- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Complications of Diabetes and Role of Insulin Resistance in Metabolic Syndrome
Zachary T. Bloomgarden, MD, MACE: We somewhat arbitrarily have divided the complications of type 2 diabetes into 2 groups: microvascular—referring to small vessel abnormalities [such as] diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy; and macrovascular—referring to atherosclerotic cardiovascular disease. These are the major complications of diabetes and affect a huge proportion of individuals with the disease.
We understand type 2 diabetes as representing the intersection of both genetically and environmentally determined patient characteristics. One is insulin resistance—decreased action of insulin at its receptor. That is caused by the environment, namely obesity, lack of physical activity, and a number of genetic factors, as well.
Then, [another characteristic is] reduction in the insulin secretory response to various stimuli, and this is probably primarily a genetic factor. So, in this context, the insulin secretory effect is not directly related to the other aspects of metabolic syndrome. But metabolic syndrome is essentially a constellation of abnormalities that are all related to insulin resistance. This is what seems to be the central actor that leads to hypertension, that leads to a certain form of dyslipidemia caused by obesity (particularly abdominal obesity), which then leads to the concurrence of diabetes with the other cardiovascular risk factors.
AI in Health Care: Closing the Revenue Cycle Gap
April 1st 2025This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.
Read More
Managed Care Reflections: A Q&A With Hoangmai H. Pham, MD, MPH
April 1st 2025To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).
Read More
Bridging Care Gaps With a Systemwide Value-Based Care Strategy
March 29th 2025Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.
Read More
