Zachary Bloomgarden | Mount Sinai School of Medicine (original) (raw)

Papers by Zachary Bloomgarden

Journal of diabetes, Jan 2, 2015

Frontiers in Endocrinology, 2012

Hypoglycemia is well-recognized to limit the degree of glycemic control possible for many individ... more Hypoglycemia is well-recognized to limit the degree of glycemic control possible for many individuals for diabetes. Although the likelihood of hypoglycemia increases as A1c levels decrease in type 1 diabetes, insulin-treated type 2 diabetic persons with higher A1c appear paradoxically to have more hypoglycemia which may explain, in part, the adverse outcome reported in the ACCORD study. Approaches to glucose-lowering that cause lesser degrees of risk for hypoglycemia, technologies to better ascertain hypoglycemic events, and better understanding of patient characteristics associated with greater likelihood of hypoglycemia will all be required to reduce this limiting factor in optimizing glycemic treatment.

Journal of Diabetes, 2011

Journal of Diabetes, 2009

Hemoglobin HbA 1c (A 1c ) has been used clinically since the 1980s as a test of glycemic control ... more Hemoglobin HbA 1c (A 1c ) has been used clinically since the 1980s as a test of glycemic control in individuals with diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight glycemic control, quantified by lower blood glucose and A 1c levels, reduced the risk of the development of complications from diabetes. Subsequently, standardization of A 1c measurement was introduced in different countries to ensure accuracy in A 1c results. Recently, the International Federation of Clinical Chemists (IFCC) introduced a more precise measurement of A 1c , which has gained international acceptance. However, if the IFCC A 1c result is expressed as a percentage, it is lower than the current DCCT-aligned A 1c result, which may lead to confusion and deterioration in diabetic control. Alternative methods of reporting have been proposed, including A 1c -derived average glucose (ADAG), which derives an average glucose from the A 1c result. Herein, we review A 1c , the components involved in A 1c formation, and the interindividual and assay variations that can lead to differences in A 1c results, despite comparable glycemic control. We discuss the proposed introduction of ADAG as a surrogate for A 1c reporting, review imprecisions that may result, and suggest alternative clinical approaches.

New England Journal of Medicine, 1978

... Acta Oncologica 32:2, 217-223. 9. Eva Tiensuu Janson, Kjell Öberg. ... (1989) Surgical Treatm... more ... Acta Oncologica 32:2, 217-223. 9. Eva Tiensuu Janson, Kjell Öberg. ... (1989) Surgical Treatment of Carcinoids and Endocrine. Acta Oncologica 28:3, 409-414. 19. Omer Kucuk, Gary Noskin, Kevin Petersen, Ediz Ezdinli, David Rollins, Satinder Singh, Suleyman Sarpel. ...

Journal of the American College of Cardiology, 1996

The Journal of Clinical Endocrinology & Metabolism, 1980

Characteristics of a 16-yr-old male with a 48,XXYY karyotype are presented; this chromosome const... more Characteristics of a 16-yr-old male with a 48,XXYY karyotype are presented; this chromosome constitution was demonstrated consistently in four tissues studied. Basal gonadotropins were elevated, and serum testosterone varied between 3.2–4.0 ng/ml. A pronounced rise was ...

Endocrine Practice, 2013

To review available data on the efficacy and safety of bromocriptine-QR (BQR) and to consider its... more To review available data on the efficacy and safety of bromocriptine-QR (BQR) and to consider its role in the management of Type 2 diabetes mellitus (T2DM). Published literature reporting the efficacy and safety of BQR in the treatment of T2DM was reviewed, including peer-reviewed abstracts and poster presentations. BQR is an oral hypoglycemic agent with a novel mechanism of action that appears to involve enhancement of morning central nervous system (CNS) dopaminergic activity, resulting in improved insulin sensitivity and reduced hepatic glucose output. Adjunctive treatment with BQR in the dosing range of 1.6 to 4.8 mg/d may result in a mean (95% confidence interval [CI]) reduction in glycated hemoglobin (A1c) levels of 0.69% (0.97%, 0.41%). Treatment with BQR appears to be associated with minimal intrinsic risk of hypoglycemia, and does not appear to be associated with clinically significant adverse effects on weight, triglycerides, free fatty acids, or blood pressure. The favorable cardiovascular risk profile of BQR suggests that it may be useful in the treatment of patients with T2DM with a history of cardiovascular disease (CVD) or who have significant risk factors for CVD. However, knowledge of the efficacy and safety of BQR is limited by the relatively small clinical trials database. As a result, there is currently insufficient information on the safety and efficacy of adjunctive BQR in T2DM patients being treated with several common diabetes regimens (e.g., thiazolidinediones, insulin).

