NEJM â Collection Updates for Diabetes

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Î±-Adrenergic Receptors and Type 2 Diabetes

Fiona M. Gribble, D.Phil., B.M., B.Ch. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

The global epidemic of type 2 diabetes mellitus is undoubtedly driven by soaring levels of obesity. Although increased body fat impairs the action of insulin, the risk of type 2...

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

Laura McGevna, M.D. and Zarry Tavakkol, M.D. — Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 63-year-old woman with a 4 1/2-year history of diabetes mellitus presented with an ulcerating rash, primarily on the shins, groin, and face (Panel A); cheilitis (Panel B); and glossitis....

ORIGINAL ARTICLE: Rituximab, B-Lymphocyte Depletion, and Preservation of Beta-Cell Function

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Background: The immunopathogenesis of type 1 diabetes mellitus is associated with T-lymphocyte autoimmunity. However, there is growing evidence that B lymphocytes play a role in many T-lymphocyteâmediated diseases. It is...

EDITORIAL: Treatment of Anemia in Chronic Kidney Disease â Strategies Based on Evidence

Philip A. Marsden, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

Anemia associated with chronic kidney disease and end-stage renal disease is due, in large part, to reduced production of renal erythropoietin and abnormalities in extracellular-fluid volume homeostasis.1 Moreover, anemia and...

ORIGINAL ARTICLE: A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Background: Anemia is associated with an increased risk of cardiovascular and renal events among patients with type 2 diabetes and chronic kidney disease. Although darbepoetin alfa can effectively increase hemoglobin...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Dr. Peter P. Moschovis (Medicine and Pediatrics): A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal...

IMAGES IN CLINICAL MEDICINE: Injection-Site Lipoatrophy

Adziri Harold Sackey, F.R.C.P.C.H. — Thu, 05Â NovÂ 2009 00:00:00 -05:00

A 13-year-old girl with a 20-month history of type 1 diabetes mellitus presented with depressed areas of skin at the sites of insulin injection (Panel A, arrows). The patient had...

EDITORIAL: Optimal Insulin Treatment in Type 2 Diabetes

Michael Roden, M.D. — Thu, 29Â OctÂ 2009 00:00:00 -05:00

Patients with type 2 diabetes have peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells. During meals, reduced first-phase insulin secretion results in postprandial hyperglycemia and in a...

ORIGINAL ARTICLE: Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Background: Evidence supporting the addition of specific insulin regimens to oral therapy in patients with type 2 diabetes mellitus is limited.

Methods: In this 3-year open-label, multicenter trial, we evaluated 708...

EDITORIAL: Gestational Diabetes â Whom Do We Treat?

David A. Sacks, M.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

In 1964, O'Sullivan and Mahan1 proposed glucose-tolerance-test criteria to define gestational diabetes mellitus â that is, any degree of glucose intolerance that first occurs or is first identified during pregnancy....

ORIGINAL ARTICLE: A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Background: It is uncertain whether treatment of mild gestational diabetes mellitus improves pregnancy outcomes.

Methods: Women who were in the 24th to 31st week of gestation and who met the criteria...

ORIGINAL ARTICLE: Sex HormoneâBinding Globulin and Risk of Type 2 Diabetes in Women and Men

Thu, 17Â SepÂ 2009 00:00:00 -05:00

Background: Circulating sex hormoneâbinding globulin levels are inversely associated with insulin resistance, but whether these levels can predict the risk of developing type 2 diabetes is uncertain.

Methods: We performed a...

EDITORIAL: Diabetes Complications and the ReninâAngiotensin System

Thu, 02Â JulÂ 2009 00:00:00 -05:00

The hypothesis that inhibition of the reninâangiotensin system may be effective in preventing diabetic nephropathy was based on a large body of evidence.1 Positive findings from studies in animal models...

ORIGINAL ARTICLE: Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: Nephropathy and retinopathy remain important complications of type 1 diabetes. It is unclear whether their progression is slowed by early administration of drugs that block the reninâangiotensin system.

Methods: We...

EDITORIAL: Diabetes with Coronary Disease â A Moving Target amid Evolving Therapies?

William E. Boden, M.D., and David P. Taggart, M.D., Ph.D. — Thu, 11Â JunÂ 2009 00:00:00 -05:00

The prevalence of diabetes mellitus is rising at an alarming rate and is projected to more than double by 2030.1 The disease currently afflicts 171 million people worldwide, with 23.6...

ORIGINAL ARTICLE: A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease

The BARI 2D Study Group — Thu, 11Â JunÂ 2009 00:00:00 -05:00

Background: Optimal treatment for patients with both type 2 diabetes mellitus and stable ischemic heart disease has not been established.

Methods: We randomly assigned 2368 patients with both type 2 diabetes...

BOOK REVIEW:

Thu, 14Â MayÂ 2009 00:00:00 -05:00

This timely book describes the pediatric precursors of adult disease, with a focus on the metabolic syndrome and diabetes. The editors weave together three topic areas: epidemiology, pathophysiology, and treatment....

REVIEW ARTICLE: Genetics of Type 1A Diabetes

Thu, 16Â AprÂ 2009 00:00:00 -05:00

In 1976, the noted human geneticist James Neel titled a book chapter âDiabetes Mellitus: A Geneticist's Nightmare.â1 Over the past 30 years, however, the phenotypic and genetic heterogeneity of diabetes...

EDITORIAL: Glucose Control in the ICU â How Tight Is Too Tight?

Silvio E. Inzucchi, M.D., and Mark D. Siegel, M.D. — Thu, 26Â MarÂ 2009 00:00:00 -05:00

For the past decade, hospitals have focused on the inpatient management of hyperglycemia, particularly in the intensive care unit (ICU). Extensive observational data have shown a consistent, almost linear relationship...

ORIGINAL ARTICLE: Intensive versus Conventional Glucose Control in Critically Ill Patients

The NICE-SUGAR Study Investigators — Thu, 26Â MarÂ 2009 00:00:00 -05:00

Background: The optimal target range for blood glucose in critically ill patients remains unclear.

Methods: Within 24 hours after admission to an intensive care unit (ICU), adults who were expected to...

CORRESPONDENCE: Rituximab and Omalizumab in Severe, Refractory Insulin Allergy

Thu, 05Â MarÂ 2009 00:00:00 -05:00

To the Editor: We describe the sequential use of two targeted biologic agents to treat a patient with severe systemic insulin allergy accompanied by marked metabolic dysregulation and corticosteroid toxicity.

In...

IMAGES IN CLINICAL MEDICINE: Proliferative Diabetic Retinopathy

Pukhraj Rishi, M.S. and Pramod S. Bhende, M.S. — Thu, 26Â FebÂ 2009 00:00:00 -05:00

A 56-year-old man with diabetes presented with a several-month history of decreased vision in the left eye. There was no history of trauma, flashes of light, or floaters. Visual acuity...

CORRESPONDENCE: An Unusual Outbreak of Hypoglycemia

Thu, 12Â FebÂ 2009 00:00:00 -05:00

To the Editor: The off-label use of drugs for the enhancement of sexual performance in persons without erectile dysfunction is a phenomenon that is increasingly recognized.1 These drugs are available...

BOOK REVIEW:

Thu, 29Â JanÂ 2009 00:00:00 -05:00

Changes in lifestyle that promote obesity and physical inactivity have led to a global increase in the prevalence of type 2 diabetes and its coexisting diseases among people of all...

ORIGINAL ARTICLE: Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: The effects of intensive glucose control on cardiovascular events in patients with long-standing type 2 diabetes mellitus remain uncertain.

Methods: We randomly assigned 1791 military veterans (mean age, 60.4 years)...

CORRESPONDENCE: Concordance for Islet Autoimmunity among Monozygotic Twins

Thu, 25Â DecÂ 2008 00:00:00 -05:00

To the Editor: The risk of type 1 diabetes among the monozygotic twins of patients with type 1 diabetes is reported to be as low as 30%; this percentage is...

EDITORIAL: Shared Genetic Risk Factors for Type 1 Diabetes and Celiac Disease

Robert M. Plenge, M.D., Ph.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

Some families seem to be afflicted with more than their fair share of chronic illness â and sometimes more than one. Why does a particular disease develop in some members...

ORIGINAL ARTICLE: Shared and Distinct Genetic Variants in Type 1 Diabetes and Celiac Disease

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Background: Two inflammatory disorders, type 1 diabetes and celiac disease, cosegregate in populations, suggesting a common genetic origin. Since both diseases are associated with the HLA class II genes on...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Boosting Beta-Cell Numbers

Harry Heimberg, Ph.D. — Thu, 18Â DecÂ 2008 00:00:00 -05:00

The restoration of functional beta-cell mass by cell therapy is possibly the most realistic current option for curing type 1 diabetes mellitus. The transplantation of human islet cells has been...

ORIGINAL ARTICLE: Clinical Risk Factors, DNA Variants, and the Development of Type 2 Diabetes

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Background: Type 2 diabetes mellitus is thought to develop from an interaction between environmental and genetic factors. We examined whether clinical or genetic factors or both could predict progression to...

ORIGINAL ARTICLE: Genotype Score in Addition to Common Risk Factors for Prediction of Type 2 Diabetes

Thu, 20Â NovÂ 2008 00:00:00 -05:00

Background: Multiple genetic loci have been convincingly associated with the risk of type 2 diabetes mellitus. We tested the hypothesis that knowledge of these loci allows better prediction of risk...

EDITORIAL: Immunotherapy on Trial for New-Onset Type 1 Diabetes

Denise L. Faustman, M.D., Ph.D. — Thu, 30Â OctÂ 2008 00:00:00 -05:00

Type 1 diabetes mellitus is an autoimmune disease in which pathologic, autoreactive T cells of the immune system attack the insulin-secreting pancreatic islets of Langerhans. Cytotoxic T cells, which bear...

EDITORIAL: Insulin Infusions in Very-Low-Birth-Weight Infants

Sudha Kashyap, M.D., and Richard A. Polin, M.D. — Thu, 30Â OctÂ 2008 00:00:00 -05:00

Advancements in the care of very-low-birth-weight (<1500 g) infants have resulted in increased survival. The provision of adequate nutrition to meet the growth needs of these infants is one of...

ORIGINAL ARTICLE: GAD Treatment and Insulin Secretion in Recent-Onset Type 1 Diabetes

Thu, 30Â OctÂ 2008 00:00:00 -05:00

Background: The 65-kD isoform of glutamic acid decarboxylase (GAD) is a major autoantigen in patients with type 1 diabetes mellitus. This trial assessed the ability of alum-formulated GAD (GAD-alum) to...

ORIGINAL ARTICLE: Early Insulin Therapy in Very-Low-Birth-Weight Infants

Thu, 30Â OctÂ 2008 00:00:00 -05:00

Background: Studies involving adults and children being treated in intensive care units indicate that insulin therapy and glucose control may influence survival. Hyperglycemia in very-low-birth-weight infants is also associated with...

EDITORIAL: UKPDS and the Legacy Effect

John Chalmers, M.D., Ph.D., and Mark E. Cooper, M.D., Ph.D. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

The United Kingdom Prospective Diabetes Study (UKPDS) continues to produce important evidence concerning the evolution of type 2 diabetes and its management. Two studies published in this issue of the...

ORIGINAL ARTICLE: 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Background: During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those...

ORIGINAL ARTICLE: Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Background: Post-trial monitoring of patients in the United Kingdom Prospective Diabetes Study (UKPDS) examined whether risk reductions for microvascular and macrovascular disease, achieved with the use of improved blood-pressure control...

ORIGINAL ARTICLE: Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes

Thu, 02Â OctÂ 2008 00:00:00 -05:00

Background: The value of continuous glucose monitoring in the management of type 1 diabetes mellitus has not been determined.

Methods: In a multicenter clinical trial, we randomly assigned 322 adults and...

PERSPECTIVE: Assessing the Cardiovascular Safety of Diabetes Therapies

Thu, 11Â SepÂ 2008 00:00:00 -05:00

The Endocrinologic and Metabolic Drugs Advisory Committee for the Food and Drug Administration (FDA), of which I am a member, convened in early July to consider whether data on long-term...

