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Monthly Archives: February 2019

Samples Are Not the Answer

adding an sglt2 inhibitor to insulin

A woman, 72 years of age was recently diagnosed with type 2 diabetes. She has a Medicare plan. I don’t know her financial situation but do know she gets Social Security and has other retirement income. Her A1C was rising. We had recommended and taught lifestyle changes which she had difficulty with; she made some changes but not enough to lower her glucose. We added metformin which she did not tolerate, so we discussed one of the SGLT-2s. After hesitating, she agreed to trying one. We gave her samples, she took them. Her A1C lowered to the goal we mutually decided upon.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #165: Molecular Genetics of Type 1 Diabetes Part 2

HLA-DR and -DQ: The highest risk of T1DM is conferred by heterozygosity for the DRB1*0301-DQA1*0501-DQB1*0201 and DRB1*04-DQA1* 0301-DQB1*0302 haplotypes, referred to as the DR3.DQ2/DR4.DQ8 genotype. This allelic combination is carried by 30–40% of individuals with T1DM, but only around 2.5% of the general population [3]. A recent meta-analysis of multiple ethnic groups suggested that this translates into an OR value greater than 16, an unusually large odds ratio for a complex disease [14]. This is consistent with an earlier study which estimated that the risk of developing T1DM was between 1 in 15 and 1 in 25 among those with the DR3.DQ2/DR4.DQ8 genotype, compared with 1 in 300 in the general population [15]. High risk is also conferred by the DR3.DQ2/DR3.DQ2 and DR4.DQ8/DR4.DQ8 homozygous genotypes (OR = 6.32 and OR = 5.68, respectively, from meta-analysis).

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Feb. 16, 2019

I have a good friend who recently left her position as head of a kidney and liver transplant center on the west coast of Florida. She had been an ADN at a large hospital and when they decided to open a transplant center, she was tasked with the responsibility of …

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