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Diabetes: Symptoms, Diagnosis, and Complications01:15

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Assessment of the Gastrointestinal System I: Subjective Data01:17

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Assessing the gastrointestinal (GI) system is a complex process that begins with collecting subjective data. This data, collected through patient interviews, provides crucial insights into the patient's health history, perception patterns, and lifestyle habits, all contributing significantly to GI health.
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Assessment of Metformin Intolerance: A Retrospective Chart Review.

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  • 1University of Arkansas for Medical Sciences College of Pharmacy and College of Medicine.

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Patients with type 2 diabetes who have lower body mass index (BMI) and chronic kidney disease (CKD) are less likely to be prescribed metformin. These metformin non-users often have prediabetic hemoglobin A1c (A1c) levels.

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Area of Science:

  • Endocrinology
  • Primary Care Medicine
  • Clinical Pharmacy

Background:

  • Metformin is a first-line treatment for type 2 diabetes.
  • Understanding patient characteristics associated with metformin non-use is crucial for optimizing diabetes management.
  • Resident-led primary care clinics serve diverse patient populations, making them ideal settings for such investigations.

Purpose of the Study:

  • To compare characteristics of type 2 diabetes patients on metformin therapy versus those not on metformin therapy.
  • To identify potential reasons for metformin non-use in a primary care setting.
  • To explore similarities among patients who are intolerant or non-users of metformin.

Main Methods:

  • Retrospective chart review of adult patients with type 2 diabetes at a family medicine clinic.
  • Comparison of a cohort of metformin non-users (n=216) against metformin users (n=869).
  • Data collection included body mass index (BMI), hemoglobin A1c (A1c), kidney function (CKD), and documented metformin intolerance.

Main Results:

  • Metformin non-users had significantly lower mean BMI (30.87 vs. 35.43) and higher rates of chronic kidney disease (CKD) (25.93% vs 14.73%) compared to users.
  • BMI was positively correlated with metformin use, while CKD was negatively correlated.
  • A significant proportion of metformin non-users had prediabetic A1c levels (5-6.4%), with some indicated for insulin therapy.

Conclusions:

  • Lower BMI and the presence of CKD are associated with reduced likelihood of metformin prescription in type 2 diabetes patients.
  • Patients not on metformin therapy may have suboptimal glycemic control, with many falling into prediabetic A1c ranges.
  • Further research is warranted to understand barriers to metformin initiation and explore alternative therapies for non-eligible patients.