CORRESPONDENCE: Widespread Amyloid Deposition in Transplanted Human Pancreatic Islets

Thu, 28Â AugÂ 2008 00:00:00 -05:00

To the Editor: We report on a patient with type 1 diabetes mellitus, diagnosed at 16 years of age, in whom widespread amyloid deposits developed many years later in transplanted...

BOOK REVIEW:

Thu, 17Â JulÂ 2008 00:00:00 -05:00

Shortly before his election as president, John F. Kennedy wrote, âLet us welcome controversial books and controversial authors.â To this statement we might add âand books on controversial medical topics,â...

EDITORIAL: Glycemic Targets and Cardiovascular Disease

William T. Cefalu, M.D. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Cardiovascular disease in patients with diabetes is clearly associated with the degree of hyperglycemia, as measured clinically with the use of glycated hemoglobin.123 However, there remains an unanswered question in...

EDITORIAL: Intensive Glycemic Control in the ACCORD and ADVANCE Trials

Robert G. Dluhy, M.D., and Graham T. McMahon, M.D., M.M.Sc. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Diabetes is associated with a reduced lifespan, largely as a consequence of cardiovascular disease.123 Although diabetes significantly increases the risk of cardiovascular events,1 the relative increase in events for each...

ORIGINAL ARTICLE: Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes

The ADVANCE Collaborative Group — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Background: In patients with type 2 diabetes, the effects of intensive glucose control on vascular outcomes remain uncertain.

Methods: We randomly assigned 11,140 patients with type 2 diabetes to undergo either...

ORIGINAL ARTICLE: Effects of Intensive Glucose Lowering in Type 2 Diabetes

The Action to Control Cardiovascular Risk in Diabetes Study Group — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Background: Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target normal glycated hemoglobin...

EDITORIAL: Aliskiren and Dual Therapy in Type 2 Diabetes Mellitus

Julie R. Ingelfinger, M.D. — Thu, 05Â JunÂ 2008 00:00:00 -05:00

The discovery 110 years ago that crude kidney extract elicited a pressor reaction provided the first evidence of the existence of the reninâangiotensinâaldosterone system, a major vasoactive system,1 and the...

ORIGINAL ARTICLE: Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy

Thu, 05Â JunÂ 2008 00:00:00 -05:00

Background: Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries. We evaluated the renoprotective effects of dual blockade of the reninâangiotensinâaldosterone system by adding treatment with...

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

Jeffrey L. Ecker, M.D., and Michael F. Greene, M.D. — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Pregnancy is associated with relative carbohydrate intolerance and insulin resistance. Gestational diabetes mellitus (carbohydrate intolerance first diagnosed during pregnancy) has long been recognized as a risk factor for a number...

ORIGINAL ARTICLE: Metformin versus Insulin for the Treatment of Gestational Diabetes

Thu, 08Â MayÂ 2008 00:00:00 -05:00

Background: Metformin is a logical treatment for women with gestational diabetes mellitus, but randomized trials to assess the efficacy and safety of its use for this condition are lacking.

Methods: We...

ORIGINAL ARTICLE: Hyperglycemia and Adverse Pregnancy Outcomes

The HAPO Study Cooperative Research Group — Thu, 08Â MayÂ 2008 00:00:00 -05:00

Background: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes.

Methods: A total of 25,505 pregnant women at...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Activated Protein C and Diabetic Nephropathy

Richard E. Gilbert, M.D., and Philip A. Marsden, M.D. — Thu, 10Â AprÂ 2008 00:00:00 -05:00

Medical students are taught that endothelial dysfunction is relevant to the pathophysiology of diabetic microvascular disease, especially the glomerular defects that are characteristic of diabetic nephropathy. The facts, however, belie...

ORIGINAL ARTICLE: Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events

The ONTARGET Investigators — Thu, 10Â AprÂ 2008 00:00:00 -05:00

Background: In patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-convertingâenzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs)...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Chemical Immunosuppression in Islet Transplantation â Friend or Foe?

Lucienne Chatenoud, M.D., Ph.D. — Thu, 13Â MarÂ 2008 00:00:00 -05:00

Insulin-dependent (type 1) diabetes mellitus is an autoimmune disease caused by the selective destruction of pancreatic beta cells by CD4+ and CD8+ autoreactive T lymphocytes. The induction of effective and...

IMAGES IN CLINICAL MEDICINE: Severe Soft-Tissue Infection

Fone-Ching Hsiao, M.D. and Chang-Hsun Hsieh, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

A 65-year-old woman with a 15-year history of diabetes presented with fever (temperature, 38.5Â°C), chills, malaise, and a rash on the medial surface of the right thigh, vulva, and lower...

ORIGINAL ARTICLE: Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes

Thu, 07Â FebÂ 2008 00:00:00 -05:00

Background: Intensified multifactorial intervention â with tight glucose regulation and the use of reninâangiotensin system blockers, aspirin, and lipid-lowering agents â has been shown to reduce the risk of nonfatal...

CLINICAL DECISIONS: Management of Type 2 Diabetes

Thu, 17Â JanÂ 2008 00:00:00 -05:00

A 55-year-old woman with type 2 diabetes, obesity, and hypertension has been under your care for the past 2 years. She has no history of microalbuminuria, retinopathy, or neuropathy. She...

EDITORIAL: Intention to Treat â Initiating Insulin and the 4-T Study

Graham T. McMahon, M.D., M.M.Sc., and Robert G. Dluhy, M.D. — Thu, 25Â OctÂ 2007 00:00:00 -05:00

The normalization of glucose levels plays an important role in protecting patients with diabetes from complications such as myocardial infarction and stroke. To accomplish this goal, most patients with type...

ORIGINAL ARTICLE: Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes

Thu, 25Â OctÂ 2007 00:00:00 -05:00

Background: Adding insulin to oral therapy in type 2 diabetes mellitus is customary when glycemic control is suboptimal, though evidence supporting specific insulin regimens is limited.

Methods: In an open-label, controlled,...

IMAGES IN CLINICAL MEDICINE: Calciphylaxis with Arterial Calcification

Jonathan Z. Li, M.D. and William Huen, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

A 53-year-old woman with diabetes mellitus and end-stage renal disease who was undergoing hemodialysis presented with fever, painful finger necrosis, and nonhealing ulceration of the legs. Hand radiographs showed no...

IMAGES IN CLINICAL MEDICINE: Herpetic Glossitis

Chih-Chieh Chan, M.D. and Hsien-Ching Chiu, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A 75-year-old woman with more than a 10-year history of hypertension and diabetes mellitus reported a 3-day history of throat discomfort and white eruptions on the tongue. On examination, multiple...

IMAGES IN CLINICAL MEDICINE: Emphysematous Cholecystitis

Yogesh Shrestha, M.D. and Steven Trottier, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

A 70-year-old man with a history of heart disease, hyperlipidemia, and diabetes mellitus presented at the hospital with a 4-day history of increasing abdominal pain, nausea, and vomiting. The temperature...

IMAGES IN CLINICAL MEDICINE: Lipemia Retinalis Associated with Secondary Hyperlipidemia

Young-Hoon Park, M.D. and Young-Chun Lee, M.D. — Thu, 06Â SepÂ 2007 00:00:00 -05:00

A 26-year-old man with a 6-month history of type 1 diabetes mellitus presented with weight loss and poor glycemic control. Physical examination revealed no xanthomas; all vessels in the posterior...

PERSPECTIVE: The Rosiglitazone Story â Lessons from an FDA Advisory Committee Meeting

Thu, 30Â AugÂ 2007 00:00:00 -05:00

On July 30, 2007, the Endocrinologic and Metabolic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee of the Food and Drug Administration (FDA) convened to discuss...

IMAGES IN CLINICAL MEDICINE: Intravesical Foreign Body

Nicola Mondaini, M.D. and Riccardo Bartoletti, M.D. — Thu, 09Â AugÂ 2007 00:00:00 -05:00

An 82-year-old woman presented with abdominal colic. She had a 20-year history of type 2 diabetes and a 2-year history of recurrent urinary tract infections despite many courses of antimicrobial...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2007 â A 58-Year-Old Woman with Headaches, Weakness, and Strokelike Episodes

Thu, 12Â JulÂ 2007 00:00:00 -05:00

Dr. Kevin N. Sheth (Neurology): A 58-year-old right-handed woman with type 1 diabetes was admitted to the hospital because of a 2-week history of increasing fatigue and word-finding difficulties and...

EDITORIAL: The Record on Rosiglitazone and the Risk of Myocardial Infarction

Bruce M. Psaty, M.D., Ph.D., and Curt D. Furberg, M.D., Ph.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

In this issue of the Journal,1 Home and colleagues report interim results from the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes, or RECORD, study (NCT00379769). The...

EDITORIAL: Rosiglitazone and Cardiotoxicity â Weighing the Evidence

David M. Nathan, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

The recently published meta-analysis by Nissen and Wolski,1 which suggested a significant increase in the risk of myocardial infarction associated with treatment with rosiglitazone (Avandia) and an increase of similar...

EDITORIAL: Rosiglitazone â Continued Uncertainty about Safety

Jeffrey M. Drazen, M.D., Stephen Morrissey, Ph.D., and Gregory D. Curfman, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

On May 21, 2007, the Journal published a meta-analysis by Nissen and Wolski1 that indicated an increased cardiovascular risk associated with rosiglitazone (Avandia), a thiazolidinedione used to treat type 2...

IMAGES IN CLINICAL MEDICINE: Severe Digital Ischemia

Rafael S. Cires, M.D. and Susana V. Maya, M.D. — Thu, 05Â JulÂ 2007 00:00:00 -05:00

A 56-year-old woman with diabetes mellitus complicated by retinopathy and mild nephropathy and managed with glyburide (glibenclamide) and metformin reported having abdominal pain and fever for the past 48 hours....

ORIGINAL ARTICLE: Rosiglitazone Evaluated for Cardiovascular Outcomes â An Interim Analysis

Thu, 05Â JulÂ 2007 00:00:00 -05:00

Background: A recent meta-analysis raised concern regarding an increased risk of myocardial infarction and death from cardiovascular causes associated with rosiglitazone treatment of type 2 diabetes.

Methods: We conducted an unplanned...

EDITORIAL: Rosiglitazone and Cardiovascular Risk

Bruce M. Psaty, M.D., Ph.D., and Curt D. Furberg, M.D., Ph.D. — Thu, 14Â JunÂ 2007 00:00:00 -05:00

In this issue of the Journal, Nissen and Wolski1 report the results of a meta-analysis of treatment trials of rosiglitazone, as compared either with other therapies for type 2 diabetes...

ORIGINAL ARTICLE: Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes

Steven E. Nissen, M.D., and Kathy Wolski, M.P.H. — Thu, 14Â JunÂ 2007 00:00:00 -05:00

Background: Rosiglitazone is widely used to treat patients with type 2 diabetes mellitus, but its effect on cardiovascular morbidity and mortality has not been determined.

Methods: We conducted searches of the...

IMAGES IN CLINICAL MEDICINE: Chronic Calcific Pancreatitis

Varsha Babu, M.B.,B.S. — Thu, 07Â JunÂ 2007 00:00:00 -05:00

A 40-year-old man with a 4-year history of diabetes mellitus and no history of gallstones was admitted to the health center after acute alcohol intoxication. He had been consuming about...

EDITORIAL: Prematurity and the Legacy of Intrauterine Stress

Julie R. Ingelfinger, M.D. — Thu, 17Â MayÂ 2007 00:00:00 -05:00

In 1960, a neonate weighing 1000 g had a 95% risk of death; today, a neonate with the same birth weight has a 95% chance of surviving. This progress in...

ORIGINAL ARTICLE: Glucose Regulation in Young Adults with Very Low Birth Weight

Thu, 17Â MayÂ 2007 00:00:00 -05:00

Background: The association between small size at birth and impaired glucose regulation later in life is well established in persons born at term. Preterm birth with very low birth weight...

IMAGES IN CLINICAL MEDICINE: Severe Proliferative Diabetic Retinopathy

Ioannis K. Petropoulos, M.D. and John X. Koliopoulos, M.D., Ph.D. — Thu, 10Â MayÂ 2007 00:00:00 -05:00

A 44-year-old woman with a 20-year history of type 1 diabetes mellitus presented with progressive visual loss over a period of 3 months in both eyes. She had no prior...

