NCBI Bookshelf. Comparative Effectiveness Reviews, No. Type 2 diabetes affects more than 9. Diabetes also contributes importantly to macrovascular complications, including coronary artery disease, peripheral arterial disease, and carotid artery disease, and increases the risk of cardiovascular-related death nearly twofold.
When beginning medical treatment, patients usually begin with a medication from one of six drug classes that have been approved by the Food and Drug Administration FDA for use as monotherapy, although several guidelines recommend use of metformin when not contraindicated as the first therapy after lifestyle modifications. Clinical guidelines, including those of the American Diabetes Association, recommend monitoring hemoglobin A1c HbA1c to determine the need for changing the medication dose or adding another agent to improve glycemic control.
Additional data on previously approved medications have also emerged, which could change the balance of benefit and risk attributable to these drugs or could alter the strength of evidence about some of the drug comparisons previously reviewed. This review updates the review on oral diabetes medications for adults with type 2 diabetes. Given the unique and emerging potential benefits and harms of some of these medications, we have included additional intermediate and safety outcomes in the review: for studies including either SGLT-2 inhibitors or GLP-1 receptor agonists, systolic blood pressure and heart rate, and for studies that include a comparison with SGLT-2 inhibitors, impaired renal function, urinary tract infections, genital infections, volume depletion, and bone fractures.
Priority medication comparisons included for each Key Question. Key Question 1a : In adults ages 18 or older with type 2 diabetes mellitus, what is the comparative effectiveness of the specified monotherapy FDA-approved diabetes medications for the intermediate outcomes of HbA1c, weight, systolic blood pressure for comparisons including SGLT-2 inhibitors or GLP-1 receptor agonistsand heart rate for comparisons including SGLT-2 inhibitors or GLP-1 receptor agonists?
Key Question 1b : In adults ages 18 or older with type 2 diabetes mellitus, what is the comparative effectiveness of metformin-based combinations of FDA-approved diabetes medications for the intermediate outcomes of HbA1c, weight, systolic blood pressure for comparisons including SGLT-2 inhibitors or GLP-1 receptor agonistsand heart rate for comparisons including SGLT-2 inhibitors or GLP-1 receptor agonists?
Key Question 2a : In adults ages 18 or older with type 2 diabetes mellitus, what is the comparative effectiveness of the monotherapy FDA-approved diabetes medications for the long-term clinical outcomes of all-cause mortality, cardiovascular and cerebrovascular morbidity and mortality, retinopathy, nephropathy, and neuropathy?
Guidelines on Writing a Research Proposal on Diabetes
Key Question 2b : In adults ages 18 or older with type 2 diabetes mellitus, what is the comparative effectiveness of the metformin-based combinations of FDA-approved diabetes medications for the long-term clinical outcomes of all-cause mortality, cardiovascular and cerebrovascular morbidity and mortality, retinopathy, nephropathy, and neuropathy?
Key Question 3a : In adults ages 18 or older with type 2 diabetes mellitus, what is the comparative safety of the monotherapy FDA-approved diabetes medications regarding liver injury, lactic acidosis, pancreatitis, hypoglycemia, congestive heart failure, cancer, severe allergic reactions, macular edema or decreased vision, and gastrointestinal side effects; and for comparisons including SGLT-2 inhibitors, what is the comparative safety regarding urinary tract infections, impaired renal function, genital mycotic infections, fracture, and volume depletion?
Key Question 3b : In adults ages 18 or older with type 2 diabetes mellitus, what is the comparative safety of metformin-based combinations of FDA-approved diabetes medications regarding liver injury, lactic acidosis, pancreatitis, hypoglycemia, congestive heart failure, cancer, severe allergic reactions, macular edema or decreased vision, and gastrointestinal side effects; and for comparisons including SGLT-2 inhibitors, what is the comparative safety regarding urinary tract infections, impaired renal function, genital mycotic infections, fracture, and volume depletion?
This review updates the Comparative Effectiveness Review on diabetes medications for adults with type 2 diabetes. The TEP included endocrinologists, general internists, biostatisticians, and representatives from government agencies. The TEP reviewed our protocol and provided feedback on the proposed methods for addressing the Key Questions.