Endocrine Practice, 2012

Abbreviations: A1C = glycated hemoglobin; ABCD = Association of British Clinical Diabetologists; ... more Abbreviations: A1C = glycated hemoglobin; ABCD = Association of British Clinical Diabetologists; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BID = twice daily; BMI = body mass index; BNP = brain natriuretic peptide; CIs = confidence intervals; CrCl = creatinine clearance; DAWN Trial = Diabetes Attitudes, Wishes and Needs Trial; DPP-4 = dipeptidyl peptidase-4; DTSQ-s: Diabetes Treatment Satisfaction Questionnairestatus; EASD = European Association for the Study of Diabetes; ER = extended release; ESRD = end-stage renal disease; EXN = exenatide; FAERS = FDA Adverse Event Reporting System; FDA = United States Food and Drug Administration; FPG = fasting plasma glucose; GI = gastrointestinal; GIP = glucosedependent insulinotropic polypeptide; GLAR = insulin glargine; GLP-1 = glucagon-like peptide-1; GLP-1 RA = glucagon-like peptide-1 receptor agonist; HOMA-B: homeostatic model assessment-β-cell function; HRQL = healthrelated quality of life; hs-CRP = high-sensitivity C-reactive protein; IDET = insulin detemir; IMT = intima-media thickness; IWQOL-Lite: Impact of Weight on Quality of Life-Lite; LEAD Trials = Liraglutide Effect and Action in Diabetes Trials; LIRA = liraglutide; MEN 2 = multiple endocrine neoplasia syndrome type 2; MET = metformin; MTC = medullary thyroid carcinoma; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NICE = National Institute for Clinical Excellence; NIH = National Institutes of Health; OAD = oral antidiabetic agent; PAI-1 = plasminogen activator inhibitor-1; PBO = placebo; PPG = postprandial glucose; PROs = patient-reported outcomes; RA = receptor agonist; RCT = randomized controlled trial; RI = renal impairment; RORs = reporting odds ratios; SCALE = Satiety and Clinical Adiposity -Liraglutide Evidence in Non-Diabetic and Diabetic Subjects; STEMI = ST segment elevation myocardial infarction; SU = sulfonylurea; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus; TZD = thiazolidinedione

Endocrine Practice, 2008

*Based on a consensus conference held in Washington, DC, on July 21 and 22, 2008. © 2008 by the A... more *Based on a consensus conference held in Washington, DC, on July 21 and 22, 2008. © 2008 by the American College of Endocrinology and the American Association of Clinical Endocrinologists ... Alan J. Garber, MD, PhD, ...

Diabetes Care, 2006

... Zachary T. Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in Ne... more ... Zachary T. Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated ... Daniel Drucker (Toronto, Canada) reviewed evidence that the incretin effect, the phenomenon of enteral glucose loading increasing the insulin ...

Diabetes Care, 2006

... T Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, N... more ... T Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the ... Nichols and Brown (abstract 117) studied 28,335 individuals in the Kaiser Permanente Northwest Region with fasting glucose <100, 100–109, and ...

Diabetes Care, 2005

... TE Adrian, London; LM Aiello, Boston; HK Akerblom, Oulu; KGMM Albert/, Newcastle-upon-Tyne; A... more ... TE Adrian, London; LM Aiello, Boston; HK Akerblom, Oulu; KGMM Albert/, Newcastle-upon-Tyne; AM Albisser, Toronto; F. R A1-ford, Melbourne; L.-O. Almer, Dammam, Saudi Arabia; N. Altszuler, New York; HPT Ammon, Ttibingen; P. Anand, London; JW Anderson, Lexington; A ...

Diabetes Care, 2003

... Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is aff... more ... Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Diabetes Center, Mount Sinai School of ... 1535, 2000. Abstract/FREE Full Text. ↵ Howard G, O'Leary DH, Zaccaro D, Haffner S, Rewers M, Hamman R, Selby JV, Saad MF ...

