I few days ago I touched on the subject of NY-area drug store chain, Duane Reade. The company established a free diabetes program a while back, offering advice, education and support groups. Duane Reade says it's expanding the program because of customer demand.

Is this part of a larger trend? Looks like it. According to yesterday's New York Times, more and more people are turning to drug stores for medical services. We're talking non-urgent things like sprains and minor infections...and diabetes care. Some are frustrated by lack of access to their regular physician. Others are having budget issues going the traditional route. It's super-convenient because you can be seen without an appointment, then get your prescription filled right there.

Drug store chains - Duane Reade, Wal-Mart, CVS and Walgreens included - are stepping up to the plate to fill the void. "Urgent Care Lite," is the tag it's been given. According to the Times, the number of these clinics has exploded in the past two years. And many feel that's a big problem because these clinics are not tightly regulated.

The American Association of Clinical Endocrinologists (AACE) has released its new medical guidelines for diabetes. Needless to say, the 66-page guidelines are intended for your doc, not for you. Unless you are having trouble getting to sleep at night...

But they're important for you to know about. Very. The guidelines are the first reference point for physicians determining the best course of care for diabetes patients. Blood sugar, blood pressure, type 1, type 2, pregnancy, metabolism, prevention etc etc. It's all in there.

So what's new? According to AACE president Dr. Richard Hellman, the focus is, for the first time, on patient safety - specifically, reducing the incidence of medical errors involving diabetes patients. "These guidelines are the first that specifically point to how best to protect the patient with diabetes against mistakes and misjudgments by all those who directly or indirectly impact their diabetes care, including themselves," said Dr. Hellman. "Patient safety is not a given."

The guidelines are being published as a supplement to the latest issue of Endocrine Practice (May/June 2007), the journal of the AACE. They can also be accessed online. Click here to view the pdf.

For athletes with type 1 diabetes, technological advances have opened up a whole new world. Tell your doctor you want to run a marathon? In past decades, the announcement might have been met with words of caution, even dismay. Exercise wasn't even part of the equation when it came to diabetes management. Being diagnosed with diabetes was a death knell for the careers of budding young athletes. Today, however, docs (well-informed ones, at least) are more likely to say, 'okay, let's come up with a plan.'

Diabetes-related technology is a big reason for this shift in attitudes. An article just out in The New York Times. looks at the extent to which technology has made life easier for type 1 diabetics. Devices like digital meters and automated pumps are not cheap. But they are increasingly efficient, safe, and sleekly high-tech. Above all, they give athletes the tools they need to control blood sugar levels with absolute precision - the kind of precision that was impossible in the days of the urine-glucose test. The down-side, I guess you could say, is the mixed blessing of all that control: "We are essentially the CEOs of our own bodies," observes type 1 diabetic and long-distance cyclist Paul Southerland, "and we don't get a break from them."

Off-label use is the practice of prescribing drugs for a purpose outside the scope of the drug's approved label. The FDA requires numerous clinical trials to prove a drug's safety and efficacy in treating a specific symptom. Once deemed safe and effective, physicians exercise discretion for the use of the drug. It is entirely legal in the United States and in many other countries to use drugs off-label.

More physicians are discovering that many drugs are effective for off-label uses and apply to the needs of their patients. Off-label prescription drugs have become so popular that, today, 1 out of every 4 prescriptions written is off-label. The antiseizure drug gabapentin (Neurontin) is used off-label to treat people with diabetic neuropathy. Another drug used off-label is Lucentis, manufactured by Genentech. It was originally approved for age related macular degeneration, but is now in FDA trials for the treatment of diabetic macular edema. If Lucentis is approved, it would be the first drug to treat this debilitating complication of diabetes.

There are advantages and disadvantages to off-label uses. First (and foremost) is the risk versus reward. You could be the first to experience a breakthrough treatment or you could suffer irreparable consequences from the off-label use. Another consideration is feasibility - often times an off-label treatment may cost you substantially more than the other treatments approved for use. For example, without enrolling in an FDA trial to receive intravitreal injections of Lucentis - it would cost me $2,000 a pop. My peepers are precious, but my pockets aren't that deep! What off-label drug would you consider for use?(With your doctor's blessing, of course).