ORIGINAL ARTICLE: Long-Term Effect of Diabetes and Its Treatment on Cognitive Function

Thu, 03Â MayÂ 2007 00:00:00 -05:00

Background: Long-standing concern about the effects of type 1 diabetes on cognitive ability has increased with the use of therapies designed to bring glucose levels close to the nondiabetic range...

ORIGINAL ARTICLE: Interleukin-1âReceptor Antagonist in Type 2 Diabetes Mellitus

Thu, 12Â AprÂ 2007 00:00:00 -05:00

Background: The expression of interleukin-1âreceptor antagonist is reduced in pancreatic islets of patients with type 2 diabetes mellitus, and high glucose concentrations induce the production of interleukin-1Î² in human pancreatic...

PERSPECTIVE: Diabetes Treatment â Bridging the Divide

Thu, 12Â AprÂ 2007 00:00:00 -05:00

In the simplest terms, diabetes mellitus results when pancreatic beta cells are unable to maintain adequate insulin secretion to prevent hyperglycemia. A combination of genetic and environmental factors causes the...

IMAGES IN CLINICAL MEDICINE: Dupuytren's Contracture

Edward Calif, M.D. and Shalom Stahl, M.D. — Thu, 22Â MarÂ 2007 00:00:00 -05:00

A 57-year-old man with a history of diabetes mellitus and alcohol consumption was referred to the hand surgery unit owing to contractures of fingers of both hands. He reported that...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2007 â A 59-Year-Old Woman with Diabetic Renal Disease and Nonhealing Skin Ulcers

Thu, 08Â MarÂ 2007 00:00:00 -05:00

Dr. Maha R. Farhat (Medicine): A 59-year-old woman was admitted to the hospital because of a nonhealing ulcer on the right heel and painful ulcers on the right thigh and...

SPECIAL ARTICLE: Improving the Management of Chronic Disease at Community Health Centers

Thu, 01Â MarÂ 2007 00:00:00 -05:00

Background: The Health Disparities Collaboratives of the Health Resources and Services Administration (HRSA) were designed to improve care in community health centers, where many patients from ethnic and racial minority...

CLINICAL PRACTICE: Diabetic Gastroparesis

Michael Camilleri, M.D. — Thu, 22Â FebÂ 2007 00:00:00 -05:00

A 36-year-old man with a 20-year history of type 1 diabetes mellitus, background retinopathy, peripheral sensory neuropathy, and nephropathy presents with a history of several months of nausea and vomiting...

CLINICAL THERAPEUTICS: Inhaled Insulin for Diabetes Mellitus

Graham T. McMahon, M.D., M.M.Sc., and Ronald A. Arky, M.D. — Thu, 01Â FebÂ 2007 00:00:00 -05:00

A 52-year-old man with an 8-year history of type 2 diabetes mellitus visits his primary care provider for advice. His glucometer readings at home have been high despite treatment with...

PERSPECTIVE: Finding New Treatments for Diabetes â How Many, How Fast .Â .Â . How Good?

Thu, 01Â FebÂ 2007 00:00:00 -05:00

Two modern-day epidemics, HIVâAIDS and type 2 diabetes mellitus, have inspired impassioned calls for more effective interventions. In the 1980s, the rapid spread of HIV, with its associated severe, acute...

PERSPECTIVE: Obesity and Diabetes in the Developing World â A Growing Challenge

Thu, 18Â JanÂ 2007 00:00:00 -05:00

Globally, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate. About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major...

PERSPECTIVE: The Preventive Polypill â Much Promise, Insufficient Evidence

Thu, 18Â JanÂ 2007 00:00:00 -05:00

The rapidly increasing global burdens of cardiovascular disease and diabetes call for interventions that have a population-wide effect, as well as interventions that identify and protect individual patients who have...

EDITORIAL: Thiazolidinediones for Initial Treatment of Type 2 Diabetes?

David M. Nathan, M.D. — Thu, 07Â DecÂ 2006 00:00:00 -05:00

The twin epidemics of obesity and type 2 diabetes mellitus have spawned a public health crisis. In the United States, an estimated 1.5 million new cases of diabetes occur every...

ORIGINAL ARTICLE: Glycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy

Thu, 07Â DecÂ 2006 00:00:00 -05:00

Background: The efficacy of thiazolidinediones, as compared with other oral glucose-lowering medications, in maintaining long-term glycemic control in type 2 diabetes is not known.

Methods: We evaluated rosiglitazone, metformin, and glyburide...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Dr. Andrea L. Utz (Endocrinology): A 35-year-old pregnant woman (gravida 2, para 1) was admitted to this hospital at 19 weeks and 6 days of gestation because of the recent...

IMAGES IN CLINICAL MEDICINE: Necrobiosis Lipoidica Diabeticorum

Nicole Wake, B.A. and James C. Fang, M.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 52-year-old man with diabetes reported a 3-month history of a pretibial rash during a routine visit. He had a 15-year history of type 2 diabetes mellitus treated with insulin...

CLINICAL PRACTICE: Management of Hyperglycemia in the Hospital Setting

Silvio E. Inzucchi, M.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 53-year-old woman with asthma and multilobar pneumonia is admitted with respiratory failure. She is intubated and treated with antibiotics, albuterol, and methylprednisolone. A random blood glucose measurement obtained on...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2006 â A 43-Year-Old Man with Diabetes, Hypogonadism, Cirrhosis, Arthralgias, and Fatigue

Raymond T. Chung, M.D., Joseph Misdraji, M.D., and Dushyant V. Sahani, M.D. — Thu, 26Â OctÂ 2006 00:00:00 -05:00

A 43-year-old white man was seen at this hospital because of hypogonadism.

The patient had felt well until 6 months earlier, when he noted the gradual onset of fatigue, decreased libido,...

EDITORIAL: Angiotensin-ConvertingâEnzyme Inhibitors for Impaired Glucose Tolerance â Is There Still Hope?

Julie R. Ingelfinger, M.D., and Caren G. Solomon, M.D., M.P.H. — Thu, 12Â OctÂ 2006 00:00:00 -05:00

In our increasingly sedentary society, the rates of overnutrition, the metabolic syndrome, and frank diabetes mellitus are rising at an alarming rate.1 Once diabetes has developed, the risks of cardiovascular...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2006 â A 15-Year-Old Girl with Severe Obesity

Thu, 12Â OctÂ 2006 00:00:00 -05:00

A 15 1/2-year-old girl was seen in the outpatient Weight Center of this hospital for the evaluation of severe obesity. She had had a normal gestation without complications and had...

ORIGINAL ARTICLE: Effect of Ramipril on the Incidence of Diabetes

The DREAM Trial Investigators — Thu, 12Â OctÂ 2006 00:00:00 -05:00

Background: Previous studies have suggested that blockade of the reninâangiotensin system may prevent diabetes in people with cardiovascular disease or hypertension.

Methods: In a double-blind, randomized clinical trial with a 2-by-2...

IMAGES IN CLINICAL MEDICINE: Yellow Palms and Soles in Diabetes Mellitus

Jiun-Nong Lin, M.D. — Thu, 05Â OctÂ 2006 00:00:00 -05:00

A 55-year-old man presented with a 1-month history of yellow discoloration of his palms and soles (arrow, right palm, as compared with a normal palm to the left). Diabetes mellitus...

EDITORIAL: Diabetes Cure â Is the Glass Half Full?

Jonathan S. Bromberg, M.D., Ph.D., and Derek LeRoith, M.D., Ph.D. — Thu, 28Â SepÂ 2006 00:00:00 -05:00

Nearly 80 years after the first clinical use of insulin, many important advances in the treatment of type 1 diabetes mellitus continue to be made. In this issue of the...

ORIGINAL ARTICLE: International Trial of the Edmonton Protocol for Islet Transplantation

Thu, 28Â SepÂ 2006 00:00:00 -05:00

Background: Islet transplantation offers the potential to improve glycemic control in a subgroup of patients with type 1 diabetes mellitus who are disabled by refractory hypoglycemia. We conducted an international,...

EDITORIAL: ATP-Sensitive Potassium Channels â Neonatal Diabetes Mellitus and Beyond

Mark A. Sperling, M.D. — Thu, 03Â AugÂ 2006 00:00:00 -05:00

The revolution in molecular biology has led to widespread appreciation of a principle first described by the British physician A.E. Garrod approximately 100 years ago â that âinborn errors of...

ORIGINAL ARTICLE: Switching from Insulin to Oral Sulfonylureas in Patients with Diabetes Due to Kir6.2 Mutations

Thu, 03Â AugÂ 2006 00:00:00 -05:00

Background: Heterozygous activating mutations in KCNJ11, encoding the Kir6.2 subunit of the ATP-sensitive potassium (KATP) channel, cause 30 to 58 percent of cases of diabetes diagnosed in patients under six...

ORIGINAL ARTICLE: Activating Mutations in the Gene in Neonatal Diabetes Mellitus

Thu, 03Â AugÂ 2006 00:00:00 -05:00

Background: The ATP-sensitive potassium (KATP) channel, composed of the beta-cell proteins sulfonylurea receptor (SUR1) and inward-rectifying potassium channel subunit Kir6.2, is a key regulator of insulin release. It is inhibited...

EDITORIAL: Genetic Variants and Common Diseases â Better Late Than Never

Stephen O'Rahilly, M.D., and Nicholas J. Wareham, M.D. — Thu, 20Â JulÂ 2006 00:00:00 -05:00

Our understanding of the molecular basis for monogenic disorders has made remarkable progress during the past 30 years, leading to new insights into disease mechanisms, a huge increase in the...

ORIGINAL ARTICLE: Polymorphisms and Progression to Diabetes in the Diabetes Prevention Program

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Background: Common polymorphisms of the transcription factor 7âlike 2 gene (TCF7L2) have recently been associated with type 2 diabetes. We examined whether the two most strongly associated variants (rs12255372 and...

IMAGES IN CLINICAL MEDICINE: Acquired Leukonychia Totalis

Emmanuel S. Antonarakis, M.D. — Thu, 13Â JulÂ 2006 00:00:00 -05:00

A 72-year-old woman with diabetes mellitus, hypertension, and peripheral vascular disease was hospitalized with chest tightness and acute shortness of breath. She reported a four-month history of worsening dyspnea on...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Reversal of Type 1 Diabetes in Mice

Douglas A. Melton, Ph.D. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

In 2003, the field of diabetes was shaken up by an article published in Science,1 stating that established autoimmune diabetes in mice could be permanently reversed with the injection of...

EDITORIAL: Retinol-Binding Protein 4, Insulin Resistance, and Type 2 Diabetes

Kenneth S. Polonsky, M.D. — Thu, 15Â JunÂ 2006 00:00:00 -05:00

The current pandemic of type 2 diabetes is closely associated with obesity and insulin resistance. It is therefore essential that we gain a greater understanding of the pathogenesis of these...

ORIGINAL ARTICLE: Retinol-Binding Protein 4 and Insulin Resistance in Lean, Obese, and Diabetic Subjects

Thu, 15Â JunÂ 2006 00:00:00 -05:00

Background: Insulin resistance has a causal role in type 2 diabetes. Serum levels of retinol-binding protein 4 (RBP4), a protein secreted by adipocytes, are increased in insulin-resistant states. Experiments in...

IMAGES IN CLINICAL MEDICINE: Pneumoperitoneum Due to Spontaneously Perforated Pyometra

Ming-Shian Tsai, M.D. and Ming-Hsun Wu, M.D. — Thu, 25Â MayÂ 2006 00:00:00 -05:00

A 40-year-old woman with long-standing diabetes presented to the emergency room with fever (temperature, 39.5Â°C) and diffuse abdominal pain. On admission, she had a distended abdomen with muscular rigidity, Blumberg's...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: A Toggle for Type 2 Diabetes?

Bernard Thorens, Ph.D. — Thu, 13Â AprÂ 2006 00:00:00 -05:00

Type 2 diabetes mellitus is characterized by a relative deficit in insulin secretion, caused by a decrease in the glucose sensitivity of the pancreatic beta cells, by a reduction in...

