We are all very familiar with the onset of type 1 diabetes in young children. In fact, we used to call type one diabetes “juvenile diabetes” until well in to the 1980’s. We no longer use that moniker, but we often think it is the oddity when someone over the …

In this week's Homerun Slides, we round out the Pituitary category in Dr. Claude Lardinois' Endocrinology Jeopardy. This week's clue is: 64-year-old male being treated for metastatic melanoma.

Neonatal diabetes (NDM) is defined as monogenic beta-cell diabetes which is diagnosed in the first six months of life. It is rare, affecting one in 200,000 live births. The evidence that a diagnosis before 6 months is the cut-off between monogenic neonatal diabetes rather than polygenic T1DM comes from studies of high-risk type 1 HLA, antibodies, birth weight (reduced before 6 months suggests a reduced insulin secretion in utero) and monogenic genetic studies.

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John S. is a 63-year-old white man 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

Which statement best describes the evidence supporting cardiovascular benefits of the antihyperglycemic agents available to treat John’s type 2 diabetes?

A. Further glucose reduction using any available agent should have similar cardiovascular disease benefit.
B. Thiazolidinediones increase the risk of heart failure and myocardial infarction in patients with type 2 diabetes.
C. Two approved GLP-1 receptor agonists have been shown to reduce mortality in patients with type 2 diabetes and cardiovascular disease.
D. Both GLP-1 receptor agonists and SGLT2 inhibitors affect cardiovascular risk through the same physiologic mechanisms.

Follow the link for the answer.