Based on the results of the Diabetes Prevention Program Outcomes Study (DPPOS), in which metformin significantly decreased the development of diabetes in individuals with baseline fasting plasma glucose (FPG) concentrations of 110–125 vs. 100–109 mg/dL (6.1–6.9 vs. 5.6–6.0 mmol/L) and A1C levels 6.0–6.4% (42–46 mmol/mol) vs. <6.0% and in women with a history of gestational diabetes mellitus, it has been suggested that metformin should be used to treat people with prediabetes. Since the association between prediabetes and cardiovascular disease is due to the associated nonglycemic risk factors in people with prediabetes, not to the slightly increased glycemia, the only reason to treat with metformin is to delay or prevent the development of diabetes. There are three reasons not to do so. First, approximately two-thirds of people with prediabetes do not develop diabetes, even after many years. Second, approximately one-third of people with prediabetes return to normal glucose regulation. Third, people who meet the glycemic criteria for prediabetes are not at risk for the microvascular complications of diabetes and thus metformin treatment will not affect this important outcome. Why put people who are not at risk for the microvascular complications of diabetes on a drug (possibly for the rest of their lives) that has no immediate advantage except to lower subdiabetes glycemia to even lower levels? Rather, individuals at the highest risk for developing diabetes—i.e., those with FPG concentrations of 110–125 mg/dL (6.1–6.9 mmol/L) or A1C levels of 6.0–6.4% (42–46 mmol/mol) or women with a history of gestational diabetes mellitus—should be followed closely and metformin immediately introduced only when they are diagnosed with diabetes.Metformin Should Not Be Used to Treat Prediabetes — Diabetes Care 2020 Sep; 43(9): 1983-1987. https://doi.org/10.2337/dc19-2221
Sheltering in place has pushed virtual health care into the mainstream, making us wonder if we’ll ever go back to waiting rooms
Unlike the currently used molecular test that uses oral swab samples, the antibody test developed by Duke-NUS Medical School has several advantages — it can detect past infection in people who have now recovered, it relies on blood samples, and can identify asymptomatic cases. Using an antibody test developed by the Duke-NUS Medical School that […]
On February 20, China once again changed the case definition in Hubei province. All clinically confirmed cases will now be classified under suspected cases. Only molecular test positives will be labelled as confirmed. On February 12, the number of new COVID-19 cases reported from mainland China witnessed the biggest increase for a given day when […]
As of October 22, 2019, a total of 1,604 cases of EVALI, including 34 deaths, were reported to CDC. Based on data collected as of October 15, 2019, use of tetrahydrocannabinol (THC)-containing products in the 3 months preceding symptom onset was reported by 86% of patients. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years.
The skeptical cardiologist has been evaluating a demo version of AliveCor’s new KardiaMobile 6L. I have been a huge advocate of Kardia’s single lead ECG and use it with great success in dozens of my afib patients. I’ve written about how this personal ECG monitoring empowers patients and providers and is a crucial component of…
Thanks Doctor for the ECG history lesson and for sharing your insights.
And congratulations on the Stanley Cup!
Go to the following link for a list of SGLT2 Inhibitors.
Fournier Gangrene does not sound like a pleasant disease.
Many thanks to Dr. P for reminding me to check and see what Dr. Attia has been up to lately.
Lately while exercising I’ve been binge-listening to podcasts from Peter Attia, a cancer surgeon turned “longevity” doctor.
I appreciate how he never opts for oversimplification of a topic as this disclaimer at the begining of his post on ketosis indicates:
If you want to actually understand this topic, you must invest the time and mental energy to do so. You really have to get into the details. Obviously, I love the details and probably read 5 or 6 scientific papers every week on this topic (and others). I don’t expect the casual reader to want to do this, and I view it as my role to synthesize this information and present it to you. But this is not a bumper-sticker issue. I…
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Thank you Dr. Pearson.
The skeptical cardiologist has been utilizing coronary artery calcium (CAC) scans to help decide which patients are at high risk for heart attacks, and sudden cardiac death for the last decade. As I first described in 2014, (see here) those with higher than expected calcium scores warrant more aggressive treatment and those with lower scores less aggrressive treatment.
Although , as I have discussed previously, CAC is not the “mammography of the heart” it is incredibly helpful in sorting out personalized cardiovascular risk. We use standard risk factors like lipids, smoking, age, gender and diabetes to stratify individuals according to their 10 year risk of atherosclerotic cardiovascular disease (ASCVD) but many apparent low risk individuals (often due to inherited familial risk) drop dead from ASCVD and many apparent high risk individuals don’t need statin therapy.
Previously, major guidelines from organizations like the AHA and the ACC did not recommend…
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Today’s early morning highlights from the major news organizations.