IMAGES IN CLINICAL MEDICINE: Bilateral Renal-Vein Thrombosis Associated with the Nephrotic Syndrome

Surat Phonsombat, M.D. and Marshall L. Stoller, M.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes reported a two-day history of increasing dull pain in the right flank and nonbloody, bilious vomiting....

PERSPECTIVE: Facing the Diabetes Epidemic â Mandatory Reporting of Glycosylated Hemoglobin Values in New York City

Thu, 09Â FebÂ 2006 00:00:00 -05:00

The diabetes epidemic in the United States continues unabated, with a staggering toll in acute and chronic complications, disability, and death. The primary culprits are poor glycemic control over the...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: No Stem Cell Is an Islet (Yet)

Didier Stainier, Ph.D. — Thu, 02Â FebÂ 2006 00:00:00 -05:00

Type 1 diabetes mellitus is one medical condition likely to benefit from stem-cell therapy: insulin-secreting pancreatic beta cells derived from stem cells â pending availability â could be transplanted into...

EDITORIAL: Glycemic Control and Cardiovascular Disease â Should We Reassess Clinical Goals?

William T. Cefalu, M.D. — Thu, 22Â DecÂ 2005 00:00:00 -05:00

Improved glycemic control reduces the risks of early microvascular complications, such as retinopathy, nephropathy, and neuropathy, in patients with diabetes.12 Such patients also have a markedly increased risk of macrovascular...

IMAGES IN CLINICAL MEDICINE: Gastric Dilatation Secondary to Diabetic Autonomic Neuropathy

Peter J. Featherstone, M.B., B.Ch. and Lindsay D. George, M.D. — Thu, 22Â DecÂ 2005 00:00:00 -05:00

A 75-year-old woman was admitted to the hospital due to severe nausea and vomiting. she had a 12-year history of type 2 diabetes with erratic glucose control complicated by severe...

ORIGINAL ARTICLE: Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes

Thu, 22Â DecÂ 2005 00:00:00 -05:00

Background: Intensive diabetes therapy aimed at achieving near normoglycemia reduces the risk of microvascular and neurologic complications of type 1 diabetes. We studied whether the use of intensive therapy as...

EDITORIAL: âDoctor, Is My Sugar Normal?â

Ronald A. Arky, M.D. — Thu, 06Â OctÂ 2005 00:00:00 -05:00

We live in an era in which the public interest in medical matters is high. When so much information and misinformation are available on the Internet, many patients devote a...

ORIGINAL ARTICLE: Normal Fasting Plasma Glucose Levels and Type 2 Diabetes in Young Men

Thu, 06Â OctÂ 2005 00:00:00 -05:00

Background: The normal fasting plasma glucose level was recently defined as less than 100 mg per deciliter (5.55 mmol per liter). Whether higher fasting plasma glucose levels within this range...

EDITORIAL: Angiogenic Pathways in Diabetic Retinopathy

Lloyd Paul Aiello, M.D., Ph.D. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

Visual loss is often considered the most feared complication of human disease, other than death. In 2002, 124 million people worldwide had poor vision and 37 million were blind.1 In...

IMAGES IN CLINICAL MEDICINE: Lipemia Retinalis

Jesse Kumar, M.R.C.P. and Anthony S. Wierzbicki, F.A.H.A. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

A 45-year-old woman presented with type V phenotype, mixed hyperlipemia and secondary type 2 diabetes mellitus. Her diseases were managed with insulin and oral hypoglycemic agents with combined nâ3 fatty...

ORIGINAL ARTICLE: Erythropoietin as a Retinal Angiogenic Factor in Proliferative Diabetic Retinopathy

Thu, 25Â AugÂ 2005 00:00:00 -05:00

Background: Although vascular endothelial growth factor (VEGF) is a primary mediator of retinal angiogenesis, VEGF inhibition alone is insufficient to prevent retinal neovascularization. Hence, it is postulated that there are...

ORIGINAL ARTICLE: Paclitaxel-Eluting or Sirolimus-Eluting Stents to Prevent Restenosis in Diabetic Patients

Thu, 18Â AugÂ 2005 00:00:00 -05:00

Background: Drug-eluting stents are highly effective in reducing the rate of in-stent restenosis. It is not known whether there are differences in the effectiveness of currently approved drug-eluting stents in...

REVIEW ARTICLE: Retinoid X Receptor Heterodimers in the Metabolic Syndrome

Andrew I. Shulman, Ph.D., and David J. Mangelsdorf, Ph.D. — Thu, 11Â AugÂ 2005 00:00:00 -05:00

The metabolic syndrome, also known as syndrome X, is characterized by abdominal obesity, atherogenic dyslipidemia, hypertension, insulin resistance, inflammation, and prothrombotic states.1 05081128.xml 05081128.xml 05081128.xml 05081128.xml Diagnostic of the metabolic...

EDITORIAL: Gastric Bypass and Nesidioblastosis â Too Much of a Good Thing for Islets?

David E. Cummings, M.D. — Thu, 21Â JulÂ 2005 00:00:00 -05:00

As the obesity pandemic continues to worsen and medical interventions remain only moderately effective, bariatric surgery is at present the only method that reliably results in major, long-term weight loss.12...

ORIGINAL ARTICLE: Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery

Thu, 21Â JulÂ 2005 00:00:00 -05:00

We describe six patients (five women and one man; median age, 47 years; range, 39 to 54) with postprandial symptoms of neuroglycopenia owing to endogenous hyperinsulinemic hypoglycemia after Roux-en-Y gastric...

ORIGINAL ARTICLE: Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: Statins reduce the incidence of cardiovascular events in persons with type 2 diabetes mellitus. However, the benefit of statins in such patients receiving hemodialysis, who are at high risk...

IMAGES IN CLINICAL MEDICINE: Calcific Arteriopathy

France Joyal, M.D. and Pascal Margaroli, M.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

A 38-year-old man who had undergone renal and pancreatic transplantation five years earlier was referred because of acral gangrene of both hands. The patient also had type 1 diabetes and...

EDITORIAL: Type 1 Diabetes â Does Suppressing T Cells Increase Insulin?

Ãke Lernmark, Med.Dr. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

During the ominous prelude to the onset of type 1 diabetes, the pancreatic-islet beta cells become the targets of a specific autoimmune attack, which ultimately results in diabetes. Although major...

ORIGINAL ARTICLE: Insulin Needs after CD3-Antibody Therapy in New-Onset Type 1 Diabetes

Thu, 23Â JunÂ 2005 00:00:00 -05:00

Background: Type 1 diabetes mellitus is a T-cellâmediated autoimmune disease that leads to a major loss of insulin-secreting beta cells. The further decline of beta-cell function after clinical onset might...

EDITORIAL: Gestational Diabetes Mellitus â Time to Treat

Michael F. Greene, M.D., and Caren G. Solomon, M.D., M.P.H. — Thu, 16Â JunÂ 2005 00:00:00 -05:00

Gestational diabetes mellitus, broadly defined as carbohydrate intolerance beginning or first recognized during pregnancy,12 was originally described decades ago and has since been the subject of extensive research. Yet the...

ORIGINAL ARTICLE: Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes

Thu, 16Â JunÂ 2005 00:00:00 -05:00

Background: We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications.

Methods: We randomly assigned women between 24 and...

ORIGINAL ARTICLE: Morphine, Gabapentin, or Their Combination for Neuropathic Pain

Thu, 31Â MarÂ 2005 00:00:00 -05:00

Background: The available drugs to treat neuropathic pain have incomplete efficacy and dose-limiting adverse effects. We compared the efficacy of a combination of gabapentin and morphine with that of each...

SPECIAL REPORT: A Potential Decline in Life Expectancy in the United States in the 21st Century

Thu, 17Â MarÂ 2005 00:00:00 -05:00

Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and Medicare. Although the Social Security Administration recently raised its...

EDITORIAL: Deadweight? â The Influence of Obesity on Longevity

Samuel H. Preston, Ph.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

Obesity has clearly become a major personal and public health problem for Americans; it affects many aspects of our society. In this issue of the Journal, Olshansky et al.1 make...

IMAGES IN CLINICAL MEDICINE: Acquired Acrodermatitis Enteropathica

Linda C. Wang, M.D., J.D. and Shail Busbey, M.D. — Thu, 17Â MarÂ 2005 00:00:00 -05:00

A 41-year-old woman with a history of alcohol abuse, hypertension, and type 1 diabetes mellitus complicated by retinopathy, nephropathy, and end-stage renal disease presented with a five-month history of alopecia...

EDITORIAL: Early Vascular Risk Factor Modification in Type 1 Diabetes

Bruce A. Perkins, M.D., M.P.H., and Vera Bril, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

The discovery of insulin some 80 years ago changed type 1 diabetes from an imminently lethal disease to a chronic condition, and clinical care evolved from preventing death to preventing...

ORIGINAL ARTICLE: Vascular Risk Factors and Diabetic Neuropathy

Thu, 27Â JanÂ 2005 00:00:00 -05:00

Background: Other than glycemic control, there are no treatments for diabetic neuropathy. Thus, identifying potentially modifiable risk factors for neuropathy is crucial. We studied risk factors for the development of...

REVIEW ARTICLE: Insulin Analogues

Irl B. Hirsch, M.D. — Thu, 13Â JanÂ 2005 00:00:00 -05:00

The discovery of insulin more than 80 years ago is considered one of the greatest medical breakthroughs of the 20th century.1 The first commercial insulin preparations contained numerous impurities and...

EDITORIAL: Bariatric Surgery â Quick Fix or Long-Term Solution?

Caren G. Solomon, M.D., M.P.H., and Robert G. Dluhy, M.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

More than 30 percent of the U.S. population is obese (body-mass index [the weight in kilograms divided by the square of the height in meters], 30 or greater), and 4.9...

ORIGINAL ARTICLE: Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery

Thu, 23Â DecÂ 2004 00:00:00 -05:00

Background: Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown.

Methods: The prospective, controlled Swedish Obese Subjects...

EDITORIAL: Prematurity â A Window of Opportunity?

Mark A. Sperling, M.D. — Thu, 18Â NovÂ 2004 00:00:00 -05:00

Infants born with evidence of restricted fetal growth â those who are small for gestational age â appear to be at increased risk for metabolic disorders (type 2 diabetes mellitus...

ORIGINAL ARTICLE: Premature Birth and Later Insulin Resistance

Thu, 18Â NovÂ 2004 00:00:00 -05:00

Background: Term infants who are small for gestational age appear prone to the development of insulin resistance during childhood. We hypothesized that insulin resistance, a marker of type 2 diabetes...

ORIGINAL ARTICLE: Angiotensin-Receptor Blockade versus ConvertingâEnzyme Inhibition in Type 2 Diabetes and Nephropathy

Thu, 04Â NovÂ 2004 00:00:00 -05:00

Background: Few studies have directly compared the renoprotective effects of angiotensin IIâreceptor blockers and angiotensin-convertingâenzyme (ACE) inhibitors in persons with type 2 diabetes.

Methods: In this prospective, multicenter, double-blind, five-year study,...

ORIGINAL ARTICLE: Preventing Microalbuminuria in Type 2 Diabetes

Thu, 04Â NovÂ 2004 00:00:00 -05:00

Background: The multicenter double-blind, randomized Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) was designed to assess whether angiotensin-convertingâenzyme inhibitors and non-dihydropyridine calcium-channel blockers, alone or in combination, prevent microalbuminuria in subjects...

PERSPECTIVE: Treating Diabetic Nephropathy â Are There Only Economic Issues?

William E. Mitch, M.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

Economic issues sometimes seem to be the primary considerations in discussions of treatment for nephropathy in patients with type 2 diabetes. But in the end, the economics of treatment are...

EDITORIAL: Embryonic Stem-Cell Research â The Case for Federal Funding

Jeffrey M. Drazen, M.D. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

In the debate between those who support federal funding for embryonic stem-cell research and those who do not, a critical point has been overlooked. Research using this technology is strongly...

