Papers by Farhad Zangeneh
Endocrine Practice, Apr 1, 2017
Most of the content herein is based on literature reviews. In areas of uncertainty, professional ... more Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. Medical professionals are encouraged to use this information in conjunction with, and not as a replacement for, their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual circumstances.
Endocrine Practice, Nov 1, 2012
The American Journal of Managed Care, Jul 16, 2013
To examine the annual cost profiles of Medicare beneficiaries with diabetes to identify patterns ... more To examine the annual cost profiles of Medicare beneficiaries with diabetes to identify patterns in their consumption of benefits. Retrospective expenditure data were collected from Medicare records. Beneficiaries with diabetes were grouped into 5 consumption clusters ranging from "crisis consumers" at the high end to "low consumers" at the low end. The percentages of beneficiaries and expenditures for the consumption clusters remained generally constant from year to year. As expected, most of Medicare's budget each year was spent on crisis, heavy, and moderate consumers. However, a notable proportion of low and light consumers from one year go on to become crisis and heavy consumers in subsequent years. A review of total 2001 through 2006 inpatient costs for the year 2000 clusters revealed that 47% of these costs were for year 2000 low and light consumers and only 27% were for year 2000 crisis and heavy consumers. This analysis revealed previously unrecognized trends, whereby a notable proportion of low and light consumers during one year went on to become crisis and heavy consumers in subsequent years, representing a large proportion of inpatient costs. These findings have important implications for disease management programs, which typically focus intervention efforts exclusively on crisis and heavy consumers.
Bariatric Endocrinology, 2018
Obesity is a disease characterized by excess adiposity that is a source of extensive morbidity an... more Obesity is a disease characterized by excess adiposity that is a source of extensive morbidity and mortality due to various weight-related complications. Therefore, the diagnostic evaluation should consist of an anthropometric measure that reflects increased fat mass and an indication of the degree to which the excess adiposity is adversely affecting the health of individual patients. Body mass index (BMI) is widely used as the anthropometric measure in the screening and diagnosis of overweight (BMI 25–29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2), and in the classification of obesity severity (BMI class I = 30–34.9 kg/m2, class II = 35–39.9 kg/m2; and class III = ≥40 kg/m2). However, BMI inter-relates height and weight and is not a direct measure of adiposity since, in addition to fat mass, weight is comprised of lean mass, bone, and extracellular fluid volume. Thus, BMI is an appropriate screening tool but must be interpreted in the context of a physical examination that confirms excess adiposity in making the diagnoses of overweight or obesity. Moreover, the BMI is not a reliable indicator of the impact of excess adiposity on health, which can vary extensively among patients at any given level of BMI. The component of the diagnostic evaluation that assesses health involves a careful clinical assessment of the risk, presence, and severity of weight-related complications. The two-component approach, involving both anthropometric and clinical evaluation, provides a meaningful and actionable diagnostic framework that helps guide clinical decisions regarding the aggressiveness of therapy.
Cardiorenal Medicine, 2014
Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death i... more Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death in the USA, regardless of self-determined race/ethnicity, and largely driven by cardiometabolic risk (CMR) and cardiorenal metabolic syndrome (CRS). The primary drivers of increased CMR include obesity, hypertension, insulin resistance, hyperglycemia, dyslipidemia, chronic kidney disease as well as associated adverse behaviors of physical inactivity, smoking, and unhealthy eating habits. Given the importance of CRS for public health, multiple stakeholders, including the National Minority Quality Forum (the Forum), the American Association of Clinical Endocrinologists (AACE), the American College of Cardiology (ACC), and the Association of Black Cardiologists (ABC), have developed this review to inform clinicians and other health professionals of the unique aspects of CMR in racial/ethnic minorities and of potential means to improve CMR factor control, to reduce CRS and CVD in diverse populations, and to provide more effective, coordinated care. This paper highlights CRS and CMR as sources of significant morbidity and mortality (particularly in racial/ethnic minorities), associated health-care costs, and an evolving index tool for cardiometabolic disease to determine geographical and environmental factors. Finally, this work provides a few examples of interventions potentially successful at reducing disparities in cardiometabolic health.
Endocrine Practice, Apr 3, 2017
Most of the content herein is based on literature reviews. In areas of uncertainty, professional ... more Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. Medical professionals are encouraged to use this information in conjunction with, and not as a replacement for, their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual circumstances.
Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2017
OBJECTIVE The development of these guidelines is mandated by the American Association of Clinical... more OBJECTIVE The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). METHODS Each Recommendation is based on a diligent review of the clinical evidence with transparent incorporation of subjective factors. RESULTS The Executive Summary of this document contains 87 Recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 202 (29.1 %) are evidence ...
Postgraduate medicine, 2002
DOI:10.4158/EP12291.RA © 2013 AACE. ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid El... more DOI:10.4158/EP12291.RA © 2013 AACE. ENDOCRINE PRACTICE Rapid Electronic Article in Press Rapid Electronic Articles in Press are preprinted manuscripts that have been reviewed and accepted for publication, but have yet to be edited, typeset and finalized. This version of the manuscript will be replaced with the final, published version after it has been published in the print edition of the journal. The final, published version may differ from this proof. DOI:10.4158/EP12291.RA © 2013 AACE.