We ran the search developed for the review with the date restrictions of April through April See Appendix A. The expanded search included medical subject headings MeSH and text words for all of the new medications included in this updated report, without date restrictions. Additionally, we searched ClinicalTrials.
We reviewed the FDA Web site for any unpublished additional studies relevant to the topic as part of our gray literature search. We also provided an opportunity for manufacturers of interventions to submit unpublished data. Two independent reviewers conducted title scans and advanced articles if either one thought them relevant.
The abstract review phase was designed to identify studies reporting the effectiveness or safety of the medications and medication combinations of interest. Two investigators independently reviewed abstracts. Differences between investigators regarding the inclusion or exclusion of abstracts were resolved through consensus adjudication. Full articles underwent another independent parallel review regarding their appropriateness for inclusion.
Selection criteria for studies are provided in Table B. Reviewers extracted information on the general study characteristics, study participant characteristics, interventions, comparisons, method of ascertainment of safety outcomes, and outcome results, including measures of variability.
Two independent reviewers assessed risk of bias. We assessed the risk of bias in individual randomized controlled trials RCTs using the Jadad criteria, consistent with the prior report. The Downs and Black tool was also applied to the observational studies that had been included in the prior report; 7 some of the previously included observational studies were excluded owing to methodological deficiencies.
For each Key Question, we created a set of detailed evidence tables containing all information extracted from eligible studies, including those from the prior Comparative Effectiveness Reviews. We conducted meta-analyses when there were sufficient data at least 3 trials and studies were sufficiently homogeneous with respect to key variables population characteristics, study duration, and drug dose. We included in the quantitative pooling those study arms with drug doses and study durations most commonly reported.
We tested the heterogeneity among the trials considered for quantitative pooling using a chi-squared test with a significance level of alpha less than or equal to 0. Stratification and metaregression only if 10 or more studies were included in the meta-analysis were done to identify and describe sources of heterogeneity and their effects on outcomes when substantial heterogeneity was identified.Please join StudyMode to read the full document.
However; sometimes a person is unable to regulate the concentration of glucose in their blood because their Pancreas does not produce the right amount of insulin. This is called Diabetes. Causes of Type 1 and Type 2 diabetes : Type 1 diabetes occurs by the pancreas not being able to produce enough insulin meaning blood glucose levels can rise to dangerously high levels.
Type 1 diabetes is an autoimmune condition. This means that your immune system treats the cells in your pancreas as if they were pathogens or foreign cells.
The immune system attacks them destroying them completely or damaging them enough to stop the cells from producing sufficient insulin. Type 1 diabetes is usually inherited, so the autoimmune reaction may also be genetic. A close relative, such as a parent, sister or brother with type 1 diabetesmeans there is a chance that a person may develop the condition as well during childhood.
Type 2 diabetes occurs when the pancreas does not produce enough insulin and the body does not respond to the However, when you live with type one diabetesthese things are constantly on your mind.
Diabetes Report Card
Managing each and every day around a deadly condition such as diabetes is a difficult task to fulfill. Although around Most Americans do not know the daily struggle of living with an illness that has no cure. Although my diabetes has a huge impact on my life, I still manage to be the person I want to be, achieve my goals, and remain optimistic. American Diabetes Association, WebMD, Question 1.
Although type one Public Awareness of Diabetes Lynn A. Monica Reed, PhD, MPH Diabetes is a disease that affects millions of people every year, and in most cases, this is a disease that is preventable.
Increasing public awareness regarding risk factors and how this debilitating disease can be controlled and prevented may reduce the number of cases diagnosed each year.
Throughout the years, scientists have developed a variety of treatment options and medications that are available for individuals diagnosed with diabetes. Future treatments for diabetes may include an artificial pancreas and stem cell therapy Yoffee, Along with community support through awareness programs and advances in technology and treatment options, this disease is controllable and in some cases, may even be prevented. Diabetes is a disease that affects how the body uses blood glucose, or blood sugar.
Individuals that suffer from diabetes have difficulty Diabetes Nutrition Having diabetes means thinking differently about food and nutrition. This can seem challenging sometimes, but it becomes a bit more manageable once you learn the facts.