REVIEW ARTICLE: Thiazolidinediones

Hannele Yki-JÃ¤rvinen, M.D., F.R.C.P. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

Insulin resistance both precedes and predicts type 2 diabetes mellitus.1 Although exercise and weight loss ameliorate insulin resistance and may in some cases prevent or delay onset of the disease,2...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: No Pancreatic Endocrine Stem Cells?

Fred Levine, M.D., Ph.D., and Mark Mercola, Ph.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

Advances in clinical islet transplantation have raised the hope that a definitive treatment for diabetes is close. However, widespread application of islet transplantation has been limited by a shortage of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2004 â A 49-Year-Old Woman with Severe Obesity, Diabetes, and Hypertension

Thu, 12Â AugÂ 2004 00:00:00 -05:00

A 49-year-old woman was evaluated at this hospital for the management of obesity. She had been overweight since childhood; at the age of 10 years she weighed 45.4 kg, at...

IMAGES IN CLINICAL MEDICINE: âPseudoinfarctionâ Pattern Due to Hyperkalemia

Kyuhyun Wang, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

A 38-year-old man presented to the emergency department with nausea, vomiting, and epigastric pain. The patient had type 1 diabetes mellitus and was being treated with insulin. He was also...

CLINICAL PRACTICE: Neuropathic Diabetic Foot Ulcers

Andrew J.M. Boulton, M.D., Robert S. Kirsner, M.D., and Loretta Vileikyte, M.D. — Thu, 01Â JulÂ 2004 00:00:00 -05:00

A 58-year-old man with type 2 diabetes mellitus has an asymptomatic plantar ulcer on the left foot that remains unhealed after four months. The ulcer measures 2 cm by 1...

ORIGINAL ARTICLE: Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease

Thu, 17Â JunÂ 2004 00:00:00 -05:00

Background: Liposuction has been proposed as a potential treatment for the metabolic complications of obesity. We evaluated the effect of large-volume abdominal liposuction on metabolic risk factors for coronary heart...

PERSPECTIVE: Thermodynamics, Liposuction, and Metabolism

David E. Kelley, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

The regulation of body weight adheres to the principles of thermodynamics: a positive energy balance causes weight gain, and weight loss occurs when the energy expenditure exceeds intake. More than...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Erythropoietin for Neurologic Protection and Diabetic Neuropathy

Stuart A. Lipton, M.D., Ph.D. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

The majority of drugs developed for neurologic indications fail because they are not clinically tolerated. A sensible strategy, therefore, is to explore the efficacy of drugs in the nervous system...

REVIEW ARTICLE: Diverse Causes of Hypoglycemia-Associated Autonomic Failure in Diabetes

Philip E. Cryer, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes.12 It causes recurrent symptomatic and sometimes, at least temporarily, disabling episodes in most people with type 1 diabetes...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 16-2004 â A 76-Year-Old Woman with Numbness and Pain in the Feet and Legs

Anthony A. Amato, M.D., and Anne Louise Oaklander, M.D., Ph.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

A 76-year-old woman was referred to the Pain Center of this hospital because of pain and numbness in her feet and legs. Six years earlier, intermittent numbness had developed in...

REVIEW ARTICLE: Autoimmune Polyendocrine Syndromes

George S. Eisenbarth, M.D., Ph.D., and Peter A. Gottlieb, M.D. — Thu, 13Â MayÂ 2004 00:00:00 -05:00

The autoimmune polyendocrine syndromes are diverse, and their diversity is a characteristic that is both clinically important and instructive when their basic immunologic features are considered (Table 1).1234 These syndromes...

ORIGINAL ARTICLE: Activating Mutations in the Gene Encoding the ATP-Sensitive Potassium-Channel Subunit Kir6.2 and Permanent Neonatal Diabetes

Thu, 29Â AprÂ 2004 00:00:00 -05:00

Background: Patients with permanent neonatal diabetes usually present within the first three months of life and require insulin treatment. In most, the cause is unknown. Because ATP-sensitive potassium (KATP) channels...

PERSPECTIVE: Open to Control â New Hope for Patients with Neonatal Diabetes

Fiona M. Gribble, B.M., B.Ch., Ph.D., and Frank Reimann, Ph.D. — Thu, 29Â AprÂ 2004 00:00:00 -05:00

Pancreatic beta cells, the insulin-releasing cells of the islets of Langerhans, are electrically excitable cells. They sense fluctuations in the plasma glucose concentration and convert the signal into a change...

ORIGINAL ARTICLE: Childhood Vaccination and Type 1 Diabetes

Thu, 01Â AprÂ 2004 00:00:00 -05:00

Background: A link between childhood vaccinations and the development of type 1 diabetes has been proposed.

Methods: We evaluated a cohort comprising all children born in Denmark from January 1, 1990,...

PERSPECTIVE: Childhood Immunizations and Chronic Illness

Lynne L. Levitsky, M.D. — Thu, 01Â AprÂ 2004 00:00:00 -05:00

These hopeful words of Edward Jenner (see Figure) were prescient, although their promise remained unfulfilled for almost 200 years. One hundred years ago, more than 48,000 people contracted smallpox annually...

IMAGES IN CLINICAL MEDICINE: Eruptive Xanthomas Associated with Hypertriglyceridemia and New-Onset Diabetes Mellitus

Keshav R. Nayak, M.D. and Richard G. Daly, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

A previously healthy, 38-year-old man with a family history of early cerebrovascular accidents presented with a sudden eruption of pink papules with creamy-colored centers on his arms and upper torso...

ORIGINAL ARTICLE: Relation of Serial Changes in Childhood Body-Mass Index to Impaired Glucose Tolerance in Young Adulthood

Thu, 26Â FebÂ 2004 00:00:00 -05:00

Background: The risk of type 2 diabetes mellitus is increased in people who have low birth weights and who subsequently become obese as adults. Whether their obesity originates in childhood...

PERSPECTIVE: Overweight in Childhood and Adolescence

William H. Dietz, M.D., Ph.D. — Thu, 26Â FebÂ 2004 00:00:00 -05:00

The prevalence of overweight doubled among children 6 to 11 years of age and tripled among those 12 to 17 years of age between the second National Health and Nutrition...

REVIEW ARTICLE: Islet Transplantation as a Treatment for Diabetes â A Work in Progress

R. Paul Robertson, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

In 1993 the Diabetes Control and Complications Trial (DCCT) established the modern standard of care for the medical management of type 1 diabetes mellitus.1 The DCCT randomly assigned 1441 patients...

ORIGINAL ARTICLE: Impaired Mitochondrial Activity in the Insulin-Resistant Offspring of Patients with Type 2 Diabetes

Thu, 12Â FebÂ 2004 00:00:00 -05:00

Background: Insulin resistance appears to be the best predictor of the development of diabetes in the children of patients with type 2 diabetes, but the mechanism responsible is unknown.

Methods: We...

PERSPECTIVE: Causation of Type 2 Diabetes â The Gordian Knot Unravels

Roy Taylor, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

Type 2 diabetes has always been a snake in the grass, sneaking up on both those with the disease and their physicians. To whit, the term âmild diabetesâ persists, even...

REVIEW ARTICLE: Diabetic Retinopathy

Robert N. Frank, M.D. — Thu, 01Â JanÂ 2004 00:00:00 -05:00

Diabetic retinopathy is the most severe of the several ocular complications of diabetes. Advances in treatment over the past 40 years have greatly reduced the risk of blindness from this...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Putting the Brakes on Insulin Signaling

Alan R. Saltiel, Ph.D. — Thu, 25Â DecÂ 2003 00:00:00 -05:00

The dramatic increase in the incidence of type 2 diabetes mellitus and obesity in the Western world signals the beginning of an epidemic that is expected to become a major...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Nerves, Fat, and Insulin Resistance

Guenther Boden, M.D., and Robert D. Hoeldtke, Ph.D., M.D. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Free fatty acids, the chief constituents of fat, are the main fuel for the heart and skeletal muscle under normal circumstances. Under special circumstances â such as exercise or exposure...

EDITORIAL: Albuminuria and Vascular Damage â The Vicious Twins

Eberhard Ritz, M.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

Diabetes mellitus causes a dramatic increase in mortality, particularly from cardiovascular causes: the survival rate among persons with either type 1 or type 2 diabetes and no history of coronary...

ORIGINAL ARTICLE: Intensive Diabetes Therapy and Carotid IntimaâMedia Thickness in Type 1 Diabetes Mellitus

Thu, 05Â JunÂ 2003 00:00:00 -05:00

Background: Cardiovascular disease causes severe morbidity and mortality in type 1 diabetes, although the specific risk factors and whether chronic hyperglycemia has a role are unknown. We examined the progression...

ORIGINAL ARTICLE: Regression of Microalbuminuria in Type 1 Diabetes

Thu, 05Â JunÂ 2003 00:00:00 -05:00

Background: In the present study, we aimed to determine the frequency of a significant reduction in urinary albumin excretion and factors affecting such reduction in patients with type 1 diabetes...

ORIGINAL ARTICLE: A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity

Thu, 22Â MayÂ 2003 00:00:00 -05:00

Background: The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed.

Methods: We randomly assigned 132 severely obese subjects (including 77 blacks and...

EDITORIAL: Contrast-AgentâInduced Acute Renal Dysfunction â Is Iodixanol the Answer?

Carl M. Sandler, M.D. — Thu, 06Â FebÂ 2003 00:00:00 -05:00

In this issue of the Journal, Aspelin et al.1 report findings from a prospective, randomized, double-blind trial that compared iodixanol, a third-generation, iso-osmolar, dimeric, nonionic iodinated contrast agent, with iohexol,...

ORIGINAL ARTICLE: Nephrotoxic Effects in High-Risk Patients Undergoing Angiography

Thu, 06Â FebÂ 2003 00:00:00 -05:00

Background: The use of iodinated contrast medium can result in nephropathy. Whether iso-osmolar contrast medium is less nephrotoxic than low-osmolar contrast medium in high-risk patients is uncertain.

Methods: We conducted a...

EDITORIAL: Reducing Cardiovascular Risk in Type 2 Diabetes

Caren G. Solomon, M.D. — Thu, 30Â JanÂ 2003 00:00:00 -05:00

Mortality from cardiovascular disease is increased by a factor of two to three in persons with diabetes as compared with the general population.1 Cardiovascular disease develops earlier in the presence...

ORIGINAL ARTICLE: Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes

Thu, 30Â JanÂ 2003 00:00:00 -05:00

Background: Cardiovascular morbidity is a major burden in patients with type 2 diabetes. In the Steno-2 Study, we compared the effect of a targeted, intensified, multifactorial intervention with that of...

EDITORIAL: Asymptomatic Bacteriuria in Patients with Diabetes â Enemy or Innocent Visitor?

Thu, 14Â NovÂ 2002 00:00:00 -05:00

The application of quantitative bacteriology to urine cultures almost five decades ago led to prospective scientific investigations of the epidemiology, pathogenesis, diagnosis, treatment, and prevention of urinary tract infections.1 Numerous...

ORIGINAL ARTICLE: Antimicrobial Treatment in Diabetic Women with Asymptomatic Bacteriuria

Thu, 14Â NovÂ 2002 00:00:00 -05:00

Background: Asymptomatic bacteriuria is common among women with diabetes, and the treatment of such infections has been recommended to prevent complications related to symptomatic urinary tract infection.

Methods: We enrolled women...

CLINICAL PRACTICE: Initial Management of Glycemia in Type 2 Diabetes Mellitus

David M. Nathan, M.D. — Thu, 24Â OctÂ 2002 00:00:00 -05:00

After an overnight fast, an asymptomatic 45-year-old Hispanic man has a plasma glucose level of 142 mg per deciliter (7.9 mmol per liter) on initial evaluation and 139 mg per...

ORIGINAL ARTICLE: Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Background: Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria...

PERSPECTIVE: Ambulatory Blood-Pressure Monitoring as a Predictive Tool

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Although some patients with type 1 diabetes mellitus have complications, such as diabetic nephropathy, many do not. Thus, a simple, noninvasive method of identifying those at highest â and lowest...

EDITORIAL: Can We Change the Course of Beta-Cell Destruction in Type 1 Diabetes?

