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Prediabetes Part 2

 In part 2 of this 2-part Homerun Slides series, Finnish vs ADA diabetes risk scores. To download the complete set in PowerPoint format, just use this link: Prediabetes Part 2. Catch up on past Homerun Slides for the Hypertension Update: Prediabetes Part 1.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #127: Beta-Cell Mass and Function in Human Type 2 Diabetes Part 3

The dominance of beta-cell functional impairment: As discussed earlier, the available evidence indicates that an average 30% loss of beta-cells is present in the islets of patients with T2DM. However, based on a series of considerations it is unlikely that this beta-cell deficit alone is the cause of most cases of diabetes. First, in vivo assessment of beta-cell function consistently shows a greater than 50% reduction in patients with overt T2DM, a difference that is amplified when using intravenous glucose.

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Double Therapy

Would you treat a new patient with a family history of heart disease, diagnosis of type 2 diabetes, and an A1c of 8% with the double therapy of a GLP-1 plus an SGLT-2 inhibitor? Follow the link to share your response.

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Clinical Case Vignette Follow-up: Two Steps Back

Mrs. Hunter is 36-year-old African-American who comes to your office for her annual wellness exam. She has excessive weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. You and Mrs. Hunter set a goal for A1C<6.5%. She returns 3 months later for a follow-up visit and her office labs show an A1C 6.8%. You congratulate her on her progress and ask her to return in another 3–4 months. When she does, she is above her goal with an A1C 8.1%. She explains that she has gone back to full-time work and just doesn’t have the time to get to the gym anymore. At this time, what would your next step be and what would her individualized glycemic targets be?

A. Encourage lifestyle modifications and start metformin with a target A1C less than 6.5%
B. Encourage lifestyle modifications and start metformin with a target A1C less than 7.5%
C. Encourage lifestyle modifications and start a 2-drug combination target A1C target less than 7%
D. Encourage lifestyle modifications and do not initiate drug therapy at this time

Follow the link for the answer.

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