Diabetes Care, 1999

A table elsewhere in this issue shows conventional and Système International (SI) units and conve... more A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

Diabetes Care, 1987

We randomized 749 insulin-treated patients on the rolls of the Mount Sinai Medical Center Diabete... more We randomized 749 insulin-treated patients on the rolls of the Mount Sinai Medical Center Diabetes Clinic in a controlled trial of diabetic patient education; 345 agreed to participate, of whom 165 were assigned to the education group and 180 to the control group. Cognitive scores increased from 5.3 +/- 1.6 to 5.8 +/- 1.6 in the education group, but there was no change in the control group, whose score was 5.3 +/- 1.7 before and after the intervention (P = .0073). HbA1c fell from 6.8 +/- 2.1 to 6.1 +/- 2.0% in the education group and from 6.6 +/- 2.0 to 6.3 +/- 2.0% in the control group, an insignificant difference (P = .1995). The fasting blood glucose decreased from 223 +/- 94 to 179 +/- 73 mg/dl in the education group and from 199 +/- 81 to 185 +/- 76 mg/dl in the controls (P = .1983). Triglycerides, high- and low-density lipoprotein cholesterol, and insulin dosage also failed to show significant variation among groups. The foot-lesion score showed similar progression in the education and control groups. Neither diastolic nor systolic blood pressure showed significantly greater change in the education or the control group, with falls noted, particularly in diastolic pressures, in both patient groups. Differences between the groups were not significant for sick days, hospitalizations, emergency room visits, or outpatient visits. The sample sizes of the study and control populations were sufficiently large to detect a difference in means between the education and control groups in the HbA1c, the primary outcome variable, of greater than 1.0%, with alpha = .05 and a power of .95. Thus, our study suggests that patient education may not be an efficacious therapeutic intervention in most adults with insulin-treated diabetes mellitus.

The American Journal of Medicine, 1983

Two patients with inadequately controlled diabetes mellitus had chronic foot ulcers that were ref... more Two patients with inadequately controlled diabetes mellitus had chronic foot ulcers that were refractory to repeated attempts with conventional treatment. In both patients, complete healing of the foot lesions occurred six to eight weeks after continuous subcutaneous insulin infusion was instituted and blood sugar levels had become normal. This suggests that good control of diabetes, as obtainable with continuous subcutaneous insulin infusion, stimulates healing of foot ulcers. Possible reasons for this finding are reviewed.

Journal of diabetes, Jan 2, 2015

Frontiers in Endocrinology, 2012

Hypoglycemia is well-recognized to limit the degree of glycemic control possible for many individ... more Hypoglycemia is well-recognized to limit the degree of glycemic control possible for many individuals for diabetes. Although the likelihood of hypoglycemia increases as A1c levels decrease in type 1 diabetes, insulin-treated type 2 diabetic persons with higher A1c appear paradoxically to have more hypoglycemia which may explain, in part, the adverse outcome reported in the ACCORD study. Approaches to glucose-lowering that cause lesser degrees of risk for hypoglycemia, technologies to better ascertain hypoglycemic events, and better understanding of patient characteristics associated with greater likelihood of hypoglycemia will all be required to reduce this limiting factor in optimizing glycemic treatment.

Journal of Diabetes, 2011

Journal of Diabetes, 2009

Hemoglobin HbA 1c (A 1c ) has been used clinically since the 1980s as a test of glycemic control ... more Hemoglobin HbA 1c (A 1c ) has been used clinically since the 1980s as a test of glycemic control in individuals with diabetes. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight glycemic control, quantified by lower blood glucose and A 1c levels, reduced the risk of the development of complications from diabetes. Subsequently, standardization of A 1c measurement was introduced in different countries to ensure accuracy in A 1c results. Recently, the International Federation of Clinical Chemists (IFCC) introduced a more precise measurement of A 1c , which has gained international acceptance. However, if the IFCC A 1c result is expressed as a percentage, it is lower than the current DCCT-aligned A 1c result, which may lead to confusion and deterioration in diabetic control. Alternative methods of reporting have been proposed, including A 1c -derived average glucose (ADAG), which derives an average glucose from the A 1c result. Herein, we review A 1c , the components involved in A 1c formation, and the interindividual and assay variations that can lead to differences in A 1c results, despite comparable glycemic control. We discuss the proposed introduction of ADAG as a surrogate for A 1c reporting, review imprecisions that may result, and suggest alternative clinical approaches.

