DOCSLIB.ORG

American Diabetes Association Standards of Medical Care in Diabetesd2019

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
American Diabetes Association Standards of Medical Care in Diabetesd2019 American Diabetes Association Standards of Medical Care in Diabetesd2019 January 2019 Volume 42, Supplement 1 [T]he simple word Care may suffice to express [the journal’s] philosophical mission. The new journal is designed to promote better patient care by serving the expanded needs of all health professionals committed to the care of patients with diabetes. As such, the American Diabetes Association views Diabetes Care as a reaffirmation of Francis Weld Peabody’s contention that “the secret of the care of the patient is in caring for the patient.” —Norbert Freinkel, Diabetes Care, January-February 1978 EDITOR IN CHIEF Matthew C. Riddle, MD ASSOCIATE EDITORS EDITORIAL BOARD George Bakris, MD Andrew J. Ahmann, MD Philip Home, DM, DPhil Lawrence Blonde, MD, FACP Vanita R. Aroda, MD George S. Jeha, MD Andrew J.M. Boulton, MD Linda A. Barbour, MD, MSPH Lee M. Kaplan, MD, PhD David D’Alessio, MD Roy W. Beck, MD, PhD M. Sue Kirkman, MD Eddie L. Greene, MD Gianni Bellomo, MD Ildiko Lingvay, MD, MPH, MSCS Korey K. Hood, PhD Geremia Bolli, MD Maureen Monaghan, PhD, CDE Frank B. Hu, MD, MPH, PhD John B. Buse, MD, PhD Kristen J. Nadeau, MD, MS Steven E. Kahn, MB, ChB Sonia Caprio, MD Gregory A. Nichols, PhD, MBA Sanjay Kaul, MD, FACC, FAHA Jessica R. Castle, MD Kwame Osei, MD Derek LeRoith, MD, PhD Robert J. Chilton, DO, FACC, FAHA Kevin A. Peterson, MD, MPH, FRCS(Ed), Robert G. Moses, MD Kenneth Cusi, MD, FACP, FACE FAAFP Stephen Rich, PhD J. Hans DeVries, MD, PhD Ravi Retnakaran, MD, MSc, FRCPC Julio Rosenstock, MD Ele Ferrannini, MD Elizabeth Seaquist, MD Judith Wylie-Rosett, EdD, RD Thomas W. Gardner, MD, MS Guntram Schernthaner, MD Jennifer Green, MD Jan S. Ulbrecht, MB, BS Meredith A. Hawkins, MD, MS Ram Weiss, MD, PhD Petr Heneberg, RNDr, PhD Deborah Wexler, MD, MSc Norbert Hermanns, PhD, MSc Vincent C. Woo, MD, FRCPC Irl B. Hirsch, MD, MACP Bernard Zinman, CM, MD, FRCPC, FACP Reinhard W. Holl, MD, PhD AMERICAN DIABETES ASSOCIATION OFFICERS CHAIR OF THE BOARD PRESIDENT-ELECT, MEDICINE & SCIENCE Karen Talmadge, PhD Louis Philipson, MD PRESIDENT, MEDICINE & SCIENCE PRESIDENT-ELECT, HEALTH CARE & Jane Reusch, MD EDUCATION Gretchen Youssef, MS, RD, CDE PRESIDENT, HEALTH CARE & EDUCATION SECRETARY/TREASURER-ELECT Felicia Hill-Briggs, PhD, ABPP Brian Bertha, JD, MBA SECRETARY/TREASURER CHIEF EXECUTIVE OFFICER Michael Ching, CPA Tracey D. Brown, MBA, BChE CHAIR OF THE BOARD-ELECT CHIEF SCIENTIFIC, MEDICAL & MISSION OFFICER David J. Herrick, MBA William T. Cefalu, MD The mission of the American Diabetes Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Diabetes Care is a journal for the health care practitioner that is intended to increase knowledge, stimulate research, and promote better management of people with diabetes. To achieve these goals, the journal publishes original research on human studies in the following categories: Clinical Care/Education/Nutrition/ Psychosocial Research, Epidemiology/Health Services Research, Emerging Technologies and Therapeutics, Pathophysiology/Complications, and Cardiovascular and Metabolic Risk. The journal also publishes ADA statements, consensus reports, clinically relevant review articles, letters to the editor, and health/medical news or points of view. