Strengthening the Public Health Infrastructure

Joint Letter to Congress Urging Budget Reconciliation Legislation to Include Lowering Prices of Insulin and Other Prescription Drugs

ACP Comment Letter to CMS Regarding CY 2018 Medicare Physician Fee Schedule Proposed Rule

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus

Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus

Glycemic Control and Type 2 Diabetes Mellitus: The Optimal Hemoglobin A1c Targets. A Guidance Statement

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline From ACP

ACP Statement to the House Ways and Means Committee Hearing on the Cost of Rising Prescription Drug Prices

Statement to the Senate Finance Committee: Hearing on Drug Pricing in America: A Prescription for Change

ACP Statement for the Record to the HELP Committee for the Hearing Reproductive Care in a Post-Roe America: Barriers, Challenges, and Threats to Women"s Health

First-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: A Cost-Effectiveness Study: Annals of Internal Medicine: Vol 175, No 10

Background: Guidelines recommend sodium–glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists as second-line therapy for patients with type 2 diabetes. Expanding their use as first-line therapy has been proposed but the clinical benefits may not outweigh their costs. Objective: To evaluate the lifetime cost-effectiveness of a strategy of first-line SGLT2 inhibitors or GLP1 receptor agonists. Design: Individual-level Monte Carlo–based Markov model. Data Sources: Randomized trials, Centers for Disease Control and Prevention databases, RED BOOK, and the National Health and Nutrition Examination Survey. Target Population: Drug-naive U.S. patients with type 2 diabetes. Time Horizon: Lifetime. Perspective: Health care sector. Intervention: First-line SGLT2 inhibitors or GLP1 receptor agonists. Outcome Measures: Life expectancy, lifetime costs, incremental cost-effectiveness ratios (ICERs). Results of Base-Case Analysis: First-line SGLT2 inhibitors and GLP1 receptor agonists had lower lifetime rates of congestive heart failure, ischemic heart disease, myocardial infarction, and stroke compared with metformin. First-line SGLT2 inhibitors cost $43 000 more and added 1.8 quality-adjusted months versus first-line metformin ($478 000 per quality-adjusted life-year [QALY]). First-line injectable GLP1 receptor agonists cost more and reduced QALYs compared with metformin. Results of Sensitivity Analysis: By removing injection disutility, first-line GLP1 receptor agonists were no longer dominated (ICER, $327 000 per QALY). Oral GLP1 receptor agonists were not cost-effective (ICER, $823 000 per QALY). To be cost-effective at under $150 000 per QALY, costs for SGLT2 inhibitors would need to be under $5 per day and under $6 per day for oral GLP1 receptor agonists. Limitation: U.S. population and costs not generalizable internationally. Conclusion: As first-line agents, SGLT2 inhibitors and GLP1 receptor agonists would improve type 2 diabetes outcomes, but their costs would need to fall by at least 70% to be cost-effective. Primary Funding Source: American Diabetes Association.

Gastric Bypass Versus Sleeve Gastrectomy in Type 2 Diabetes: Effects on Hepatic Steatosis and Fibrosis: A Randomized Controlled Trial: Annals of Internal Medicine: Vol 175, No 1

