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Related Concept Videos

Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Oral Hypoglycemic Agents: Glinides01:06

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Chronic Pancreatitis II: Collaborative Care01:29

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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
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Glucose Homeostasis: Regulation of Blood Glucose01:02

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Carbohydrates consumed through foods are converted into glucose, a crucial energy source for the body. In the prandial state, high blood glucose levels stimulate the secretion of insulin from the pancreas. Insulin inhibits hepatic glucose production and stimulates glucose uptake and metabolism by muscle and adipose tissue. The excess glucose is converted into glycogen and stored in the liver and muscles.
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Clinical and Economic Outcomes Associated With Musculoskeletal Care in an Integrated Advanced Primary Care Model: Controlled Cohort Analysis.

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Glycemic Impact on Knee Osteoarthritis Symptoms on Physical, Radiographic, and Inflammatory Markers among Individuals Aged 50 and Over with Diabetes
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Change in Glycemic Control for Patients Enrolled in a Membership-Based Primary Care Program: Longitudinal

Lenard I Lesser1, Raj Behal1

  • 1One Medical, San Francisco, CA, United States.

JMIR Diabetes
|May 17, 2021
PubMed
Summary

Primary care using the chronic care model (CCM) significantly lowered HbA1c in uncontrolled diabetes patients. This approach offers long-term, clinically meaningful improvements in diabetes management and cholesterol levels.

Keywords:
chronic care modelclinical information systemdecision supportdecision-makingdiabetesdiabetes mellitusdigital healthobservationalpatientprimary careself-management

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Area of Science:

  • Internal Medicine
  • Endocrinology
  • Public Health

Background:

  • Chronic care model (CCM) practices and digital therapeutics show promise for improving diabetes care.
  • Membership-based primary care services offer a structured approach to managing chronic conditions.

Purpose of the Study:

  • To evaluate the effectiveness of a membership-based primary care service, grounded in the CCM, on diabetes control.
  • To assess changes in glycated hemoglobin (HbA1c) for patients with initially uncontrolled diabetes.

Main Methods:

  • Observational study analyzing data from a diabetes registry.
  • Included 621 patients with initial HbA1c ≥9%, accessing a technology-enhanced CCM primary care practice.
  • Tracked HbA1c changes over an average of 1.2 years.

Main Results:

  • Average HbA1c decreased from 10.7 to 8.7, a statistically significant reduction of 2.03 (P<.001).
  • Clinically meaningful long-term reductions in HbA1c were observed.
  • Significant improvements were also noted in total cholesterol, HDL, LDL, and triglycerides.

Conclusions:

  • Technology-enhanced primary care based on the CCM leads to sustained, clinically significant HbA1c reductions in patients with uncontrolled diabetes.
  • This model of care positively impacts key metabolic markers beyond glycemic control.