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators, and other health professionals. More information about the journal can be found online at care.diabetesjournals.org. Copyright © 2018 by the American Diabetes Association, Inc. All rights reserved. Printed in the USA. Requests for permission to reuse content should be sent to Copyright Clearance Center at www.copyright.com or 222 Rosewood Dr., Danvers, MA 01923; phone: (978) 750-8400; fax: (978) 646-8600. Requests for permission to translate should be sent to Permissions Editor, American Diabetes Association, at [email protected]. The American Diabetes Association reserves the right to reject any advertisement for any reason, which need not be disclosed to the party submitting the advertisement. Commercial reprint orders should be directed to Sheridan Content Services, (800) 635-7181, ext. 8065. Single issues of Diabetes Care can be ordered by calling toll-free (800) 232-3472, 8:30 A.M. to 5:00 P.M. EST, Monday through Friday. Outside the United States, call (703) 549-1500. Rates: $75 in the United States, $95 in Canada and Mexico, and $125 for all other countries. Diabetes Care is available online at care.diabetesjournals.org. Please call the numbers listed above, e-mail [email protected], or visit the online journal for more information about submitting manuscripts, publication charges, ordering reprints, PRINT ISSN 0149-5992 subscribing to the journal, becoming an ADA member, advertising, permission to reuse ’ ONLINE ISSN 1935-5548 content, and the journal s publication policies. PRINTED IN THE USA Periodicals postage paid at Arlington, VA, and additional mailing offices. AMERICAN DIABETES ASSOCIATION PERSONNEL AND CONTACTS ASSOCIATE PUBLISHER, EDITORIAL CONTENT MANAGER ADVERTISING REPRESENTATIVES SCHOLARLY JOURNALS Nancy C. Baldino Christian S. Kohler American Diabetes Association Paul Nalbandian Associate Publisher, Advertising & TECHNICAL EDITORS Sponsorships EDITORIAL OFFICE DIRECTOR Theresa Cooper Lyn Reynolds [email protected] Donna J. Reynolds (703) 549-1500, ext. 4806 Tina Auletta PEER REVIEW MANAGER Senior Account Executive Shannon Potts DIRECTOR, MEMBERSHIP/SUBSCRIPTION SERVICES [email protected] Donald Crowl (703) 549-1500, ext. 4809 ASSOCIATE MANAGER, PEER REVIEW PHARMACEUTICAL/DEVICE DIGITAL ADVERTISING Larissa M. Pouch The Walchli Tauber Group SENIOR ADVERTISING MANAGER Maura Paoletti Julie DeVoss Graff National Sales Manager DIRECTOR, SCHOLARLY JOURNALS [email protected] [email protected] Heather Norton Blackburn (703) 299-5511 (443) 512-8899, ext. 110 January 2019 Volume 42, Supplement 1 Standards of Medical Care in Diabetes—2019 S1 Introduction S90 9. Pharmacologic Approaches to Glycemic Treatment S3 Professional Practice Committee Pharmacologic Therapy for Type 1 Diabetes S4 Summary of Revisions: Standards of Medical Care in Diabetes—2019 Surgical Treatment for Type 1 Diabetes Pharmacologic Therapy for Type 2 Diabetes S7 1. Improving Care and Promoting Health in S103 10. Cardiovascular Disease and Risk Populations Management Diabetes and Population Health Hypertension/Blood Pressure Control Tailoring Treatment for Social Context Lipid Management 2. Classification and Diagnosis of Diabetes Antiplatelet Agents S13 Cardiovascular Disease Classification Diagnostic Tests for Diabetes S124 11. Microvascular Complications and Foot Care A1C Chronic Kidney Disease Type 1 Diabetes Diabetic Retinopathy Prediabetes and Type 2 Diabetes Neuropathy Gestational Diabetes Mellitus Foot Care – Cystic Fibrosis Related Diabetes 12. Older Adults Posttransplantation Diabetes Mellitus S139 Monogenic Diabetes Syndromes Neurocognitive Function Hypoglycemia S29 3. Prevention or Delay of Type 2 Diabetes Treatment Goals Lifestyle Interventions Lifestyle Management Pharmacologic Interventions Pharmacologic Therapy Prevention of Cardiovascular Disease Treatment in Skilled Nursing Facilities Diabetes Self-management Education and Support and Nursing Homes End-of-Life Care S34 4. Comprehensive Medical Evaluation and 13. Children and Adolescents Assessment of Comorbidities S148 Type 1 Diabetes Patient-Centered Collaborative Care Type 2 Diabetes Comprehensive Medical Evaluation Transition From Pediatric to Adult Care