In this week's Homerun Slides, we begin a new category in Dr. Claude Lardinois' Endocrinology Jeopardy! This week's clue: 1.5 cm mass found on CT Scan 1 mg overnight DST cortisol is 3.3 mg/dL.

Renal cysts and diabetes (RCAD) syndrome: HNF1B-MODY
Molecular genetics of RCAD
HNF1B is a transcription factor with a role in regulating gene expression in a number of tissues. HNF1B forms homo and heterodimers with HNF1A, is present in similar tissues although at different levels, and binds to the same DNA consensus sequence. Despite these similarities HNF1B mutations cause diabetes by a different mechanism and have a distinct phenotype. There is autosomal dominant inheritance, although up to 50% of cases arise from de novo mutations or deletions.

Study assesses effect of variable glycemic levels on risk of vascular complication in patients without diabetes.

Study attempts to determine association between elevated triglyceride levels and achieving glycemic goals for those with insulin-treated diabetes.

Study assessed association of cancer and sodium glucose transporter 2 expression as well as potential benefit of SGLT-2 treatment.

Drugs shown to increase risk of hypoglycemic and cardiovascular events.

Following diabetes diagnosis, children and adolescents have high risk of developing psychiatric condition.

Researchers find every 0.1% increase in HbA1c above 5.1% increases diagnosis risk by 22%.

John S. is a 63-year-old white male with significant abdominal obesity, type 2 diabetes, hypertension, and dyslipidemia as well. On the basis of an exercise stress test, John was recently diagnosed with silent ischemia. John’s current medications include metformin, a DPP-4 inhibitor, an ACE inhibitor/HCTZ agent, a calcium channel blocker, a high-dose statin, and ezetimibe. John’s relevant physical exam and laboratory findings are as follows:

BMI: 34.8 kg/m2
Blood pressure: 140/86 mm Hg
HbA1C: 7.2%
Total cholesterol: 150 mg/dL
LDL-C: 79 mg/dL
HDL-C: 42 mg/dL
Triglycerides: 145 mg/dL
non-HDL-C: 118 mg/dL
eGFR: 65 mL/min/1.73 m2
ACR: 100 mg albumin/g creatinine

Question: In consideration of John’s overall risks and guideline recommendations, which of the following options would you recommend to manage his type 2 diabetes?

A. Stop the DPP-4 inhibitor due to risk of heart failure. It will not be necessary to add another antihyperglycemic agent as long as John’s HbA1C remains less than 8%.
B. Encourage John with practical advice for improving his lifestyle, and continue with the current regimen.
C. Add basal insulin to John’s regimen and titrate the dose until his HbA1C is less than 7%.
D. Recommend starting a GLP-1 receptor agonist or an SGLT2 inhibitor to improve John’s glucose control.

Follow the link for the answer.

Should we treat prediabetes pharmaceutically, along with diet and physical activity, for patients with an A1c of 6-6.4%? Follow the link to see how you compare to your colleagues.