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Epidemiology is particularly important since it enables to monitor the development and the evolution of diabetes, its progression, frequency and distribution among a population. As such, it contributes to a better understanding of the disease and its origin. Furthermore, epidemiological studies may reveal factors that intervene at the outbreak of the disease.

Presentations listing

Populations at Risk for Diabetes - Dr. Milan Gupta
Hypertension in Diabetes: Time Trends and Predictors of BP... - Dr. Peter M. Nilsson
Australia and the Obesity Epidemic - Past and Future - Dr. Senator Guy Barnett
Diabetes and Metabolic Syndrome - An Asian Perspective - Prof. Juliana Chan
Epidemiology of Prediabetes and Metabolic Syndrome in... - Dr. A. Ramachandran
Diabetes: The Global Pandemic - Prof. Paul Zimmet
Diabetes: The Magnitude of the problem and it's... - Prof. Bernard Zinman
DM and Cardiovascular Disease in Women - Dr. Gillian Booth
Microalbuminuria and Kidney Disease In Type 2 Diabetes - Dr. Steven Soroka
Genetics, Environment and a Global Epidemic - Dr. Salim Yusuf
Welcome, introductions and objectives - Dr. Lawrence A. Leiter
Diabetes Care and Outcomes in Ontario - Dr. Gillian Booth

"Populations at Risk for Diabetes"

Dr. Milan Gupta (biography)
English - 2006-10-24 - 29 minutes
(30 slides)

Summary :
Diabetes is known to be associated with increased cardiovascular risk, and abdominal obesity is strongly related to diabetes risk (1) and the risk of myocardial infarction (2).

Is the risk for abdominal obesity, diabetes, or CVD similar among ethnic groups? The Canadian SHARE study published in 2000 indicates that there are differences, with South Asians being particularly...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The link between diabetes and cardiovascular risk
- The link between diabetes and obesity
- The relation of ethnicity to glycaemic and cardiovascular risk
- Pre-diabetic conditions

Bibliographic references :
1. Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, Speizer FE,
Manson JE.Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study. Am J Epidemiol. 1997 Apr 1;145(7):614-9.

2. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais
P, Varigos J, Lisheng L; INTERHEART Study Investigators.Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study Lancet. 2004 Sep 11-17;364(9438):937-52.

3. Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, Kelemen L, Yi C,
Lonn E, Gerstein H, Hegele RA, McQueen M.Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE) Lancet. 2000 Jul 22;356(9226):279-84.

4. Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willett WC, Manson JE.Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Diabetes Care. 2002 Jul;25(7):1129-34.

5. The DECODE Study Group on behalf of the European Diabetes Epidemiology GroupIs the Current Definition for Diabetes Relevant to Mortality Risk From All Causes and Cardiovascular and Noncardiovascular Diseases? Diabetes Care 26:688-696, 2003.



"Hypertension in Diabetes: Time Trends and Predictors of BP Control"

Dr. Peter M. Nilsson (biography)
English - 2006-05-17 - 40 minutes
(32 slides)

Summary :
In this presentation Dr. Nilsson talks about the importance of blood pressure control in type 2 diabetes, and presents data from the National Diabetes Register of Sweden on trends in blood pressure control as well as predictors of successful long-term blood pressure control in type 2 diabetic patients.

Raised blood pressure is strongly associated with the risk of diabetic...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Clinical benefits of reducing high blood pressure in type 2 diabetic patients
- Useful drug combinations for blood pressure control in patients with hypertension and type 2 diabetes
- Trends in glycemic and blood pressure control and predictors of successful long-term blood pressure control in type 2 diabetic patients: data from the National Diabetes Register of Sweden

Bibliographic references :
1. Amanda I Adler, epidemiologist, Irene M Stratton, senior statistician, H Andrew W Neil, university lecturer in clinical epidemiology, John S Yudkin, consultant physician, David R Matthews, consultant diabetologist, Carole A Cull, senior statistician, Alex D Wright, consultant physician, Robert C Turner, director, Rury R Holman, director, a on behalf of the UK Prospective Diabetes Study Group.Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study BMJ 2000;321:412-419.

2. Nilsson, Peter M a; Cederholm, Jan b; Gudbjornsdottir, Soffia c; Eliasson, Bjorn d; for the Steering Committee of the National Diabetes Register of SwedenPredictors of successful long-term blood pressure control in type 2 diabetic patients: data from the Swedish National Diabetes Register (NDR). Journal of Hypertension. 23(12):2305-2311, December 2005.