Assessment of Comorbidities S165 14. Management of Diabetes in Pregnancy S46 5. Lifestyle Management Diabetes in Pregnancy Diabetes Self-management Education and Support Preconception Counseling Nutrition Therapy Glycemic Targets in Pregnancy Physical Activity Management of Gestational Diabetes Mellitus Smoking Cessation: Tobacco and e-Cigarettes Management of Preexisting Type 1 Diabetes Psychosocial Issues and Type 2 Diabetes in Pregnancy S61 6. Glycemic Targets Pregnancy and Drug Considerations Postpartum Care Assessment of Glycemic Control A1C Goals S173 15. Diabetes Care in the Hospital Hypoglycemia Hospital Care Delivery Standards Intercurrent Illness Glycemic Targets in Hospitalized Patients 7. Diabetes Technology Bedside Blood Glucose Monitoring S71 Antihyperglycemic Agents in Hospitalized Patients Insulin Delivery Hypoglycemia Self-monitoring of Blood Glucose Medical Nutrition Therapy in the Hospital Continuous Glucose Monitors Self-management in the Hospital Automated Insulin Delivery Standards for Special Situations Transition From the Acute Care Setting S81 8. Obesity Management for the Treatment of Type 2 Diabetes Preventing Admissions and Readmissions Assessment S182 16. Diabetes Advocacy Diet, Physical Activity, and Behavioral Therapy Advocacy Statements Pharmacotherapy Disclosures Medical Devices for Weight Loss S184 Metabolic Surgery S187 Index This issue is freely accessible online at care.diabetesjournals.org/content/42/Supplement_1. Keep up with the latest information for Diabetes Care and other ADA titles via Facebook (/ADAJournals) and Twitter (@ADA_Journals). Diabetes Care Volume 42, Supplement 1, January 2019 S1 Introduction: Standards of Medical Care in Diabetesd2019 Diabetes Care 2019;42(Suppl. 1):S1–S2 | https://doi.org/10.2337/dc19-SINT01 Diabetes is a complex, chronic illness The ADA strives to improve and update updates the Standards of Care annually. requiring continuous medical care with the Standards
Load more

Recommended publications
  • Management of Diabetes Mellitus Standards of Care and Clinical Practice Guidelines
    WHO-EM/DIN6/E/G MANAGEMENT OF DIABETES MELLITUS STANDARDS OF CARE AND CLINICAL PRACTICE GUIDELINES Edited by Dr A.A.S. Alwan Regional Adviser, Noncommunicable Diseases WHO Regional Office for the Eastern Mediterranean WHO-EM/DIN6/E/G INTRODUCTION Available data from many countries of the Eastern Mediterranean Region (EMR) indicate that diabetes mellitus has become a problem of great magnitude and a major public health concern. Studies have demonstrated that, in some countries, diabetes affects up to 10% of the population aged 20 years and older. This rate may be doubled if those with impaired glucose tolerance (IGT) are also included. The manifestations of diabetes cause considerable human suffering and enormous economic costs. Both acute and late diabetic complications are commonly encountered. Long-term complications represented by cardiovascular diseases, cerebrovascular accidents, end-stage renal disease, retinopathy and neuropathies are already major causes of morbidity, disability and premature death in countries of this Region. The development of long-term complications is influenced by hyperglycaernia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms. Intensified therapy and maintaining near-normal blood glucose levels can result in considerable reduction in the risk of development of retinopathy, nephropathy and neuropathy. However, despite the high prevalence of diabetes and its complications and the availability of successful prevention strategies, essential health care requirements and facilities for self-care are often inadequate in this Region. Action is needed at all levels of health care and in the various aspects of diabetes care to bridge this gap and to improve health care delivery to people with diabetes.
