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Researchers find every 0.1% increase in HbA1c above 5.1% increases diagnosis risk by 22%.

John S. is a 63-year-old white male with significant abdominal obesity, type 2 diabetes, hypertension, and dyslipidemia as well. On the basis of an exercise stress test, John was recently diagnosed with silent ischemia. John’s current medications include metformin, a DPP-4 inhibitor, an ACE inhibitor/HCTZ agent, a calcium channel blocker, a high-dose statin, and ezetimibe. John’s relevant physical exam and laboratory findings are as follows:

BMI: 34.8 kg/m2
Blood pressure: 140/86 mm Hg
HbA1C: 7.2%
Total cholesterol: 150 mg/dL
LDL-C: 79 mg/dL
HDL-C: 42 mg/dL
Triglycerides: 145 mg/dL
non-HDL-C: 118 mg/dL
eGFR: 65 mL/min/1.73 m2
ACR: 100 mg albumin/g creatinine

Question: In consideration of John’s overall risks and guideline recommendations, which of the following options would you recommend to manage his type 2 diabetes?

A. Stop the DPP-4 inhibitor due to risk of heart failure. It will not be necessary to add another antihyperglycemic agent as long as John’s HbA1C remains less than 8%.
B. Encourage John with practical advice for improving his lifestyle, and continue with the current regimen.
C. Add basal insulin to John’s regimen and titrate the dose until his HbA1C is less than 7%.
D. Recommend starting a GLP-1 receptor agonist or an SGLT2 inhibitor to improve John’s glucose control.

Follow the link for the answer.

Should we treat prediabetes pharmaceutically, along with diet and physical activity, for patients with an A1c of 6-6.4%? Follow the link to see how you compare to your colleagues.

Young woman, 15 years of age, presented with class II obesity (BMI 37), irregular periods, hirsutism, and continuing to gain weight. Her first visit was with her mother. We met and discussed the possibility of her having polycystic ovarian syndrome because of her symptoms. We confirmed with labs.

Andrea Dunaif, M.D., is the Lillian and Henry M. Stratton Professor of Molecular Medicine and Chief of the J. Lester Gabrilove Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, New York, NY. Dr. Dunaif is an internationally recognized expert in endocrinology and women’s health. Her research on polycystic ovary syndrome (PCOS), the most common hormonal disorder of reproductive-age women, has shown that it is a leading risk factor for type 2 diabetes mellitus. Further, this research has revolutionized the treatment of PCOS with insulin sensitizing drugs.

In this week's Homerun Slides, we round out the Pituitary category in Dr. Claude Lardinois' Endocrinology Jeopardy. This week's clue is: 64-year-old male being treated for metastatic melanoma.

Neonatal diabetes (NDM) is defined as monogenic beta-cell diabetes which is diagnosed in the first six months of life. It is rare, affecting one in 200,000 live births. The evidence that a diagnosis before 6 months is the cut-off between monogenic neonatal diabetes rather than polygenic T1DM comes from studies of high-risk type 1 HLA, antibodies, birth weight (reduced before 6 months suggests a reduced insulin secretion in utero) and monogenic genetic studies.

In this Exclusive Interview transcript, Andrea Dunaif talks with Diabetes in Control Medical Editor Joy Pape during the ADA 2018 convention in Orlando about the relation of Polycystic Ovarian Syndrome to diabetes, its causes, diagnosis, and even the inaccuracy of the name.

In this Exclusive Interview, Andrea Dunaif talks with Diabetes in Control Medical Editor Joy Pape during the ADA 2018 convention in Orlando about the causes, diagnosis, and even the inaccuracy of the name Polycystic Ovarian Syndrome (PCOS), as well as its relation to diabetes.

In part 1 of this Exclusive Interview, Andrea Dunaif talks with Diabetes in Control Medical Editor Joy Pape about the importance of understanding PCOS and its associated risks.