#51: Diabetes treatment in 2017: New meds, insulin, and cardiac risk reduction
Get cozy with these new drugs for diabetes treatment. Don’t be scared, they won’t bite. On this episode, we interview Endocrinologist and current president of AACE, Dr. Jonathan D. Leffert, MD, FACP, FACE, ECNU about how to utilize the myriad of new diabetes drugs on the marketplace including SGLT2 inhibitors, DPP4 inhibitors, GLP1 agonists, and new ultra long acting insulins. Plus, we’ll teach you how to choose between agents, common side effects, A1C goals, and the cardiovascular benefits of these newer agents. Help patients afford their meds with this resource from AACE http://prescriptionhelp.aace.com
Full show notes available at http://thecurbsiders.com/podcast
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Case: Case from Kashlak Memorial Hospital: 49 yo M with HTN, BMI 29, hyperlipidemia, family history of premature CAD (dad age 45yo), and type 2 diabetes with A1C increase from 6.4% to 9% while on metformin monotherapy.
Latent autoimmune diabetes of aging (LADA): Autoimmune disease similar to type 1 diabetes (DM1). Suspect if older adult presents w/new insulin dependence. Check glutamic acid decarboxylase (GAD) antibodies, which are most sensitive and specific. Often positive in LADA/DM1. Can also check islet cell Ab or insulin autoantibodies.
A1C and anemia: Based on red cell (RBC) survival. Falsely high a1c if RBC turnover is low → Older RBCs that accumulate more glucose e.g. Iron, vitamin B12, or folate deficiency anemia. Falsely low a1c if rapid RBC turnover e. Continue reading