Background: Weight loss improves fatty liver disease. No randomized trial has compared the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on liver fat content and fibrosis. Objective: To compare the 1-year effects of SG and RYGB on hepatic steatosis and fibrosis. Design: Single-center, randomized, controlled trial (Oseberg [ObesitySurgery in Tønsberg]). (ClinicalTrials.gov: NCT01778738) Setting: Tertiary care obesity center in Norway. Participants: 100 patients (65% female; mean age, 47.5 years; mean body mass index, 42 kg/m2) with type 2 diabetes mellitus (T2DM). Intervention: From January 2013 to February 2018, patients were randomly assigned (1:1 ratio) to SG or RYGB. Measurements: The primary outcome was remission of T2DM (previously published). Predefined secondary outcomes in the present study were hepatic steatosis and fibrosis assessed by magnetic resonance imaging (liver fat fraction), enhanced liver fibrosis (ELF) test, noninvasive indices, and liver enzymes. Results: Liver fat fraction declined similarly after SG (−19.7% [95% CI, −22.5% to −16.9%]) and RYGB (−21.5% [CI, −24.3% to −18.6%]) from surgery to 1-year follow-up, and almost all patients (SG, 94%; RYGB, 100%) had no or low-grade steatosis at 1 year. The ELF score category remained stable in 77% of patients, but 18% experienced worsening of fibrosis at 1 year, with no substantial between-group difference. Limitations: Single-center study, short follow-up time, and lack of power for secondary outcomes. Conclusion: With an almost complete clearance of liver fat 1 year after surgery, RYGB and SG were both highly effective in reducing hepatic steatosis. Bariatric surgery had less influence on degree of fibrosis in the short term, but assessment of long-term progression is warranted. Primary Funding Source: Vestfold Hospital Trust and the South-Eastern Norway Regional Health Authority.

Effect of Sotagliflozin on Total Hospitalizations in Patients With Type 2 Diabetes and Worsening Heart Failure: A Randomized Trial: Annals of Internal Medicine: Vol 174, No 8

Background: In the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure) trial, sotagliflozin, a sodium–glucose cotransporter-1 and sodium–glucose cotransporter-2 inhibitor, reduced total occurrences of cardiovascular deaths, hospitalizations for heart failure, and urgent visits for heart failure relative to placebo by 33%. Objective: To determine whether sotagliflozin increased the prespecified efficacy outcome of days alive and out of the hospital (DAOH) in the SOLOIST-WHF trial. Design: Randomized, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT03521934) Setting: 306 sites in 32 countries. Participants: 1222 patients with type 2 diabetes and reduced or preserved ejection fraction who were recently hospitalized for worsening heart failure. Intervention: 200 mg of sotagliflozin once daily (with a possible dose increase to 400 mg) or matching placebo. Measurements: The primary analysis included hospitalizations for any reason on the basis of investigator-reported incidence and duration of admissions after randomization. Days alive and out of the hospital and its converse (days dead and days in the hospital) were analyzed using prespecified Poisson regression models. Results: Although similar proportions of patients in the sotagliflozin and placebo groups were hospitalized at least once (38.5% vs. 41.4%), fewer patients in the sotagliflozin group were hospitalized more than once (16.3% vs. 22.1%). There were 64 and 76 deaths in the sotagliflozin and placebo groups, respectively. The DAOH rate in the sotagliflozin group was 3% higher than in the placebo group (rate ratio [RR], 1.03 [95% CI, 1.00 to 1.06]; P = 0.027). This difference was primarily driven by a reduction in the rate of days dead (RR, 0.71 [CI, 0.52 to 0.99]; P = 0.041) rather than by a reduction in the rate of days hospitalized for any cause. For every 100 days of follow-up, patients in the sotagliflozin group were alive and out of the hospital for 3% or 2.9 more days than those in the placebo group (91.8 vs. 88.9 days); this difference reflected a 2.6-day difference in days dead (6.3 vs. 8.9 days) and a 0.3-day difference in days in the hospital (1.9 vs. 2.2 days). Limitation: Other than heart failure, the primary reason for each hospitalization was unspecified. Conclusion: Sotagliflozin increased DAOH, a metric that may provide an additional patient-centered outcome to capture the totality of disease burden. Future studies are needed to quantify the consequences of increasing DAOH in terms of health economics and patient quality of life. Primary Funding Source: Sanofi at initiation and Lexicon Pharmaceuticals at completion.

