Resources

ADA Guidelines highlight importance of social stability in diabetes management.

After four years of good glycemic control with metformin 1500 mg a day, Mrs. Hunter returns for her 6-month follow-up visit. At this time, her office A1C is 8.2% and she has gained seven pounds. She is very concerned about her weight gain. If weight is a concern, what would be the best antiglycemic drug to add to her regimen? A. A sulfonylurea B. A DPP-4 inhibitor C. A thiazolidinedione D. A GLP-1 receptor agonist Follow the link for the answer.

Are you seeing more children with type 2 diabetes in your practice? Follow the link to share your response.

We all know the benefits of the newer insulins, i.e., faster action times, less peak from the long actings, etc. But the cost, more often than we know, can lead to patients decreasing insulin doses, doing without until the next payday, or doing without it altogether, as we’ve read about. …

In this week's Homerun Slides, we begin to take a look at how the structure of technology's use in outpatient care. Dr. Stanley Schwartz discusses how this might benefit the management of diabetes.

Incretin defect: Oral glucose elicits a greater insulin response than does intravenous glucose. As first demonstrated by Nauck et al., when tested at matched plasma glucose concentrations (iso- glycemic protocol) the oral route of glucose administration induces a robust increment in insulin secretion as compared with the intravenous route. In nondiabetic subjects, such potentiation — named incretin effect — averages 50 – 70% with a standard (75 g) oral glucose load, and increases with the size of the glucose load. As depicted in Figure 24.10, the incretin effect is characteristically lost in patients with T2DM.

Several population studies have demonstrated that when people are diagnosed with type 2 diabetes earlier in life, the risk of earlier complications including mortality related to the diabetes is significantly higher than in older populations.

Increased consumption of dietary sugars does not show increase risk of developing type 2 diabetes.

Identifying the lifestyle behaviors that can reduce the risk of type 2 diabetes in individuals considered low-risk.

Mr. Carlson is 52-year old Caucasian grocery store manager you saw last week for a new patient visit. His labs from that visit were significant for elevated random plasma glucose 166 mg/dL, A1C 7.4% and elevated lipids (TG equals 175 mg/dL, LDL 148 mg/dL, HDL 38 mg/dL, total cholesterol 221 mg/dL). He has returned to your clinic for a follow-up appointment. His physical exam is notable for central abdominal obesity (waist circumference 42”),left eyelid xanthelasma, BP 147/91, HR 72, RR 18, BMI 36 kg/m2, but otherwise normal. A repeat A1C test shows A1C 7.6% Mr. Carlson smokes between 1 and 1.5 packs of cigarettes daily. After discussing the labs and your findings with Mr. Carlson, you begin collaborating on a management plan. You write prescriptions for metformin, a statin and ACE inhibitor. Mr. Carlson doesn’t think “taking medication will be too tough” but expresses skepticism about your recommendations for a change in his diet, exercise and smoking programs because he has tried them, without success in the past. What is considered the starting BMI for consideration of bariatric surgery? 1. BMI greater than 28 kg/m2 2. BMI greater than 30 kg/m2 3. BMI greater than 35 kg/m2 4. BMI greater than 37 kg/m2 Follow the link for the answer.