geoffrey modest medical blogs

i have written many blogs on the differences between the diabetes meds GLP1s and SGLT2s, but i think it might be useful to have a summary review that weaves in new info. GLP1 receptor agonists: -- these restore a normal physiologic response to food, the "incretin effect", that is aberrant in diabetics     --relevant human incretins are glucagon-like peptide-1 (GLP1) and glucose-dependent insulinotropic polypeptide (GIP)     --in diabetics GLP1 is reduced by 30-40%     --deficiency of GLP1 exacerbates insulin deficiency, glucagon excess, and also reduces CNS control of satiety/gastic emptying --advantages of GLP1s  include:     --they can lead to very dramatic reductions in A1c levels [i have had several patients with A1c's in the 10-14% range who are largely non-adherence to diabetic diets and are being treated with insulin and metformin, but adding GLP1 agonists have had their A1cs plummet to the 6-7% range!!] ...

Brief review of the 2020 diabetes guidelines recently published by the Am Diabetes Assn ( see https://care.diabetesjournals.org/content/43/Supplement_1 ). I’m focusing on type II diabetes and the specific changes or different nuances in these guidelines over prior ones. Last year's review was a bit more comprehensive (see  http://gmodestmedblogs.blogspot.com/2019/01/2019-diabetes-guidelines.html  ). there was also a mid-year ADA update pushing SGLT2s as well as GLP1s for those with CKD (see  http://gmodestmedblogs.blogspot.com/2019/06/diabetes-guideline-update-pushing-sglt.html  ). my comments are imbedded in the text . -- Tailoring treatment for social context     -- assess patient for potential food insecurity, housing stability, financial barriers; use this information for treatment decisions     -- refer patients to local community resources     -- provide self management support: health coaches, navigators, com...

taking statins and bp meds can undercut healthy lifestyle G      Geoff A. Modest, M.D. Wed 2/12/2020 8:08 AM Geoff A. Modest, M.D.    An article was just published finding that the initiation of antihypertensive and lipid-lowering medications may affect patients' lifestyle choices (see  statin htn meds dec lifestyle JAHA2020  in dropbox or DOI: 10.1161/JAHA.119.014168) Details: -- 41,225 participants of the Finnish Public Sectors study, aged   >40yo who were initially free of cardiovascular disease and responded to at least 2 consecutive surveys in 4-year intervals from 2000-2013. This study reflects a cohort of employees in 10 towns and 6 hospital districts -- 84% female, mean age 52, 76% married/cohabitating, 32% upper grade non-manual workers/27% lower grade non-manual workers/34% manual workers, 89% employed, 50% normal BMI/36% overweight/15% obese, 41%...