In this week's conclusion of this series of Homerun Slides, patient care and triage reminders, and other knowledge-based computerized patient record information.

First-phase insulin secretion: In response to i.v. glucose, insulin is secreted in a biphasic pattern with an early burst of insulin release within the first 10 min followed by a progressively increasing phase of insulin secretion that persists as long as the hyperglycemic stimulus is present. This biphasic insulin response is not observed after oral glucose, because of the more gradual rise in plasma glucose concentration. Loss of first-phase insulin secretion is a characteristic and early abnormality in patients destined to develop T2DM.

Key ADA poster summaries include liraglutide in type 1 diabetes, oral semaglutide, bottled water's association with type 2 diabetes, & SGLT-2 combo LIK066.

ADA 2018 abstracts of interest include Entresto for the Treatment of Diabetic Peripheral Neuropathy; Oral Contraceptive Associated with Postmenopausal Diabetes; Glucokinase as Adjunct Therapy in People with Type 1 Diabetes, and more.

Overview from a presentation at the 2018 American Diabetes Associations 78th Scientific Sessions.

The “artificial pancreas” provides glucose control for non-critically ill patients

A single dose of BCG vaccine appears to decrease progression of new onset diabetes.

Multiple testings still recommended for certain groups.

At what A1c do you feel comfortable using triple therapy for a patient with type 2 and excessive weight? 8%, 9%, 10%, or 11%? Follow the link to respond.

Mr. Huang is a 61-year-old Asian American businessman who comes in to see you for a follow-up appointment. He was diagnosed with type 2 diabetes four years ago and has a long-standing history (15 years) of hypertension and hypercholesterolemia, which are currently well-controlled. Current medications are metformin (1500 mg/day), lisinopril, and simvastatin. He has excess weight (BMI 29 kg/m2) but feels he has a healthy diet and gets out for a 25-30 minute walk 3 or 4 times per week. He feels great, but over the last nine months or so, he has noticed that his home average glucose levels are in the 180-198 mg/dL range. At today’s visit, his A1C is 8.3%. Based on Mr. Huang’s individual glycemic target of A1C<7%, you would like to add another antihyperglycemic. You choose linagliptin over glimepiride. What is the best reason for your choice?

A. Greater weight loss benefits
B. More effective at lowering blood glucose levels
C. Lower cost of treatment

Follow the link for the answer.