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.

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.

More than eight servings per cycle also tied to higher frequency of intercourse

Concentration of NNSs decreases gradually over the course of observation after consumption

Decrease in mean Thacher rickets severity total score from dosing every two weeks or every four weeks

Active major depression in women not associated with negative fertility outcomes

Each 10 ng/mL higher 25(OH)D concentration associated with hazard ratio of 0.64 for diabetes

We preach good health, lean body muscle mass, exercise, and weight control to our patients, but at times we actually have patients who do too good a job. A good example of this can be seen in this week’s Disaster Averted. Our patient, the picture of perfect health and body …

A man, lean and muscular, with type 1 for over 25 years, has been pumping for 15 years and wearing a sensor for the past five years. Glucose levels have been very erratic. We checked his sites and were concerned that the erratic glucose levels were mostly related to lack of subcutaneous fat and scar tissue, so he was actually getting insulin into his muscle, scar tissue, or subcutaneous tissue at various times. Also, the patient wears an OmniPod and thought it could only be in one particular direction.

In part 1 of this 2-part Homerun Slides series, screening and monitoring prediabetes.