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A clinical trial at the Veterans Affairs Puget Sound Health Care System and the University of Washington will address new approaches to prevent the development of type 2 diabetes or slow its progression. The Restoring Insulin Secretion, or RISE, Study will examine the effects of three such medication regimens.  Each will be administered for 12 months.
Thestudyis a nationwide program looking at the effects of various treatments to preserve insulin secretion and thereby prevent the development of diabetes or its progression early in the disease.
The study, sponsored by the National Institutes of Health, is currently recruiting patients. More details are available at the National Institute of Health’s clinical trials website, identifier: NCT01779362.
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Diet, exercise, and education remain the foundation of all type 2 diabetes treatment programmes. After metformin, it is reasonable to consider combination therapy with an additional 1-2 oral or injectable agents with the objective of minimising side-effects where possible.
For many patients insulin therapy alone or in combination with other agents will ultimately be required to maintain glucose control.
All treatment decisions, where possible, should take into account the patient’s preferences, needs and values. Diabetes may be diagnosed based on HbA1c criteria or plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value after a 75-g oral glucose tolerance test (OGTT). For all patients, particularly those who are overweight or obese, testing should begin at age 45 years.
Two primary techniques are available to assess the effectiveness of glycaemic control: Patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C. Patients on multiple-dose insulin or insulin pump therapy should perform SMBG prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycaemic, and prior to critical tasks such as driving.
Initial therapy: Most patients should begin with lifestyle changes – healthy eating, weight control, increased physical activity, and diabetes education.
Advancing to dual combination therapy: If the HbA1c target is not achieved after ~3 months with metformin, there are six drug choices including a second oral agent (sulfonylurea, TZD, DPP-4 inhibitor, or SGLT2 inhibitor), a GLP-1 receptor agonist, or basal insulin.
Advancing to triple combination therapy: Evidence suggests that there is some advantage in adding a third noninsulin agent to a two-drug combination not achieving the glycaemic target. Do you agree that private hospitals should be paid via the NTPF to cut public hospital waiting lists? Having type 2 diabetes greatly increases your risk of having a heart attack or stroke as well as other health complications.
Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 All About Heart Rate (Pulse) 4 What are the Symptoms of High Blood Pressure? This site complies with the HONcode standard for trustworthy health information: verify here. HbA1c is a term often used in relation to diabetes and this guide explains what HbA1c is, how it's used for diabetes diagnosis and how it differs from blood glucose levels. When glucose sticks to these molecules it forms a glycoslated haemoglobin molecule, also known as A1c and HbA1c. Due to the fact that red blood cells survive for 8-12 weeks before renewal, by measuring HbA1c, an average blood glucose reading can be returned.
For people with diabetes, an HbA1c level of 6.5% is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics.
How often HbA1c levels should be taken depends on the person with diabetes and their history of control and treatment objections. There is little point in having HbA1c checked regularly if you are not making efforts to control your diabetes. Although HbA1c level alone does not predict diabetes complications, good control is known to lower the risk of complications.

In well-controlled diabetes without a high level of glucose in the blood, a lower level of glycosylated haemoglobin will be returned. In the case of poor control, with more glucose, a higher level of glycosylated haemoglobin will be returned. This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. Please note that we are unable to respond back directly to your questions or provide medical advice. Of course, we get excited about new technology and love being able to test drive the latest gadgets. Our periodic Deep Dive series continues today with a look at Electronic Health Records (EHR), one of the hottest debated topics in healthcare these days and purported to be the future of care. Once you shake the hand of the President of the United States and get to talk with him about your passion -- in this case technology-driven diabetes care -- it doesn't seem like much in life could trump that. I think that when my only motivation for testing is to know if I need to add a unit or two, it's impossible to get motivated to log. As a physician with type 1 DM for several decades (since childhood), I don't think it is "normal" for anyone to WANT to test. My husband and I have just recently started logging his blood sugar levels and the insulin he takes, not the amount of carbs he ate, unless the next blood sugar test was wacky. Participants will be treated with medications normally used for people who have had diabetes for at least one year.
The UW and VA diabetes research group in Seattle is one of three recruiting adult patients for the medication trial, along with the University of Chicago and Indiana University in Indianapolis. Steven Kahn, professor of medicine, Division of Metabolism, Endocrinology and Nutrition, at the University of Washington,  leads the Seattle clinical trial and is also chairs the national study. To be eligible, patients must be between 20 and 65 years old, have prediabetes or self-reported type 2 diabetes for less than one year, and must not have taken any medications to treat diabetes in the past. Diabetes may be identified in seemingly low risk individuals who happen to have glucose testing, in symptomatic patients, and in higher-risk individuals who are tested because of a suspicion of diabetes. When lifestyle efforts alone have not achieved or maintained glycemic goals, metformin monotherapy should be added at, or soon after, diagnosis (in patients intolerant, or with contraindications for, metformin, select initial drug from other treatment options). I wish the meter manufacturers would make a concerted effort to have a standardized BG charting program and that cables to attach your meter to your computer would come WITH the meter.
I'm so caught up in the day-to-day of this disease that I feel I really DO need to fight it one day at a time. The study will enroll individuals who have prediabetes or have been recently diagnosed with diabetes, but who are not taking medications to treat the condition. The expectation is that the use of these medications before diabetes has developed will preserve or enhance the body’s ability to produce insulin, the hormone that is crucial to maintain normal blood sugar levels. Shared decision making with the patient is important to help in the selection of therapeutic option. Since diabetes is associated with progressive beta-cell loss, many patients, especially those with long-standing disease, will ultimately need to be transitioned to insulin. I know that right now, the paradigm is: free meters---costly strips, but I have the meter I have because it is the cheapest to operate strip-wise and I paid for it out-of-pocket.Seriously, how many of you out there write out a log book for your auto anymore?
I've been fairly successful with this approach, though it's only been a little over a year I've been taking meal-time insulin. The investigators aim to enroll 85 patients who will participate in the trial for 21 months. The choice is based on patient and drug characteristics, with the over-riding goal of improving glycaemic control while minimising side-effects.
Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Position statement of the American Diabetes Association and the European Association for the Study of Diabetes.

