Type 2 Diabetes Mellitus: Rational Management

by Michael Lazarus, MD

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      Slides 02-03 Diabetes Mellitus part 1.pdf
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      Reference List Endocrinology.pdf
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    00:00 What does one do with hemoglobin A1c levels between 7% and 8%? Evidence shows that treating targets of less than 7% compared with targets around 8% do not reduce death or macrovascular events over about 5-10 years of treatment but do result in harm. Low blood sugar targets may be appropriate for patients who have a long life expectancy usually in the range of greater than 15 years and in patients who are interested in more intensive glycemic control with pharmacological therapy despite the risk of hypoglycemia. When discussing rational diabetes management, avoid targeting lower hemoglobin A1c levels in patients with a low life expectancy. Advanced age 80 years or older, residents in nursing homes or those with chronic active medical conditions do not do well when blood sugars are very very tightly controlled as the incidence of hypoglycemia increases. Harm clearly outweighs the benefits in these populations. Focus on treating these patients to reduce symptoms from disease or treatment rather than setting stringent treatment targets.

    About the Lecture

    The lecture Type 2 Diabetes Mellitus: Rational Management by Michael Lazarus, MD is from the course Diabetes Mellitus.

    Included Quiz Questions

    1. A 19-year-old woman with type 1 diabetes who plays collegiate basketball
    2. A 25-year-old man with type 2 diabetes with an end-stage glioblastoma
    3. A 75-year-old man living independently with a history of recurrent falls
    4. An 85-year-old woman living in a nursing home in good health for her age
    5. A 55-year-old man with coronary artery disease who has had CABG and has poorly-controlled COPD

    Author of lecture Type 2 Diabetes Mellitus: Rational Management

     Michael Lazarus, MD

    Michael Lazarus, MD

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