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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #122: The Insulin Resistance Syndrome Part 3

Adipose-derived markers and insulin resistance: Whilst rising BMI or waist circumference are clearly linked to insulin resistance and risk for T2DM, a number of adipose-derived factors have attracted interest with respect to determining insulin resistance. Adiponectin, as recently reviewed, has been the most notable of these biomarkers. Adiponectin is unlike the other adipocyte hormones in that its concentrations decline with rising obesity. Therefore low levels predict higher risk for T2DM but there are a number of complexities in this relationship.

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Clinical Case Study: Metformin Side Effects

Mr. Hernandez' lab results are A1C 7.5%, FPG 137 mg/dL, LDL 190 mg/dL, HDL 38 mg/DL and triglycerides 232 mg/dL. He is started on metformin, lifestyle modifications, an ACE inhibitor, and a statin. He was asked to return in 3 months' time to evaluate how everything is going. However, he fails to keep his appointment. He returns 1 year after his initial diagnosis for a recurrent yeast infection. His A1C is currently 7.7%. Upon questioning, he admits that while he has been good about taking his “heart meds,” he has not taken the “sugar pill” because he didn’t like it. What side effect did the patient most likely find intolerable? A. Diarrhea and abdominal cramping B. Paresthesias C. Increased appetite D. Insomnia Follow the link for the answer.

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ACP’s New A1C Targets

The American College of Physicians (ACP) has issued a new recommendation that type 2 patients should not have a target A1C level below 8 percent for any patient population and should not have any A1C targets for older adults (e.g., age 80 and older) or younger individuals with limited life expectancy because of other serious diseases and illnesses. Do you agree with the American College of Physicians' new A1C target recommendations? Follow the link to share your opinion.

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Know the Difference When Choosing Between CGMs

You may wonder which CGM monitor is best for your patients. I know I do. Learn from Dr. Stephen W. Ponder, MD, FAAP, CDE-AADE Educator of the Year, Board Certified Pediatric Endocrinologist, Pediatric Residency Program Director at Baylor Scott & White McLane Children's Hospital and 50 year Joslin Medalist. He also helps people with diabetes through the "sugar surfing" method to empower individuals who have diabetes to live fuller and more satisfying lives.

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