The Dual Burden of Type 1 Diabetes and COVID-19

Diabetes Screening by Race and Ethnicity in the United States: Equivalent Body Mass Index and Age Thresholds

Background: Racial/ethnic minority populations in the United States have increased rates of diabetes compared with White populations. The 2021 guidelines from the U.S. Preventive Services Task Force recommend diabetes screening for adults aged 35 to 70 years with a body mass index (BMI) of 25 kg/m2 or greater. Objective: To determine the BMI threshold for diabetes screening in major racial/ethnic minority populations with benefits and harms equivalent to those of the current diabetes screening threshold in White adults. Design: Cross-sectional study. Setting: NHANES (National Health and Nutrition Examination Survey), 2011 to 2018. Participants: Nonpregnant U.S. adults aged 18 to 70 years (n = 19 335). Measurements: A logistic regression model was used to estimate diabetes prevalence at various BMIs for White, Asian, Black, and Hispanic Americans. For each racial/ethnic minority group, the equivalent BMI threshold was defined as the BMI at which the prevalence of diabetes in 35-year-old persons in that group is equal to that in 35-year-old White adults at a BMI of 25 kg/m2. Ranges were estimated to account for the uncertainty in prevalence estimates for White and racial/ethnic minority populations. Results: Among adults aged 35 years with a BMI of 25 kg/m2, the prevalence of diabetes in Asian Americans (3.8% [95% CI, 2.8% to 5.1%]), Black Americans (3.5% [CI, 2.7% to 4.7%]), and Hispanic Americans (3.0% [CI, 2.1% to 4.2%]) was significantly higher than that in White Americans (1.4% [CI, 1.0% to 2.0%]). Compared with a BMI threshold of 25 kg/m2 in White Americans, the equivalent BMI thresholds for diabetes prevalence were 20 kg/m2 (range, <18.5 to 23 kg/m2) for Asian Americans, less than 18.5 kg/m2 (range, <18.5 to 23 kg/m2) for Black Americans, and 18.5 kg/m2 (range, <18.5 to 24 kg/m2) for Hispanic Americans. Limitation: Sample size limitations precluded assessment of heterogeneity within racial/ethnic groups. Conclusion: Among U.S. adults aged 35 years or older, offering diabetes screening to Black Americans and Hispanic Americans with a BMI of 18.5 kg/m2 or greater and Asian Americans with a BMI of 20 kg/m2 or greater would be equivalent to screening White adults with a BMI of 25 kg/m2 or greater. Using screening thresholds specific to race/ethnicity has the potential to reduce disparities in diabetes diagnosis. Primary Funding Source: Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed a clinical practice guideline in 2020 for the management of patients with diabetes and chronic kidney disease (CKD). Methods: The KDIGO Work Group (WG) was tasked with developing the guideline for diabetes management in CKD. It defined the scope of the guideline, gathered evidence, determined systematic review topics, and graded evidence that had been summarized by an evidence review team. The English-language literature searches, which were initially done through October 2018, were updated in February 2020. The WG used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of the recommendations. Expert judgment was used to develop consensus practice points supplementary to the evidence-based graded recommendations. The guideline document underwent open public review. Comments from various stakeholders, subject matter experts, and industry and national organizations were considered before the document was finalized. Recommendations: The guideline includes 12 recommendations and 48 practice points for clinicians caring for patients with diabetes and CKD. This synopsis focuses on the key recommendations pertinent to the following issues: comprehensive care needs, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and educational and integrated care approaches.

The Right Diabetes Medication for the Right Patient for the Right Outcome: Can a Network Meta-analysis Help Us Decide?

Pharmacologic Approaches to Glycemic Treatment of Type 2 Diabetes: Synopsis of the 2020 American Diabetes Association's Standards of Medical Care in Diabetes Clinical Guideline

Description: The American Diabetes Association (ADA) updates the Standards of Medical Care in Diabetes annually to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of diabetes. Methods: To develop the 2020 Standards, the ADA Professional Practice Committee, comprising physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts, continuously searched MEDLINE (English language only) from 15 October 2018 through August–September 2019 for pertinent studies, including high-quality trials that addressed pharmacologic management of type 2 diabetes. The committee selected and reviewed the studies, developed the recommendations, and solicited feedback from the larger clinical community. Recommendations: This synopsis focuses on guidance relating to the pharmacologic treatment of adults with type 2 diabetes. Recommendations address oral and noninsulin injectable therapies, insulin treatment, and combination injectable therapies. Results of recent large trials with cardiovascular and renal outcomes are emphasized.

