Mr. Fontello is an overweight, Caucasian 63-year old patient who comes in for a 6-month check-up. He has a 12-year history of type 2 diabetes. He was diagnosed at age 33 with high blood pressure, but had never really done much about it as it was “too much of a hassle” and he felt “just fine.” At the time his diabetes was diagnosed, he was referred to a diabetes education program and was started on metformin, lovastatin, losartan and aspirin. He has an individualized A1C goal of 7%. Four years after diagnosis, pioglitazone was added to Mr. Fontello’s diabetes regimen. Three years ago, he came in for an appointment complaining of polyuria, polydipsia and fatigue with an office A1C of 9.3%. At that time he was started nightly basal insulin detemir. Since that time, he has made concerted efforts to eat a healthy diet and get to the gym. Today, he reports his SBGM fasting plasma glucose levels are on target (FPG below 130mg/dL). He also states that his feet always feel a little bit swollen. BP 128/78, HR 73, RR 19. Physical exam is remarkable for peripheral edema and mildly decreased pedal pulses. Current medications: metformin, pioglitazone, insulin detemir, lovastatin, losartan, aspirin. At today’s visit, his office A1C is 8.1%. What changes would you recommend for his antihyperglycemic regimen? Select one answer: [A] Add a premixed insulin to all three meals of the day [B] Increase his detemir dose [C] Add a sulfonylurea to his regimen [D] Add a rapid-acting insulin analogue to his largest meal of the day Are you right? Follow the link to find out!

In study, 40 percent of adults with type 2 diabetes achieved a fasting glucose level of less than 126mg/dL.(7mmol/L) after eight weeks on a very low-calorie diet.

To combat the negative effects of too much sitting, standing desks have been rising in popularity. But does the science support their supposed benefits?

Electro-acupuncture may be beneficial through different mechanisms: weight loss, anti-inflammatory effects, and improvement of lipid metabolism and adipokines.

Meta-analysis examines the effectiveness of interventions in improving and preventing diabetes depression.

Do you use Diabetes Apps with your patients? Follow the link to let us know and see what others are doing!

Type 2 patients who used saxagliptin or sitagliptin had similar risks for heart failure as those who received other anti-hyperglycemic agents, according to a retrospective cohort study.

Mrs. Wilson is an overweight 71-year old African American patient who has come to your clinic today for a new patient visit. She recently moved to the area to live with her daughter and is concerned about her diabetes care plan. She was diagnosed with type 2 diabetes 12 years ago at a wellness check through routine screening. In hindsight, she wonders if maybe she “went undiagnosed for a while” because she “didn’t get to the clinic very often and was having some problems with frequent urination at night” before she was screened. She currently takes metformin, glyburide, captopril, pravastatin, aspirin and has recently titrated to.6 U/kg/day insulin NPH as a nightly basal dose. Her current A1C goal is below 7.5% and she has been working hard to get to that level. However, for the first time her life, she is finding herself to be nauseated and irritable in the morning, but always feels better after a little breakfast. She states she feels “pretty good for her age” although she occasionally has “a little chest tightness when walking more than 4 or 5 blocks.” Last time she remembered to check it a few days ago, her postprandial glucose was a little high at 214 mg/dL. After discussing her situation with her, you decide to modify Mrs. Wilson’s antihyperglycemic regimen. Which of the following treatment options would you choose? [A] metformin + long-acting analogue + rapid-acting analogue [B] metformin + glyburide + long-acting insulin analogue + rapid-acting analogue [C] metformin + glyburide + NPH + rapid-acting analogue [D] metformin + NPH + rapid-acting analogue Follow the link to see if you're correct!

According to more than 200 studies involving 1.4 million patients, metformin reduces heart disease risk in diabetes patients more effectively than its competitors.

A year after the FDA warning, a strong response to the question: are SGLT-2 inhibitors safe?