There are several forms of diabetes. Diabetes can occur at any age. Insulin is a hormone produced by special cells, called beta cells, in the pancreas, an organ located in the area behind your stomach.This report provides current information on the status of diabetes in the United States.
It includes information and data about diabetes, prediabetes, preventive care practices, risk factors, quality of care, outcomes, progress made towards meeting national diabetes goals, and, to the extent possible, national and state trends.
Diabetes Report Essay Sample
Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Diabetes Report Card. Minus Related Pages. To receive updates about diabetes topics, enter your email address: Email Address.
Cancel Continue.People with diabetes should see their main doctor, whether it be an internist, primary care physician or endocrinologist to obtain their 3-month blood work. Most ordered blood work is routine information for the physician, but it may be meaningless to you. Managing your diabetes also requires visiting various doctors throughout the year and taking other important lab tests. Always request a copy of your lab tests during your next exam to read over and discuss the results with your doctor.
Maintain a file to keep and compare each lab report in the future. Learning how to read a lab report may help you take control of your health and diabetes. Laboratory tests are done to keep track of your health and refine your diabetes self-management plan. These tests are used to determine your blood sugar control, cardiovascular well-being, and kidney function.
No matter what type of lab test you are reading, all the reports have some standard features. These include basic information such as your name, identification number, the name and address of the lab and the authorized people who ordered the tests. The lab test will indicate the specimen type, such as blood or urine, along with all the tests done on that specimen. The results may be expressed as positive, negative or in numbers. Out-of-range or abnormal results appear in bold print or are highlighted.
Critical results will show a date of notification to your doctor which will likely result in a follow-up phone call to you. Reference ranges are provided to show how your results compare with the normal results of those who are tested.
You will also see a unit of measurement for each test result. Use your lab report results to ask your doctor about any questions or concerns you may have.
People with diabetes are either unable to produce or respond to insulin properly. This leads to elevated blood sugar levels. Three specific lab tests are used to diagnose diabetes. The A1C is also used to monitor your 3-month average after your diabetes diagnosis.
Keep track of your A1C levels to follow your diabetes control. People taking the fasting plasma blood glucose test, fast, except for water, for at least eight hours prior to taking the test. After an initial evaluation the fasting blood test is repeated.
For the oral glucose tolerance test, the person is given a high glucose drink and is tested to determine the response.
The blood sugar is drawn prior to drinking the sweet solution. Then the blood is redrawn in two hours after drinking.When you plan to prepare a research paper about diabetes, you ought to complete a good research proposal that will illustrate your project in detail. A research proposal is a brief outline of your research paper.
You should know how to organize it correctly when you observe such a serious and broad subject as diabetes. You are able to make your great research proposal on diabetes if you pay attention to these basic writing guidelines. Students who are struggling with writing a Diabetes academic paper can get professional help with research proposal at SmartWritingService online, fast and easily. You will not succeed in research proposal writing if you do not know about the subject of your paper.
Go to the library and read a few publications devoted to diabetes, its cause and effect. Study this disease and get to know about its nature. Bear in mind that you ought to be good at this topic if you plan to complete an academic research paper.
It will be smart to focus on several specific cases of diabetes in order to catch its symptoms and methods of treatment. Furthermore, pay attention to the complicated cases that can be newsworthy to your teacher. You can say that you have become interested in diabetes when you read about several uncommon cases of this disease. A good introduction is a half of a successful research paper.
The right introduction should explain the choice of your topic to the reader. Therefore, you can write about the relevance of the problem of diabetes inasmuch as the number of people suffering from this disease increases constantly. According to the statistics ofmore than million people fell ill with diabetes. Focus on the geography of its epidemiology. Write about the danger of this disease. Is it an international problem? Is it possible to cure diabetes? Of course, this question is disputable because no one has invented the remedy for diabetes yet.
You can organize your research proposal as a project aimed at the invention of the remedy. Every research proposal should contain a sound research question. The entire research proposal is the answer to your research question. Thus, it should be simple and logical. When you research a particular topic, you should work out numerous books, periodicals, encyclopedias and articles devoted to it. The teacher should see that you have read a lot to analyze the problem of diabetes intensively.