Thu, 30Â MayÂ 2002 00:00:00 -05:00

Imagine a nephrologist with no biopsy needle, no imaging techniques, no serum creatinine measurement â a nephrologist whose patients need dialysis when they first present for care. This is the...

ORIGINAL ARTICLE: Anti-CD3 Monoclonal Antibody in New-Onset Type 1 Diabetes Mellitus

Thu, 30Â MayÂ 2002 00:00:00 -05:00

Background: Type 1 diabetes mellitus is a chronic autoimmune disease caused by the pathogenic action of T lymphocytes on insulin-producing beta cells. Previous clinical studies have shown that continuous immune...

ORIGINAL ARTICLE: Effects of Insulin in Relatives of Patients with Type 1 Diabetes Mellitus

Diabetes Prevention TrialâType 1 Diabetes Study Group — Thu, 30Â MayÂ 2002 00:00:00 -05:00

Background: It is unknown whether insulin therapy can delay or prevent diabetes in nondiabetic relatives of patients with diabetes.

Methods: In a randomized, controlled, nonblinded clinical trial, we screened 84,228 first-degree...

CLINICAL PRACTICE: Nephropathy in Patients with Type 2 Diabetes

Giuseppe Remuzzi, M.D., Arrigo Schieppati, M.D., and Piero Ruggenenti, M.D. — Thu, 11Â AprÂ 2002 00:00:00 -05:00

A 60-year-old man was found to have type 2 diabetes mellitus two months ago. He has a serum creatinine level of 1.5 mg per deciliter (133 Î¼mol per liter); a...

EDITORIAL: Childhood Obesity and a Diabetes Epidemic

Thu, 14Â MarÂ 2002 00:00:00 -05:00

Childhood obesity has reached epidemic proportions; worldwide, approximately 22 million children under five years of age are overweight.1 During the past three decades, the number of overweight children in the...

ORIGINAL ARTICLE: Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity

Thu, 14Â MarÂ 2002 00:00:00 -05:00

Background: Childhood obesity, epidemic in the United States, has been accompanied by an increase in the prevalence of type 2 diabetes among children and adolescents. We determined the prevalence of...

ORIGINAL ARTICLE: Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin

Diabetes Prevention Program Research Group — Thu, 07Â FebÂ 2002 00:00:00 -05:00

Background: Type 2 diabetes affects approximately 8 percent of adults in the United States. 02020727.xml Some risk factors â elevated plasma glucose concentrations in the fasting state and after an...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2001 â A Newborn Girl with Seizures and Persistent Hypoglycemia

Ab Sadeghi-Nejad and Fiona M. Graeme-Cook — Thu, 20Â DecÂ 2001 00:00:00 -05:00

A two-day-old girl was admitted to the hospital because of persistent hypoglycemia.

The infant had been born at 34 weeks' gestation to a 35-year-old mother after an uneventful pregnancy. The birth...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Diabetes, Insulin Secretion, and the Pancreatic Beta-Cell Mitochondrion

Thu, 13Â DecÂ 2001 00:00:00 -05:00

Type 2 diabetes, the most common form of diabetes, affects about 135 million people worldwide. Insulin resistance and dysfunction of pancreatic beta cells are central abnormalities of the disease. Insulin...

ORIGINAL ARTICLE: Intensive Insulin Therapy in Critically Ill Patients

Thu, 08Â NovÂ 2001 00:00:00 -05:00

Background: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Resistin, Obesity, and Insulin Resistance â The Emerging Role of the Adipocyte as an Endocrine Organ

Thu, 01Â NovÂ 2001 00:00:00 -05:00

One hundred years ago, type 2 diabetes mellitus was considered a rare disease, but recently there has been an explosive increase in its incidence. About 16 million Americans have type...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Closing in on Type 1 Diabetes

Thu, 04Â OctÂ 2001 00:00:00 -05:00

In this issue of the Journal, Martin et al.1 present a striking report of a boy with X-linked agammaglobulinemia in whom typical type 1 insulin-dependent diabetes mellitus developed at the...

ORIGINAL ARTICLE: Development of Type 1 Diabetes despite Severe Hereditary B-Cell Deficiency

Thu, 04Â OctÂ 2001 00:00:00 -05:00

Type 1 diabetes results from an immune-mediated destruction of pancreatic beta cells. The disease can be transmitted by bone marrow transplantation in humans1 and animals.23 Furthermore, T cells that are...

REVIEW ARTICLE: Molecular Mechanisms and Clinical Pathophysiology of Maturity-Onset Diabetes of the Young

Stefan S. Fajans, M.D., Graeme I. Bell, Ph.D., and Kenneth S. Polonsky, M.D. — Thu, 27Â SepÂ 2001 00:00:00 -05:00

Maturity-onset diabetes of the young (MODY) is a clinically heterogeneous group of disorders characterized by nonketotic diabetes mellitus, an autosomal dominant mode of inheritance, an onset usually before the age...

EDITORIAL: Prevention of End-Stage Renal Disease Due to Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

The prevalence of end-stage renal disease is increasing at an alarming rate. In 2000, chronic kidney failure developed in over 90,000 people in the United States; the current population of...

ORIGINAL ARTICLE: The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: Microalbuminuria and hypertension are risk factors for diabetic nephropathy. Blockade of the reninâangiotensin system slows the progression to diabetic nephropathy in patients with type 1 diabetes, but similar data...

ORIGINAL ARTICLE: Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: Diabetic nephropathy is the leading cause of end-stage renal disease. Interruption of the reninâangiotensin system slows the progression of renal disease in patients with type 1 diabetes, but similar...

ORIGINAL ARTICLE: Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: It is unknown whether either the angiotensin-IIâreceptor blocker irbesartan or the calcium-channel blocker amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity...

ORIGINAL ARTICLE: Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women

Thu, 13Â SepÂ 2001 00:00:00 -05:00

Background: Previous studies have examined individual dietary and lifestyle factors in relation to type 2 diabetes, but the combined effects of these factors are largely unknown.

Methods: We followed 84,941 female...

ORIGINAL ARTICLE: Neonatal Diabetes Mellitus Due to Complete Glucokinase Deficiency

Thu, 24Â MayÂ 2001 00:00:00 -05:00

Diabetes mellitus is a heterogeneous disorder that can occur at any age.1 Neonatal diabetes mellitus, defined as insulin-requiring hyperglycemia within the first month of life, is a rare disorder that...

EDITORIAL: Changing Habits to Delay Diabetes

Thu, 03Â MayÂ 2001 00:00:00 -05:00

For centuries, fatter and more sedentary people have been considered more likely to get diabetes. More recently, many prospective studies have established that obesity and physical inactivity are risk factors...

ORIGINAL ARTICLE: Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance

Thu, 03Â MayÂ 2001 00:00:00 -05:00

Background: Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions...

EDITORIAL: Predicting Cerebral Edema during Diabetic Ketoacidosis

Thu, 25Â JanÂ 2001 00:00:00 -05:00

Cerebral edema is a devastating complication of diabetic ketoacidosis and remains the leading cause of serious illness and death in children with diabetes mellitus.1 The causes of cerebral edema are...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2001 â A 59-Year-Old Diabetic Man with Unilateral Visual Loss and Oculomotor-Nerve Palsy

Richard B. Brown, Stephen K. Lau — Thu, 25Â JanÂ 2001 00:00:00 -05:00

A 59-year-old man was admitted to the hospital because of right-sided visual loss and oculomotor-nerve palsy.

The patient had had type 2 diabetes mellitus for 25 years; during most of those...

ORIGINAL ARTICLE: Risk Factors for Cerebral Edema in Children with Diabetic Ketoacidosis

Thu, 25Â JanÂ 2001 00:00:00 -05:00

Background: Cerebral edema is an uncommon but devastating complication of diabetic ketoacidosis in children. Risk factors for this complication have not been clearly defined.

Methods: In this multicenter study, we identified...

EDITORIAL: Oral Hypoglycemic Drugs for Gestational Diabetes

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Gestational diabetes mellitus has been a contentious subject since it was first described. From a global perspective, authors have questioned its very existence, the burden of morbidity that it causes,...

ORIGINAL ARTICLE: A Comparison of Glyburide and Insulin in Women with Gestational Diabetes Mellitus

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Background: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these...

IMAGES IN CLINICAL MEDICINE: Mesenteric Ischemia

Azam Ansari, M.D. and Ronald Decesare, M.D. — Thu, 28Â SepÂ 2000 00:00:00 -05:00

Figure 1. An 81-year-old woman with long-standing hypertension and diabetes mellitus was evaluated for increasingly frequent and longer episodes of epigastric pain soon after eating. She grew progressively more fearful...

REVIEW ARTICLE: Foot Ulcers

Bauer E. Sumpio, M.D., Ph.D. — Thu, 14Â SepÂ 2000 00:00:00 -05:00

Ulcers result from breaks in the dermal barrier, with subsequent erosion of underlying subcutaneous tissue. In severe cases, the breach may extend to muscle and bone. Primary care providers are...

REVIEW ARTICLE: Islet Amyloid and Type 2 Diabetes Mellitus

Thu, 10Â AugÂ 2000 00:00:00 -05:00

Almost a century ago, in 1901, Eugene L. Opie described âhyaline degeneration of the islands of Langerhansâ in the pancreas of patients with hyperglycemia (Figure 1).1 A relation with diabetes...

EDITORIAL: Successful Islet Transplantation for Patients with Diabetes â Fact or Fantasy?

Thu, 27Â JulÂ 2000 00:00:00 -05:00

Medical history is replete with sagas of scientists who doggedly pursue dreams of better ways to treat disease. In these tales, somewhere on the road between the first success and...

ORIGINAL ARTICLE: Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen

Thu, 27Â JulÂ 2000 00:00:00 -05:00

Background: Registry data on patients with type 1 diabetes mellitus who undergo pancreatic islet transplantation indicate that only 8 percent are free of the need for insulin therapy at one...

ORIGINAL ARTICLE: Beneficial Effects of High Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus

Thu, 11Â MayÂ 2000 00:00:00 -05:00

Background: The effect of increasing the intake of dietary fiber on glycemic control in patients with type 2 diabetes mellitus is controversial.

Methods: In a randomized, crossover study, we assigned 13...

ORIGINAL ARTICLE: Enteritis Necroticans (Pigbel) in a Diabetic Child

Thu, 27Â AprÂ 2000 00:00:00 -05:00

Background: Enteritis necroticans (pigbel), an often fatal illness characterized by hemorrhagic, inflammatory, or ischemic necrosis of the jejunum, occurs in developing countries but is rare in developed countries, where its...

ORIGINAL ARTICLE: The Effect of Previous Coronary-Artery Bypass Surgery on the Prognosis of Patients with Diabetes Who Have Acute Myocardial Infarction

Thu, 06Â AprÂ 2000 00:00:00 -05:00

Background: Acute myocardial infarction in patients with diabetes is associated with high mortality. We studied whether previous revascularization by coronary-artery bypass grafting (CABG), as compared with percutaneous transluminal coronary angioplasty...

EDITORIAL: Coronary Heart Disease in Patients with Diabetes

Thu, 06Â AprÂ 2000 00:00:00 -05:00

Type 2 diabetes increases the risk of coronary heart disease by a factor of two to four.1 The relative increase in the rate of coronary heart disease among patients with...

EDITORIAL: Antihypertensive Therapy and the Risk of Type 2 Diabetes Mellitus

Thu, 30Â MarÂ 2000 00:00:00 -05:00

Although thiazide diuretics and beta-blockers are often used as first-line therapy in patients with hypertension, including those with diabetes mellitus,1 the possibility that these drugs may promote glucose intolerance remains...

ORIGINAL ARTICLE: Hypertension and Antihypertensive Therapy as Risk Factors for Type 2 Diabetes Mellitus

Thu, 30Â MarÂ 2000 00:00:00 -05:00

Background: Previous research has suggested that thiazide diuretics and beta-blockers may promote the development of type 2 diabetes mellitus. However, the results of these studies have been inconsistent, and many...

