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Patients with type 1 or type 2 diabetes in Sweden were studied to examine trends in mortality and cardiovascular disease incidence between 1998 and 2014. Both outcomes declined substantially, although fatal outcomes declined less among patients with type 2 diabetes than among controls. Diabetes mellitus is a complex and heterogeneous group of chronic metabolic diseases that are characterized by hyperglycemia. Type 1 diabetes occurs predominantly in young people (diagnosis at 30 years of age or younger) and is generally thought to be precipitated by an immune-associated destruction of insulin-producing pancreatic beta cells, leading to insulin deficiency and an absolute need for exogenous insulin replacement. 1 Type 2 diabetes is a progressive metabolic disease that is characterized by insulin resistance and eventual functional failure of pancreatic beta cells. 2 The prevalence of type 2 diabetes has been increasing dramatically over the past few decades, 3 with projections . . .

Therapeutic footwear becomes the first treatment line in the prevention of diabetic foot ulcer and future complications of diabetes. Previous studies and the International Working Group on the Diabetic Foot have described therapeutic footwear as a protective factor to reduce the risk of re-ulceration. In this study, we aimed to analyze the efficacy of a rigid rocker sole to reduce the recurrence rate of plantar ulcers in patients with diabetic foot. Between June 2016 and December 2017, we conducted a randomized controlled trial in a specialized diabetic foot unit. Fifty-one patients with diabetic neuropathy who had a recently healed plantar ulcer were randomized consecutively into the following two groups: therapeutic footwear with semi-rigid sole (control) or therapeutic footwear with a rigid rocker sole (experimental). All patients included in the study were followed up for 6 months (one visit each 30 ± 2 days) or until the development of a recurrence event. Primary outcome measure was recurrence of ulcers in the plantar aspect of the foot. A total of 51 patients were randomized to the control and experimental groups. The median follow-up time was 26 [IQR-4.4-26.1] weeks for both groups. On an intention-to-treat basis, 16 (64%) and 6 (23%) patients in the control and experimental groups had ulcer recurrence, respectively. Among the group with >60% adherence to therapeutic footwear, multivariate analysis showed that the rigid rocker sole improved ulcer recurrence-free survival time in diabetes patients with polyneuropathy and DFU history (P = 0.019; 95% confidence interval, 0.086-0.807; hazard ratio, 0.263). We recommend the use of therapeutic footwear with a rigid rocker sole in patients with diabetes with polyneuropathy and history of diabetic foot ulcer to reduce the risk of plantar ulcer recurrence. ClinicalTrials.gov NCT02995863.

\"Plan delicious, diabetes-friendly meals--easily! When you have diabetes, meal planning and preparation are important parts of caring for your health. Quick Diabetic Recipes for Dummies gives you everything you need to create healthy, diabetes-friendly meals in a snap. Find recipes for delicious soups and stews, appetizers, salads, veggies even the kids will eat, hearty breakfasts, satisfying entrâees, and even desserts! Tips on shopping, cooking, keeping a healthy kitchen, and more will make your healthy eating journey even easier! Inside... basics of diabetes nutrition and meal planning; nutritious foods to keep in stock; healthy cooking techniques; dishes your guests will love; portion control tips and tricks, diabetes choices/exchanges\"-- Page 4 of cover.

Standards of Medical Care in Diabetes—2007 American Diabetes Association ABI, ankle-brachial index AMI, acute myocardial infarction ARB, angiotensin receptor blocker CAD, coronary artery disease CBG, capillary blood glucose CHD, coronary heart disease CHF, congestive heart failure CKD, chronic kidney disease CMS, Centers for Medicare and Medicaid Services CSII, continuous subcutaneous insulin infusion CVD, cardiovascular disease DCCB, dihydropyridine calcium channel blocker DCCT, Diabetes Control and Complications Trial DKA, diabetic ketoacidosis DMMP, diabetes medical management plan DPN, distal symmetric polyneuropathy DPP, Diabetes Prevention Program DRI, dietary reference intake DRS, Diabetic Retinopathy Study DSME, diabetes self-management education DSMT, diabetes self-management training ECG, electrocardiogram ESRD, end-stage renal disease ETDRS, Early Treatment Diabetic Retinopathy Study FDA, Food and Drug Administration FPG, fasting plasma glucose GDM, gestational diabetes mellitus GFR, glomerular filtration rate HRC, high-risk characteristic ICU, intensive care unit IFG, impaired fasting glucose IGT, impaired glucose tolerance MNT, medical nutrition therapy NDEP, National Diabetes Education Program NPDR, nonproliferative diabetic retinopathy OGTT, oral glucose tolerance test PAD, peripheral arterial disease PDR, proliferative diabetic retinopathy PPG, postprandial plasma glucose RDA, recommended dietary allowance SMBG, self-monitoring of blood glucose TZD, thiazolidinedione UKPDS, U.K. Prospective Diabetes Study Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to refs. 1–3. The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E. I. CLASSIFICATION AND DIAGNOSIS A. Classification In 1997, ADA issued new diagnostic and classification criteria (4); in 2003, modifications were made regarding the diagnosis of impaired fasting glucose (IFG) (5). The classification of diabetes includes four clinical classes: Type 1 diabetes (results from β-cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) Other specific types of diabetes due to other causes, e.g., genetic defects in β-cell function, genetic defects in insulin action, diseases … [Full Text of this Article]

Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.

Diabetic kidney disease is a major cause of renal failure that urgently necessitates a breakthrough in disease management. Here we show using untargeted metabolomics that levels of phenyl sulfate, a gut microbiota-derived metabolite, increase with the progression of diabetes in rats overexpressing human uremic toxin transporter SLCO4C1 in the kidney, and are decreased in rats with limited proteinuria. In experimental models of diabetes, phenyl sulfate administration induces albuminuria and podocyte damage. In a diabetic patient cohort, phenyl sulfate levels significantly correlate with basal and predicted 2-year progression of albuminuria in patients with microalbuminuria. Inhibition of tyrosine phenol-lyase, a bacterial enzyme responsible for the synthesis of phenol from dietary tyrosine before it is metabolized into phenyl sulfate in the liver, reduces albuminuria in diabetic mice. Together, our results suggest that phenyl sulfate contributes to albuminuria and could be used as a disease marker and future therapeutic target in diabetic kidney disease. Diabetes is a major cause of kidney disease. Here Kikuchi et al. show that phenol sulfate, a gut microbiota-derived metabolite, is increased in diabetic kidney disease and contributes to the pathology by promoting kidney injury, suggesting phenyl sulfate could be used a marker and therapeutic target for the treatment of diabetic kidney disease.