    [Show full text]
  • WELLNESS SCREENING TEST EXPLANATION SHEET We Encourage You to Share All Lab Results with Your Primary Care Provider
    WELLNESS SCREENING TEST EXPLANATION SHEET We encourage you to share all lab results with your primary care provider. EXPLANATION OF BLOOD TESTS HEMOGLOBIN A1C: A Hemoglobin A1c level is HEMATOLOGY WELLNESS: expressed as a percent and is used to evaluate the Blood counts are often used as a broad screening test average amount of glucose in the blood over the last to determine an individual’s general health status. 2 to 3 months. This test may be used to screen for and White blood cells are the cells that are part of the diagnose diabetes or risk of developing diabetes. body’s defense system against infections and cancer and also play a role in allergies and inflammation. ALT: This test is used to determine if a patient has Red blood cells are the cells that transport oxygen liver damage. In healthy individuals, ALT levels in the throughout the body. Hemoglobin measures the blood are low and they rise in various disease states. total amount of the oxygen-carrying protein in the blood, which generally reflects the number of red CALCIUM: A calcium test is ordered to screen for, blood cells in the blood. Hematocrit measures the diagnose and monitor a range of conditions percentage of a person’s total blood volume that relating to the bones, heart, nerves, kidneys and consists of red blood cells. Platelets are cell fragments teeth. The test may also be ordered if a person has that are vital for normal blood clotting. symptoms of parathyroid disorder, malabsorption or an overactive thyroid. FREE T4: Free T4 is used to help evaluate thyroid function, generally after determining the TSH is CREATININE: The creatinine blood test is used to abnormal.
    [Show full text]
  • Sorbonne Université/China Scholarship Council Program 2021
    Sorbonne Université/China Scholarship Council program 2021 Thesis proposal Title of the research project: Hnf1b regulation during kidney development and regeneration Joint supervision: no Joint PhD (cotutelle): no Thesis supervisor: … Muriel Umbhauer. Email address of the thesis supervisor: [email protected] Institution: …… Sorbonne Université …. Doctoral school (N°+name): ED …. …… ED 515 Complexité du Vivant Research laboratory: UMR7622 CNRS Laboratory of developmental biology Name of the laboratory director: … Sylvie Schneider-Maunoury Email address of the laboratory director: [email protected] Subject description (2 pages max): 1) Study context The POU homeodomain transcription factor hepatocyte nuclear factor 1β (Hnf1b) plays an essential role in vertebrate kidney development. Heterozygous mutations in human HNF1B cause the complex multisystem syndrome known as Renal Cysts And Diabetes (RCAD). The most prominent clinical features of this autosomal dominant disorder are non-diabetic renal disease resulting from abnormal renal development and diabetes mellitus (reviewed by Clissold RL et al., 2015). During early mouse kidney development, Hnf1b has been shown to be required for ureteric bud branching and initiation of nephrogenesis (Lokmane et al., 2010). Hnf1b conditional inactivation in murine nephron progenitors has revealed an additional role in segment fate Xenopus is a well established and attractive model to study kidney development (Krneta-Stankic V. et al, 2017). Renal function at larval stages relies on two pronephroi located on both sides of the body, each consisting on one giant nephron displaying the same structural and functional organisation than the mammalian nephron. Moreover, pronephric and metanephric differentiation and morphogenesis share most of the signalling cascades and gene regulatory networks.
    [Show full text]
  • The Naming of Moscows in the USA
    Names, Vol. 37, No.1 (March 1989) The Naming of Moscows in the USA Irina Vasiliev Abstract Since 1800, at least forty-seven populated places in the United States have borne the name Moscow. The reasons for having been so named fall into four classes of placename type: commemorative, anticipatory, transfer, and mistake. The stories of these communities and their namings tell much about the growth of this country, the flow of in- formation within it, and each community's perception of itself. ***** The names Berlin, London; Moscow, and Paris evoke images of European sophistication and Old World charm. Here in the United States, these and other European and classical names have been applied as place names to communities that bear no resemblance to the original cities. We have all seen. them on our road maps: the Romes and the Petersburgs, the Viennas and Madrids. They have become commonplace to us. And there are many of each of them: not just one Rome, but thir- ty-five; not just one Cairo, but twenty-one. So the questions come up: Why were these communities named what they were? Who·were the people behind the naming? What were the reasons for the names they chose? It would be too large a task to examine all of the Old W orldnames that have been used across the United States in the last two hundred years. However, I have been able look at one name and determine the reasons for its widespread use. The name that I have chosen to look at is Moscow.