Bariatric Endocrinology, 2018
Hyperglycemic disorders are very common in patients with overweight or obesity. With increasing f... more Hyperglycemic disorders are very common in patients with overweight or obesity. With increasing fat mass and the development of adiposopathy comes increasing risk of developing hyperglycemia. However, the prevalence of overweight or obesity is estimated at over 60% of the American population. Yet, type 2 diabetes mellitus affects only 16.4% of people with an extreme body mass index. The progression from lean and healthy to overweight or obesity with type 2 diabetes offers opportunities for diagnosing individuals at risk, and for treatment. Adiposopathy, which includes accrual of intra-abdominal adipose tissue and the development of an inflammatory milieu, promotes insulin resistance. Insulin resistance in turn leads to ineffective insulin activity and hyperglycemia. Prediabetes, defined as hyperglycemia, which does not meet thresholds for diabetes mellitus, already carries an increased risk of cardiovascular disease and death. The standard of care for patients with insulin resistanc...
Postgraduate medicine, 2016
To provide an evidence-based practice overview on the clinical use of bromocriptine-quick release... more To provide an evidence-based practice overview on the clinical use of bromocriptine-quick release (QR) across the natural history of type 2 diabetes mellitus (T2DM). Articles for inclusion were selected after a comprehensive literature search of English-language PubMed articles and identification of other relevant references through other sources. Inclusion criteria were animal studies examining the mechanism of action and efficacy of bromocriptine, and clinical studies examining the safety and efficacy of bromocriptine-QR in patients with T2DM, without a time limitation. The brain plays a key role in total body metabolism, in particular ensuring that sufficient levels of glucose are available for proper neural functioning. The hypothalamic suprachiasmatic nucleus (SCN), the body's biological clock, plays a key role in the regulation of seasonal and diurnal variations of insulin sensitivity. A daily surge of dopaminergic activity in the SCN upon waking enables insulin sensitivit...
Diabetes care, Jan 18, 2016
In 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Competitive Bidding Prog... more In 2011, the Centers for Medicare & Medicaid Services (CMS) launched the Competitive Bidding Program (CBP) in nine markets for diabetes supplies. The intent was to lower costs to consumers. Medicare claims data (2009-2012) were used to confirm the CMS report (2012) that there were no disruptions in acquisition caused by CBP and no changes in health outcomes. The study population consisted of insulin users: 43,939 beneficiaries in the nine test markets (TEST) and 485,688 beneficiaries in the nontest markets (NONTEST). TEST and NONTEST were subdivided: those with full self-monitoring of blood glucose (SMBG) supply acquisition (full SMBG) according to prescription and those with partial/no acquisition (partial/no SMBG). Propensity score-matched analysis was performed to reduce selection bias. Outcomes were impact of partial/no SMBG acquisition on mortality, inpatient admissions, and inpatient costs. Survival was negatively associated with partial/no SMBG acquisition in both cohorts (P ...
Postgraduate Medicine, 2002
T he article "Type 2 Diabetes Therapy" by Adam B. Mayerson, MD, and Silvio E. lnzucchi,... more T he article "Type 2 Diabetes Therapy" by Adam B. Mayerson, MD, and Silvio E. lnzucchi, MD (March, page 83 ), states that "the currently available thiazolidinediones, rosiglitazone maleate (Avandia) and pioglitazone hydrochloride (Aetas), are not known to contribute to idiosyncratic hepatocellular injury." Rosiglitazone and pioglitazone are the successors to troglitazone {Rezulin), which was the prototypical agent in the thiazolidinedione class of drugs approved by the US Food and Drug Administration (FDA) in 1997. Rosiglitazone was not associated with hepatotoxicity in premarketing trials. 1 However, hepatotoxicity has been reported in at least two diabetic patients treated with rosiglitazone. Both patients were taking other medications or had comorbidities that may have contributed to the hepatic injury/· but rosiglitazone appeared to be the most likely culprit. During premarketing drug trials, 0.26% of patients taking pioglitazone (and a similar percentage of those taking placebo) had an asymptomatic, reversible increase in alanine aminotransferase levels to more than three times the upper limit of normal. Hepatotoxicity was not observed or reported with pioglitazone in the early postmarketing period.4 Three cases of pioglitazoneassociated hepatotoxicity were reported in the medical literature in recent months. The cases represent a spectrum of hepatocellular injury, including hepatitis after 7 months of therapy/ fulminant hepatic failure, 6 and mixed reversible hepatocellularcholestatic liver injury after 6 months of therapy. 7 It is not known whether these case reports represent a causal relationship with, an association with, or a direct link to therapy. Recommended periodic monitoring of liver enzyme levels, espe; cially in the first year of therapy, may identify potential idiosyncratic reactions. Until more long-term data on safety are available, current clinical evidence suggests that rosiglitazone and pioglitazone do not share the hepatotoxic profile of troglitazone. The differences may be due to troglitazone's structure and its unique tocopherol side
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Papers by Farhad Zangeneh