My Hemoglobin A1C is (fill in the blank)


Jonas DE, Crotty K, Yun JDY, et al. Screening for Prediabetes and Type 2 Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021;326(8):744–760. doi:10.1001/jama.2021.10403

New Blood Test Improves Prostate Cancer Screening – the Stockholm3 test

On July 9 2021, results from the STHLM3MRI study were presented in The New England Journal of Medicine, indicating that over-diagnosis could be reduced by substituting traditional prostate biopsies with magnetic resonance imaging (MRI) and targeted biopsies. The new results, now published in The Lancet Oncology, show that the addition of the Stockholm3 test, which was developed by researchers at Karolinska Institutet, can be an important complement. It is a blood test that uses an algorithm to analyze a combination of protein markers, genetic markers and clinical data.

Karolinska Institutet. “New blood test improves prostate cancer screening.” ScienceDaily. (accessed August 14, 2021).

Thursday 08.12.21 – More Diabetes Research for Your Reading Pleasure

Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes

Our findings show that a substantial proportion of patients had existing complications including CKD, stable angina, and peripheral neuropathy at the time of T2D diagnosis. Results also show that among those newly diagnosed with T2D, the highest incidence rates of complications included peripheral neuropathy, CKD, and CVD (myocardial infarction, unstable angina, and stroke).

Time to incidence of microvascular and macrovascular complications was only a few years; peripheral vascular disease, stable angina, CKD, and peripheral neuropathy developed earlier in the disease course.

BMJ Open Diabetes Research and Care –

Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders

CONCLUSIONS Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of DKA and nearly sixfold increased risk of death compared with their peers without eating disorders.

Diabetes Care 2021 Aug; 44(8): 1783-1787.

Fenofibrate Use Is Associated With Lower Mortality and Fewer Cardiovascular Events in Patients With Diabetes: Results of 10,114 Patients From the Korean National Health Insurance Service Cohort

Diabetes Care 2021 Aug; 44(8): 1868-1876.

I’ve been out of town the past three weekends in a row. Prior to taking these trips I was feeling a bit burned out. I had little desire to continue my research activities. I had even less desire to write or post to my blogs. But as suddenly as my energy levels dipped, the mojo came back.

Hiatus is over. The SupremeCmdr is back.

Just Another Sweet Sunday

RESEARCH DESIGN AND METHODS We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores <4. Analyses were adjusted for a range of established CVD risk factors.

RESULTS In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores <4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38–2.31) in ADDITION-Denmark, 1.57 (CI 1.27–1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41–1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83–1.48).

CONCLUSIONS The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies — Diabetes Care 2021 Jul; 44(7): 1714-1721.

The results for the 500 young adult participants in the Treatment Options for Type 2 Diabetes in Adolescents and Youth 2 (TODAY 2) study were published online July 28 in the New England Journal of Medicine by the TODAY study group.At follow-up — after originally participating in the TODAY trial when they were young teenagers — they had a mean age of 26.4 years.

At this time, more than two thirds had hypertension and half had dyslipidemia.

Overall, 60% had at least one diabetic microvascular complication (retinal disease, neuropathy, or diabetic kidney disease), and more than a quarter had two or more such complications.

‘Shocking’ Early Complications From Teen-Onset Type 2 Diabetes – Medscape – Jul 28, 2021. –

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort

Conclusion All NAFLD histological stages were associated with significantly increased overall mortality, and this risk increased progressively with worsening NAFLD histology. Most of this excess mortality was from extrahepatic cancer and cirrhosis, while in contrast, the contributions of cardiovascular disease and HCC were modest.

Mortality in biopsy-confirmed nonalcoholic fatty liver disease: results from a nationwide cohort —

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?


NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

More Retirement Income Ahead!

Total individual life insurance policy sales increased 11% in the first quarter, compared with first quarter 2020. This is the highest growth in the number of policies sold in a quarter since 1983. New annualized premium also experienced significant growth, up 15% from prior year, according to LIMRA’s First Quarter U.S. Individual Life Insurance Sales Survey.

LIMRA: First Quarter U.S. Life Insurance Policy Sales Highest Since 1983 —

I don’t know who you are. I don’t know what you want. If you are looking for ransom, I can tell you I don’t have money. But what I do have are a very particular set of skills; skills I have acquired over a very long career. Skills that make me a nightmare for people like you.

Bryan Mills, played by Liam Neeson in the film Taken

I had my annual wellness visit earlier this week.

5.10 168 130/84 BMI 24.14 O2 sat 98%

HDL 65 mg/dL

All of my other labs were normal too.