Uses and Limitations of the Restricted Mean Survival Time: Illustrative Examples From Cardiovascular Outcomes and Mortality Trials in Type 2 Diabetes

The restricted mean survival time (RMST) has been advocated as an alternative or a supplement to the hazard ratio for reporting the effect of an intervention in a randomized clinical trial. The RMST difference allows quantification of the postponement of an outcome during a specified (restricted) interval and corresponds to the difference between the areas under the 2 survival curves for the intervention and control groups. This article presents examples of the use of the RMST in a research and a clinical context. First, the authors demonstrate how the RMST difference can answer research questions about the efficacy of different treatments. Estimates are presented for the effects of pharmacologic or strategy-driven glucose-lowering interventions for adults with type 2 diabetes from 36 trials and 9 follow-up studies reporting cardiovascular outcomes and mortality. The authors show how these measures may be used to mitigate uncertainty about the efficacy of intensive glucose control. Second, the authors demonstrate how the RMST difference may be used in the setting of a clinical consultation to guide the decision to start or discontinue a treatment. They then discuss the advantages of the RMST over the absolute risk difference, the number needed to treat, and the median survival time difference. They argue that the RMST difference is both easy to interpret and flexible in its application to different settings. Finally, they highlight the major limitations of the RMST, including difficulties in comparing studies of heterogeneous designs and in inferring the long-term effects of treatments using trials of short duration, and summarize the available statistical software for calculating the RMST.

Assessing the Risk for Gout With Sodium–Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Population-Based Cohort Study: Annals of Internal Medicine: Vol 172, No 3

Background: Hyperuricemia is common in patients with type 2 diabetes mellitus and is known to cause gout. Sodium–glucose cotransporter-2 (SGLT2) inhibitors prevent glucose reabsorption and lower serum uric acid levels. Objective: To compare the rate of gout between adults prescribed an SGLT2 inhibitor and those prescribed a glucagon-like peptide-1 (GLP1) receptor agonist. Design: Population-based new-user cohort study. Setting: A U.S. nationwide commercial insurance database from March 2013 to December 2017. Patients: Persons with type 2 diabetes newly prescribed an SGLT2 inhibitor were 1:1 propensity score matched to patients newly prescribed a GLP1 agonist. Persons were excluded if they had a history of gout or had received gout-specific treatment previously. Measurements: The primary outcome was a new diagnosis of gout. Cox proportional hazards regression was used to estimate hazard ratios (HRs) of the primary outcome and 95% CIs. Results: The study identified 295 907 adults with type 2 diabetes mellitus who were newly prescribed an SGLT2 inhibitor or a GLP1 agonist. The gout incidence rate was lower among patients prescribed an SGLT2 inhibitor (4.9 events per 1000 person-years) than those prescribed a GLP1 agonist (7.8 events per 1000 person-years), with an HR of 0.64 (95% CI, 0.57 to 0.72) and a rate difference of −2.9 (CI, −3.6 to −2.1) per 1000 person-years. Limitation: Unmeasured confounding, missing data (namely incomplete laboratory data), and low baseline risk for gout. Conclusion: Adults with type 2 diabetes prescribed an SGLT2 inhibitor had a lower rate of gout than those prescribed a GLP1 agonist. Sodium–glucose cotransporter-2 inhibitors may reduce the risk for gout among adults with type 2 diabetes mellitus, although future studies are necessary to confirm this observation. Primary Funding Source: Brigham and Women's Hospital.

