Special issue of Current Diabetes Review explores the management of diabetes in medically complex patients

Diabetes affects roughly 30 million Americans, and is one of the leading causes of disability and mortality. As a result, organizations such as the American Diabetes Association (ADA), Endocrine Society and American Association of Clinical Endocrinologists (AACE) have made efforts to move away from the one size fits all management of diabetes. Instead, diabetes management is now customized based on patient variables such as age, life expectancy, co-morbid conditions, finances, and patient goals.

As a result this special issue of Current Diabetes Review guest edited by Dr. Alyson Myers explores the management of diabetes in medically complex patients. The ADA has recently released a statement in November 2016 on the need to assess for psychosocial issues that impair diabetes management. Two articles of this special issue address mental illness. In the article Diabetes and Schizophrenia, Dr. Jeffrey Rado explores the association between diabetes and schizophrenia. Antipsychotic medications, as well as sedentary lifestyle make this population vulnerable to developing diabetes. Drs. Madhuker Trivedi and Alyson Myers discuss the management of the self-harming or suicidal patient with diabetes. Insulin is considered a high risk medication, thus it can be manipulated to cause severe hyper or hypoglycemia which can both potentially lead to death.

In addition to the integration of psychosocial assessment into diabetes management, weight management is also a part of diabetes care. Drs. Maria Pena and Trisha Newaz review post-bariatric surgery care for those with diabetes. Many of these patients require medication adjustments due to hormonal changes which decrease insulin resistance. Those with shorter duration of diabetes or on oral agents have a greater chance of reversal of diabetes with bariatric surgery.

Another group of persons with diabetes who require specialized care are older adults. Dr. Nana Yaw Adu-Sarkodie, gerontologist describes how aging can affect glucose metabolism. Also he explores the need medication adjustments and vulnerability of the elderly to side effects of diabetic medications. Elderly patients are at increased risk of hospitalizations, so the transitions of care from the inpatient to outpatient setting are examined by Nurse Practitioner Patricia Garnica.

Lastly we still have not closed the gap on the poorer outcomes for disparity populations. Non-white Hispanics have lower rates of complications when compared to ethnic minorities. Dr. Maya Fayfman explores the biological and psychosocial variables leading to this.

This special edition is aimed for health care providers who manage persons with diabetes in both the inpatient and ambulatory care settings.