In this conversation, two pediatric endocrinology specialists, David Cook, MD, FACE and Dr. Laurence Katznelson, MD, join Dr. Carlos Hamilton, Jr. to discuss Therapeutic Goals of Acromegaly.

In this conversation, two pediatric endocrinology specialists, David Cook, MD, FACE and Dr. Laurence Katznelson, MD, join Dr. Carlos Hamilton, Jr. to discuss Therapeutic Goals of Acromegaly.

According to estimates, at least 15% to 30% of hospitalized patients have hyperglycemia or diabetes. A full 2/3 of critical care patients fall into this category, as do 1/3 of cardiac surgery patients. Hyperglycemia is associated with poor outcomes in the inpatient setting, including a higher rate of infection, delayed healing, and more procedure-related complications.

The standard treatment paradigm for newly diagnosed patients with diabetes is counseling the patient about diet and exercise and starting them on an oral agent.

Optimizing glycemic control in the inpatient setting is critical. In the ICU, target blood glucose (BG) levels should be less then 110 mg/dL. In the non-ICU inpatient setting, the level may vary, since patients are likely to be eating

There is a great deal of evidence that tight glycemic control in the intensive care unit after surgery, especially cardiovascular surgery, shortens the duration of hospitalization and prevents complications.

For newly diagnosed patients with type 1 or type 2 diabetes, education about diabetes is critical and should start immediately. For the clinician, the major tasks are to provide key information in the context of a "partnership" approach to treatment without overwhelming the patient.

Treatment of type 2 diabetes begins with efforts to improve lifestyle factors, including diet and exercise. However, lifestyle intervention alone has had limited long-term success in maintaining glycemic goals for most patients with type 2 diabetes, and the majority of patients with type 2 diabetes will require medication over the course of their diabetes.

Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise and weight reduction when appropriate. Oral monotherapy is often initiated as first-line therapy, though insulin may be indicated ...

Diet and physical activity are critically important in the treatment of type 1 and type 2 diabetes. Basic principles of nutritional management, however, are often poorly understood, both by both clinicians and their patients.

Current recommendations of the American Diabetes Association (ADA), which have been used predominantly in the United States, present goals for fasting/preprandial and bedtime glucose levels but do not define a target for postprandial glucose. The ADA guidelines also present a glycated hemoglobin (A1C) goal of less than 7%. The International Diabetes Federation (IDF) and the American College of Endocrinology (ACE) have each published guidelines that define targets for both fasting/preprandial and 2-h postprandial blood glucose and present 6.5% as their A1C goal for glycemic control.