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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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There’s a New Diabetes Website in Town

Decades ago, going to an International Diabetic Athletes Association (IDAA) meeting in 1990 helped shaped the future direction of my career in diabetes and exercise. I remember talking with people about managing blood glucose with type 1 diabetes during activities of varying types and intensities, and my interest in compiling such useful information led to my first book attempting to create a guide for exercisers with diabetes in 2001. IDAA later became the Diabetes Exercise & Sports Association (DESA), and it later combined with InsulinDependence.org. Sadly, all those organizations are now defunct, the latest casualties of money problems that many not-for-profit organizations have experienced of late.

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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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