ORIGINAL ARTICLE: Retinopathy and Nephropathy in Patients with Type 1 Diabetes Four Years after a Trial of Intensive Therapy

Thu, 10Â FebÂ 2000 00:00:00 -05:00

Background: Among patients with type 1 diabetes mellitus, intensive therapy (with the aim of achieving near-normal blood glucose and glycosylated hemoglobin concentrations) markedly reduces the risk of microvascular complications as...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Pigment-EpitheliumâDerived Factor â A Key Coordinator of Retinal Neuronal and Vascular Functions

Thu, 03Â FebÂ 2000 00:00:00 -05:00

Precise regulation of vascular development is critical in the eye, where a few microns' deviation can cause blood vessels to move into normally avascular areas such as the cornea, vitreous,...

EDITORIAL: Rapid-Onset Type 1 Diabetes with Pancreatic Exocrine Dysfunction

Thu, 03Â FebÂ 2000 00:00:00 -05:00

We tend to view type 1 diabetes mellitus as a chronic autoimmune disease with a preclinical phase that usually lasts for a number of years.1 The classic symptoms of type...

ORIGINAL ARTICLE: A Novel Subtype of Type 1 Diabetes Mellitus Characterized by a Rapid Onset and an Absence of Diabetes-Related Antibodies

Thu, 03Â FebÂ 2000 00:00:00 -05:00

Background: and Methods: Type 1 diabetes mellitus is now classified as autoimmune (type 1A) or idiopathic (type 1B), but little is known about the latter. We classified 56 consecutive Japanese...

REVIEW ARTICLE: Infections in Patients with Diabetes Mellitus

Thu, 16Â DecÂ 1999 00:00:00 -05:00

Contrary to common belief, the association between diabetes mellitus and increased susceptibility to infection in general is not supported by strong evidence.12 However, many specific infections are more common in...

REVIEW ARTICLE: Gestational Diabetes Mellitus

Siri L. Kjos, M.D., and Thomas A. Buchanan, M.D. — Thu, 02Â DecÂ 1999 00:00:00 -05:00

Gestational diabetes mellitus is defined as glucose intolerance that is first detected during pregnancy.1 This simple definition belies the complexity of a condition that spans a spectrum of glycemia, pathophysiology,...

REVIEW ARTICLE: Nephropathy in Patients with Type 2 Diabetes Mellitus

Eberhard Ritz, M.D., and Stephan Reinhold Orth, M.D. — Thu, 07Â OctÂ 1999 00:00:00 -05:00

In the not-so-distant past, type 2 diabetes mellitus was thought to be a relatively benign condition, at least in the elderly, with relatively little effect on life expectancy or renal...

REVIEW ARTICLE: Treatment of Diabetic Retinopathy

Frederick L. Ferris III, M.D., Matthew D. Davis, M.D., and Lloyd M. Aiello, M.D. — Thu, 26Â AugÂ 1999 00:00:00 -05:00

Diabetic retinopathy has been and probably remains one of the four major causes of blindness in the United States.12 The risk of retinopathy is directly related to the degree and...

REVIEW ARTICLE: Glucose Transporters and Insulin Action â Implications for Insulin Resistance and Diabetes Mellitus

Peter R. Shepherd, Ph.D., and Barbara B. Kahn, M.D. — Thu, 22Â JulÂ 1999 00:00:00 -05:00

Insulin was discovered more than 75 years ago, but only recently have we begun to understand the mechanisms by which insulin promotes the uptake of glucose into cells. This review...

ORIGINAL ARTICLE: Impaired Glucose Transport as a Cause of Decreased Insulin-Stimulated Muscle Glycogen Synthesis in Type 2 Diabetes

Thu, 22Â JulÂ 1999 00:00:00 -05:00

Background: Insulin resistance, a major factor in the pathogenesis of type 2 diabetes mellitus, is due mostly to decreased stimulation of glycogen synthesis in muscle by insulin. The primary rate-controlling...

IMAGES IN CLINICAL MEDICINE: Lipemia Retinalis

Herbert L. Fred, M.D. and Michel Accad, M.D. — Thu, 24Â JunÂ 1999 00:00:00 -05:00

Figure 1. A 36-year-old woman with newly discovered diabetes mellitus had eruptive xanthomata on her elbows and knees together with striking retinal changes. Her vision was normal, but all retinal...

ORIGINAL ARTICLE: Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension

Thu, 04Â MarÂ 1999 00:00:00 -05:00

Background: Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk...

REVIEW ARTICLE: Protection of AcidâBase Balance by pH Regulation of Acid Production

Virginia L. Hood, M.B., B.S., M.P.H., and Richard L. Tannen, M.D. — Thu, 17Â SepÂ 1998 00:00:00 -05:00

Under normal physiologic conditions, acidâbase balance is maintained by renal excretion of hydrogen ions generated during the metabolism of dietary protein and other metabolic processes. In normal subjects, these so-called...

ORIGINAL ARTICLE: Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction

Thu, 23Â JulÂ 1998 00:00:00 -05:00

Background: Type 2 (non-insulin-dependent) diabetes is associated with a marked increase in the risk of coronary heart disease. It has been debated whether patients with diabetes who have not had...

ORIGINAL ARTICLE: Reversal of Lesions of Diabetic Nephropathy after Pancreas Transplantation

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Background: In patients with type 1 diabetes mellitus who do not have uremia and have not received a kidney transplant, pancreas transplantation does not ameliorate established lesions of diabetic nephropathy...

EDITORIAL: Pancreas Transplantation and Diabetic Complications

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Hyperglycemia is an important factor in the development and progression of the complications of diabetes mellitus. In this issue of the Journal, Fioretto et al. report that pancreas transplantation reverses...

ORIGINAL ARTICLE: Decreased Epinephrine Responses to Hypoglycemia during Sleep

Thu, 04Â JunÂ 1998 00:00:00 -05:00

Background: In patients with type I diabetes mellitus, hypoglycemia occurs commonly during sleep and is frequently asymptomatic. This raises the question of whether sleep is associated with reduced counterregulatory-hormone responses...

REVIEW ARTICLE: The Nephrotic Syndrome

Stephan R. Orth, M.D., and Eberhard Ritz, M.D. — Thu, 23Â AprÂ 1998 00:00:00 -05:00

The nephrotic syndrome is defined by a urinary protein level exceeding 3.5 g per 1.73 m2 of body-surface area per day. At the turn of the century, clinicians distinguished a...

EDITORIAL: A Novel Antidiabetic Drug, Troglitazone â Reason for Hope and Concern

Thu, 26Â MarÂ 1998 00:00:00 -05:00

Type II (non-insulin-dependent) diabetes mellitus is characterized by insulin resistance, increased hepatic glucose production, and impaired secretion of insulin by pancreatic beta cells. Although the primary defect underlying these abnormalities...

ORIGINAL ARTICLE: Efficacy and Metabolic Effects of Metformin and Troglitazone in Type II Diabetes Mellitus

Thu, 26Â MarÂ 1998 00:00:00 -05:00

Background: Combination therapy is logical for patients with non-insulin-dependent (type II) diabetes mellitus, because they often have poor responses to single-drug therapy. We studied the efficacy and physiologic effects of...

ORIGINAL ARTICLE: Effect of Troglitazone in Insulin-Treated Patients with Type II Diabetes Mellitus

Thu, 26Â MarÂ 1998 00:00:00 -05:00

Background: Troglitazone is a new oral antidiabetic drug that increases the sensitivity of peripheral tissues to insulin. It may therefore increase the efficacy of exogenous insulin in patients with insulin-resistant...

ORIGINAL ARTICLE: The Effect of Nisoldipine as Compared with Enalapril on Cardiovascular Outcomes in Patients with Non-Insulin-Dependent Diabetes and Hypertension

Thu, 05Â MarÂ 1998 00:00:00 -05:00

Background: It has recently been reported that the use of calcium-channel blockers for hypertension may be associated with an increased risk of cardiovascular complications. Because this issue remains controversial, we...

REVIEW ARTICLE: Protective and Damaging Effects of Stress Mediators

Bruce S. McEwen, Ph.D. — Thu, 15Â JanÂ 1998 00:00:00 -05:00

Over 60 years ago, Selye1 recognized the paradox that the physiologic systems activated by stress can not only protect and restore but also damage the body. What links these seemingly...

EDITORIAL: Screening for Gestational Diabetes Mellitus

Thu, 27Â NovÂ 1997 00:00:00 -05:00

Gestational diabetes mellitus was originally defined by O'Sullivan and Mahan1 in a group of 752 unselected pregnant women in Boston as indicated by two or more blood glucose concentrations that...

ORIGINAL ARTICLE: Selective Screening for Gestational Diabetes Mellitus

Thu, 27Â NovÂ 1997 00:00:00 -05:00

Background: The usual approach to detecting gestational diabetes mellitus is to screen all pregnant women by measuring their plasma glucose after a 50-g oral glucose load at 24 to 28...

REVIEW ARTICLE: Insulin Lispro

Frits Holleman, M.D., and Joost B.L. Hoekstra, M.D., Ph.D. — Thu, 17Â JulÂ 1997 00:00:00 -05:00

The difference in amino acid composition between beef and porcine insulins and human insulin was long thought to be responsible for the immunogenicity of these animal insulins in humans. As...

EDITORIAL: Eating Disorders and Diabetic Complications

Thu, 26Â JunÂ 1997 00:00:00 -05:00

Poor metabolic control in adolescents with insulin-dependent diabetes mellitus (IDDM) is sometimes accepted as inevitable but likely to resolve when the patient's hormones, metabolism, and psyche finally come to terms...

ORIGINAL ARTICLE: Disordered Eating Behavior and Microvascular Complications in Young Women with Insulin-Dependent Diabetes Mellitus

Thu, 26Â JunÂ 1997 00:00:00 -05:00

Background: Insulin-dependent diabetes mellitus (IDDM) and eating disorders are relatively common among young women in North America. Their coexistence could lead to poor metabolic control and an increased risk of...

REVIEW ARTICLE: Insulin-Like Growth Factors

Derek Le Roith, M.D., Ph.D. — Thu, 27Â FebÂ 1997 00:00:00 -05:00

The insulin-like growth factors (IGFs) participate in the growth and function of almost every organ in the body.1 Because of the wide range of their biologic effects and their therapeutic...

EDITORIAL: Initiation and Progression of Diabetic Nephropathy

Thu, 28Â NovÂ 1996 00:00:00 -05:00

A clinical diagnosis of diabetic nephropathy can be made in a patient with diabetes on the basis of persistent albuminuria (>300 mg per 24 hours), the presence of diabetic retinopathy,...

ORIGINAL ARTICLE: Development and Progression of Renal Disease in Pima Indians with Non-Insulin-Dependent Diabetes Mellitus

Thu, 28Â NovÂ 1996 00:00:00 -05:00

Background: Non-insulin-dependent diabetes mellitus (NIDDM) is a major cause of end-stage renal disease. However, the course and determinants of renal failure in this type of diabetes have not been clearly...

ORIGINAL ARTICLE: Increased Glucose TransportâPhosphorylation and Muscle Glycogen Synthesis after Exercise Training in Insulin-Resistant Subjects

Thu, 31Â OctÂ 1996 00:00:00 -05:00

Background: Insulin resistance in the offspring of parents with non-insulin-dependent diabetes mellitus (NIDDM) is the best predictor of development of the disease and probably plays an important part in its...

ORIGINAL ARTICLE: Increased Glucose TransportâPhosphorylation and Muscle Glycogen Synthesis after Exercise Training in Insulin-Resistant Subjects

Thu, 31Â OctÂ 1996 00:00:00 -05:00

EDITORIAL: Islet and Pancreatic Transplantation â Autoimmunity and Alloimmunity

Thu, 19Â SepÂ 1996 00:00:00 -05:00

Given the autoimmune cause of insulin-dependent diabetes mellitus,1 the theoretical barriers to successful pancreatic and islet transplantation are autoimmunity (destruction of beta cells due to recurrent autoimmunity) and alloimmunity (rejection...

ORIGINAL ARTICLE: Recurrence of Autoimmune Diabetes Mellitus in Recipients of Cadaveric Pancreatic Grafts

Thu, 19Â SepÂ 1996 00:00:00 -05:00

Insulin-dependent diabetes mellitus is an autoimmune disease in which the beta cells of the islets of Langerhans are selectively destroyed.1 In a patient with this disease, a transplanted pancreas should...

