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CONDITIONS

When Pills Are Hard to Swallow, Find Alternatives

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Woman, 67 years of age, newly diagnosed with type 2 diabetes with an A1C of 7.8%. Met with PCP who prescribed metformin ER and referred patient for diabetes education. Patient made some dietary and physical activity changes at first, but upon return visit her A1C was 8.5%. She reported she did not take the metformin. “I can’t swallow big pills. The bottle said not to crush or break the tablets. They were just too big to swallow. So then I just gave up on everything.”

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #12: Epidemiology and Geography of Type 2 Diabetes Mellitus Part 1 of 5

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Age- and sex-specific prevalence of type 2 diabetes in different ethnic groups: Type 2 diabetes mellitus (T2DM) is now taking its place as one of the main threats to human health in the twenty-first century. In 1921, Dr Elliot Joslin was already concerned that according to his count there had been a doubling of diabetes in three decades. The impact of T2DM is increasingly felt around the world, with its prevalence rising dramatically over recent decades.

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Diabetes Information Best Shared By Patients and HCPs Alike

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Woman, 58 years of age, history of PCOS, prediabetes, strong family history of type 2 diabetes, cardiovascular disease and obesity. This patient lives a healthy lifestyle, including a lower carb meal plan, is very active, and keeps her weight down. Those interventions did not lower her A1C, so she educated herself and asked her NP/CDE if she should start metformin. This was about 20 years ago. Since starting metformin, A1C is in the 5.1-5.5% range. Patient regularly checks glucose, which was recently rising. A1C rose to prediabetes range again. Started on GLP-1 by NP/CDE. Patient then went to a new PCP who told her she should not be taking metformin or the GLP-1 because she does not have diabetes. Wanted to refer her to an endocrinologist....

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #11: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 5 of 5

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In industrialized countries, 20–40% of T1DM patients younger than 20 years present with diabetic ketoacidosis. After adjusting for age, gender, ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education. Younger children present with more severe symptoms at diagnosis, because children younger than 7 years old have lost on average 80% of the islets, compared to 60% in those 7–14 years old and 40% in those older than 14 years.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #10: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 4 of 5

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Twin and family studies indicate that genetic factors alone cannot explain the etiology of T1DM. Seasonality, increasing incidence and epidemics of T1DM as well as numerous ecological, cross-sectional and retrospective studies suggest a critical role of environmental factors, such as infections with certain viruses (especially enteric infections in early life) and effects of early childhood diet. Natural history studies that follow children at increased risk of T1DM provide the best opportunity to study environmental triggers.

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