Volume 103, Issue s85

Early screening of patients at high risk for type 1 or type 2 diabetes mellitus is key to early diagnosis and comprehensive treatment. Because osteopathic physicians predominantly practice primary care, they are well positioned to serve a leadership role in the fight against the dual epidemics of obesity and diabetes. This overview provides some important and helpful practice “jewels” to guide a primary care approach to screening, diagnosis, and treatment of diabetes.

This clinical review looks at tight control of blood glucose with oral agents and insulin in adults and children with type 2 diabetes mellitus. It includes recommendations based on the treatment algorithms from the Texas Diabetes Council. The focus is on specific indications for selecting initial monotherapy, early dual therapy, or combination oral therapy. Discussion includes glycemic targets and times to goal along with recommendations for insulin management that depend on patient stratification as “treatment naïve” or “combination oral agent failures” (defined as A1c value ⩽9.5% or >9.5%). This presentation also includes protocols for once-daily injections, multidose insulin injections, and intensive insulin therapy (physiologic insulin delivery) as well as discussion of starting doses, titration schedules, optimum basal bolus insulin regimen, and calculation of insulin augmentation.

Members of the “osteopathic medical family” who themselves are patients with diabetes related their medical histories at the American College of Osteopathic Family Physicians symposium, “The Faces of Diabetes.” The program was conducted Monday, October 7, 2002, in Las Vegas during the 107th Annual American Osteopathic Association Convention and Scientific Seminar. This article briefly discusses issues in the management of diabetes illustrated by the individual histories. Topics represented by “the faces of diabetes” include diabetes and comorbidities, hypoglycemia in diabetes mellitus, abnormalities associated with insulin-induced hypoglycemia, and diabetes in pregnancy.

Evidence-based “Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications” outline the goals of medical nutrition therapy for type 1 and type 2 diabetes mellitus. Those goals are (1) to attain and maintain optimal metabolic outcomes, (2) to prevent and treat the chronic complications of diabetes, (3) to improve health through healthy food choices and through physical activity, and (4) to address individual patient nutritional needs. Discussion focuses on moderate caloric restriction and an increase in physical activity. Carbohydrate counting is offered as an option for all patients with diabetes. Working with other health care professionals can be a benefit to both the primary health care provider and the patient.