"Australia and the Obesity Epidemic - Past and Future"

Dr. Senator Guy Barnett (biography)
English - 2005-04-14 - 20 minutes
(11 slides)

Summary :
Australians are getting fatter, asserts Australian Senator Guy Barnett of Tasmania. What is to be done about it?

Senator Barnett presents here a synopsis of the state of the obesity epidemic in Australia, highlighting both the health and economic costs and addressing some of the societal issues that may be at the root of this growing problem.

Most interestingly,...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The state of the obesity epidemic in Australia
• The initiatives that the Australian Government has instituted in the community
• The initiatives that the Australian Government has instituted with key stakeholders



"Diabetes and Metabolic Syndrome - An Asian Perspective"

Prof. Juliana Chan (biography)
English - 2005-04-14 - 32 minutes
(45 slides)

Summary :
In this presentation Dr. Chan gives an Asian perspective on diabetes and the metabolic syndrome, focusing on studies from China.

About 60 million Chinese adults of age 35-74 years are estimated to have diabetes or impaired fasting glucose, and Dr. Chan shows data from the DECODA study on the prevalence of diagnosed and undiagnosed DM, and IFG/IGT in Chinese and Japanese men and...

Learning objectives :
After viewing this presentation the participant will be able to discuss studies from Asian (mainly Chinese) populations on the following:

- The prevalence of obesity, diabetes and metabolic syndrome
- The relationship between metabolic syndrome and CVD
- The effect of weight reduction on components of the metabolic syndrome

Bibliographic references :
Gu D, Reynolds K, Duan X, Xin X, Chen J, Wu X, Mo J, Whelton PK, He J; InterASIA Collaborative Group.Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA).Diabetologia. 2003 Sep;46(9):1190-8. Epub 2003 Jul 15.

The DECODA Study Group Age- and Sex-Specific Prevalence of Diabetes and Impaired Glucose Regulation in 11 Asian Cohorts Diabetes Care 26:1770-1780, 2003

Chee-Eng Tan, Stefan Ma, Daniel Wai, Suok-Kai Chew, and E.-Shyong TaiCan We Apply the National Cholesterol Education Program Adult Treatment Panel Definition of the Metabolic Syndrome to Asians?Diabetes Care 27: 1182-1186.

Jung-Nan Wei; Fung-Chang Sung; Chau-Ching Lin; Ruey-Shiung Lin; Chuan-Chi Chiang; Lee-Ming ChuangNational Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children JAMA, Sep 2003; 290: 1345 - 1350.

Peter C. Y. Tong; Zoe S. K. Lee; Man-Mei Sea; Chun-Chung Chow; Gary T. C. Ko; Wing-Bun Chan; Wing-Yee So; Ronald C. W. Ma; Risa Ozaki; Jean Woo; Clive S. Cockram; Juliana C. N. Chan The Effect of Orlistat-Induced Weight Loss, Without Concomitant Hypocaloric Diet, on Cardiovascular Risk Factors and Insulin Sensitivity in Young Obese Chinese Subjects With or Without Type 2 Diabetes Archives of Internal Medicine, Nov 2002; 162: 2428 - 2435.



"Epidemiology of Prediabetes and Metabolic Syndrome in Indians"

Dr. A. Ramachandran (biography)
English - 2005-04-14 - 25 minutes
(22 slides)

Summary :
Objective: To highlight high prevalence and the peculiarities of prediabetic conditions and the metabolic syndrome in India.

Method: Epidemiological data on the prevalence and risk associations of prediabetic conditions, and occurrence and peculiarities in metabolic syndrome are described.

Results: Both IFG (8.7%) and IGT (8.1%) show high prevalence in India with an...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The prevalence of prediabetes in the Indian population based on IGT and IFG;
• The prevalence of the metabolic syndrome among the Indian population.

Bibliographic references :
Ramachandran A, Snehalatha C, Vijay V.Temporal changes in prevalence of type 2 diabetes and impaired glucose tolerance in urban southern India.Diabetes Res Clin Pract. 2002 Oct;58(1):55-60

Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Nair JD; Diabetes Epidemiology Study Group in India (DESI).High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.Diabetologia. 2001 Sep;44(9):1094-101.