He should see that you already know something and you want to share your knowledge with others. Choose the most credible and trustworthy authors and their publications to use their wise ideas in your paper. Rely on the works of the prominent physicists who have studies the problem of diabetes profoundly. Do you support them? Are these sources useful? It is vital to find the elements of diabetes that are already known. Your research proposal should be authentic and fresh. Think about other factors that cause diabetes.
Try to find the categories that have not been analyzed by anyone. This section is probably the most notable one whereas it demonstrates your theoretical and practical approach towards the research of the problem of diabetes.
In what way are you going to explore the subject? What do you want to achieve? Try to select the most appropriate methods that will help you observe diabetes, its cause and effect and treatment from all possible sides.Approved in certain countries to prevent or delay the onset of diabetes in patients at high risk of the disease after lifestyle intervention.
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Cookie Disclaimer. Leaving website. Welcome to Merck Healthcare! Help us direct you to the right information by selecting one of the following options:.Diabetes is a disease that has been plaguing mankind since as early as the time of the Egyptians in BC Canadian Diabetes Association, as we know it.
We, at the moment, understand it to be a disease created by the presence of insulin whether deficiency or resistance to insulin.
Insulin is a hormone that is secreted from the pancreas and its purpose is to maintain the levels of glucose within the body through usage. A lack of insulin would therefore generally result in the inability to absorb glucose hence, for example as a side-effect, sweet urine is produced. Throughout time, our knowledge of diabetes has improved as well as our diagnosis methods and treatment methods.
The following is a brief rundown of the development of the understanding of diabetes. This conclusion was drawn from the weight loss that occurred in diabetic patients due to the inability to absorb nutrients. The term Mellitus was then later added due to the sweet tasting nature of the urine. It should be noted that circaa mathematician by the Geronimo Cardona found the volume of urine is less than the fluids consumed by a person suffering from diabetes rather than the view that more urine was produced than water consumed which was prevalent until that time.
Individuals with Type I diabetes require insulin injections, often two to four times a day, to provide the body with In people with diabetes, glucose levels build up in the blood and urine, causing excessive urination, InAllen establishes the first treatment clinic After Galen, there was Paracelsus in the 16th century. He had been a renaissance author of the sort and he had believed diabetes to be a serious general disorder. He had believed that the body must maintain a balance of minerals in order to function properly.
His view was very different to the others of his time and was viewed with contempt. InMatthew Dobson found the link between sugar and diabetes through experimentation. He had also found the source of the sweet taste in urine by evaporating a sample of urine from a diabetic patient which resulted in the formation of a powdery white substance which had the properties of sugar.
Sanders L J, Claude Bernard, inperformed an experiment in which he had observed the amounts of sugar present in the liver. He had examined the level of sugar in a liver and then compared it to another liver in which he had left for a day. It was noted that the second liver had a higher sugar content hence there was a definite reaction occurring that had been resulting in the formation of sugar in the liver.
Bernard C, in L Clendening, He then later discovered in that a starch-like substance was secreted by the liver. This substance, which he had termed glycogen, Ahmed A M, was defined by him to be an internal secretion.
The disease is also called granulomatous enteritis, colitis, regional enteritis, regional ileitis, ileitis, or terminal ileitis and it causes ulcerations of the small and large intestine.
The disease can affect the digestive system anywhere from the mouth to the anus, but distinctively affects the terminal InPaul Langerhans identified what we now know as the Islets of Langerhans albeit he had not know their function until in when it was found that they produced a secretion Sanders, L J Minkowski, by the end of the 19th Century had found that removing the pancreas from a dog would make it display the symptoms of diabetes.
It was only after their successful discovery that effective treatments for diabetes were developed. Prior to the discovery of insulin, various and less effective methods of treating diabetes were used.
There were also very limited methods of diagnosing diabetes. In the past, the physician would generally just taste the urine sample of the patient and check for the presence of sweetness but nowadays, other methods such as blood tests, as well as tests for the level of sugar in the urine are used instead.