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Production Assistant, Diabetes In Control

A1C Treatment Plan

A 54-year-old male presents to your office for an initial visit. His past medical history is significant for hypertension, hypertriglyceridemia and acute pancreatitis. His current lab results show an A1C 9.1%, which is confirmed on a repeat lab. You would like to start him on an antihyperglycemic treatment regimen. Which of the following two-drug combinations is contraindicated for this patient? A. Metformin + a sulfonylurea B. Metformin + an insulin C. Metformin + a meglitinide D. Metformin + a GLP-1 receptor agonist Follow the link to get the answer.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #100: Pathogenesis of nonalcoholic fatty liver disease (NAFLD) Part 2

Cause of NAFLD: obesity and abnormalities in adipose tissue. Although both NAFLD and the MetS can occur in nonobese subjects, the prevalence of NAFLD is markedly increased in obesity as is that of the MetS. In the third National Health and Nutrition Examination Survey (NHANES), the prevalence of NAFLD averaged 7.5% and 6.7% in normal-weight men and women but was 57 and 44% in persons with a body mass index (BMI) greater than 35 kgm−2.

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Treating Increased A1C

Test Your Knowledge

A 64-year-old female presents to your office for her 3-month follow-up. She has previously been diagnosed with mild diastolic heart failure, secondary to hypertension. She currently takes an ace-inhibitor and a diuretic with good control of her heart failure symptoms and hypertension. At her last visit, she had a FPG 118 mg/dl. In a subsequent conversation with her, you discussed how she has developed prediabetes and suggested lifestyle modifications. Since her last visit, she has taken up very gentle walking four times/week and has changed her diet to a more healthful one. Despite these positive changes, this visit’s labs return an A1C 7.8%; her remaining labs are within normal limits. Which one of the following antihyperglycemic medication classes would you choose to initiate treatment? A. Sulfonylureas B. Biguanides C. Insulin D. Thiazolidinediones Follow the link for the answer.

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Treating Comorbidities

In treating your patients with diabetes who have hypertension, elevated blood sugars, and elevated LDL’s, do you treat 1 or 2 of the comorbidities or all 3 at the same time? Follow the link to share your response.

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Scare Them or Inspire Them?

Today, my patient, a woman, 42 years of age, brought her daughter who is 18 years of age with her for her visit. Mother has PCOS, class III obesity and type 2 diabetes. She told me she brought her because of the strong family history of diabetes on both sides of his family. She wanted her to understand what someone who has diabetes goes through.

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