#51: Diabetes treatment in 2017: New meds, insulin, and cardiac risk reduction

The Curbsiders Internal Medicine Podcast

Health & Fitness, Medicine, Science, Higher Education, Education

4.8 • 3.1K Ratings

🗓️ 7 August 2017

⏱️ 47 minutes

🔗️ Recording | iTunes | RSS

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Summary

Get cozy with these new drugs for diabetes. 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.

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 DM2 with A1C increase from 6.4% to 9% while on metformin monotherapy.

Time Stamps

00:00 Intro

04:33 Getting to know our guest

09:50 Clinical case of diabetes

12:40 Latent autoimmune diabetes

15:16 Life expectancy and A1C goal

16:47 Anemia’s effect on A1C

18:40 Back to our case, choice of agent

20:57 Lifestyle changes effect on A1C

22:55 Starting an SGLT2 inhibitor, what to look for

26:45 SGLT2 inhibitor use in patient already on diuretic

27:53 Discussion of CV risk reduction and newer DM meds

33:27 Euglycemic DKA

34:30 Choice of agent GLP1 vs SGLT2

37:10 Use of DPP4 inhibitors

38:55 Back to the case

39:37 Degludec, long acting insulin

41:34 Clinical case conclusion

43:03 Take home points

45:15 Outro

Tags: diabetes, medications, glucose, insulin, oral, therapy, drug, hypoglycemia, a1c, blood, cardiac, risk, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Transcript

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0:00.0	Yeah, I just turned it up two notches. Let me just do the whole range real quick. Okay. I'm monotone and I'm just saying hi to Paul.
0:10.2	Now I am ecstatic. Hey, boy, how you doing? Let's do high
0:30.1	Welcome back to the curbsiders. Hello Matthew. The internal medicine. Hello. Never gets less creepy.
0:38.5	You're not in my house. Not tonight. This is the internal medicine podcast that uses expert
0:46.0	interviews to bring you clinical pearls and practice changing knowledge. I'm Dr. Matthew Wato
0:50.9	here with my co-hosts, Dr. Stewart Brigham and Dr. Paul and Dr. Paul Williams.
0:57.1	Oh.
0:59.1	Stewart forces me to say hello to him like six times in episode.
1:02.8	I'm going to start keeping track. I'm just going to get into our web page just to tracking
1:07.1	how often you say hello to Stewart. Yes. Stewart, did you want to start us off here by
1:12.1	reading some listener feedback? Yeah, I'll read one just one this time actually. Okay. So we got
1:18.8	this feedback from someone from Facebook. This is from one of our listeners who says hello there,
1:23.6	guys. I am a family nurse practitioner student, probably not your typical listener. And just
1:28.8	wanted to say that I am slightly obsessed with your podcast. There aren't a lot of podcasts
1:33.9	available for other non-MD primary care providers. And I suggest yours to everyone I know there's
1:39.9	an exclamation mark right there because I am learning so much. So am I here. It says and more
1:47.9	importantly, I am learning how much I don't know every episode and make a list of all the apps and
1:54.0	books and websites to learn more about it and decide that that what I want to do is to go to all
1:59.0	the conferences, learn all the things so that I could be excellent. There's a lot of caps in there
2:04.0	that providing care. Anyway, it's this this feedback just basically says that they're really appreciative
2:09.4	of what we do here. And we're very appreciative of that feedback. It really gives us some insight
2:15.1	into our listener base and really who's listening. And we like the idea. You had mentioned
	...

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