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Production Assistant, Diabetes In Control

Screening for Type 2

A patient that you haven’t seen for several years comes to your clinic for a wellness check-up. Since her last visit, she has gained about 15 pounds (5’6”, BMI 27 kg/m2). Her stage 1 hypertension is controlled with hydrochlorothiazide. As you discuss her weight gain, you learn that she doesn’t get more than 30 minutes a week of physical activity. You decide it would be best to check her A1C. Which of the following information from her history leads you to screen her for type 2 diabetes? A. Her youngest child weighed 8.5 pounds at birth. B. Two of her cousins have type 2 diabetes. C. She just celebrated her 41st birthday. D. She has a history of hypertension. Follow the link for the answer.

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New A1C Recommendation

The American College of Physicians (ACP) said doctors can tell patients to aim for a glycosylated hemoglobin, or HbA1C, level between 7 percent and 8 percent, rather than the traditional 6.5 percent to 7 percent. Plus, clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%. (See article 2)

Do you agree A1c should be between 7% and 8%?

Follow the link to see what your colleagues think.

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Gout Diagnosis

Gout is a tricky diagnosis to make. Rarely is it made via the gold standard technique of synovial aspiration and polarized light microscopy. The vast majority of diagnoses are clinical. A primary care and rheumatologist team of Dutch researchers led by Hein Janssens derived and published a clinical decision rule in 2010. This app brings that decision rule to primary care physicians, rheumatologists, and acute care (ER/urgent-care) clinicians everywhere.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #115: Diabetes and Sleep Apnea Part 5

OSA and beta-cell function: While the impact of OSA in IR has been studied extensively, the impact of OSA on beta-cell function has received little attention, despite being an essential part of the pathogenesis of T2DM and prediabetes. A small number of animal studies showed that intermittent hypoxia increases beta-cell death, and results in beta-cell dysfunction, although the intermittent hypoxia used in this study is far greater than that which occurs in humans with OSA.

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