New England Journal of Medicine, 1978

... Acta Oncologica 32:2, 217-223. 9. Eva Tiensuu Janson, Kjell Öberg. ... (1989) Surgical Treatm... more ... Acta Oncologica 32:2, 217-223. 9. Eva Tiensuu Janson, Kjell Öberg. ... (1989) Surgical Treatment of Carcinoids and Endocrine. Acta Oncologica 28:3, 409-414. 19. Omer Kucuk, Gary Noskin, Kevin Petersen, Ediz Ezdinli, David Rollins, Satinder Singh, Suleyman Sarpel. ...

Journal of the American College of Cardiology, 1996

The Journal of Clinical Endocrinology & Metabolism, 1980

Characteristics of a 16-yr-old male with a 48,XXYY karyotype are presented; this chromosome const... more Characteristics of a 16-yr-old male with a 48,XXYY karyotype are presented; this chromosome constitution was demonstrated consistently in four tissues studied. Basal gonadotropins were elevated, and serum testosterone varied between 3.2–4.0 ng/ml. A pronounced rise was ...

Endocrine Practice, 2013

To review available data on the efficacy and safety of bromocriptine-QR (BQR) and to consider its... more To review available data on the efficacy and safety of bromocriptine-QR (BQR) and to consider its role in the management of Type 2 diabetes mellitus (T2DM). Published literature reporting the efficacy and safety of BQR in the treatment of T2DM was reviewed, including peer-reviewed abstracts and poster presentations. BQR is an oral hypoglycemic agent with a novel mechanism of action that appears to involve enhancement of morning central nervous system (CNS) dopaminergic activity, resulting in improved insulin sensitivity and reduced hepatic glucose output. Adjunctive treatment with BQR in the dosing range of 1.6 to 4.8 mg/d may result in a mean (95% confidence interval [CI]) reduction in glycated hemoglobin (A1c) levels of 0.69% (0.97%, 0.41%). Treatment with BQR appears to be associated with minimal intrinsic risk of hypoglycemia, and does not appear to be associated with clinically significant adverse effects on weight, triglycerides, free fatty acids, or blood pressure. The favorable cardiovascular risk profile of BQR suggests that it may be useful in the treatment of patients with T2DM with a history of cardiovascular disease (CVD) or who have significant risk factors for CVD. However, knowledge of the efficacy and safety of BQR is limited by the relatively small clinical trials database. As a result, there is currently insufficient information on the safety and efficacy of adjunctive BQR in T2DM patients being treated with several common diabetes regimens (e.g., thiazolidinediones, insulin).

Endocrine Practice, 2012

Abbreviations: A1C = glycated hemoglobin; ABCD = Association of British Clinical Diabetologists; ... more Abbreviations: A1C = glycated hemoglobin; ABCD = Association of British Clinical Diabetologists; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BID = twice daily; BMI = body mass index; BNP = brain natriuretic peptide; CIs = confidence intervals; CrCl = creatinine clearance; DAWN Trial = Diabetes Attitudes, Wishes and Needs Trial; DPP-4 = dipeptidyl peptidase-4; DTSQ-s: Diabetes Treatment Satisfaction Questionnairestatus; EASD = European Association for the Study of Diabetes; ER = extended release; ESRD = end-stage renal disease; EXN = exenatide; FAERS = FDA Adverse Event Reporting System; FDA = United States Food and Drug Administration; FPG = fasting plasma glucose; GI = gastrointestinal; GIP = glucosedependent insulinotropic polypeptide; GLAR = insulin glargine; GLP-1 = glucagon-like peptide-1; GLP-1 RA = glucagon-like peptide-1 receptor agonist; HOMA-B: homeostatic model assessment-β-cell function; HRQL = healthrelated quality of life; hs-CRP = high-sensitivity C-reactive protein; IDET = insulin detemir; IMT = intima-media thickness; IWQOL-Lite: Impact of Weight on Quality of Life-Lite; LEAD Trials = Liraglutide Effect and Action in Diabetes Trials; LIRA = liraglutide; MEN 2 = multiple endocrine neoplasia syndrome type 2; MET = metformin; MTC = medullary thyroid carcinoma; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NICE = National Institute for Clinical Excellence; NIH = National Institutes of Health; OAD = oral antidiabetic agent; PAI-1 = plasminogen activator inhibitor-1; PBO = placebo; PPG = postprandial glucose; PROs = patient-reported outcomes; RA = receptor agonist; RCT = randomized controlled trial; RI = renal impairment; RORs = reporting odds ratios; SCALE = Satiety and Clinical Adiposity -Liraglutide Evidence in Non-Diabetic and Diabetic Subjects; STEMI = ST segment elevation myocardial infarction; SU = sulfonylurea; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus; TZD = thiazolidinedione

Endocrine Practice, 2008

*Based on a consensus conference held in Washington, DC, on July 21 and 22, 2008. © 2008 by the A... more *Based on a consensus conference held in Washington, DC, on July 21 and 22, 2008. © 2008 by the American College of Endocrinology and the American Association of Clinical Endocrinologists ... Alan J. Garber, MD, PhD, ...

