High frequency of infections associated with islet cell autoimmunity and disease progression.

A 41-year-old patient with a BMI of 39 kg/m2 returns for a follow-up visit 3 months after initiating metformin. She is highly sensitive to her weight and has tried to implement lifestyle modifications, but is finding it difficult to make any meaningful changes in her diet or exercise routines. Her current A1C is 7.7%, with a target goal A1C<7%. In addition to discussing consideration of bariatric surgery, which drug class might you add? A. Thiazolidinedione B. Sulfonylurea C. DDP-4 inhibitor D. GLP-1 receptor agonist Follow the link to see the correct answer.

Received a phone call from someone I know. Has not yet come in for a visit. Just called to see if she qualified to come in for a visit. Woman, 68 years of age, denies history of diabetes, hypertension or other health problems, except being overweight. She stated, “Last year my weight was up. I went on a diet because my triglycerides were high, in the 600’s, but they came down to 140’s when I lost 30 pounds last year. I think I gained back about 10 pounds so that would be about 155 pounds now.” I asked her if she’s weighed herself. She said, no, not since I got off the program, but when I was on the program, I weighed daily. You know, I had holidays, travel, I was with a group, paid for the food, so ate what they all ate, then I just couldn’t get back on track.”

In this week's Homerun Slides, an explanation of some important diabetes trials such as EPPIC, SUN, BEACON, etc.

Nicotinic acid (niacin) has been used for more than 50 years to lower LDL-C and TGs, and increase the level of HDL-C. Indeed, niacin is the most potent HDL-C-raising pharmacologic agent available. Of note, we still, at this late time in the life of niacin, do not have definitive evidence regarding its mechanism(s) at the molecular level.

Meal sequencing may decrease glucose levels and insulin utilization.

Increased cardio risk of Saxagliptin found during trial prompts FDA decision.

Trial results promising, but DKA still a concern with use of new once-daily pills.

Philadelphia youth see rise in diagnosis; especially for African Americans, by 70%.

Common osteoarthritis treatment may be beneficial in lowering HbA1c.