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Biomedical subjects

Steven V Edelman

Publications and source records attributed to Steven V Edelman.

9 recordsLinked to original sources
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↗
PubMed2002

Unresolved challenges with insulin therapy in type 1 and type 2 diabetes: potential benefit of replacing amylin, a second beta-cell hormone.

Current insulin therapy still fails to safely restore near-normoglycemia in the majority of patients. Among the barriers to achieving tight long-term glycemic control with insulin in both type 1 and type 2 diabetes are an increased risk of hypoglycemia, undesired weight gain, and a failure to normalize postprandial hyperglycemia and excessive unpredictable diurnal glucose fluctuations. Amylin is a second beta-cell hormone that is cosecreted with insulin in response to meals, and is deficient in patients with type 1 and insulin-requiring type 2 diabetes. Preclinical studies indicate that amylin acts as a neuroendocrine hormone that complements the effects of insulin in postprandial glucose regulation by suppressing postprandial glucagon secretion and slowing the rate of nutrient delivery from the stomach to the small intestine. Human amylin is not optimal for replacement therapy because of its propensity to aggregate; thus, pramlintide, a soluble, nonaggregating synthetic peptide analog of human amylin, was developed that has potency at least equal to that of human amylin. In clinical studies, subcutaneous injections of pramlintide prior to meals, in addition to insulin therapy, significantly reduced postprandial glucose excursions and lowered HbA(1c) levels in patients with type 1 and type 2 diabetes. The improvement in long-term glycemic control was associated with a significant reduction in body weight and occurred without increases in total daily insulin use or in overall severe hypoglycemia event rates. Because of this unique spectrum of clinical effects, amylin replacement with pramlintide as an adjunctive therapy to insulin is a promising approach that may fulfill some of the unmet clinical needs of insulin-using patients with type 1 and type 2 diabetes.

Amino Acid Sequence↗