unknown cause was 537 and 87, 80 and 53, and 343 and 38 pg/ml, respectively. The receiver-operating characteristic (ROC) values for mortality in two groups in relation to BNP revealed the area under the curve to be 0.720 and 0.691, respectively (p < 0.01 in both). Among commonly used prognostic indicators in diabetics, only the ROC for triglycerides was significant. The most accurate cut-point in both the N-R group (87%) and R group (61%) was 120 pg/ml of BNP. Cox regression analysis showed BNP to be the most significant predictor of all-cause mortality in the R group. There was a marked decrease in survival in the patient group with BNP >120 pg/ml. CONCLUSIONS: B-type natriuretic peptide appears to be a reliable predictor of future cardiac and all-cause mortality in diabetic patients.

Adult↗
PubMed2004

Insulin therapy in type 2 diabetes.

Unlike type 1 diabetic patients, who have no significant insulin secretion and require insulin therapy from the disease onset, a prominent feature in the early stages of type 2 diabetes is insulin resistance with hyperinsulinemia. Therefore, improving insulin sensitivity by diet, exercise, and weight management will benefit type 2 diabetic patients. When these measures fail, glycemic goals may be achieved with oral agents. However, at the late stage of disease,most patients require exogenous insulin therapy to achieve optimal glucose control. The American Diabetes Association recommends that the objective of normalizing glycemia and glycosylated hemoglobin concentrations for patients with type 2 diabetes should be similar to that for type 1 diabetes.

Age Distribution↗
PubMed2004

Improved glucose excursions using an implantable real-time continuous glucose sensor in adults with type 1 diabetes.

OBJECTIVE: The capability of emerging glucose sensor technology to continuously monitor glucose levels may provide ways to achieve glycemic targets while reducing hypoglycemia. RESEARCH DESIGN AND METHODS: A first-generation, long-term continuous glucose sensor (DexCom, San Diego, CA) was implanted subcutaneously in 15 patients with type 1 diabetes. Safety, efficacy, and potential benefits were evaluated during a blinded control period and in a study period during which patients had real-time access to the glucose data. RESULTS: The bias differences between self-monitored blood glucose (SMBG) and sensor data were <15% at 2.8, 4.4, 5.6, 8.3, and 11.1 mmol/l. No procedure or device-related adverse events were observed. Of 15 patients, 13 (87%) had functional sensors during the 12-h simulated home use study with 96% of points in the A and B regions of the Clarke error grid, an R value of 0.88, and a mean absolute relative difference of 16% when retrospectively compared with SMBG. In actual home use, during the blinded control period (50 +/- 16 days) data were not displayed to the patient, whereas during the unblinded study period (44 +/- 17 days) the data were presented to the patient, and alerts were set at 3.1, 5.6, and 11.1 mmol/l. Patients spent a median of 47% less time below 3.1 mmol/l (P<0.05) and 25% less time above 13.3 mmol/l (P<0.05) during the nonblinded study period compared with the blinded control period. CONCLUSIONS: The availability of real-time continuous glucose values may help patients reduce their hyperglycemic excursions and lower the risk of hypoglycemia.

Adult↗
PubMed2003

Osteoporosis and diabetes.

Osteoporosis is the most prevalent metabolic bone disease in the United States. Although the disease has historically been reported mostly in white women, it can affect individuals of both sexes and all ethnic groups. The presence of osteoporosis related to diabetes is not well acknowledged and the impact of osteoporosis in a diabetic patient is often not considered. Routine screening or initiation of preventive medications for osteoporosis in all patients with type 1 or type 2 diabetes is not recommended at the present time. However, in all patients with diabetes, besides optimal glycemic control, general recommendations regarding adequate dietary calcium intake, regular exercise, and avoidance of other potential risk factors such as smoking should be given. In patients who have positive risk factors for osteoporosis, or in those who present with fractures, evaluation of bone density should be done and respective preventive or therapeutic interventions should be applied.

Blood Glucose↗
PubMed2003

Gastrointestinal disturbances in diabetes.

Gastrointestinal disorders are common in patients with diabetes mellitus. As many as 75% of patients visiting diabetes clinics will report significant gastrointestinal (GI) symptoms. The symptom complex experienced may vary widely. Many patients go undiagnosed and undertreated. Patients with a history of retinopathy, nephropathy, or neuropathy should be presumed to have GI abnormalities until proven otherwise. The workup should start with a thorough patient history and appropriate laboratory, radiographic, and GI testing. In addition to pharmacologic therapy, glycemic control and dietary manipulation play an important role in managing GI disorders in people with diabetes.

Blood Glucose↗
PubMed2003

Serum 1,5-anhydroglucitol (GlycoMark ): a short-term glycemic marker.

1,5-Anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, has been measured and used clinically in Japan for over a decade to monitor short-term glycemic control. Evaluation of glucose control otherwise requires measuring plasma glucose or glycated proteins whose levels reflect average glucose concentration over the half-life of the protein analyzed. Hemoglobin A1c measurements reflect blood glucose levels over that past 2-3 months, while fructosamine can be used to evaluate glycemic control over 10-14 days. In contrast, 1,5-AG levels in blood respond within 24 h as a result of glucose's competitive inhibition of 1,5-AG reabsorption in the kidney tubule. When glucose levels rise, even transiently, urinary loss of 1,5-AG occurs, and circulating levels fall. Because of changes in renal hemodynamics in normal pregnancies, 1,5-AG appears of limited usefulness in evaluation of gestational diabetes. However, the characteristics of 1,5-AG levels in patients with moderate to near-normal glycemic control suggest that it may be a valuable complement to frequent self-monitoring or continuous monitoring of plasma glucose to confirm stable glycemic control. Measurements performed daily or weekly in a given patient would suggest that overall glycemic control has been stable or improved if 1,5-AG levels are stable or increasing. If 1,5-AG levels fall, greater attention to glucose monitoring and both lifestyle and medical management could be prescribed to correct the glycemic excursions that would underlie such changes. The behavior of this analyte is different from all others used in the management of diabetes, creating potential opportunities for its use in clinical practice.

Biomarkers↗
PubMed2003

The role of the thiazolidinediones in the practical management of patients with type 2 diabetes and cardiovascular risk factors.

The American Diabetes Association's objective for treating patients with type 2 diabetes mellitus is to normalize glycemia and glycosylated hemoglobin concentrations while controlling blood pressure, cholesterol, and other cardiovascular risk factors. This article focuses on the role of thiazolidinediones (TZDs) in the management of patients with type 2 diabetes with comorbid cardiovascular disease. Insulin resistance is one of the earliest and main defects in type 2 diabetes and is strongly linked to comorbid cardiovascular conditions. The TZDs rosiglitazone and pioglitazone work mainly by reducing insulin resistance and may have the potential to alter the natural history of type 2 diabetes and reduce the cardiovascular mortality and morbidity associated with this condition.

Blood Glucose↗
PubMed2002

Erectile dysfunction and diabetes.

Erectile dysfunction (ED) has been the most neglected complication of diabetes. It is a common abnormality that affects more than 20 million American men. The prevalence of ED in the general population between the ages of 40 to 70 years is 52%. In men with diabetes, it ranges from 35% to 75%, and occurs at an earlier age. There have been several advances in the understanding of the physiologic and biochemical mechanisms controlling penile erections. Improved techniques in diagnoses and treatment of impotence have given the male with diabetes some hope in the management of this prevalent and emotionally disturbing complication.

Diabetes Mellitus↗