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Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy

Rodica Pop-Busui, MD, PhD; Lynn Ang, MD; Andrew J.M. Boulton, MD, DSc (Hon), FRCP, FACP, FICP; Eva L. Feldman, MD. PhD; Robin L. Marcus, PT, PhD, FAPTA; Kara Mizokami-Stout, MD, MSc; J. Robinson Singleton, MD; Dan Ziegler, MD, FRCPE

Diabetic neuropathies are the most common chronic complications of diabetes, with an estimated lifetime prevalence exceeding 50% in people with diabetes. Among various forms of neuropathy, diabetic peripheral neuropathy (DPN) is the most common and has the strongest evidence base regarding therapeutic approaches. This American Diabetes Association clinical compendium summarizes the latest information about screening for, diagnosing, and treating painful DPN in routine clinical practice.

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New Evidence-Based Therapies for Complex Diabetic Foot Wounds

Andrew J.M. Boulton, MD, DSc (Hon), FACP, FRCP; David G. Armstrong, DPM, MD, PhD; Magnus Löndahl, MD, PhD; Robert G. Frykberg, DPM, MPH; Frances L. Game, MD; Michael E. Edmonds, MD, FRCP; Dennis P. Orgill, MD, PhD; Kimberly Kramer, MPH; Geoffrey C. Gurtner, MD, FACS; Michael Januszyk, MD, PhD; Loretta Vileikyte, MD, PhD

This publication is the third in a series of American Diabetes Association compendia on the diabetic foot. Previous installments focused on the diagnosis and management of diabetes foot complications and infections. Here, the authors turn their attention to the latest evidence-based therapies for diabetic foot ulcers (DFUs). The monograph begins with an overview of the current state of diabetic foot care, as well as a brief history of oxygen therapy for the treatment of DFUs. The most recently published evidence-based data concern topical oxygen therapies, and these are described in detail.

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A Practical Guide to Diabetes-Related Eye Care

Thomas W. Gardner, MD, MS; Blake A. Cooper, MD, MPH; Sherrol A. Reynolds, OD, FAAO; Michael Huvard, MD; Anjali R. Shah, MD; and Rebecca Wu, MD

Vision loss from diabetes-related eye disease (DRD) is preventable, yet DRD remains a leading cause of vision impairment and blindness worldwide. In this guide, the authors review the practical aspects of diabetes-related eye screenings and DRD treatment and offer suggestions to facilitate successful collaboration between eye care professionals and health care professionals. 

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Chronic Kidney Disease and Type 2 Diabetes

Matthew R. Weir; MD, Rajiv Agarwal, MD, MS; Peter Rossing, MD, DMSc; Muhammad Shariq Usman, MD; Muhammad Shahzeb Khan, MD, MSc; Javed Butler, MD, MPH, MBA; Keith C. Norris, MD, PhD; Sam Dagogo-Jack, MD, DSc; Sandra C. Naaman, MD, PhD; George L. Bakris, MD, MA

Diabetic kidney disease (DKD) remains an important clinical problem with substantial medical comorbidity despite many recent medical advances (1,2). More focus on the earlier identification of patients with type 2 diabetes who are at risk for developing chronic kidney disease (CKD) is needed, especially with regard to biomarkers, genetics, and high-risk phenotypes. Another key area of opportunity is the need for better clinical care models to eliminate socioeconomic and racial disparities.

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Diagnosis and Management of Diabetic Foot Infections

Andrew J.M. Boulton, MD, DSc (Hon), FACP, FRCP; David G. Armstrong, DPM, MD, PhD; Matthew J. Hardman, PhD; Matthew Malone, PhD, FFPM RCPS (Glasg); John M. Embil, MD, FACP, FRCPC; Christopher E. Attinger, MD; Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP (London), FFPM RCPS (Glasg); Javier Aragón-Sánchez, MD, PhD; Ho Kwong Li, MBBS, MRCP (UK), DTM&H; Gregory Schultz, PhD; Robert S. Kirsner, MD, PhD

After the success and positive reception of the American Diabetes Association’s 2018 compendium Diagnosis and Management of Diabetic Foot Complications (1) the association asked us to proceed with a second volume. The first publication offered a broad general overview of diabetic foot issues, encompassing the etiopathogenesis of complications, screening, and wound classification; management of diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs); recognition and treatment of peripheral artery disease (PAD) and Charcot neuroarthropathy; off-loading, wound management, and adjunctive therapies; and maintenance of the foot in remission.

