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
This article is written by an Emergency Medicine doctor for other Emergency Medicine doctors as a quick primer on recognizing and diagnosing anorexia. While those of us in the life insurance business are not diagnosticians you will definitely benefit from this short ten minute article on the next case you encounter where Momma Bear is applying for $2,000,000 on her skinny 15 year old daughter who can’t seem to gain weight no matter how much the kid eats.
AN is a common, severe psychiatric illness. It is often present with co-morbid psychiatric illnesses. There is a high mortality rate, 5.6% per decade. It is notoriously difficult to treat with psychotherapy and pharmacotherapy.
COVID-19 has had the biggest short-term effect on life insurance in two ways:
Insurers extending grace periods for paying premiums.
Placing a greater emphasis on accelerated underwriting.
Full article at the link below.
What were the demographics of the forty-one admitted 2019-nCoV patients included in this study?
Most were men (30/41 patients; 73%)
Median age = 49 years
13/41 patients (32%) had underlying disease (e.g. diabetes, hypertension, cardiovascular disease, COPD, cancer)
What kind of symptoms did the forty-one admitted 2019-nCoV patients included in this study have?
Fever (40/41 patients; 98%)
Cough (31/41 patients; 76%)
Myalgia or Fatigue (18/41 patients; 44%)
These three symptoms were the major ones. There were patients who had sputum production, headache, hemoptysis, and diarrhea; however, these symptoms were less common.
Dyspnea occurred in 55% later in the course, with mean time to onset of dyspnea at 8 days.
Here’s a nice short summary of a recent study published in Lancet. The balance of the source article can be found at emDOCs.net
And if you want to maintain your sanity regarding this emerging infectious disease threat avoid social media.
Social media, for all its many ills and its few redeeming qualities, identifies idiots.
Can we turn serious for a minute? Are you on social media, talking to people that you don’t know about things that you know nothing about? If so, what are you doing? There’s a great big wonderful wide world out there. Why not trying exploring it? Talk to people. See things. Read stuff that is longer than 14 words.
The month isn’t over yet the events of the past few weeks already make this a memorable year. My contract with a large insurance company that shall not be named ended. I was with the client for nearly ten years. When I tell people I’ve contracted with a single client for ten years mouths drop open. In the gig economy this is about as rare as rare gets. Who contracts with a single client for ten years? Friday January 10th was my last day. Two days later I was in Lynchburg Virginia. Sometimes life moves quickly. When you get to the same stage and age in life as me you’ll come to appreciate the memories more and more with each passing year. But this trip was special and I want to capture and share these memories before they fade away. For me every day is another opportunity to learn something. Here’s what I learned from five days in Lynchburg.
“Don’t go around saying the world owes you a living. The world owes you nothing. It was here first.” Mark Twain
It’s Nice to Get Out of the House
I’ve been working from home since 2006. Seriously, I don’t get out much and when I do I try to practice my social skills. Working alone at home, or being face down in your smartphone (which makes you dumb), or severe anxiety where you need your benzos, all can erode what little you have left of social interaction skills. The Boss knows this all too well. The last business trip was over 2.5 years ago and placing me in a situation where I have to interact with others can be dicey.
“Be professional. Don’t be yourself.”
“The hardest challenge is to be yourself in a world where everyone is trying to make you be somebody else.”
The Boss knows at the minimum I’ll try to behave. Hopefully I passed the audition.
Staying in a Nice Hotel and Eating Out is Pretty Awesome
I had an excellent stay at the Virginian. The hotel was a block away from my new client’s office and the room was stocked with bottled water from local springs and a Keurig coffee maker. I did what I always do when I arrive in a hotel room with a coffee maker. I check the coffee supply for correctness. As I suspected the K-cup selection was all wrong. I had four servings of DECAF. I immediately went down to the front desk with the K-cups in hand.
“Mr. Lee, is there a problem?”
I handed the coffee to the front desk employee and stated in a low firm voice,
“This is so wrong.”
