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Stuart Weiss Part 3, Diabetes Medications

In part 3 this Exclusive Interview, Dr. Stuart Weiss talks with Diabetes in Control Publisher Steve Freed during the AACE meeting in Austin, Texas about the development of today’s diabetes drugs, his preferences, and how he uses them with his patients.

Dr. Stuart Weiss, is currently an Assistant Clinical Professor of Endocrinology at NYU Langone Medical Center. He has a long history of clinical practice in the management of patients in the field of diabetes, endocrinology and metabolism.

Transcript of this video segment:

Steve: I don’t know how long you’ve been in practice, but do you remember when we only had one oral drug for diabetes?

Dr. Weiss: I came in just about the time…. There were only sulfonylureas and at that time the only thing that we really had was diet and exercise but nobody really knew what diet and exercise meant.

Steve: So now we have metformin in ’95, and from ’95 to today, we have all these new classes of drugs…But today there’s over a million possible combinations if you include insulin…How do you determine which drug or combination of drugs that you want to…use?

Dr. Weiss: What I use is the general scheme. The general scheme is the patient comes to me, I have them learn how to use a glucose meter, I have them keep diet and exercise records for a week’s time. Writing down everything they eat and checking their blood sugars as much as I can get them to do, but before and after meals and bedtime. They do that first before I make any assessment about what kind of medications they’ll need. They usually come to me on a medication or two, usually metformin and something else. Very variable. Then when I see how they eat, what they eat I go from there and what their glucose profile is after discussion how they’re eating and what they’re eating and then I make adjustments in their medications. If they’re overweight that’s a consideration, if they have high blood pressure that’s another consideration, Nowadays I feel very comfortable with the SGLT2 class and also the GLP1s on top of metformin. There is a lot of arguments on whether or not metformin should be first line. But I’m not in control of the finances of the whole deal, so I’m using metformin as first line for that reason mostly and then SGLT2s, although I don’t like SGLT2 for the reason that people eat food and then take a pill to allow them to pee out the food that they’ve eaten I think it’s environmentally insane and I think that it’s something that works and I use tons of, but I don’t emotionally like using them.

Steve: So obviously, you favor GLP1’s.

Dr. Weiss:  GLP1s are very very good medications, they work very nicely, they mimic what the body does, it addresses an early problem that we’ve ignored for quite a long time and that is the role of glucagon in diabetes management. So, hyper-glucagon is a huge problem in mobilizing sugar from the liver and it does raise blood sugars. I like the DPP4 products used early, early on like newly diagnosed or even prediabetes because they augment the normal physiology that’s lost. A normal person eats – glucagon levels fall, a diabetic eats – glucagon levels rise. In between in prediabetes glucagon levels don’t fall the way they ought to and they even rise more before insulin deficiency is seen.

Steve: I think one of the neat things about the GLp-1’s is that it’s a hormone that our bodies normally produce anyway where all the other drugs, they’re nothing that our bodies desire and have more side effects.

Dr. Weiss: Absolutely, the GLP1’s are great drugs and they’re easy to tolerate. Sometimes there is GI upset with the medication. What I like to do is tell patients that if they get GI upset before they eat,  it’s the drug; if they get GI upset after they eat, they’ve eaten too much.

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