    [Show full text]
  • Overlap of Vitamin a and Vitamin D Target Genes with CAKUT- Related Processes [Version 1; Peer Review: 1 Approved with Reservations]
    F1000Research 2021, 10:395 Last updated: 21 JUL 2021 BRIEF REPORT Overlap of vitamin A and vitamin D target genes with CAKUT- related processes [version 1; peer review: 1 approved with reservations] Ozan Ozisik1, Friederike Ehrhart 2,3, Chris T Evelo 2, Alberto Mantovani4, Anaı̈s Baudot 1,5 1Aix Marseille University, Inserm, MMG, Marseille, 13385, France 2Department of Bioinformatics - BiGCaT, Maastricht University, Maastricht, 6200 MD, The Netherlands 3Department of Bioinformatics, NUTRIM/MHeNs, Maastricht University, Maastricht, 6200 MD, The Netherlands 4Istituto Superiore di Sanità, Rome, 00161, Italy 5Barcelona Supercomputing Center (BSC), Barcelona, 08034, Spain v1 First published: 18 May 2021, 10:395 Open Peer Review https://doi.org/10.12688/f1000research.51018.1 Latest published: 18 May 2021, 10:395 https://doi.org/10.12688/f1000research.51018.1 Reviewer Status Invited Reviewers Abstract Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) are a 1 group of abnormalities affecting the kidneys and their outflow tracts, which include the ureters, the bladder, and the urethra. CAKUT version 1 patients display a large clinical variability as well as a complex 18 May 2021 report aetiology, as only 5% to 20% of the cases have a monogenic origin. It is thereby suspected that interactions of both genetic and 1. Elena Menegola, Università degli Studi di environmental factors contribute to the disease. Vitamins are among the environmental factors that are considered for CAKUT aetiology. In Milano, Milan, Italy this study, we collected vitamin A and vitamin D target genes and Any reports and responses or comments on the computed their overlap with CAKUT-related gene sets.
    [Show full text]
  • Clinical Use of Hemoglobin A1c to Improve Diabetes Management
    PRACTICAL POINTERS Clinical Use of Hemoglobin A1c to Improve Diabetes Management Alan M. Delamater, PhD, ABPP or more than 25 years, the hemo- one recent study conducted in Norway6 A1C values. Only 14% of the youths globin A1c (A1C) test has been revealed that the majority (82.6%) of were able to accurately describe the A1C Fthe most widely accepted out- 201 adult patients with type 1 diabetes test. Just 11, 7.8, and 7.8% correctly come measure for evaluating glycemic knew what their last A1C was, and most identified the A1C ranges for good, fair, control in individuals with diabetes. patients (90%) knew what a satisfactory and poor glycemic control, respectively. The test provides an index of a patient’s A1C value would be. But a significant Very few youths (1.6–3.2%) knew the average blood glucose level during the number of patients (42%) reported they blood glucose values corresponding to past 2–3 months1 and is considered to had low knowledge of A1C testing in specific A1C results. Only a small num- be the most objective and reliable general. Furthermore, 25% of patients ber of youths correctly estimated the measure of long-term metabolic con- did not think that treatment intensifica- short- and long-term risks associated trol.2,3 The Diabetes Control and tion should occur at an A1C value of with A1C values of 7 and 12%. In this Complications Trial established that 10%. sample, there was a significant lack of maintaining A1C levels as close as pos- A recent cross-sectional study knowledge concerning the meaning and sible to the normal range results in con- examined the relationship between implications of the A1C test.
