The Curbsiders Internal Medicine Podcast REBOOT #387: Diabetes Updates with Dr. Marie McDonnell: New Tools for the New Rules
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Jul 29, 2024 Dr. Marie McDonnell, a leading expert in diabetes advancements, discusses the evolving landscape of diabetes care. The conversation covers the personalized approach to managing type 2 diabetes, emphasizing real-life strategies over numerical guidelines. New medications like GLP-1 agonists are highlighted for their effectiveness, along with the importance of lifestyle changes. The role of extended-release medications and optimizing metformin dosing for patient adherence are also explored, showcasing innovative strategies for better diabetes management.
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Check Autoimmune Markers In Rapid A1C Rise
- Do check GAD65 antibodies and consider a C‑peptide in symptomatic young patients with a rapid A1C rise to rule out adult‑onset autoimmune diabetes.
- Dr Marie McDonnell recommended testing before committing to noninsulin agents when patients report polyuria or feel unwell.
Start GLP‑1 Early For Young Obese Patients
- Do consider initiating a GLP‑1 receptor agonist early for young, obese patients with high A1C who need both weight loss and potent glucose lowering.
- Dr McDonnell framed GLP‑1s as insulin‑level potency plus weight and cardiometabolic benefits for long‑term control.
Metformin Still Valid But Not Mandatory
- Insight: Metformin remains a reasonable first‑line choice but is no longer the only appropriate starter when weight and cardio benefits matter.
- McDonnell: metformin is "never wrong" unless contraindicated, yet GLP‑1/SGLT2 choices depend on individual goals.