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Volume 28, Number 1 (March/April)

Direct Renin Inhibition (pages 6-15)

Curtis Triplitt, Pharm.D., C.D.E., and Shay L. Reichert, Pharm.D., B.C.P.S., C.D.E.

Hypertension affects almost 80% of people with diabetes, and effective treatment often requires multiple medications. Current guidelines recommend the use of ACE inhibitors and angiotensin II receptor blockers. Drs. Triplitt and Reichert examine direct renin inhibitors, a new class of antihypertensive agents, describing their mechanism of action and analyzing evidence for their use both as monotherapy and in combination with other antihypertensives.
Drug treatmentAntihypertensives
Complications and comorbiditiesCardiovascular diseaseHypertension

Sleep Apnea (pages 16-20)

Virginia Zamudio Lange, R.N., M.S.N., C.D.E.

Obstructive sleep apnea affects about 20 million Americans, an estimated 80% of whom remain undiagnosed. It can cause daytime fatigue, weight gain, and high blood pressure and has been shown to raise the risk of insulin resistance. The author gives a thorough review of the symptoms, risks, diagnosis, and treatment of sleep apnea. The article also includes a detailed explanation of how sleep studies work and what their results mean as well as a discussion of treatment with continuous positive airway pressure and its effect on insulin sensitivity.
Complications and comorbiditiesSleep disorders

Continuous Subcutaneous Insulin Infusion Therapy (pages 21-28)

Lyle Myers, M.D., Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E., and Diane Ballard, R.N., C.D.E., C.P.T.

Insulin pump therapy has become a popular tool for diabetes management. The authors explain how insulin pumps work, discuss their advantages, and detail practical solutions to problems that can occur with their use. The article also includes an instructive case study as well as sample insulin pump data downloads.
EquipmentInsulin pumps

Treatment of Low HDL Cholesterol Level—Too Little, Too Late (pages 29-31)

Charles A. Reasner, M.D.

Although large clinical trials have not established firm treatment targets for HDL cholesterol levels, the fact remains that a low level of HDL cholesterol is an often-overlooked risk for heart disease and a particular concern for people with diabetes. The Editor reviews several studies that have examined the effect of low HDL cholesterol levels on heart disease risk and examines a variety of drug and nondrug treatments that can raise HDL cholesterol. He then gives some practical guidance for using these treatments with minimal side effects.
Complications and comorbiditiesCardiovascular diseaseDyslipidemia