In adults with BMI ≥27 kg/m2 and type 2 diabetes, adding tirzepatide to a lifestyle intervention increased weight loss at 72 wk.

SOURCE CITATION: Garvey WT, Frias JP, Jastreboff AM, et al; SURMOUNT-2 investigators. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402:613-626. 37385275.

Beneficial Effect of Remote Glucose Monitoring and Computerized Insulin Dose Adjustment Algorithms Independent of Insulin Dose Increases in Sizeable Minorities of Patients.

This article describes a program through which interactions every 2-3 weeks between patients and primary care clinicians (PCCs), with recommendations based on analysis of remote glucose monitoring by computerized insulin dose adjustment algorithms, significantly improved diabetes control. Insulin doses increased by 30% in the majority of patients. A sizeable minority (36%) had a decrease or no increase in insulin doses, but still showed an improvement in diabetes control. Frequent interactions allowed PCCs the opportunity to recognize and address medication nonadherence.

In adults with obesity without diabetes, adding tirzepatide to a lifestyle intervention increased weight loss at 72 wk.

SOURCE CITATION: Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387:205-16. 35658024.

A Conversation on an Effective, Straightforward, Quantitative Approach to the Outpatient Use of Insulin.

For primary care providers, using insulin can present challenges that can be met by a straightforward approach using the following principles. Depending on when it is injected, each component of the insulin regimen has a maximal effect on a specific period of the 24-hour cycle (e.g., overnight, morning, afternoon, or evening). The glucose pattern in that period determines whether the dose of that component of the insulin regimen requires adjusting. Regarding which insulin types and insulin regimens to use, human insulin (NPH and regular) is as effective as analog insulins, and a two-injection intensified insulin regimen is as effective as a four-injection regimen.

Effect of Diabetes-Trained Nurse Practitioners on Glycemic Outcomes: Their Suggested Use in Busy Primary Care Practices.

A Federally Qualified Health Center received ongoing external support for half-time salaries for two nurse practitioners to treat people with poorly controlled diabetes (A1C >9.0%) in the clinic's diabetes program using approved detailed treatment protocols. Patients were treated for 1 year and graduated from this program if their A1C fell to <7.5%. Ninety-one percent graduated, and treatment was deemed to have failed in 9% who did not achieve an A1C <7.5% by the end of the year of treatment. The suggestion is made to assign a specially trained diabetes nurse or physician assistant to serve many primary care providers at important clinical junctures to improve diabetes outcomes throughout busy primary care practices.

Erratum: Delayed Response to U-500 Regular Insulin. Clinical Diabetes 2018;36: 77-79 (DOI: 10.2337/cd16-0058).

[This corrects the article on p. 77 in vol. 36, PMID: 29382984.].

Comparison of Insulin Dose Adjustments by Primary Care Physicians and Endocrinologists.

IN BRIEF Insulin dose adjustment decisions in 20 simulated patients by nine primary care physicians (PCPs) and nine endocrinologists were compared to the algorithms used in a diabetes program in a large safety-net clinic. The number of dose changes was similar in the PCP and endocrinologist groups; however, the amounts of the dose changes in the PCP group were significantly closer to the diabetes program algorithms than the amounts in the endocrinologist group. Time constraints, rather than lack of ability, seem to be the major barrier to PCPs treating patients with insulin.

Insulin Therapy: A Personal Approach.

IN BRIEF Insulin therapy is challenging for providers as well as for patients. This article describes a set of principles underlying appropriate insulin treatment and a detailed discussion of how to use them.

Community screening for pre-diabetes and diabetes using HbA1c levels in high-risk African Americans and Latinos.

OBJECTIVE: To evaluate community screening using HbA1c levels in high risk African Americans and Latinos in those not known to have diabetes. DESIGN: HbA1c levels were measured in 1542 African Americans and Latinos aged > or = 40 years with one or more of the following risk factors: family history in first degree relatives, waist circumference > or = 40 inches in males or > or = 35 inches in females, and hypertension, either treatment for or a measured BP of > or = 140/ 90 mm Hg. Oral glucose tolerance tests (OGTT) were offered to those meeting the HbA1c criterion for pre-diabetes. SETTING: Churches, community health fares, senior citizen sites. PARTICIPANTS: People without known diabetes. MAIN OUTCOME MEASURES: Proportion of people meeting the HbA1c criteria for prediabetes (5.8-6.4%) and diabetes (> or = 6.5%). RESULTS: 32% had one, 50% had two and 18% had three risk factors. By HbA1c criteria, 40% had pre-diabetes and 25% had diabetes. Increased waist circumference was the most common risk factor followed by a positive family history, and lastly, hypertension. Each individual risk factor was significantly (P < .001) and progressively more common as glycemia increased. Each additional risk factor increased the odds of pre-diabetes or diabetes by 2- to 4-fold. In individuals with pre-diabetes who underwent an OGTT, 59% were normal, 35% had pre-diabetes and only 6% had diabetes. CONCLUSIONS: Community screening of high risk African Americans and Latinos with HbA1c levels identifies a large proportion of people with pre-diabetes and diabetes. Those identified with pre-diabetes are unlikely to meet the OGTT criteria for diabetes.