Gastric emptying and the personalized management of type 1 diabetes
Date
2018
Authors
Marathe, C.
Rayner, C.
Wu, T.
Jones, K.
Horowitz, M.
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Journal article
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Journal of Clinical Endocrinology and Metabolism (JCEM), 2018; 103(9):3503-3506
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Chinmay S. Marathe, Christopher K. Rayner, Tongzhi Wu, Karen L. Jones and Michael Horowitz
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Abstract
It is increasingly advocated that management of type 1 and type 2 diabetes be “personalized” (i.e., targeted to the characteristics of the individual patient). This approach has major implications for health care costs, has proven successful in monogenic diabetes (2), and is practiced widely in other areas of medicine, such as oncology. Management strategies for type 1 diabetes currently focus on the achievement of targeted glycemic control, as assessed by a glycated hemoglobin (HbA1c) value <7% (or perhaps even lower) to diminish the development and progression of microvascular complications (i.e., retinopathy, neuropathy, and nephropathy) without increasing the risk of hypoglycemia (3). The longstanding strategy of normalizing fasting/preprandial blood glucose level, with lesser attention to postprandial blood glucose level, is now recognized as inappropriate. Indeed, this is to some extent self-evident, as in modern societies, many individuals eat three larger meals a day interspersed with snacks and accordingly spend the majority of the day in a postprandial state, with a period of true fasting of only a few hours before breakfast (4).
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Copyright © 2018 Endocrine Society