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Person-Centered, Outcomes-Driven Treatment: A New Paradigm for Type 2 Diabetes in Primary Care

Stewart B. Harris, CM, MD, MPH, FCFP, FACPM; Alice Y.Y. Cheng, MD, FRCPC; Melanie J. Davies, CBE, MBChB, MD, FRCP, FRCGP, FMedSci; Hertzel C. Gerstein, MD, MSc, FRCPC; Jennifer B. Green, MD; Neil Skolnik, MD

Type 2 diabetes affects approximately 90% of the estimated 463 million people diagnosed with diabetes worldwide (1). In the United States, about 12% of the population has diabetes, about one-fourth of whom are undiagnosed (2), and the direct and indirect costs of diabetes were estimated to be $327 billion in 2017 (3). People living with diabetes are at higher risk of long-term complications, with increased morbidity and premature mortality (4). Nearly one-third of people with type 2 diabetes have atherosclerotic cardiovascular disease (ASCVD), encompassing myocardial infarction (MI), unstable angina, stroke, and peripheral arterial disease.

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The Role of Blood Glucose Monitoring in Diabetes Management

Ruth S. Weinstock, MD, PhD, FACE, FACP; Grazia Aleppo, MD, FACE, FACP; Timothy S. Bailey, MD, FACE, FACP, CPI; Richard M. Bergenstal, MD; William A. Fisher, PhD; Deborah A. Greenwood, PhD, RN, BC-ADM, CDCES, FADCES; Laura A. Young, MD, PhD

In her introduction, lead author Ruth S. Weinstock, MD, PhD, FACE, FACP, of Upstate Medical University in Syracuse, NY, notes that, although home BGM revolutionized diabetes self-management four decades ago, the more recent advent of personal continuous glucose monitoring (CGM) systems has raised questions regarding its role moving forward. She and her team of expert coauthors then set out to answer those questions, explaining why BGM remains a useful and cost-effective source of glycemic data for many people with diabetes.

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Prevention and Management of Diabetes-Related Eye Disease

Thomas W. Gardner, MD, MS; Blake A. Cooper, MD; Ravi S.J. Singh, MD; Jill E. Bixler, MD; Jennifer A. Wyckoff, MD; Anjali R. Shah, MD; Charles C. Wykoff, MD, PhD

This compendium is intended as a guide to diabetes-related eye disease for primary care providers (PCPs), who treat the vast majority of people with diabetes in the United States. Its goal is to provide the information PCPs need to understand the eye complications of diabetes and effectively counsel patients about them. The chapters included offer discussions of 1) diabetes-related risk factors for vision impairment; 2) cataracts and cataract surgery in people with diabetes; 3) diabetes-related retinopathy (DR), including its pathogenesis, classification, diagnosis, and treatment; and 4) the emotional aspects of diabetes-induced vision impairment.

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Role of Continuous Glucose Monitoring in Diabetes Treatment

Irl B. Hirsch, MD; Tadej Battelino, MD, PhD; Anne L. Peters, MD; James J. Chamberlain, MD; Grazia Aleppo, MD, FACE, FACP; Richard M. Bergenstal, MD; Tadej Battelino, MD, PhD

Attempts to quantify glucose in the urine date back to the mid-1800s and laid the foundation for modern diabetes care. The most important development in the commercialization of urine glucose testing came in 1908, when Benedict developed a copper reagent for urine glucose, which was used, with some modifications, for more than 50 years (1). The cumbersome methodology of heating became more convenient in 1945 with the development of Clinitest (Ames, Elkhart, IN), which featured a modified copper reagent tablet. Glucose was oxidized, and the amount of glycosuria was proportional to the color of the heated solution.

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Diagnosis and Management of Diabetic Foot Complications

Andrew J.M. Boulton, MD, DSc (Hon), FACP, FRCP; David G. Armstrong, DPM, MD, PhD; Robert S. Kirsner, MD, PhD; Christopher E. Attinger, MD; Lawrence A. Lavery, DPM, MPH; Benjamin A. Lipsky, MD, FACP, FIDSA, FRCP (London), FFPM, RCPS (Glasg); Joseph L. Mills, Sr., MD, FACS; John S. Steinberg, DPM, FACFAS

Foot problems in diabetes are common and costly, and people with diabetes make up about half of all hospital admissions for amputations. In the United Kingdom, people with diabetes account for more than 40% of hospitalizations for major amputations and 73% of emergency room admissions for minor amputations. Because most amputations in diabetes are preceded by foot ulceration, a thorough understanding of the causes and management of ulceration is essential.

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