    [Show full text]
  • Boada SEA Eagenda 2020
    TheBestof South East Asia 2020 Bangladesh, Brunei, Cambodia, Indonesia, Laos, Malaysia, Maldives, Myanmar, Philippines, Singapore, Sri Lanka, Vietnam FACULTY The American Diabetes Association (ADA) and Novo Nordisk are pleased to invite you to a series of official webinars highlighting the most important education from the American Diabetes Association Scientific Sessions. Mark your calendars now. Athena Philis-Tsimikas, MD Simon Heller, MD Jay H. Shubrook DO FACOFP, FAAFP Derek LeRoith, MD, PhD, FACP Corporate Vice President of the Scripps Whittier Professor of Clinical Diabetes Professor. Primary Care Department Director of Research Diabetes Institute at Scripps Health. Director of University of Sheffield Director of Clinical Research and Diabetes Services Division of Endocrinology, Diabetes Monday, June 22 Community Engagement at Scripps Translational Sheffield, England Touro University California College of Osteopathic and Bone Diseases Icahn School Science Institute. San Diego, California, USA Medicine, Vallejo, California, USA of Medicine, Mount Sinai, New York, USA Webinar 1: 6:00PM-7:30PM Malaysia Time Monday, June 29 Webinar 2: 6:00PM-7:30PM Malaysia Time Monday, July 6 Webinar 3: 6:00PM-7:30PM Malaysia Time Monday, July 13 Webinar 4: 6:00PM-7:30PM Malaysia Time Kenneth Cusi, M.D., Andrew JM Boulton, MD, DSc (Hon), Michelle Magee, MD, MBBCh, Richard E. Pratley, MD F.A.C.P., F.A.C.E. FACP, FICP, FRCP BAO, LRCPSI AdventHealth. Samuel E. Crockett Chair in Diabetes Research. Professor of Medicine President, International Diabetes
    [Show full text]
  • Genetic Syndromes and Genes Involved
    ndrom Sy es tic & e G n e e n G e f Connell et al., J Genet Syndr Gene Ther 2013, 4:2 T o Journal of Genetic Syndromes h l e a r n a DOI: 10.4172/2157-7412.1000127 r p u y o J & Gene Therapy ISSN: 2157-7412 Review Article Open Access Genetic Syndromes and Genes Involved in the Development of the Female Reproductive Tract: A Possible Role for Gene Therapy Connell MT1, Owen CM2 and Segars JH3* 1Department of Obstetrics and Gynecology, Truman Medical Center, Kansas City, Missouri 2Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 3Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA Abstract Müllerian and vaginal anomalies are congenital malformations of the female reproductive tract resulting from alterations in the normal developmental pathway of the uterus, cervix, fallopian tubes, and vagina. The most common of the Müllerian anomalies affect the uterus and may adversely impact reproductive outcomes highlighting the importance of gaining understanding of the genetic mechanisms that govern normal and abnormal development of the female reproductive tract. Modern molecular genetics with study of knock out animal models as well as several genetic syndromes featuring abnormalities of the female reproductive tract have identified candidate genes significant to this developmental pathway. Further emphasizing the importance of understanding female reproductive tract development, recent evidence has demonstrated expression of embryologically significant genes in the endometrium of adult mice and humans. This recent work suggests that these genes not only play a role in the proper structural development of the female reproductive tract but also may persist in adults to regulate proper function of the endometrium of the uterus.
    [Show full text]
  • Diagnosis of Insulinoma in a Maine Coon
    JOR0010.1177/2055116919894782Journal of Feline Medicine and Surgery Open ReportsGifford et al 894782research-article2020 Case Report Journal of Feline Medicine and Surgery Open Reports Diagnosis of insulinoma in 1 –10 © The Author(s) 2020 Article reuse guidelines: a Maine Coon cat sagepub.com/journals-permissions DOI:https://doi.org/10.1177/2055116919894782 10.1177/2055116919894782 journals.sagepub.com/home/jfmsopenreports This paper was handled and processed by the American Editorial Office (AAFP) 1 2 3 Carol H Gifford , Anita P Morris , Kurt J Kenney and for publication in JFMS Open Reports J Scot Estep4 Abstract Case summary A 9-year-old male neutered Maine Coon cat presented with a 6-month history of polyphagia and one recent episode of tremors and weakness. Blood work revealed profound hypoglycemia and results of a paired insulin glucose test were consistent with an insulinoma. Abdominal ultrasound revealed a solitary pancreatic mass, and results of a fine-needle aspirate (FNA) gave further support for the location of the neuroendocrine tumor. After unsuccessful medical management of the hypoglycemia, the mass was surgically removed. Immunohistochemistry confirmed that it was an insulinoma. At the time of writing, the patient had been in clinical remission for 9 months. Relevance and novel information Feline insulinomas are rare and there is very little information on their behavior, clinical course and histologic characteristics. This is the first reported case of an insulinoma in a Maine Coon cat and the first to describe results of an ultrasound-guided FNA of the mass. In addition, the progression of disease, histopathology and immunohistochemistry results add to the currently minimal database for feline insulinomas.
