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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #121: The Insulin Resistance Syndrome Part 2

Concept of ectopic fat as a cause of tissue insulin resistance: It appears that individuals prone to T2DM (based in part on their nonmodifiable characteristics) show a greater propensity to accumulate visceral or ectopic fat for a given weight. Interestingly this characteristic, in turn, may be a downstream consequence of “impaired” subcutaneous fat storage capacity, the mechanisms of which deserve further research. As an extreme example of this concept, lipodystrophic individuals have an impaired ability to store subcutaneous fat and, as a consequence, they accumulate fat in visceral and ectopic tissues and so have marked insulin resistance.

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The Joint is Jumping: CGMS, AI and Wearables

Guest Post by David Kliff, Editor, Diabetic Investor
Senseonics has taken their Eversense implantable CGM before an FDA panel, and Bigfoot has announced they have closed their series B $55 million financing round. The FDA has approved Dexcom’s G6 system, pushing shares in the company higher in early trading. And while they didn’t announce anything recently, our friends at Tandem are feeling the love as shares continue to surge higher in anticipation of their new system, which has low glucose suspend.

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Clinical Parameters

Mr. Hernandez's labs are notable for A1C 7.5, FPG 137 mg/dL, LDL-cholesterol 190 mg/dL, HDL-cholesterol 38 mg/dL, and triglycerides 232 mg/dL. You discuss his lab results, his diagnosis, and how to manage diabetes, then you make referrals to the appropriate diabetes team clinicians. You start Mr. Hernandez on metformin, lifestyle modifications, an ACE inhibitor, and a statin. What clinical parameters are you looking to achieve? A. A1C less than 7%, BP less than 130/80 mmHg, LDL less than 100 mg/dL B. A1C less than 7%, BP less than 130/90 mmHg, LDL less than 100 mg/dL C. A1C less than 7%, BP less than 140/80 mmHg, LDL less than 100 mg/dL D. A1C less than 7%, BP less than 140/90 mmHg, LDL less than 150 mg/dL Follow the link for the answer.

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