ORIGINAL ARTICLE: Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease

The Bypass Angioplasty Revascularization Investigation (BARI) Investigators — Thu, 25Â JulÂ 1996 00:00:00 -05:00

Background: Coronary-artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are alternative methods of revascularization in patients with coronary artery disease. We tested the hypothesis that in selected patients...

REVIEW ARTICLE: The Psychological Care of Patients with Insulin-Dependent Diabetes Mellitus

Alan M. Jacobson, M.D. — Thu, 09Â MayÂ 1996 00:00:00 -05:00

Patients with insulin-dependent diabetes mellitus (IDDM) face major changes in lifestyle and the possibility of debilitating and life-threatening complications. Treatment requires a knowledgeable health care team that includes a physician,...

ORIGINAL ARTICLE: Effect of the Angiotensin-ConvertingâEnzyme Inhibitor Benazepril on the Progression of Chronic Renal Insufficiency

Thu, 11Â AprÂ 1996 00:00:00 -05:00

Background: Drugs that inhibit angiotensin-converting enzyme slow the progression of renal insufficiency in patients with diabetic nephropathy. Whether these drugs have a similar action in patients with other renal diseases...

REVIEW ARTICLE: Non-Insulin-Dependent Diabetes Mellitus â A Genetically Programmed Failure of the Beta Cell to Compensate for Insulin Resistance

Kenneth S. Polonsky, M.D., Jeppe Sturis, Ph.D., and Graeme I. Bell, Ph.D. — Thu, 21Â MarÂ 1996 00:00:00 -05:00

Non-insulin-dependent diabetes mellitus (NIDDM), the commonest form of diabetes, affects approximately 5 percent of the population of the United States. Although the pathophysiology of this condition has not been fully...

REVIEW ARTICLE: Metformin

Clifford J. Bailey, Ph.D., M.R.C.Path., and Robert C. Turner, M.D. — Thu, 29Â FebÂ 1996 00:00:00 -05:00

Metformin (dimethylbiguanide) is an orally administered drug used to lower blood glucose concentrations in patients with non-insulin-dependent diabetes mellitus (NIDDM).1 It improves insulin sensitivity and thus decreases the insulin resistance...

NEJM â Collection Updates for Diabetes

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Î±-Adrenergic Receptors and Type 2 Diabetes

IMAGES IN CLINICAL MEDICINE: Necrolytic Migratory Erythema

ORIGINAL ARTICLE: Rituximab, B-Lymphocyte Depletion, and Preservation of Beta-Cell Function

EDITORIAL: Treatment of Anemia in Chronic Kidney Disease â Strategies Based on Evidence

ORIGINAL ARTICLE: A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

IMAGES IN CLINICAL MEDICINE: Injection-Site Lipoatrophy

EDITORIAL: Optimal Insulin Treatment in Type 2 Diabetes

ORIGINAL ARTICLE: Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes

EDITORIAL: Gestational Diabetes â Whom Do We Treat?

ORIGINAL ARTICLE: A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes

ORIGINAL ARTICLE: Sex HormoneâBinding Globulin and Risk of Type 2 Diabetes in Women and Men

EDITORIAL: Diabetes Complications and the ReninâAngiotensin System

ORIGINAL ARTICLE: Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

EDITORIAL: Diabetes with Coronary Disease â A Moving Target amid Evolving Therapies?

ORIGINAL ARTICLE: A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease

BOOK REVIEW:

REVIEW ARTICLE: Genetics of Type 1A Diabetes

EDITORIAL: Glucose Control in the ICU â How Tight Is Too Tight?

ORIGINAL ARTICLE: Intensive versus Conventional Glucose Control in Critically Ill Patients

CORRESPONDENCE: Rituximab and Omalizumab in Severe, Refractory Insulin Allergy

IMAGES IN CLINICAL MEDICINE: Proliferative Diabetic Retinopathy

CORRESPONDENCE: An Unusual Outbreak of Hypoglycemia

BOOK REVIEW:

ORIGINAL ARTICLE: Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes

CORRESPONDENCE: Concordance for Islet Autoimmunity among Monozygotic Twins

EDITORIAL: Shared Genetic Risk Factors for Type 1 Diabetes and Celiac Disease

ORIGINAL ARTICLE: Shared and Distinct Genetic Variants in Type 1 Diabetes and Celiac Disease

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Boosting Beta-Cell Numbers

ORIGINAL ARTICLE: Clinical Risk Factors, DNA Variants, and the Development of Type 2 Diabetes

ORIGINAL ARTICLE: Genotype Score in Addition to Common Risk Factors for Prediction of Type 2 Diabetes

EDITORIAL: Immunotherapy on Trial for New-Onset Type 1 Diabetes

EDITORIAL: Insulin Infusions in Very-Low-Birth-Weight Infants

ORIGINAL ARTICLE: GAD Treatment and Insulin Secretion in Recent-Onset Type 1 Diabetes

ORIGINAL ARTICLE: Early Insulin Therapy in Very-Low-Birth-Weight Infants

EDITORIAL: UKPDS and the Legacy Effect

ORIGINAL ARTICLE: 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

ORIGINAL ARTICLE: Long-Term Follow-up after Tight Control of Blood Pressure in Type 2 Diabetes

ORIGINAL ARTICLE: Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes

PERSPECTIVE: Assessing the Cardiovascular Safety of Diabetes Therapies

CORRESPONDENCE: Widespread Amyloid Deposition in Transplanted Human Pancreatic Islets

BOOK REVIEW:

EDITORIAL: Glycemic Targets and Cardiovascular Disease

EDITORIAL: Intensive Glycemic Control in the ACCORD and ADVANCE Trials

ORIGINAL ARTICLE: Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes

ORIGINAL ARTICLE: Effects of Intensive Glucose Lowering in Type 2 Diabetes

EDITORIAL: Aliskiren and Dual Therapy in Type 2 Diabetes Mellitus

ORIGINAL ARTICLE: Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

ORIGINAL ARTICLE: Metformin versus Insulin for the Treatment of Gestational Diabetes

ORIGINAL ARTICLE: Hyperglycemia and Adverse Pregnancy Outcomes

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Activated Protein C and Diabetic Nephropathy

ORIGINAL ARTICLE: Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Chemical Immunosuppression in Islet Transplantation â Friend or Foe?

IMAGES IN CLINICAL MEDICINE: Severe Soft-Tissue Infection

ORIGINAL ARTICLE: Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes

CLINICAL DECISIONS: Management of Type 2 Diabetes

EDITORIAL: Intention to Treat â Initiating Insulin and the 4-T Study

ORIGINAL ARTICLE: Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes

IMAGES IN CLINICAL MEDICINE: Calciphylaxis with Arterial Calcification

IMAGES IN CLINICAL MEDICINE: Herpetic Glossitis

IMAGES IN CLINICAL MEDICINE: Emphysematous Cholecystitis

IMAGES IN CLINICAL MEDICINE: Lipemia Retinalis Associated with Secondary Hyperlipidemia

PERSPECTIVE: The Rosiglitazone Story â Lessons from an FDA Advisory Committee Meeting

IMAGES IN CLINICAL MEDICINE: Intravesical Foreign Body

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2007 â A 58-Year-Old Woman with Headaches, Weakness, and Strokelike Episodes

EDITORIAL: The Record on Rosiglitazone and the Risk of Myocardial Infarction

EDITORIAL: Rosiglitazone and Cardiotoxicity â Weighing the Evidence

EDITORIAL: Rosiglitazone â Continued Uncertainty about Safety

IMAGES IN CLINICAL MEDICINE: Severe Digital Ischemia

ORIGINAL ARTICLE: Rosiglitazone Evaluated for Cardiovascular Outcomes â An Interim Analysis

EDITORIAL: Rosiglitazone and Cardiovascular Risk

ORIGINAL ARTICLE: Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes

IMAGES IN CLINICAL MEDICINE: Chronic Calcific Pancreatitis

EDITORIAL: Prematurity and the Legacy of Intrauterine Stress

ORIGINAL ARTICLE: Glucose Regulation in Young Adults with Very Low Birth Weight

IMAGES IN CLINICAL MEDICINE: Severe Proliferative Diabetic Retinopathy

ORIGINAL ARTICLE: Long-Term Effect of Diabetes and Its Treatment on Cognitive Function

ORIGINAL ARTICLE: Interleukin-1âReceptor Antagonist in Type 2 Diabetes Mellitus

NEJM â Collection Updates for Diabetes

EDITORIAL: Treatment of Anemia in Chronic Kidney Disease â Strategies Based on Evidence

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

EDITORIAL: Gestational Diabetes â Whom Do We Treat?

ORIGINAL ARTICLE: Sex HormoneâBinding Globulin and Risk of Type 2 Diabetes in Women and Men

EDITORIAL: Diabetes Complications and the ReninâAngiotensin System

EDITORIAL: Diabetes with Coronary Disease â A Moving Target amid Evolving Therapies?

EDITORIAL: Glucose Control in the ICU â How Tight Is Too Tight?

EDITORIAL: Gestational Diabetes â Setting Limits, Exploring Treatments

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Chemical Immunosuppression in Islet Transplantation â Friend or Foe?

EDITORIAL: Intention to Treat â Initiating Insulin and the 4-T Study

PERSPECTIVE: The Rosiglitazone Story â Lessons from an FDA Advisory Committee Meeting

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2007 â A 58-Year-Old Woman with Headaches, Weakness, and Strokelike Episodes

EDITORIAL: Rosiglitazone and Cardiotoxicity â Weighing the Evidence

EDITORIAL: Rosiglitazone â Continued Uncertainty about Safety

ORIGINAL ARTICLE: Rosiglitazone Evaluated for Cardiovascular Outcomes â An Interim Analysis

ORIGINAL ARTICLE: Interleukin-1âReceptor Antagonist in Type 2 Diabetes Mellitus

PERSPECTIVE: Diabetes Treatment â Bridging the Divide

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2007 â A 59-Year-Old Woman with Diabetic Renal Disease and Nonhealing Skin Ulcers

PERSPECTIVE: Finding New Treatments for Diabetes â How Many, How Fast .Â .Â . How Good?

PERSPECTIVE: Obesity and Diabetes in the Developing World â A Growing Challenge

PERSPECTIVE: The Preventive Polypill â Much Promise, Insufficient Evidence

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2006 â A 35-Year-Old Pregnant Woman with New Hypertension

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 33-2006 â A 43-Year-Old Man with Diabetes, Hypogonadism, Cirrhosis, Arthralgias, and Fatigue

EDITORIAL: Angiotensin-ConvertingâEnzyme Inhibitors for Impaired Glucose Tolerance â Is There Still Hope?

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2006 â A 15-Year-Old Girl with Severe Obesity

EDITORIAL: Diabetes Cure â Is the Glass Half Full?

EDITORIAL: ATP-Sensitive Potassium Channels â Neonatal Diabetes Mellitus and Beyond

EDITORIAL: Genetic Variants and Common Diseases â Better Late Than Never

PERSPECTIVE: Facing the Diabetes Epidemic â Mandatory Reporting of Glycosylated Hemoglobin Values in New York City

EDITORIAL: Glycemic Control and Cardiovascular Disease â Should We Reassess Clinical Goals?

EDITORIAL: âDoctor, Is My Sugar Normal?â

EDITORIAL: Gastric Bypass and Nesidioblastosis â Too Much of a Good Thing for Islets?

EDITORIAL: Type 1 Diabetes â Does Suppressing T Cells Increase Insulin?

EDITORIAL: Gestational Diabetes Mellitus â Time to Treat

EDITORIAL: Deadweight? â The Influence of Obesity on Longevity

EDITORIAL: Bariatric Surgery â Quick Fix or Long-Term Solution?

EDITORIAL: Prematurity â A Window of Opportunity?

ORIGINAL ARTICLE: Angiotensin-Receptor Blockade versus ConvertingâEnzyme Inhibition in Type 2 Diabetes and Nephropathy

PERSPECTIVE: Treating Diabetic Nephropathy â Are There Only Economic Issues?

EDITORIAL: Embryonic Stem-Cell Research â The Case for Federal Funding