This chapter will concentrate on the monogenic disorders of the beta cell that account for 1–2% of diabetes. They are discrete disorders, which are a significant cause of diabetes in their own right. Correct molecular diagnosis is important to predict clinical course, explain other associated clinical features, enable genetic counseling, diagnose family members, and most importantly guide appropriate treatment. In addition to this clinical importance, the discovery and study of monogenic disorders has given further insight into the physiology and pathophysiology of the beta cell.

New combination drug has better efficacy in glucose control and weight loss than when taken separately.

Empagliflozin shows improvements in A1C while also having major adverse effects, but there could be a balance.

Study tests new closed-loop control technology using new Control-IQ algorithm.

With pressure from patients, elected representatives and the medical community, we are finally seeing some positive results in lowering the cost of a life-sustaining drug.

Which of the following is true regarding the presentation and diagnosis of hypertriglyceridemia?

A. Hypertriglyceridemia is usually asymptomatic until triglyceride levels are greater than 500-900 mg/dL.
B. When triglycerides are elevated, blood glucose and A1c should be checked to rule out uncontrolled diabetes.
C. Second-degree relatives should be screened for hyperlipidemia.
D. The use of oral contraceptives, beta-blockers, and thiazide diuretics have been linked to decreased plasma triglyceride and very low-density lipoprotein (VLDL) levels.

Follow the link for the answer.

If you could have any A1c result for yourself what would that be?

- Below 8%
- Below 7%
- Below 6%
- Below 5%

Follow the link to see how you and your colleagues compare.

Male, 68 years of age, type 2 diabetes, Italian, on long-acting insulin and GLP-1. Basal glucose levels are within target as are most post-prandials except every night after dinner. We have talked several times about lowering carbs, which he has done during the daytime, but has difficulty cutting back on dinner meal. We had in the past discussed taking rapid-acting insulin for meals, but he refused. After two weeks, patient sent me his CGM results. Even he started getting concerned about his evening post-prandial levels. Rapid-acting insulin added before dinner and post-prandials are now in target range. He has not once complained about taking the rapid-acting insulin before dinner.

In this week's Homerun Slides, a focus on CGM outcomes.

Clinical significance of glucose toxicity: After diagnosis of type 1 diabetes, initiation of insulin therapy induces partial clinical remission in ∼30% of the patients during the first year. This honeymoon period is characterized by normoglycemia, recovery of endogenous insulin secretion, and by improved insulin sensitivity. Although correction of several alterations secondary to insulin deficiency, such as increased counterregulatory hormone secretion, hyperosmolarity, acidosis, electrolyte changes and high free fatty acids could contribute to normalization of insulin secretion and sensitivity, reversal of glucose toxicity may also be of importance for the occurrence of remission.