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Diabetes - Treatment The diabetic foot The incidence of diabetes mellitus, already one of the most common chronic diseases in the United States, is expected to increase over the next several decades as our population ages. Despite our awareness that tight glycemic control can reduce the incidence of complications in patients with diabetes, such complications remain a major cause of costly and devastating morbidity.Diabetic foot infections are often encountered in clinical practice and are the most common complication requiring hospital admission. Foot ulceration and infection, in turn, significantly increase the risk of subsequent amputation. In the United States, diabetes alone accounts for about half of all nontraumatic lower extremity amputations, a rate exceeding 40 time that for people who do not have diabetes. Unfortunately, most patients who need amputation have not received adequate management of earlier, potentially reversible foot problems. In fact, it is estimated that up to 85% of diabetic foot and leg amputations can be prevented. Ref: Vol 106/No 1/July 1999/Postgraduate Medicine/The Diabetic Foot
New therapeutic agents for type 2 diabetes Milder forms of earlier stages of type 2 diabetes mellitus can often be treated with nutritional therapy and exercise regimens to promote weight loss and disposal of glucose by skeletal muscle. If diet and exercise fail to achieve adequate glycemic control, several pharmacologic options are available. Sulfonylureas, biguanides, alpha-glucosidase inhibitors, and thiazolidinediones are types of oral agents that act at different sites of the diabetic metabolic pathway to reduce hyperglycemia; some of them have a positive effecdt on insulin sensitivity, hyperinsulinemia, and the lipid profile. Injectable insulin reduces hyperglycemia but induces hyperinsulinism, and considerable patient effort and medical monitoring are required for insulin therapy to be optimally effective. Newer drugs, including some that are usually administered for conditions other than type 2 diabetes, are being evaluated for their effectiveness in reducing hyperglycemia, hyperinsulinemia, and body weight.Ref: Managing Type 2 Diabetes - A Post Graduate Special Report
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