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http://general-medicine.jwatch.org/cgi/content/full/2010/1230/3?q=topic_diabetes 老年糖尿病患者，嚴格血糖控制，對ESRD, retinopathy沒有用，neuropathy有一點點用 血脂控制(加上fenofibrate)也沒有滿意的答案 唯一一個明確的答案是BP control SBP 130mmHg 即可 ACCORD: Microvascular Outcomes In older diabetic patients, clinical microvascular endpoints were unaffected by tight glycemic control. In the landmark ACCORD trial, older patients with longstanding type 2 diabetes were randomized to various intensities of glycemic control, blood pressure (BP) control, and lipid management. The first round of published results dealt with so-called "macrovascular outcomes" — myocardial infarction, stroke, and cardiovascular death (JW Gen Med Jun 6 2008, JW Cardiol Mar 14 2010, and JW Cardiol Mar 14 2010; also JW Gen Med Dec 30 2010). In 2010, data on microvascular outcomes were published. In the glycemic-control arm of the study, patients were randomized to intensive or standard treatment, which resulted in mean glycosylated hemoglobin (HbA1c) levels

http://general-medicine.jwatch.org/cgi/content/full/2010/1230/2?q=topic_diabetes long standing type 2 DM, age 60+ -> BP 130即可,fenofibrate沒啥用 對於vascular event而言 ACCORD: Blood Pressure and Lipid Results For older diabetic patients, a systolic BP target in the 130s probably is best. The ACCORD trial is best known for its findings, published in 2008, on the effect of glycemic control on macrovascular endpoints. Older patients (mean age, 62) with longstanding type 2 diabetes (average duration, 10 years) received either intensive or standard glucose-lowering therapy, resulting in mean glycosylated hemoglobin (HbA1c) levels of 6.4% and 7.5%, respectively. The trial was halted after about 4 years of follow-up, during which overall mortality actually was higher with intensive glycemic control, and the primary endpoint (myocardial infarction, stroke, or cardiovascular death) occurred with similar frequency in the two groups (JW Gen Med Jun 6 2008). Many ACCORD patients also were randomized to

有氧運動--每週走兩小時，(3 miles/hr speed) 阻力運動--一周三天 合併 -- 80% aerobic 1/3 resistance 搞九個月，分別降 0.24%, 0.16%. 0.34% HBA1c，一點點成績!! so patients are probably best advised to exercise however they can, whenever they can, doing whatever they like, rather than trying to follow an overly prescriptive regimen. Exercise and Glucose Control in Patients with Type 2 Diabetes A combination of resistance and aerobic training was better than either one alone. Aerobic exercise and resistance training often are recommended in combination in patients with type 2 diabetes mellitus, but the data supporting a combination, as opposed to either type alone, are scarce. In a randomized controlled trial, 262 sedentary patients (mean age, 56; mean body-mass index, 35 kg/m2, mean glycosylated hemoglobin [HbA1c] level, 7.7%) were assigned to resistance training alone, aerobic exercise alone, both exercises together, or usual activity. Aerobic exercise consisted of walking at a pace of about 3 miles per hour for about 2 hours

加拿大健保局資料庫文章 過去我們都認為ICS很safe, 提防osteoporosis/cataract就好 但是根據此篇文章 low dose ICS 增加 34%，high odse ICS增加64% DM risk Inhaled Corticosteroids Might Provoke Diabetes In an observational study, diabetes was more likely to develop in current steroid users. Randomized trials have not shown a connection between use of inhaled corticosteroids (ICS) and risk for diabetes; however, these studies might have been underpowered to detect this association. In a new study, researchers evaluated risk for developing diabetes among nearly 400,000 residents of Quebec, Canada, who did not have diabetes when they began ICS treatment between 1990 and 2005. During a mean follow-up of 5.5 years, 30,000 people initiated treatment for diabetes. After adjustment for multiple factors, including respiratory disease severity and comorbid conditions, incidence of diabetes was 34% higher among people who were currently receiving ICS than among those who were not. A dose–response association also was detected (rate ratios,