Picture Guillermo Umpierrez

Dr. Guillermo Umpierrez has graciously offered to provide GAADE with periodic articles covering a variety of topics of interest to the diabetes educator community. We suggest that you bookmark this page so that you can visit often.

Articles Contributed by Guillermo Umpierrez M.D.

Hypoglycemia is the most important adverse effect of intensive glycemic management in patients with diabetes. Hypoglycemia has been associated with increased risk of complications and mortality in recent randomized trials (ACCORD, VADT, ADVANCE) in T2DM.

What's Preventing Us from Preventing Diabetes?

Physician Empathy and Diabetes Complications, 2012

Below are links to 3 PDFs

1.  The effects of baseline characteristics, glycemia treatment approach, and glycated hemoglobin concentration on the risk of severe hypoglycemia: post hoc epidemiological analysis of the ACCORD study. BMJ 2010;340:b5444

2.  The association between symptomatic, severe hypoglycemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study Severe Hypoglycemia and Risks of Vascular Events and Death.  BMJ 2010;340:b4909

3.  Severe Hypoglycemia and Risks of Vascular Events and Death.  N Engl J Med 363:1410-8 2010
These are 3 VERY IMPORTANT studies that call for caution in implementing tight glycemic control = avoid hypoglycemia!

Hypoglycemia, Diabetes, and Cardiovascular Events care.diabetesjourlan.org June, 2010

Review Article - Hypoglycaemia in Type 2 Diabetes - Diabetic Medicine - September 2007

Association between serious ischemic cardiac outcomes and medications used to treat diabetes - Pharmacoepidemiology and Drug Safety - 2008


Breast Abscesses in Nonlactating Women With Diabetes


The American Journal of the Medical Sciences, August 2009


75% of nonlactating women with breast abscesses had T2DM at presentation or went to develop DM within 5 yrs of follow-up. The odds ratio of having DM in women with breast abscess was 14.24 (95% confidence interval, 6.72–30.17).

As expected, DM women had increased length of hospital stay and a more severe clinical course than women without DM.

Dr. Umpierrez's comments:  Rizzo suggested that breast abscesses in nonlactating women may be considered one of the “typical” infections (together with mucormycosis, malignant otitis, emphysematous pyelonephritis, and emphysematous cholecystitis).

Articles and Slides from July 2009 GAADE Meeting

BG Control & CV Outcomes - Lancet 2009

BG Control & CVD in Type 2 Diabetes - Annual Internal Medicine 2009 (pdf)

DM Control & CVD New Slides (power point)


Two meta-analysis were published in September 2009 (Lancet and Annals) exploring the impact of BG control and CV outcome. Attached are the PDF and a set of slides that I prepared for a lecture. I hope the slides will help to update your files.


•These 2 meta-analysis found that, compared with conventional control, intensive glucose control reduce the risk for cardiovascular disease (mostly nonfatal myocardial infarction) but not for cardiovascular death or all-cause mortality, and increased risk for severe hypoglycemia.

•Early trials suggested possible decreased risk for death with intensive control, whereas some more recent trials suggested possible increased risk for death with more stringent control.

Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes A Randomized Trial

Comments: This study helps in designing our recommendations on dietary Rx in T2DM. This paper raises an interesting question: should we treat newly diagnosed T2DM patients with diet alone and reserve drug therapy for those with A1C > 7%? The ADA/EASD recommends starting Drug therapy at diagnosis (in all patients).

Effect of Telmisartan on Renal Outcomes Ann Intern Med. 2009;151:1-10.

Stress hyperglycemia Lancet 2009; 373: 1798–807

International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes

Redefining the Diagnosis of Diabetes Using Glycated Hemoglobin