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Volume 28, Number 4 (November/December)

Diabetes Goes to Work (pages 4-12)

Victoria L. Thomas, J.D., and Daniel Lorber, M.D., F.A.C.P., C.D.E.

The Americans with Disabilities Act of 1990 (ADA) was designed to protect people with diabetes from workplace discrimination. Over the years, however, the protections for people with diabetes were eroded. To remedy the situation, Congress passed the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), which broadens the ADA’s definitions of disability. This article clearly describes how physicians can help their patients use the ADAAA to protect their rights and receive appropriate accommodations at work. In particular, there is practical advice on how a physician can document (1) that the patient has a disability as defined by the ADAA; (2) that the patient is qualified to perform the job; (3) that a particular workplace accommodation is necessary. A sample letter from physician to employer is also provided.
Management strategies and toolsEmployment issues

Pathophysiology and Complications of Type 2 Diabetes (pages 13-26)

Derek D. Mafong, M.D., and Robert R. Henry, M.D.

The pathophysiology of Type 2 diabetes involves a complex interplay of insulin resistance and beta-cell dysfunction. The condition typically occurs in individuals who are overweight or obese, and micro- and macrovascular complications—notably cardiovascular disease—are common. Although oral drugs that address glycemic control are often the first line of treatment, some can contribute to weight gain, potentially exacerbating complications. Drs. Mafong and Henry offer a thorough and up-to-date review of the pathophysiology and complications of Type 2 diabetes, including a discussion of the incretin effect. They then examine the evidence for the use of the GLP-1 receptor agonist exenatide, which has the potential to improve insulin resistance and enhance beta-cell function while effecting weight loss.
Complications and comorbiditiesCardiovascular disease
Drug treatmentIncretin mimetics

Strategies for Describing Gliptins (pages 27-29)

Virginia Peragallo-Dittko, R.N., B.C.-A.D.M., C.D.E.

Describing a new medicine to a patient can be a difficult task. This is especially true when the medicine has a complex mechanism of action, as is the case with DPP-4 inhibitors, the incretin therapies known as “gliptins.” Ms. Peragallo-Dittko explains how figurative language can help educators discuss these medicines with their patients.
Drug treatmentDPP-4 inhibitors
EducationHealth literacy

Cycloset's Long Road (pages 29-30)

Charles A. Reasner, M.D.

Bromocriptine (Cycloset) is an oral drug recently approved to lower blood glucose levels in people with Type 2 diabetes. The Editor traces its tortuous, 28-year path from idea to final approval, reflecting on the difficulty a small company faces in introducing a new drug to the U.S. market.
Drug treatment