I have multiple relatives who have lived well into their 90’s. My maternal grandmother lived to 100. I’m going to need another source of retirement income. And for all of my friends and colleagues who never thought I would make it this far…

AST 23 U/L


GGT 36 U/L (12/2015)

PSA 0.7 (9/2020)

Ten Commandments of Emergency Medicine Revisited

#2 Remember naloxone, glucose, and thiamine (NGT)
Original: Consider or give naloxone, glucose and thiamine
The number of patients presenting with opioid intoxication is growing, and the gentle reversal of patients without severe respiratory depression with naloxone is in the art of medicine – consider starting with 0.4mg and titrate to effect.

In contrast to empiric administration of glucose in the altered or ill patient, rapid assessment of glucose level with point-of-care testing is recommended.

Thiamine deficiency may be less prevalent than previously thought in intoxicated patients, but we now know that giving 100mg of IV thiamine can benefit other malnourished patients, including those with calorie-malnourishment from cancer, gastric bypass, hyperemesis gravidarum, and eating disorders. Personally, I use the ‘T’ of ‘NGT’ to remind myself not to miss alcohol withdrawal.

Ten Commandments of Emergency Medicine Revisited

Why does this matter? I hear you thinking we underwrite life insurance, we’re not doctors. So true. But if we think like doctors we will get better at what we do by recognizing the subtleties buried within the medical charts we read. Here’s what my eyes/brain picked up.

The bold in the excerpt above are mine to illustrate how the mind of a mortality risk expert works. In Emergency Department records pay attention to the initial treatments provided which in some cases hints to a serious condition impacting mortality. Naloxone and opioids are obvious. But would you have associated the administration of IV thiamine to malnutrition or alcohol withdrawal? I thought so.

So read and research widely. You’ll always find little jewels to improve your skills and to impress your friends with. Or in my case to make Dr. Lee think his old man knows more than he actually does.

NAFLD: not a benign disease

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide, affecting at least a quarter of the global adult population. It is rapidly becoming one of the most common indications for liver transplantation in Western countries. NAFLD is widely considered as the hepatic manifestation of the metabolic syndrome. It is particularly common among patients with type 2 diabetes and obesity. Nonetheless, emerging data suggest that NAFLD is present in a significant proportion of lean individuals. In a systematic review and meta-analysis of 93 studies (involving over 10 million individuals), Ye et al found that 19.2% and 40.8% of patients with NAFLD were lean and non-obese, respectively, according to ethnic-specific body mass index (BMI) cut-offs.1 However, over 80% of the studies included in this systematic review were from Asia, raising the suspicion that NAFLD in lean individuals is a unique phenomenon among Asians, especially as Asians are known to have more central fat deposition and develop NAFLD and metabolic complications at a lower BMI.2

NAFLD in lean individuals: not a benign disease —

80% of the studies reviewed were from Asia which helps to explain why NAFLD was found in lean and non-obese people. I wonder how their diets have changed from traditional cuisines to cause this incidence level? Western style fast food?

Also see previous posts:

NAFLD – Why are Life Insurers Taking This Risk at Standard Rates?


NAFLD and Obesity: What Is the Mortality Risk? | Medpage Today

NAFLD = Higher Mortality Rate

Alkaline phosphatase 59 U/L, AST 28. ALT 10 as of September 2020. GGTP 36 as of December 2015. Sharing these numbers for all of my friends from the past who thought I would never live long enough to boast about these numbers.

Cost effectiveness of dietetic intervention in management of type 2 diabetes — Journal of Human Nutrition and Dietetics Notes

Siopsis et al., JHND Early View Background The management of diabetes costs in excess of $1.3 trillion per annum worldwide. Diet is central to the management of type 2 diabetes. It is not known whether dietetic intervention is cost effective. This scoping review aimed to map the existing literature concerning the cost effectiveness of medical […]

Cost effectiveness of dietetic intervention in management of type 2 diabetes — Journal of Human Nutrition and Dietetics Notes

Of 2387 abstracts assessed for eligibility, four studies combining 22 765 adults with type 2 diabetes were included. Dietetic intervention was shown to be cost‐effective in terms of diabetes‐related healthcare costs and hospital charges, at the same time as also reducing the risk of cumulative days at work lost to less than half and the risk of disability ‘sick’ days at work to less than one‐seventh.

Conclusions: The findings highlight the importance of advocacy for medical nutrition therapy for people with type 2 diabetes, with respect to alleviating the great global economic burden from this condition. Further studies are warranted to elucidate the factors that mediate and moderate cost effectiveness and to allow for the generalisation of the findings.

First published: 14 October 2020