#192 Debate on First-Line Medications for Diabetes

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 5 November 2025

⏱️ 39 minutes

🔗️ Recording | iTunes | RSS

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Summary

SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how do you weigh their side effects and practical use?

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🔹 Transcript and Show Notes

Timestamps:

(01:42) | Starting Treatment for Newly Diagnosed Type 2 Diabetes

(08:40) | Balancing Cost, Coverage, and First-Line Therapy Choices

(13:44) | Choosing Therapy for CAD and CKD: The Case for SGLT2 vs. GLP-1

(19:42) | Managing Obesity, Sleep Apnea, and Pain in Diabetes Care

(27:57) | Rethinking Sulfonylureas and Shifting Toward Modern Agents

(29:07) | Choosing Between GLP-1 and SGLT2 Inhibitors for Comorbidities

(35:34) | Weighing Side Effects and Practical Use of GLP-1 and SGLT2 Inhibitors

Tags: CoreIM, Primary Care, Endocrinology, Diabetes Mellitus, Type 2 Diabetes, Type 1 Diabetes, Metformin, GLP-1, SGLT2, Insulin, CGM, A1C, DKA, Medical Education, Clinical Reasoning, Hospital Medicine

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Transcript

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0:00.0	Let's be honest, between the back-to-back patients, inbox overload, and real life, our schedules
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1:02.6	forget to use the code Core 30. Welcome to Corian. Today, we are spending things around with
1:08.1	the diabetes debate and we're going to dig into a very real world
1:11.3	clinical question. In this stage, we have so many different diabetes options, which is great,
1:16.4	but a very good question is what do you start and why? And so today we have a good lineup of meds.
1:22.7	We actually kept it simple to hammer home some of the learning points to three medications. We've got
1:27.3	foreman, SGLT2 inhibitors, and GLP1 agonists. And we also have three very experienced frontline
1:34.3	primary care docs who each have chosen a medication to defend for our diabetes battle. Of course,
1:39.8	it's going to be a respectful one. But Tracy, I'll hand it off for you first to introduce
1:44.0	yourself and which
	...

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