My impression of people who pump (I do not) is that they depend upon a CGM to keep them abreast of what's going on, so it seems like they would be even LESS motivated to log than I am!
I would like to hear from insulin pumpers on this subject as well as their motivation to log.
I have my own word document that I email to patients for them to fill in and email back or I can print it out for them to fill in by hand. In using triple combinations the essential consideration is obviously to use agents with complementary mechanisms of action. I tell patients if they lose their will power one day or for a while, or just have a crazy day, they don't have to share their blood sugars with me if they don't want. I encourage them, however, not to be afraid to show me these results if they want suggestions how to minimize the effects of "off days". DeFronzo said that he frequently sees patients who'd rather have their doctor feel good about BG results, rather than using logs to inform themselves about what's actually going on.Yup, often we patients feel that BG checking or logging isn't worth the effort either because we don't know how to act on the data or because we find it "bad," frustrating, and discouraging. I tell them if they are human, they will lose their will power at times and have crazy days. After, of course, I swear at my meter and shake my head.I've always been this way, but in my younger years I tried to hide my results. That was easier and made me feel better, even if I was only kidding myself and couldn't get past the truth of my A1C, the three-month average that wasn't impacted by whatever my paper logbooks said.
At some point, I learned that the meter could disprove what I said and so other tricks came to light, like using only half as much blood to get a lower result that I could flash around as proof I wasn't lying.Basically, I always assumed that those "horror stories" about losing limbs and worse became a likely reality in my mind, and led to a "Why Bother?" attitude where I just didn't care. I wanted to be "normal" and live my life, not be defined by that big bad D that would probably kill me. And a consequence of that was not testing, and then trying to convince everyone that I was doing OK so they wouldn't bother me (lame, I know now!).I bring this up because apparently despite all the new technology, there are still kids and teens out there who will go to any length to disguise what's really going on with their D-management. Bode told a story about one teenage girl who went as far as using her lunch money to persuade friends at school to prick their fingers for 25 cents a poke, giving her the ability to fake "perfect" BG results right in her meter's memory. Bode said he requires his patients have a meter that can be downloaded in the office, and if a PWD doesn't bring that meter - or maybe the paper log book - with results, the person is sent home!"Because if they don't have that, I can't help them," Bode said.
Seems a little harsh, doesn't it?An endo in the audience later made the comment, "You don't go to the dentist without your teeth, so why would you come to us without your blood glucose results?"Polonsky said he at first felt a little queasy when hearing about that ultimatum.
My endo may not be able to make any changes or determine how I'm really doing, but we can examine whether I'm going through burnout or something else that's standing in my way of wanting to test and log data. That's valuable.An informal survey of the medical pros in the audience had few people raising their hand when asked if docs are downloading data in offices, and that's not even getting to the whole issue about charging for this service. I've heard some in the Diabetes Online Community say their endos offices tag a fee for downloading data, where others (like my endo) do not. Easy-to-interpret summary data to help inspire PWDs to keep good records is one option, they said.
That gives me a sense of accomplishment and keeps me accountable, being able to see how it compares not only to the past hours but the same times of recent days. For me, it's just not the same to have to plug that number into a device and see it on a computer screen, regardless of how "easy" that may be.
Call me old-school, but that works best for me.Obviously, Your Diabetes May Vary and it seems that many do best with a connection cable or wireless link putting their BG data onto a device that can then be downloaded and transmitted to their doc or CDE. Again, whatever works.Honestly, I think it comes down the individual person wanting to check BGs and track that information.
If that means finding motivation outside the endo's office, or finding a better doc-patient relationship that includes better conversation, then I'm all for it.In the end, we may not necessarily be defined by our numbers, but they are the bread and butter that get us to whatever definition of success we're shooting for in our D-lives.Anybody out there have any motivation tips?

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