Diabetes has become a worldwide health problem, the global estimated prevalence approaches ten percent and the burden of this disease in terms of morbidity and mortality is unprecedented. The advances acquired through the knowledge of the mechanisms of the disease and the variety of therapeutic approaches contrast with the inability of private and public health systems in underdeveloped and even developed countries to achieve the goals of treatment. This paradox has been described in many sources: the surge of scientific advances contrast with an unprecedented amount of human suffering. Thus, a patient centered and an evidence based approach with the capacity to produce measurable clinical and economic outcomes is required. The purpose of this textbook is multiple: to offer a comprehensive resource covering all aspects of outpatient management; to address diabetes as a health problem from an epidemiological, economic and clinical perspective; to discuss the role of social determinants of health on the worldwide increase in diabetes; to highlight the challenges and obstacles in providing adequate care; and to outline a multidisciplinary approach to management in which medical visits retain their importance as part of a team comprising the patient, his or her family and a multidisciplinary group of health professionals who are able to move beyond the traditional approach of diabetes as a disease and greatly improve outcomes.
Introduction: A New Disease?.- Section 1 Magnitude of the Problem from an Individual and Social Context.- The Dynamics of Diabetes Prevalence, Morbidity and Mortality.- Economic Costs, from Individuals to Health Systems: Evidence from a Middle Income Country.- The Ecological Approach to Self-Care in Diabetes.- Social Determinants of Health and Diabetes Outcomes.- Section 2 Diagnosis, Classifications and Mechanisms of Disease.- Definition, Diagnostic Criteria, Screening, Diagnosis and Classification of Diabetes and Categories of Glucose Intolerance.- Pathophysiology of Type 1 Diabetes.- Pathophysiology of Type 2 Diabetes.- Genetic Determinants of Type 2 Diabetes.- Gene Expression Modifications in Type 2 Diabetes.- The Immune System and Inflammation in Type 2 Diabetes.- Dysfunction and Death of Pancreatic Beta Cells in Type 2 Diabetes.- Obesity in the Pathophysiology of Diabetes.- Pathogenesis of Gestational Diabetes.- Non-Alcoholic Fatty Liver in the Pathogenesis of Diabetes.- Section 3 Global Experiences in Diabetes Care.- Diabetes Management in Europe.- Diabetes Management in Asia.- Diabetes Management in the United States.- Diabetes Management in Africa.- Section 4 Basic Components of Management: Patient Centeredness, Evidence-Based Medicine and Outcomes. Challenges for Implementation.- The Patient-Centered Medical Home, Primary Care and Diabetes.- Outpatient Diabetes Management and the Chronic Care Model.- Clinical Practice Guidelines for Diabetes.- Quality of Diabetes Care: Measuring Clinical Impact, Cost Effectiveness and Patient Experience of Care.- Clinical Inertia in Diabetes: The Role of Physicians.- Patient Adherence in Diabetes: Challenges, Myths and Realities.- Section 5 Resources of Support for Persons with Diabetes.- Challenges and Opportunities in Diabetes Education.- Diabetes and Mental Health: From Distress to Depression.- Tools of Self-Care: Self-Monitoring of Blood Glucose and Tele-health Resources.- Continuous Glucose Monitoring and Clinical Decision Making.- Diabetes and Lifestyle Medicine.- Evidence and Implementation of Nutrition Therapy in Persons with Diabetes.- Evidence and Implementation of Physical Activity and Exercise.- Section 6 Drug Therapy.- The "Old" Oral Antidiabetics.- Incretin Therapies: Current Use and Emerging Possibilities.- Sodium Glucose Transporter Inhibitors.- Insulin in Outpatient Diabetes Management.- Insulin Pump Therapy.- Section 7 Cardiovascular Risk Factors.- Diabetes and Hypertension.- Diabetes and Atherogenic Dyslipidemia.- Diabetes and Obesity.- Diabetes and Smoking.- Section 8 Acute Complications.- Hyperglycemic Crisis: Diabetic (ketoacidosis (DKA).- Hypoglycemia: Diagnosis, Management and Prevention.- Inpatient Management of Diabetes and Hyperglycemia.- Diabetes and Infection.- Section 9 Chronic Complications.- Diabetes and Stroke: The Role of Glucose Regulation.- Diabetes and Peripheral Artery Disease.- Biochemical and Molecular Mechanisms of Vascular Complications in Diabetes.- Ophthalmologic Eye Disease.- Diabetes and Oral Health.- Renal Disease in Diabetes.- Peripheral Diabetic Neuropathies.- Diabetic Cardiac Autonomic Neuropathy.- Autonomic Visceral Neuropathy and Gastrointestinal Disorders.- Urologic Complications and Sexual Dysfunction.- Musculoskeletal Complications of Diabetes.- Diabetes and the Skin.- Foot Complications.- Diabetes and Cancer.- Section 10 Diabetes in Special Populations.- Children and Adolescents.- Pregnancy: Pregestational and Gestational Management.- The Elderly with Diabetes.- Section 11 Diabetes Prevention.- Prevention of Type 2 Diabetes: Evidence and Challenges.- Section 12 Novel Therapeutic Approaches: Evidence-Based and Others.- Insulin Pumps and Closed Loop Systems and the Artificial Pancreas.- Unproven Therapies for Diabetes.