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Production Assistant, Diabetes In Control

That Time of Year Again: What’s Right For Me?

As a CDE who specializes in obesity medicine and diabetes, I hear many patients with either or both diagnoses say they are ready to get a “new start.” It’s not unusual for patients to change the medications, or even stop the medications, we have agreed on for them, and their numbers go up.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #107: Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Part 5

Glucose-lowering agents: Metformin is a biguanide that has been used worldwide for more than 50 years for the treatment of T2DM although its exact mechanism of action remains incompletely understood. It decreases hepatic glucose production and improves insulin sensitivity at the level of the liver, and to a lesser extent, muscle. Metformin has been reported to reduce plasma aminotransferase levels in patients with NAFLD. Early small studies suggested that metformin improved hepatic steatosis, necro-inflammation and/or fibrosis in patients with NASH, but not in more recent and better controlled clinical trials.

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Antihyperglycemic Regimen

A 75-year-old man presents to your office with complaints of occasional mild hypoglycemia. His current antihyperglycemic regimen includes metformin and nateglinide. You would like to modify his treatment regimen to minimize his risk of hypoglycemia. Which one of the following 2-drug combinations would NOT be a suitable substitution? A. Metformin + pioglitazone B. Metformin + glipizide C. Metformin + vildaglipitin D. Metformin + exenatide Follow the link for the answer.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #106: Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Part 4

The role of statins in the primary and secondary prevention of CVD has been well established. Patients with NAFLD are believed to have increased cardiovascular risk and are logical candidates for their long-term use. In accordance with their higher cardiovascular risk, the use of statins should be encouraged in patients with NAFLD but their use has remained controversial in such patients, particularly in the setting of elevated liver enzymes. Recent practice guidelines on statin use in patients with NAFLD have clearly established that they are overall safe and that they do not carry a higher risk of liver toxicity.

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