Ramachandran A, Snehalatha C, Baskar AD, Mary S, Kumar CK, Selvam S, Catherine S, Vijay V.Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India.Diabetologia. 2004 May;47(5):860-5. Epub 2004 Apr 28.



"Diabetes: The Global Pandemic"

Prof. Paul Zimmet (biography)
English - 2004-04-14 - 53 minutes
(56 slides)

Summary :
In this One on One presentation Prof. Zimmet answers the question posed by Dr. Lawrence Leiter: ''What does epidemiology teach us about the causes of the diabetes epidemic and, more importantly, its potential prevention and treatment?''

Prof. Zimmet discusses the burden of diabetes worldwide, and presents data from several epidemiological studies. These studies tell us how the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The prevalence of diabetes and IGT in various populations around the world
- Global projections for the diabetes and IGT epidemics
- Type 2 diabetes in children and adolescents
- Approaches to preventing type 2 diabetes

Bibliographic references :
Michael L Booth, Tien Chey, Melissa Wake, Kevin Norton, Kylie Hesketh, Jim Dollman and Ian Robertson. Change in the prevalence of overweight and obesity among young Australians, 1969–1997 American Journal of Clinical Nutrition 2003; 77(1): 29-36.

VJ Carey, EE Walters, GA Colditz, CG Solomon, WC Willett, BA Rosner, FE Speizer and JE Manson. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study American Journal of Epidemiology 1997;145(7):614-619

David W. Dunstan, PHD, Paul Z. Zimmet, MD, Timothy A. Welborn, PHD, Maximilian P. de Courten, MD, Adrian J. Cameron, MPH, Richard A. Sicree, MPH, Terry Dwyer, PHD, Stephen Colagiuri, MD, Damien Jolley, MSC, Matthew Knuiman, PHD, Robert Atkins, MD and Jonathan E. Shaw, MD On Behalf of the AusDiab Steering Committee. The Rising Prevalence of Diabetes and Impaired Glucose Tolerance The Australian Diabetes, Obesity and Lifestyle Study Diabetes Care 2002; 25:829-834.

Anthony JG Hanley, Stewart B Harris, Joel Gittelsohn, Thomas MS Wolever, Brit Saksvig and Bernard Zinman. Overweight among children and adolescents in a Native Canadian community: prevalence and associated factors American Journal of Clinical Nutrition 2000; 71(3):693-700.

SB Harris, J Gittelsohn, A Hanley, A Barnie, TM Wolever, J Gao, A Logan and B Zinman. The prevalence of NIDDM and associated risk factors in native Canadians Diabetes Care 1997; 20(2):185-187.

Bo Isomaa, MD, Peter Almgren, MSC, Tiinamaija Tuomi, MD, Björn Forsén, MD, Kaj Lahti, MD, Michael Nissén, MD, Marja-Riitta Taskinen, MD and Leif Groop, MD. Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome Diabetes Care 2001; (24):683-689.

Kitagawa T, Owada M, Urakami T, Yamauchi K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila). 1998 Feb;37(2):111-5.



"Diabetes: The Magnitude of the problem and it's relationship to the Metabolic Syndrome"

Prof. Bernard Zinman (biography)
English - 2003-06-16 - 14 minutes
(11 slides)

Summary :
The prevalence of diabetes is expected to increase by 76% by 2025, and this increase seems to be taking place not only in Europe and North America, but in developing countries as well. Driving this epidemic is another one - the obesity epidemic, and we know that larger and larger food portions have been contributing to this. Regarding pathophysiology, we know that beta cell failure leads to type...

Learning objectives :
The participant will be given a recap of the recent foci of research on the pathophysiology of type 2 diabetes, as well as an introduction to baseline findings from the ADOPT study addressing the prevalence of the metabolic syndrome in recently diagnosed type 2 diabetics:

- Beta cell failure leads to type 2 diabetes, but treatment of insulin resistance improves many of its associated factors such as hyperinsulinemia, ambulatory BP, dyslipidemia, visceral fat, microalbuminuria and hyperglycemia, with data still to come on whether CVD outcomes can also be changed.

- New research is giving us more and more information on the role of “adipokines” in contributing to insulin resistance.

- The ADOPT Study has so far revealed a > 80% prevalence of metabolic syndrome in recently-diagnosed type 2 diabetics, and points to NCEP criteria as being superior to WHO criteria in identifying affected patients.

