Monofilament test alone may not rule in or rule out peripheral neuropathy

Feet

Different grades of monofilament are used to test the sensitivity of different areas of a patient’s foot. This systematic review set out to establish the accuracy of this method for diagnosing diabetic peripheral neuropathy. Clinical question: In diabetic patients does monofilament testing diagnose peripheral neuropathy? The evidence: Fourteen studies were included in the review, comprising [read the full story…]

Non-drug interventions were better than drug interventions at preventing progression to type 2 diabetes

healthylifestyle_senior

Clinical question: In people with impaired glucose tolerance, what interventions prevent progression to type 2 diabetes and reduce the risk of macrovascular complications? The evidence: The reviewers found 10 RCTs comprising 23,152 participants. When they combined individual data from these studies, they found that: Both drug interventions and non-drug interventions, when compared to controls, reduced [read the full story…]

Limited evidence for GLP-1 analogs as second line treatment for type 2 diabetes

A syringe

There remains considerable uncertainty as to the next step for treatment of type 2 diabetes that has not been successfully controlled using metformin.  A recent systematic review looked at this issue. Clinical question: In type 2 diabetes inadequately controlled on metformin alone, what additional therapy improves glycemic control? The reviewers also looked at potential adverse [read the full story…]

In people with obesity and type 2 diabetes, an intensive lifestyle programme reduced disability

A fat stomach

We don’t usually include individual studies in diabetes because there are so many of them.  However, a new report of the Look AHEAD trial, published in the New England Journal of Medicine, points towards significant potential benefits from an intensive lifestyle intervention for people suffering from obesity and type 2 diabetes. Clinical question: In overweight [read the full story…]

TZDs were significantly associated with heart failure in type 2 diabetes

heart

Recent evidence has suggested that thiazolidinediones (TZDs) are associated with a higher risk of heart failure (HF) in type 2 diabetes.   This systematic review sought to clarify the evidence in this area, and investigate whether the effects are different for different types of TZD. Clinical question: In people with or at risk of type [read the full story…]

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Diagnostic criterial predict adverse pregnancy outcomes in gestational diabetes.

Taking a blood test during pregnancy

There remains some uncertainty about the best diagnostic criteria for gestational diabetes mellitus (GDM).  This systematic review set out to test the ability of different glucose levels after a 75g oral glucose tolerance test (OGTT) to predict adverse pregnancy outcomes. Clinical question: In women with gestational diabetes, what is the risk of adverse outcomes? The [read the full story…]

American Diabetes Association: Standards of Care 2012

Logo of the American Diabetes Association

The latest edition of Diabetes Care contains the most recent guidance from the American Diabetes Association. These standards of care are intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. The guidelines address: Classification and diagnosis [read the full story…]

Unclear evidence on whether metformin reduces the risk of cancer in type 2 diabetes

cancercell

Previous observational studies have suggested that use of metformin is associated with a reduction in the risk of cancer. This systematic review set out to clarify this question by incorporating the findings of recent trials. Clinical question: In people with type 2 diabetes taking metformin, what is the risk of cancer of any type? The [read the full story…]

Review: some evidence that lifestyle education can help diabetics with schizophrenia

Fruit slices

For many different reasons, people with schizophrenia and schizoaffective disorders have a greater risk of type 2 diabetes.  This review looked for evidence of the efficacy of interventions to help them manage their diabetes. Clinical question: In people with type 2 diabetse and schizophrenia or schizo-affective disorder, what lifestyle interventions improve self-management? The scope included [read the full story…]

Review: unclear evidence about education for type 1 diabetes using pump therapy

Insulin Pump with sensor

This systematic review set out to establish the effectiveness and optimal delivery of educational interventions to help adults with type 1 diabetes who are using insulin pump therapy. Clinical question: In adults with type 1 diabetes using or starting insulin pump therapy, what is the effectiveness of educational interventions? The review included both patients starting [read the full story…]