In part 2 of this Exclusive Interview, Jeffrey Emmick talks with Diabetes in Control Medical Editor Joy Pape about the combination of GLP1s and SGLTs while Diabetes in Control Publisher Steve Freed makes a quick appearance to ask about the possible effects of their combined use.

Exclusive insights from Dr. Ruth Loos on the new research on how genes contribute to body-fat distribution, which has identified 24 new genetic variants involved in determining where fat is stored, and how examining the links between fat distribution and diseases like diabetes may someday aid in developing new treatments.

As noted in our Editor's Letter, David Joffe discusses the importance of how we talk with patients. And to that I'll add...how or if we listen to our patients. David's letter made me think about what we say to patients when they are at risk, when they are diagnosed, and during the treatment phase. If we keep current with our knowledge of diseases — in this case, diabetes — and share what we know today but be clear that we may learn more and differently in the future, the patient may be more open to accept changes and work toward their health goals while at the same time taking into consideration what is known and currently available.

Woman, 55 years of age visited with me 3 weeks ago. Her glucose levels were in the 200-250 mg/dL range. She was actually a new patient of ours; her A1C was 9.2%. We recommended a CGM. She purchased one and brought it to the office for me to teach her how to use it. I did so. This patient is well-educated and seemed tech-savvy. When she left the visit, she "seemed" to understand CGM, what it is, what to do, and how to insert the sensor, get readings, interpret readings, etc.

When I was studying to become a CDE, the students in our class who did not have diabetes were given the assignment to live as though we did have insulin-requiring diabetes for a period of time. It was very helpful. At that time, we did not have continuous glucose monitors (CGM), but we did have insulin, vials and syringes (not sure about the pens but I don’t recall those), glucose monitors, and other supplies. We gave ourselves normal saline as if it were insulin, checked our glucose at least four times/day, carb counted, and everything else required to manage our "diabetes" daily. One incident that stands out to me was a friend faking having a hypoglycemia event while waiting for her food at a restaurant. It was quite an eye-opening period of time for all of us.

If this happens in my practice, I’m sure it likely happens with your patients too. So many of our patients take metformin. They may be new to using metformin or have been taking it for many years. Either way it’s not unusual to have untoward GI side effects from taking it. They may have done fine taking it for years, so they don’t even think about it being their metformin.

Man, 36 years of age, type 2 diabetes, obesity class II, fatty liver, was taking metformin 1,000mg twice daily, and lower dose of SGLT-2. A1C was elevated 9% due to steroids; had been in the 6-7% range. Came in for 3-month follow up — A1C 9.9%, glucose 359, urine positive for glucose and for ketones, gained 19 pounds since last office visit, B/P 126/78-HR 78 and regular. The patient reports he took a "holiday" from everything during the holidays. He ate and drank anything and everything he wanted, including alcohol, and stopped his medications. He complained of  increased hunger and thirst. Very thirsty.

I have a patient who has type 2 diabetes. He was started on long-acting insulin 8 months ago. Before adding the insulin, he was taking a daily GLP-1. He had experienced diabetic ketoacidosis (DKA) while on a SGLT-2, and did not tolerate metformin due to GI side effects. Therefore, these …

Young woman, 15 years of age, presented with class II obesity (BMI 37), irregular periods, hirsutism, and continuing to gain weight. Her first visit was with her mother. We met and discussed the possibility of her having polycystic ovarian syndrome because of her symptoms. We confirmed with labs.

Andrea Dunaif, M.D., is the Lillian and Henry M. Stratton Professor of Molecular Medicine and Chief of the J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Dunaif is an internationally recognized expert in endocrinology and women’s health. Her research on polycystic ovary syndrome (PCOS), the most common hormonal disorder of reproductive-age women, has shown that it is a leading risk factor for type 2 diabetes mellitus. Further, this research has revolutionized the treatment of PCOS with insulin sensitizing drugs.