Bibliographic references :
Viberti G, Kahn SE, Greene DA, Herman WH, Zinman B, Holman RR, Haffner SM, Levy D, Lachin JM, Berry RA, Heise MA, Jones NP, Freed MI. A diabetes outcome progression trial (ADOPT): an international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes. Diabetes Care. 2002 Oct;25(10):1737-43.



"DM and Cardiovascular Disease in Women"

Dr. Gillian Booth (biography)
English - 2003-05-23 - 28 minutes
(35 slides)
(8 questions)

Summary :
We are now all familiar with the increased risk of heart disease in patients with diabetes mellitus (Haffner et al.1998. NEJM 339: 229-34). What about gender differences within this population? The Nurses Health Study showed a marked increase in the risk for diabetic women with a history of CHD to have a fatal CHD event if they had diabetes for over 15 years (Hu et al. 2001. Arch Int Med 161:...

Learning objectives :
The participant will review a substantial body of data derived from the Ontario Diabetes Database (ODD) elucidating the following points:

- DM reduces the gender gap in CVD
- Relatively higher CVD procedure use in men than in women
- Both genders – earlier and greater risk of CVD

Bibliographic references :
Arch Intern Med 2001 Jul 23;161(14):1717-23
The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women: 20 years of follow-up.
Hu FB, Stampfer MJ, Solomon CG, Liu S, Willett WC, Speizer FE, Nathan DM, Manson JE.

N Engl J Med 1998 Jul 23;339(4):229-34
Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.
Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M.



"Microalbuminuria and Kidney Disease In Type 2 Diabetes"

Dr. Steven Soroka (biography)
English - 2002-11-23 - 28 minutes
(46 slides)

Summary :
Here we will get a nephrology perspective on type 2 diabetes. Type 2 diabetes and chronic kidney disease are both common, but microalbuminuria (MAU) is more closely correlated with CVD than is kidney disease. Two important questions we have been asking ourselves are: What are the modifiable risk factors for kidney disease? And, What is the most cost effective way of treating kidney disease and...

Learning objectives :
The participant will get a nephrology perspective on the delay of onset and treatment of diabetic nephropathy:

- Diabetes and chronic kidney disease are common
- Early, aggressive treatment is needed
- Blood pressure control is essential and cost effective
- RAAS blockade confers additional cardio renal protection

Bibliographic references :
Deira J, Diaz H, Grande J. 2003. Complete blockade of the Renin-Angiotensin system in patients with advanced diabetic nephropathy. Diabetes Care 2003 May;26(5):1635-6

Jungmann E. 2003. Prevention and treatment of diabetic nephropathy in older patients. Drugs Aging 2003;20(6):419-35



"Genetics, Environment and a Global Epidemic"

Dr. Salim Yusuf (biography)
English - 2002-10-28 - 31 minutes
(19 slides)
(2 questions)

Summary :
It is not commonly recognized that the majority of cardiovascular disease now occurs in developing countries. While cardiovascular disease rates had increased in western countries between 1950 and 1980, they have come down markedly (by as much as 50%) in many countries, including Canada and the US. By contrast the age-adjusted rates of cardiovascular disease is increasing in most of the...

Learning objectives :
The presentation will outline the rising burden of obesity and diabetes globally and discuss the proposed hypotheses for the dramatic rise in metabolic syndrome.

Bibliographic references :
Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization.

Yusuf S, Reddy S, Ounpuu S, Anand S.

Population Health Research Institute and Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Circulation 2001 Nov 27;104(22):2746-53



"Welcome, introductions and objectives"

Dr. Lawrence A. Leiter (biography)
English - 2002-04-26 - 17 minutes
(21 slides)

Summary :
In this introductory talk at the beginning of the first Working Group on Insulin Resistance conference, Dr Leiter gives an overview of some epidemiological aspects of type 2 daibetes, its etiology, complications and pathology. Studies such as UKPDS and ADOPT are discussed, as well as CDA guidelines for glycemic control. Finally, Dr Leiter outlines the objectives of the Working Group on Insulin...

Learning objectives :
The participant will get an overview of some current topics in the nature and treatment of type 2 diabetes.

Bibliographic references :
Diabetes Screening in Canada (DIASCAN) Study: prevalence of undiagnosed diabetes and glucose intolerance in family physician offices.

Leiter LA, Barr A, Belanger A, Lubin S, Ross SA, Tildesley HD, Fontaine N; Diabetes Screening in Canada (DIASCAN) Study.

