1
|
Retnakaran R, Kashyap SR, Gerstein HC, Aroda VR. Contemporary Clinical Perspectives on Targeting Remission of Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:1179-1188. [PMID: 38108415 DOI: 10.1210/clinem/dgad746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
It has long been known that some patients with type 2 diabetes (T2DM) can experience sustained metabolic improvement to near-normal levels of glycemia either spontaneously or after medical intervention. Now recognized as remission of diabetes, this intriguing state is currently more feasible than ever before due to profound advances in metabolic surgery, pharmacologic therapy, and regimens of lifestyle modification. This enhanced capacity to induce remission has revealed new pathophysiologic insights, including the presence of a reversible component of the pancreatic beta-cell dysfunction that otherwise drives the chronic progressive nature of T2DM. In doing so, it has changed the therapeutic landscape by offering new potential management objectives and considerations for patients and providers. However, the excitement around these developments must also be tempered by the sobering realities of our current understanding of remission, including the recognition that this condition may not be permanent (resulting in glycemic relapse over time) and that beta-cell function may not be normalized in the setting of remission. These limitations highlight both the many gaps in our current understanding of remission and the caution with which clinical discussions must be handled for clear patient-directed communication of the pros and cons of targeting this outcome in practice. In this mini-review, we consider this rapidly growing literature, including its implications and its limitations, and thereby seek to provide objective balanced perspectives on targeting remission of T2DM in current clinical care.
Collapse
Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON M5S 3H2, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Sangeeta R Kashyap
- Division of Endocrinology, Diabetes, and Metabolism, New York Presbyterian-Weill Cornell Medicine, New York, NY 10021, USA
| | - Hertzel C Gerstein
- Division of Endocrinology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
3
|
Tong Y, Chen H, Wang Y, Wu Z, Gu J, Wu Q, Wang J, Luo H, Bao A, Zheng H. An Innovative Teaching Approach for Diabetes Mellitus in Laboratory Medicine Uses the Clinical Laboratory Diagnostic Pathway. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219396. [PMID: 38152834 PMCID: PMC10752126 DOI: 10.1177/23821205231219396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
Objectives The routine teaching mode of diabetes mellitus (DM) is divided into various sub-majors of medical laboratory, which is not conducive to clinical laboratory physicians quickly mastering relevant knowledge. A novel DM laboratory testing pathway is established to improve teaching efficiency and enhance the effects of talent cultivation in laboratory medicine. Methods The guidelines and expert consensuses of DM were gathered from professional websites and databases. The clinical laboratory diagnostic pathway was formulated, and the questionnaire and mutual evaluation were used to evaluate the teaching effectiveness of 8-year undergraduate students enrolled in 2018 and enrolled in 2019, respectively. Results Clinical laboratory physicians developed and approved the DM clinical laboratory diagnostic pathway, which included the entire process of DM diagnosis and differential diagnosis, drug selection, treatment impact monitoring, prognosis evaluation, etc. The results of the questionnaires showed that, in comparison to the teaching mode used with the students enrolled in 2018 and enrolled in 2019, the percentages of more improvement and significant improvement were significantly increased (P < 0.01) and the percentages of no improvement and slight improvement were significantly decreased (P < 0.01). Following the instruction of the DM clinical laboratory diagnostic route, the results were greatly improved, including points emphasized and the accuracy of responding to questions, among other things, according to the teachers' and students' mutual evaluation (P < 0.05). Conclusions To enhance the teaching quality in laboratory medicine, it is required to build the disease clinical laboratory diagnostic pathway for a novel teaching method. This may boost teachers' and students' confidence and broaden their knowledge.
Collapse
Affiliation(s)
- Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| | - Hongbin Chen
- Department of Pulmonary and Critical Care Medicine of Renmin Hospital, Wuhan University, Wuhan, China
| | - YingYing Wang
- Department of Out-Patient Services, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zegang Wu
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| | - Jian Gu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Wu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingwei Wang
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| | - Hongbo Luo
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Anyu Bao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyun Zheng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
- Office of Laboratory Medicine Teaching Affairs, The First Clinical College of Wuhan University, Wuhan, China
| |
Collapse
|
4
|
Ricci M, Mancebo-Sevilla JJ, Cobos Palacios L, Sanz-Cánovas J, López-Sampalo A, Hernández-Negrin H, Pérez-Velasco MA, Pérez-Belmonte LM, Bernal-López MR, Gómez-Huelgas R. Remission of type 2 diabetes: A critical appraisal. Front Endocrinol (Lausanne) 2023; 14:1125961. [PMID: 37077356 PMCID: PMC10107406 DOI: 10.3389/fendo.2023.1125961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Michele Ricci
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- *Correspondence: Michele Ricci, ; Maria Rosa Bernal-López,
| | - Juan José Mancebo-Sevilla
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Lidia Cobos Palacios
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Jaime Sanz-Cánovas
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Almudena López-Sampalo
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Halbert Hernández-Negrin
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
| | - Miguel Angel Pérez-Velasco
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
| | - Luis M. Pérez-Belmonte
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- Servicio de Medicina Interna, Hospital Helicópteros Sanitarios, Marbella, Spain
| | - Maria Rosa Bernal-López
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Michele Ricci, ; Maria Rosa Bernal-López,
| | - Ricardo Gómez-Huelgas
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma BIONAND), Malaga, Spain
- Faculty of Medicine, Universidad de Málaga, Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
5
|
MacKay D, Chan C, Dasgupta K, Dominy C, Gagner M, Jin S, Kim J, Little JP, MacDonald B, McInnes N, Reichert S, Bajaj HS, Bajaj HS, Gilbert J, Houlden R, Kim J, MacDonald B, MacKay D, Mansell K, Rabi D, Senior P, Sherifali D. Remission of Type 2 Diabetes: Diabetes Canada Clinical Practice Guidelines Expert Working Group. Can J Diabetes 2022; 46:753-761.e8. [PMID: 36567079 DOI: 10.1016/j.jcjd.2022.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|