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Triple Therapy Trigger

At what A1c do you feel comfortable using triple therapy for a patient with type 2 and excessive weight? 8%, 9%, 10%, or 11%? Follow the link to respond.

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CLINICAL CASE VIGNETTE: Antihyperglycemic Treatments

Mr. Huang is a 61-year-old Asian American businessman who comes in to see you for a follow-up appointment. He was diagnosed with type 2 diabetes four years ago and has a long-standing history (15 years) of hypertension and hypercholesterolemia, which are currently well-controlled. Current medications are metformin (1500 mg/day), lisinopril, and simvastatin. He has excess weight (BMI 29 kg/m2) but feels he has a healthy diet and gets out for a 25-30 minute walk 3 or 4 times per week. He feels great, but over the last nine months or so, he has noticed that his home average glucose levels are in the 180-198 mg/dL range. At today’s visit, his A1C is 8.3%. Based on Mr. Huang’s individual glycemic target of A1C<7%, you would like to add another antihyperglycemic. You choose linagliptin over glimepiride. What is the best reason for your choice?

A. Greater weight loss benefits
B. More effective at lowering blood glucose levels
C. Lower cost of treatment

Follow the link for the answer.

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The Real Story Continues

When we first met this patient, he did not think he was getting the right treatment. When he visited one week later... When I asked him, and told him I would not judge him, he admitted to drinking a tea his mother recommended to bring down his glucose. He then mentioned several other supplements. His glucose was not lower, but higher.

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Laura Shane-McWhorter Complete Interview

Laura Shane-McWhorter, PharmD, BCPS, BC-ADM, CDE, FASCP, FAADE is a Professor (Clinical) Emeritus in the Department of Pharmacotherapy at the University of Utah College of Pharmacy.  She obtained her Bachelor of Arts Degree in Psychology and Chemistry at the University of Texas at Austin. She obtained a Master of Science at East Texas State University (now Texas A&M Commerce) in Biology and Chemistry.  After completing both her Bachelor of Science and Doctor of Pharmacy at the University of Utah, she did an ASHP Residency in Geriatrics. She is a Board-Certified Pharmacotherapy Specialist, is Board Certified in Advanced Diabetes Management and is a Certified Diabetes Educator.  She is a Fellow of the American Society of Consultant Pharmacists and a Fellow of the American Association of Diabetes Educators (AADE). She is a member of the Board of Directors of the American Association of Diabetes Educators.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #133: Pathogenesis of Type 2 Diabetes Mellitus Part 4

Type 2 diabetes with hypoinsulinemia: A large body of clinical and experimental evidence documents that hyperinsulinemia and insulin resistance precede the onset of T2DM. Nonetheless, a number of studies have shown that absolute insulin deficiency, with or without impaired tissue insulin sensitivity, can lead to the development of T2DM. This scenario is best exemplified by patients with maturity onset diabetes of youth (MODY) [69–71]. This familial subtype of T2DM is characterized by early age of onset, autosomal dominant inheritance with high penetrance, mild-to-moderate fasting hyperglycemia, and impaired insulin secretion.

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