The Curbsiders Internal Medicine Podcast #387: Diabetes Updates with Dr. Marie McDonnell: New Tools for the New Rules
28 snips
Mar 27, 2023 AI Snips
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Episode notes
Rule Out Autoimmune Diabetes First
- Check GAD65 antibodies and consider a C-peptide if young patients present with rapid A1C rise or catabolic symptoms.
- Start a potent therapy (GLP-1 RA) quickly for symptomatic, high-A1C patients and follow up soon to reassess.
Use GLP‑1 RA Early For Potent Control
- Offer GLP-1 receptor agonists early for obese patients with high A1C because they provide potent glucose lowering plus weight loss.
- If patients resist injections, start metformin and bring them back quickly to reconsider injectable therapy.
Metformin Is Still Valid But Not Exclusive
- Metformin remains reasonable first-line therapy but isn't mandatory when patient-specific goals or comorbidities favor newer agents.
- Consider cardiovascular risk when choosing agents that also confer organ protection.