The Endocrine Club

Testosterone therapy is safe and effective in older men with CAD.

Lincoff et al. New Eng J Med 389(2):107-117

If levothyroxine dose requirements are much higher than expected, consider evaluating for gastrointestinal disorders

ATA

How often you ask diabetic patients to check blood glucose at home ?

Hip fractures in people with DM are associated with higher risk of mortality, longer recovery and delayed healing compared with non diabetic patients

ADA 2024

A formal diagnosis of posttransplantation diabetes mellitus (PTDM) is best made once the individual is stable on an immunosuppressive plan and in the absence of an acute infection. B

The OGTT is the preferred test

ADA2024

Interested in inpatient management of diabetes and admission insulin management. NICE SUGAR study is the most important in the field

Intensive versus Conventional Glucose Control in Critically Ill Patients | NEJM Original Article from The New England Journal of Medicine — Intensive versus Conventional Glucose Control in Critically Ill Patients

Starting prandial insulin

Add prandial insulin 4 units per day or 10% of basal insulin dose

ADA 2024

High intensity statin these can lower LDL by 50% or more.
Atorvastatin 40 and 80 mg
Rosouvastatin 20and 40 mg

The expected LDL lowering with different medications.
- Statin 30-50%
- Adding Ezetimibe additional 15%
-PCSK9 I 60%

ESC2019

The expected LDL lowering with different medications.
- Statin 30-50%
- Adding Ezetimibe additional 15%
-PCSK9 I 60%

ESC2019

Explanation
In T2DM with low risk for CAD and no CKD or heart failure, any agent can be used to treat hyperglycemia.
If obese GLP1 followed by SGLT2 is the choice

In adults with type 2 diabetes without cardiovascular and/or kidney disease, pharmacologic agents should address both the individualized glycemic and weight goals

ADA 2024

Hold metformin the day of ( Iodine contrast containing procedure) and resume 24-48 hours after given that creatinine is stable.
Especially if GFR below 60

Revised FDA

The Best management in hospitalized diabetic patients is insulin to keep the BG ( 140-180 )
DPP4 inhibitors can be continued.
-SU may cause hypoglycemia if fasting or decrease intake
- GLP1RA may increase nausea in sick patients (treat as per case)
- SGLT2 inhibitors may increase ketosis

Still using glyburide in your practice?
What are the cases you consider it ?

Perform an A1C test on all people with diabetes or hyperglycemia (RBG >140 mg/dL admitted to the hospital.

ADA 2024

Early combination therapy can be considered in adults with type 2 diabetes at treatment initiation to shorten time to attainment of individualized treatment goals. A

ADA 2024

This is based on VERIFY study

In hypothyroid women treated with LT4 who are planning pregnancy, serum TSH should be evaluated preconception, and LT4 dose adjusted to achieve a TSH value between the
lower reference limit and 2.5 mU/L.

ATA 2022

In conclusion, GLP-1 receptor agonists did not increase or decrease the risk of thyroid cancer, hyperthyroidism, hypothyroidism, thyroiditis,

Meta-Analysis of Randomized Controlled Trials. Front. Endocrinol. 13:927859.

Pregnant individuals with type 1 or type 2 diabetes should be prescribed low-dose aspirin 100–150 mg/ day starting at 12 to 16 weeks of gestation to lower the risk of preeclampsia.

ADA 2024

Weight loss of 5-15% should be a primary target in management for many people living with type 2 diabetes.

5-10% loss confers metabolic improvement, and a loss of 10-15% or more of body weight can have a disease-modifying effect, and lead to remission of diabetes

ADA/EASD 2022

Statin-associated muscle symptoms (SAMS) characterized by resolution on de-challenge and recurrence with re-challenge.

NICE guidelines

ADA 2024 recommendations regarding sweeteners
In summary water is the best, sugar sweetened is the worst.

Aspirin for primary prevention of CAD

Risk of bleeding

Aspirin in primary prevention. Risk of major bleeding, Intracranial bleeding , GI bleeding vs benefit

SGLT2 and GLP1RA 2 anti diabetics used by cardiologists and nephrologists

The ‘10 commandments’ for the 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes

BP management in diabetic patient page 2

ADA 2024

Individuals with hypertension who are not meeting blood pressure targets on three classes of antihypertensive medications (including a diuretic) should be considered for MRA therapy. A

ADA 2024

MRA Therapy for HTN: Spironolactone

Patient important Hirsutism is Unwanted sexual hair growth of any degree that causes sufficient distress for women to seek additional treatment

Endo Society

Lactation can increase the risk of overnight hypoglycemia, and insulin dosing may need to be adjusted

ADA 2022

This is the full ATA/ AACE guidelines of hypothyroidism

content.guidelinecentral.com

The answer is NO except in a pregnancy with TSH 2.5 -4 it should be treated if antibodies are positive and not if negative ( > 4 should be treated)