The very nice young woman at the front desk agreed and allowed me to exchange my four K-cups of DECAF to the real caffeinated kind. I also left a note next to the brewer for housekeeping to restock with only real coffee NO DECAF. The rest of my stay went quite well. The room was comfortable, quiet, and I had plenty of coffee.
Eating Restaurant Food Causes Obesity
I arrived in Lynchburg late on a Sunday evening and the only food available at the hotel was at the rooftop bar. There was local craft beer on tap. I ate there three times during my stay. When you work from home you eat a lot of leftovers. Some days you eat leftover leftovers. By the time Saturday rolls around you simply have to go out to eat. Taking all of my meals outside of the house this week was awesome despite needing to loosen my belt a notch by Wednesday. The team treated me to dinner at The Depot Grille, a renovated old train stop that had nice local craft beer on tap. Before I left town I was introduced to The Water Dog which was more of a Millennial type establishment that had even more nice local beers on tap. After seeing the (beer) menus I thought to myself I could live here.
Despite the proximity of some fine eateries I took most of my meals at the company cafeteria. This company amenity should never be taken for granted. I had plenty of good food, freshly prepared at reasonable prices. When you’re on business expense this is kind of important to avoid any potential criticism of your spending habits when someone else is paying. So the accountants will be happy I found Benny’s.
I had forgotten how easy it is for me to put the weight back on. Over the years I’ve moved away from the standard American diet (SAD) because it was my diet that was the proximate cause for ballooning up to 370 pounds. It might have been more but I stopped weighing myself at 370 (for obvious reasons). For this trip I relaxed my dietary preferences and ate whatever I wanted to. I haven’t weighed myself since the trip ended but my belt fits again at its usual belt hole. I’m easing back into my usual dietary routine. And I have no regrets about passing on the fried tofu sandwich at The Depot Grille. I didn’t want anyone to think I was a vegan.
“Look for the human connection as you make your journey. Connect us to the people who connected with you.” William Zinsser
There are Really Nice People in Lynchburg
During my week in Lynchburg I met some very nice people. The people you work with are just as important to your happiness as the work itself. I ate lunch at the underwriter table in the company cafeteria all week. I figured I needed as many contacts as possible once I started work in the system and needed guidance. I may work by myself from home but no one ever works alone.
It’s just a job. Grass grows, birds fly, waves pound the sand. I beat people up.
The Boss has told me change is good and my new adventure will be good. I know she’s right. And I am thrilled with the opportunity.
That hasn’t escaped the notice of Dan Dahl, of Dahl Funeral Home in East Grand Forks and the former president of the Minnesota Funeral Directors Association.
“The older I get, the younger everyone else gets. I’m 59, and it used to be when I was 35, 35-year-olds didn’t die, it seemed like. It kind of sticks out now the older you get,” he said. “We’re not supposed to be burying our kids, our kids are supposed to be burying us.”
Read the source article at this link.
It takes moxie to flip an unhealthy lifestyle to a healthy one — particularly for folks over 60. Most baby boomers approach retirement age unwilling to follow basic healthy lifestyle goals established by the American Heart Association, said Dr. 683 more words
Navigating Aging Navigating Aging focuses on medical issues and advice associated with aging and end-of-life care, helping America’s 45 million seniors and their families navigate the health care system. To contact Judith Graham with a question or comment, click here. Join the Navigating Aging Facebook Group. See All Columns DENVER — Pauline Jeffery had let things slide…
CONCLUSIONS Findings indicate that LB women develop type 2 diabetes at younger ages than heterosexual women. Higher BMI in LB women is an important contributor to this disparity. Public health and clinical efforts to prevent, detect, and manage obesity and type 2 diabetes among LB women are warranted.
Source article here.
A new study has found that a common e-cigarette flavoring that has chemical characteristics similar to toxic chemicals found in cigarette smoke disrupts an important mechanism of the lungs’ antibacterial defense system.
Read the geeky stuff here.