In the conclusion of this Exclusive Interview, Dr. Stuart Weiss talks with Diabetes in Control Publisher Steve Freed during the AACE meeting in Austin, Texas about the introduction of medication into a patient’s management plan.
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 want to thank you for your time. I thought it was very informative. It’s always great to talk to physicians that know what they’re doing when it comes to diabetes, because most of the GPs out there are having a difficult time.
Dr. Weiss: The GPs need to learn a lot. They need to learn to start early and not wait until the A1C is 6.5 before treating their patients.
Steve: What would you say if a person walks into your office and they have an A1c of 5.8%, 5.9% just below 6%, do you just tell them to diet and exercise?
Dr. Weiss: Well, I don’t just say diet and exercise. That’s very easy. A lot of people kneejerk diet and exercise as an expression. But really, I have them do the same thing, I send them home with sheets to write down everything they eat and I have them check their blood sugar post-prandial. Post-prandial blood sugars can be high well before the A1C is going to be elevated and it’s the first indication of a problem, also high triglycerides, the post-prandial numbers are high, that’s what we need to address
Steve: At what point do you put them on medication? Or do you wait until they hit 6.5%?
Dr. Weiss: I beat them over the head about diet a lot, and I have a lot of success with it. I hear people say that after 6 months people fall off their diets and after a year they’ve regained all their weight and their sugars are just bad again. I keep calling my patients back on a 3-month basis to reinforce or have them meet with the educators to reinforce the need for that. If, however, they’re slipping that’s when I think a DPP4/Metformin combination early on.
Steve: Even before 6.5?
Dr. Weiss: Even before 6.5, if they have a strong family history of type 2 diabetes and they’re headed that way, then absolutely.
Steve: Even though technically that’s off label?
Dr. Weiss: It’s off label, yes.
Steve: You’re one of the few physicians…I guess you can do that in a private practice, but you couldn’t do that if you were working for a large company because you have to follow their standards of care.
Dr. Weiss: Well, yeah. Not a big fan of standards of care. (laughter)