Diabetes Care, 2006

... Zachary T. Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in Ne... more ... Zachary T. Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated ... Daniel Drucker (Toronto, Canada) reviewed evidence that the incretin effect, the phenomenon of enteral glucose loading increasing the insulin ...

Diabetes Care, 2006

... T Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, N... more ... T Bloomgarden, MD. Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the ... Nichols and Brown (abstract 117) studied 28,335 individuals in the Kaiser Permanente Northwest Region with fasting glucose <100, 100–109, and ...

Diabetes Care, 2005

... TE Adrian, London; LM Aiello, Boston; HK Akerblom, Oulu; KGMM Albert/, Newcastle-upon-Tyne; A... more ... TE Adrian, London; LM Aiello, Boston; HK Akerblom, Oulu; KGMM Albert/, Newcastle-upon-Tyne; AM Albisser, Toronto; F. R A1-ford, Melbourne; L.-O. Almer, Dammam, Saudi Arabia; N. Altszuler, New York; HPT Ammon, Ttibingen; P. Anand, London; JW Anderson, Lexington; A ...

Diabetes Care, 2003

... Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is aff... more ... Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Diabetes Center, Mount Sinai School of ... 1535, 2000. Abstract/FREE Full Text. ↵ Howard G, O'Leary DH, Zaccaro D, Haffner S, Rewers M, Hamman R, Selby JV, Saad MF ...

Diabetes Care, 1999

A table elsewhere in this issue shows conventional and Système International (SI) units and conve... more A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

Diabetes Care, 1987

We randomized 749 insulin-treated patients on the rolls of the Mount Sinai Medical Center Diabete... more We randomized 749 insulin-treated patients on the rolls of the Mount Sinai Medical Center Diabetes Clinic in a controlled trial of diabetic patient education; 345 agreed to participate, of whom 165 were assigned to the education group and 180 to the control group. Cognitive scores increased from 5.3 +/- 1.6 to 5.8 +/- 1.6 in the education group, but there was no change in the control group, whose score was 5.3 +/- 1.7 before and after the intervention (P = .0073). HbA1c fell from 6.8 +/- 2.1 to 6.1 +/- 2.0% in the education group and from 6.6 +/- 2.0 to 6.3 +/- 2.0% in the control group, an insignificant difference (P = .1995). The fasting blood glucose decreased from 223 +/- 94 to 179 +/- 73 mg/dl in the education group and from 199 +/- 81 to 185 +/- 76 mg/dl in the controls (P = .1983). Triglycerides, high- and low-density lipoprotein cholesterol, and insulin dosage also failed to show significant variation among groups. The foot-lesion score showed similar progression in the education and control groups. Neither diastolic nor systolic blood pressure showed significantly greater change in the education or the control group, with falls noted, particularly in diastolic pressures, in both patient groups. Differences between the groups were not significant for sick days, hospitalizations, emergency room visits, or outpatient visits. The sample sizes of the study and control populations were sufficiently large to detect a difference in means between the education and control groups in the HbA1c, the primary outcome variable, of greater than 1.0%, with alpha = .05 and a power of .95. Thus, our study suggests that patient education may not be an efficacious therapeutic intervention in most adults with insulin-treated diabetes mellitus.

The American Journal of Medicine, 1983

Two patients with inadequately controlled diabetes mellitus had chronic foot ulcers that were ref... more Two patients with inadequately controlled diabetes mellitus had chronic foot ulcers that were refractory to repeated attempts with conventional treatment. In both patients, complete healing of the foot lesions occurred six to eight weeks after continuous subcutaneous insulin infusion was instituted and blood sugar levels had become normal. This suggests that good control of diabetes, as obtainable with continuous subcutaneous insulin infusion, stimulates healing of foot ulcers. Possible reasons for this finding are reviewed.