Problem: Diabetes mellitus is a dysfunction of metabolism affecting more than 25 million Americans and was the 7 th leading cause of death in the United States in 2010. The effectiveness of physician assistants (PAs) in treating patients with diabetes compared to other health care providers such as nurse practitioners (NPs) or physicians is of interest as PAs often care for patients in the primary care setting. Methods: The Weill Cornell Medical College Library online and the PubMed search engine were used to search for articles published between 2003 and 2013. Search terms included "diabetes", "physician assistant", "glycosylated hemoglobin", "glycated hemoglobin", "dietitian", "nutritionist", "diabetes educator" and "diabetes outcomes." Results: The number of articles identified was 673. Only 9 studies met inclusion criteria and 2 studies evaluated the effects of PAs on diabetes outcomes such as hemoglobin A1 (Hgb A1c) and cholesterol levels. Outcomes for NPs, certified diabetes educators (CDEs), and registered dietitians (RDs) were more promising than preliminary results for PAs. Conclusions: Further studies are needed to better evaluate diabetes outcomes when care is primarily delivered by PAs to determine if patient outcomes are comparable, that is, at least as good, as other primary care providers, namely NPs and physicians.

This issue of Physician Assistant Clinics, Guest Edited by Kim Zuber, PA-C and Jane S. Davis, CRNP, DNP, is devoted to Diabetes. Articles in this outstanding issue include: A Century of Discovery: The Centennial of Insulin; What it is and How we know: Diabetes in the 21st Century; The Ominous Octet and other Scary Diabetes Stories; Putting the Diabetes Patient in Charge; Diabetes: Counting Carbs Instead of Pennies; Non-insulin Therapy for Diabetes; Pens and Needles: Insulin Therapy for Diabetes; Managing Diabetes in the Digital Age; When Crisis Strikes: The acute complications of diabetes; Living Day to Day: Chronic Complications in Diabetes; Sugar Babies: Diabetes in the Pediatric Population; And Baby Makes 2: Gestational Diabetes; The Boomers Come of Age: Elderly and Frail Diabetes Patients; The Rising Price of Sugar; and The Future of Diabetes. A CME program is also available to subscribers of Physician Assistant Clinics.

Annotation *The only resource that focuses on key clinical content in PA practice as well as what is likely to be covered in certification and recertification exams *Features contributions by more than 90 outstanding physician assistants *New to this edition: expanded coverage of substance abuse, including tobacco; new chapters on dermatology, pediatrics, OB-GYN, infectious disease, respiratory disease, and more.

Diabetes Type 2 is the 6 th leading cause of death in the United States. Diabetes can lead to multiple organ involvement and morbidity. Importantly, the American Diabetes Association (ADA, 2008) recognizes that for every 1% drop in HgbA1c serum blood level there is a decrease in the risk of complications by 37%. Diabetes management remains suboptimal in U.S. medical centers but even more so in primary care offices. This study utilized a quantitative, descriptive retrospective design which was based on Orem's self-care framework. The setting for data collection occurred at three outpatient offices where Nurse Practitioners and Physician Assistants function as primary care providers. Convenience samples of 74 charts were reviewed. The charts reviewed were patients greater than 18 years of age with a diagnosis of Type 2 Diabetes, and visited the mid-level provider within the last twelve months. The researcher developed a tool for data collection with the age, race, payment type, HgbA1c, and interventions recommended. Approximately 66.7% of the patients exceeded the ADA guidelines of HgbA1c

First multi-year cumulation covers six years: 1965-70.

These Guiding Principles for Diabetes Care: For Health Care Professionals provide an overview of the key elements of early and intensive clinical diabetes care and prevention. They form the basis of the National Diabetes Education Program's (NDEP's) public and professional awareness programs. The principles are based on the best level of evidence available, and key sources are noted. The NDEP adopts guidelines developed by the American Diabetes Association (ADA), and many have been incorporated into these guiding principles. Numerous other guidelines are available and some are noted in this document. It is essential that in practice, health care professionals focus on the similarities rather than the differences in diabetes-related guidelines. This document also provides links to supporting resources and further information. As the proportion of both minority populations and people aged 60 and older increases in the United States, and the obesity epidemic continues, people with diabetes are becoming a larger part of the practices of family physicians and other primary care clinicians. Health care professionals involved in new or expanding diabetes care practices can use these guiding principles to ensure that they provide essential components of comprehensive diabetes care. In addition, health care payers, managed care organizations, and large employers can use this information to establish diabetes care principles and to assure quality diabetes care and treatment options in health plans. NDEP encourages people with or at risk for diabetes and their families to participate actively with their health care team to plan and implement their care. While these principles serve as a guide for diabetes prevention and management, each person and his or her health care team should determine a specific prevention or management plan. Team care is essential for effective diabetes prevention and management. Team structure is best determined by the practice setting. Teams should be led by the most appropriate health care professional, and may include primary care physicians, diabetes educators, endocrinologists, dietitians, nurses, nurse practitioners, pharmacists, physician assistants, psychologists, dental professionals, exercise professionals, social workers, specialists for care of the eye, foot, heart, and kidney, and others as necessary. Many of these team members also may be certified diabetes educators. Trained lay educators such as “promotores” and community health workers can be effective team members. Other elements of importance to the delivery of diabetes care, in addition to team care, such as creating a patient registry, assessing practice needs, implementing processes of care, connecting to community resources, and evaluating outcomes are presented in detail on www.BetterDiabetesCare.nih.gov. This website provides tools and resources to help health care professionals implement systems changes. Early identification and management of pre-diabetes can delay or prevent the onset of type 2 diabetes. In people with type 1 and type 2 diabetes, ongoing comprehensive diabetes care, including the ABCs of diabetes (A1C for glucose, Blood pressure, and Cholesterol), can prevent or control diabetes-related microvascular and macrovascular complications. With proper medical management, education, self-care, and attention to behavior, social, and environmental factors, people with diabetes and pre-diabetes can live long, active, and productive lives.