St. Michael's Hospital and University of Toronto, 61 Queen St. E., M4V 2L5 Toronto, Ontario, Canada.

OBJECTIVE--To assess the prevalence of undiagnosed diabetes and glucose intolerance in individuals > or =40 years of age who contacted their family physician for routine care. RESEARCH DESIGN AND METHODS--The study used a stratified randomized selection of family physicians across Canada that was proportional to provincial and urban/rural populations based on Statistics Canada Census data (1996). Consecutive patients > or=40 years of age were screened for diabetes. If a casual fingerprick blood glucose was >5.5 mmol/l, the patient returned for a fasting venous blood glucose test. If the fasting blood glucose was 6.1-6.9 mmol/l, a 2-h 75-g post-glucose load venous blood glucose was obtained. Results of these tests were used to classify patients in diagnostic categories. RESULTS--Data were available for 9,042 patients. Previously undiagnosed diabetes was discovered in 2.2% of the patients, and new glucose intolerance was found in an additional 3.5% of patients. Overall, 16.4% of patients had previously known diabetes. The decrease in fasting plasma glucose criterion from 7.8 to 7.0 mmol/l resulted in a 2.2% versus a 1.6% prevalence of new diabetes. Several risk factors were reported in a significantly greater proportion of patients with new glucose intolerance and either new and known diabetes compared with the normal glucose tolerance group of patients. CONCLUSIONS--Routine screening for diabetes by family physicians is justified in patients >or =40 years of age, given the finding of previously undiagnosed diabetes in 2.2% of these patients and newly diagnosed glucose intolerance in an additional 3.5% of these patients. Another 16.4% of primary care patients > or =40 years of age have known diabetes. This has important implications regarding health resources and physician education.

Diabetes Care 2001 Jun;24(6):1038-43



"Diabetes Care and Outcomes in Ontario"

Dr. Gillian Booth (biography)
English - 2002-01-19 - 25 minutes
(22 slides)

Summary :
Discussion on medical care for diabetes in Ontario. Statistical information providing an overview on the geographic distribution of diabetes in Ontario, as well as the quality and type of medical care offered.

Learning objectives :
Upon completion of this presentation, participants should be able to:1. Learn how administrative data can be used to study the quality of care and outcomes of diabetes in Ontario.2. Understand how well guidelines for diabetes care are generally adhere

Bibliographic references :
Diabetes care in the u.s. And Canada.

Booth GL, Zinman B, Redelmeier DA.

Department of Medicine St. Michael's Hospital, Toronto, Ontario, Canada. Mount Sinai Hospital, Toronto, Ontario, Canada. Sunnybrook and Women's College Health Science Centre, University of Toronto, Toronto, Ontario, Canada.

OBJECTIVE-To compare the glycemic control of patients with type 1 diabetes treated in the U.S. and Canada.
RESEARCH DESIGN AND METHODS-A large multicenter randomized clinical trial conducted in the U.S. and Canada was analyzed. Patients with type 1 diabetes, screened from 1983 to 1989 for enrollment in the Diabetes Control and Complications Trial (DCCT), were categorized as treated in the U.S. (n = 2,604) or Canada (n = 245). HbA(1c) levels were compared between U.S. and Canadian patients, both before and after adjustment for predictors of HbA(1c).
RESULTS-In general, volunteers screened for the DCCT were highly educated and following healthy lifestyles. Canadians were somewhat younger (25 vs. 27 years of age, P = 0.002), less likely to be college educated (62 vs. 71%, P = 0.002), more likely to receive care through a family doctor (41 vs. 28%, P = 0.001), and had a higher frequency of out-patient visits (4 vs. 3 per year, P = 0.004). Despite these differences in health care delivery, the mean HbA(1c) at baseline was identical in the two countries (8.9 vs. 9.0, P = 0.40). Adjustment for demographic, lifestyle, andclinical predictors of HbA(1c) yielded similar findings (9.0 vs. 9.2, P = 0.15). Equal percentages of American and Canadian patients who were screened ultimately entered the trial (21 vs. 19%, P = 0.20), and those randomized to conventional care achieved similar mean HbA(1c) levels (9.1 vs. 9.2, P = 0.50).
CONCLUSIONS-Differences in care delivery patterns do not yield large differences in glycemic control for patients with type 1 diabetes who were recruited in the U.S. and Canada for a large randomized trial.

Diabetes Care 2002 Jul;25(7):1149-53


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