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Volume 35, Number 1 (March/April)

Unrecognized Insulin Infusion Set Failure: The Achilles Heel of CSII with a Focus on Silent Occlusions (pages 7-15)

John Walsh, P.A., C.D.T.C., Physician Assistant and Diabetes Clinical Specialist, Advanced Metabolic Care and Research Ruth Roberts, M.A., medical writer, editor and educational consultant on intensive self-management

Insulin delivery balanced with hepatic glucose production, ingested carbs, counter-regulatory hormones and correction of hyperglycemia constitute the essence of diabetes management. This balance can be impacted by a wide variety of factors and daily events like activity, stress, the glycemic index of carbs, the mixture of fat and protein with carbs, adolescent and menstrual hormones, pregnancy, weight changes and illness. Even though the person with diabetes must ultimately self-manage these confounding factors, clinicians have an important role in aiding patients to clarify issues and minimize or eliminate factors that have an adverse impact on glycemic control and/or variability.
EquipmentInsulin pumps

Metformin: A lifesaver for those with and without diabetes (pages 16-17)

David S. H. Bell, MB, Southside Endocrinology, Mountain Brook, Alabama

A study from a large British database compared mortality in Type 2 diabetic subjects utilizing metformin monotherapy with those utilizing sulfonylurea monotherapy and age matched non-diabetic controls. As expected, mortality was highest in those who were utilizing sulfonylureas followed by the control group with the metformin group having the lowest mortality. While metformin modestly lowers the rate of cardiac events, this effect on mortality probably is not due to decreased cardiac mortality in either diabetic or non-diabetic subjects and most likely is an anti-cancer effect. As a result of this and other studies, metformin now is being studied as an anti-aging drug in non-diabetic subjects.
Drug treatmentMetformin

Journal Watch (pages 18-19)

This column highlights recent clinical trial data and landmark clinical trials to provide readers with relevant information and links for obtaining clinical trial data and articles to facilitate discussion with patients and other providers. It features the results of the Diabetic Retinopathy Clinical Research Network’s Phase III, prospective, multi-center randomized clinical trial PROMPT PANRETINAL PHOTOCOAGULATION VERSUS RANIBIZUMAB+DEFERRED PANRETINAL PHOTOCOAGULATION FOR PROLIFERATIVE DIABETIC RETINOPATHY; Also a look at the new IDF 2015 Diabetes Atlas, released by the International Diabetes Federation (IDF), and its global estimates of diabetes, prediabetes, gestational diabetes and Type 1 diabetes in youth.
Clinical trials

Commentary: Six Months of ICD-10 (pages 20)

ICD-10 was finally introduced in the U.S. in October 2015 after many delays and even more rumors of how complicated it would be. The warning that it was complicated was always cushioned by the fact that it would be more specific and therefore would have more clinical utility. The utility of the increased specificity means that as a scientist, I can gain more useful data from coding databases, which sounds like a bigger headache to me, a busy clinician. However, when we look at diabetes-specific coding, the new system has been fairly straightforward.
Health services and insurance