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hypercortisolism common in hard-to-treat diabetes

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    In patients with difficult-to-control type II diabetes, an impressive study found that about one quarter of them have hypercortisolism, and mifepristone improves their hyperglycemia (see dm hypercortisolism DiabCar2025  in dropbox or https://doi.org/10.2337/dc24-2841 ). thanks to Dr Elvira Isganaitis for bringing this to my attention.   Details : -- the CATALYST study enrolled 1063 participants with type II diabetes and a hemoglobin A1c ranging from 7.5%-11.5% and who were on two or more glucose lowering medications with or without micro/macro vascular complications or taking multiple blood pressure lowering medications -- these patients were screened with a 1 mg dexamethasone suppression test (DST)     -- common causes of false positives in DST evaluations were excluded, including taking oral contraceptives, excessive alcohol consumption, severe untreated sleep apnea, severe psych/medical/surgical illness, night shift work or hemodia...
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tirzepatide vs semaglutide for obesity without diabetes

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  A recent article found tirzepatide to be superior to semaglutide in obese patients without diabetes, in this drug company sponsored and designed trial (see  tirzepatide vs semaglutide obesity no diabetes NEJM2025  in dropbox, or DOI: 10.1056/NEJMoa2416394)   Details : -- 750 individuals with obesity but without diabetes were randomized to maximum tolerated doses of tirzepatide (10 or 15 mg) or semaglutide (1.7 to 2.4mg) weekly in this 72 week  phase 3b, open-label, controlled trial of adults, in 32 sites in the US and Puerto Rico     -- all were at least 18yo, had BMI of at least 30 or 27 with at least one obesity complication (hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease) and at least one unsuccessful dietary effort for weight reduction -- mean age 45 (8% at least 65yo), 65% females, 76% white/19% Black/26% Hispanic -- BMI 39 (69% had BMI at least 35), 113 kg, duration of obesity 16 years -- prediabetes 57%, 50...
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facial palsy distinguishing bells vs Lyme; new tick problem with B. miyamotoi

  Facial palsies are quite common and can be associated with Lyme disease or attributed to Bell’s palsy, however the treatments for these conditions are very different. This study developed a clinical risk tool to help differentiate the cause of the facial palsy (see   facial palsy bells vs lyme NeuroClinPrac2025  in dropbox or   doi.org/10.1212/CPJ.0000000000200476 )   Details: -- they accessed the records of 285 patients with facial palsies who were seen in the Massachusetts Eye and Ear Infirmary (MEEI) between October 18, 2005 and December 13, 2021, having first been seen in various primary care, acute care, and emergency care facilities throughout the US before being referred to this site -- inclusion criteria for the study included those with a rapid onset of unilateral flaccid facial paralysis, with full evolution of weakness over 72 hours and onset of recovery of facial tone and movement occurring within four months -- exclusion c...
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