    [Show full text]
  • Becoming Global, Staying Local: the Internationalization of Bertelsmann
    170 Hartmut Berghoff Becoming Global, Staying Local 171 2) Random House: book publishing; 3) Gruner+ Jahr: magazine publishing; 6. 2002-2010. In this period, Bertelsmann refocused on its core competencies 4) Arvato: media, communication and other services; and 5) Direct Group: and sold or wound down many of its loss-generating Internet activities. book and media clubs and bookstores. In 2009, Random House and Direct It also divested itself of the music business due to the massive challenge Group had by far the highest international orientation with more than four­ of free music downloads. The club business entered the final stage of its fifths of their revenue coming from outside Germany. RTL, with almost product cycle, and an increasing number of clubs were sold. The most two-thirds, was slightly above the company's average, while Arvato and dynamic divisions up to the present have been RTL and Arvato, which Gruner+ Jahr were below average but still generated more the half of their have pulled the company back into growth and profitability. income abroad. This transformation occurred in six phases. 1. 1950-1961. In 1950, Bertelsmann began its club strategy, founding the book club "Lesering" in Germany. The record club "Schallplat­ 10.1 KEY QUESTIONS AND THEORETICAL MODELS OF tenring" followed in 1956. Bertelsmann bought licenses for top-selling INTERNATIONALIZATION 'titles and sold them in high volume at low prices. The German law designed to maintain retail sales prices for books did not apply to The Uppsala model of internationalization states that future multinationals book clubs so that Bertelsmann was able to exploit this loophole and develop competitive advantages in domestic markets before they move abroad.
    [Show full text]
  • Release Notes for Fedora 15
    Fedora 15 Release Notes Release Notes for Fedora 15 Edited by The Fedora Docs Team Copyright © 2011 Red Hat, Inc. and others. The text of and illustrations in this document are licensed by Red Hat under a Creative Commons Attribution–Share Alike 3.0 Unported license ("CC-BY-SA"). An explanation of CC-BY-SA is available at http://creativecommons.org/licenses/by-sa/3.0/. The original authors of this document, and Red Hat, designate the Fedora Project as the "Attribution Party" for purposes of CC-BY-SA. In accordance with CC-BY-SA, if you distribute this document or an adaptation of it, you must provide the URL for the original version. Red Hat, as the licensor of this document, waives the right to enforce, and agrees not to assert, Section 4d of CC-BY-SA to the fullest extent permitted by applicable law. Red Hat, Red Hat Enterprise Linux, the Shadowman logo, JBoss, MetaMatrix, Fedora, the Infinity Logo, and RHCE are trademarks of Red Hat, Inc., registered in the United States and other countries. For guidelines on the permitted uses of the Fedora trademarks, refer to https:// fedoraproject.org/wiki/Legal:Trademark_guidelines. Linux® is the registered trademark of Linus Torvalds in the United States and other countries. Java® is a registered trademark of Oracle and/or its affiliates. XFS® is a trademark of Silicon Graphics International Corp. or its subsidiaries in the United States and/or other countries. MySQL® is a registered trademark of MySQL AB in the United States, the European Union and other countries. All other trademarks are the property of their respective owners.
    [Show full text]
  • Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy
    Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy October 2014 This document is coded JBDS 08 in the series of JBDS documents Other JBDS documents: Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical team; December 2013, JBDS 07 The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes; August 2012, JBDS 06 Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes; June 2012, JBDS 05 Self-management of diabetes in hospital; March 2012, JBDS 04 Management of adults with diabetes undergoing surgery and elective procedures: improving standards; April 2011, JBDS 03 The Management of Diabetic Ketoacidosis in Adults; revised September 2013, JBDS 02 The hospital management of hypoglycaemia in adults with diabetes mellitus; revised September 2013, JBDS 01 These documents are available to download from: ABCD website: www.diabetologists-abcd.org.uk/JBDS/JBDS.htm Diabetes UK website: www.diabetes.org.uk Contents Page Foreword 4 Authorship and acknowledgments 5-6 Introduction 7 Steroids - mechanism of action 8 Steroid therapy – impact on blood glucose 9 Glucose targets 10 Glucose monitoring 11 Diabetes treatment options 12-13 Treatment of steroid induced hyperglycaemia 14-15 Hospital discharge 16-17 Steroid treatment in pregnancy 18 Steroid treatment in end of life 19 Audit standards 20 Controversial areas 21 References 22 Appendix 1 – Algorithm to show treatment of steroid 23 induced diabetes Appendix 2 – Algorithm to show management of patients 24 with diabetes on once daily steroids Appendix 3 – End of life steroid management 25 Appendix 4 – Patient letter – Glucose monitoring and 26 steroid use 3 Foreword This is the latest in the series of Joint British Diabetes Societies for Inpatient Care (JBDS-IP) guidelines, and focuses on steroid induced hyperglycaemia and steroid induced diabetes.
    [Show full text]