Beyond Preeclampsia: Steroid-Refractory Minimal Change Disease Presenting as Hypertension and Proteinuria in Pregnancy | Annals of Internal Medicine: Clinical Cases

We present a case of a 35-year-old pregnant woman (second pregnancy, 0 term or preterm births, 1 abortion/miscarriage, and 0 living children) with new-onset hypertension, lower extremity edema, and proteinuria in the third trimester who was initially diagnosed with preeclampsia. After delivery, her edema and proteinuria continued to increase, prompting consideration of alternative diagnoses. Her evaluation included a kidney biopsy that revealed minimal change disease/focal segmental glomerulosclerosis. Treatment with prednisone resulted in a rapid, but only partial, response. She was later treated with tacrolimus, with steady improvement. This case highlights the importance of looking beyond preeclampsia when a pregnant or postpartum patient has persistent hypertension and nephrotic-range proteinuria.

Postmenopausal Occult Ovarian Disease With Hirsutism – A 6-Year Follow-up Course | Annals of Internal Medicine: Clinical Cases

A postmenopausal woman presented with long-standing androgenic alopecia and progressive hirsutism. Despite normal imaging, markedly elevated testosterone levels (18.58 nmol/L) prompted surgical exploration. Bilateral salpingo-oophorectomy revealed a Leydig cell tumor, confirmed histologically by Reinke crystals. Postoperative hormonal normalization and clinical improvement affirmed the ovarian origin. This case underscores the diagnostic challenge of occult androgen-secreting tumors in postmenopausal women, especially when imaging is inconclusive. It highlights the need for high clinical suspicion and thorough evaluation in cases of virilization, emphasizing that Leydig cell tumors, though rare, remain a critical differential in postmenopausal hyperandrogenism.

Familial Metastatic Bladder Paraganglioma With Multisystem Complications | Annals of Internal Medicine: Clinical Cases

Bladder paragangliomas represent less than 0.05% of bladder tumors, with familial metastatic cases being exceptionally rare. This case outlines a relatively healthy 44-year-old woman presenting with classic symptoms of paraganglioma that initially manifested as cardiac dysrhythmia, new-onset heart failure with reduced ejection fraction, and hypercoagulability. Subsequent questioning and genetic testing identified a family history of paragangliomas and a pathogenic SDHB pR46 mutation. This case highlights the importance of early recognition of signs and symptoms associated with catecholamine-secreting tumors, indications for diagnostic testing, and appropriate genetic testing to prevent devastating complications associated with multisystem failure.

Adult Diagnosis of Cystic Fibrosis: A Cause of Recurrent Pneumonia | Annals of Internal Medicine: Clinical Cases

We describe a patient presenting for evaluation of nearly annual pneumonias since the age of 9 years, eventually requiring multiple hospitalizations. Genetic testing revealed compound heterozygous mutations for 2184insA and L206W, indicative of cystic fibrosis. The patient received Trikafta (combination of ivacaftor, tezacaftor, and elexacaftor), a cystic fibrosis transmembrane regulator modulator with subsequent improvement of her symptoms. This case highlights the importance of maintaining a broad differential diagnosis for recurrent pulmonary infections, including diagnoses not typical for a patient's population or age group. Initiation of therapies such as Trikafta has been associated with improvement in lung function in a life-limiting disease.

Granulomatosis With Polyangiitis Presenting With Initially Isolated Cutaneous Facial Ulceration Without Early Other Characteristic Changes | Annals of Internal Medicine: Clinical Cases

Granulomatosis with polyangiitis (GPA) is a multiorgan system disease process in which cutaneous involvement is not uncommon. However, this article reports a case of GPA that presented with an unusually destructive chronic cutaneous facial lesion without other characteristic organ changes to suggest GPA, which represented a unique diagnostic challenge. It highlights the importance of maintaining high suspicion for vasculitic disease processes and prompt diagnosis to reduce disease burden.

Beyond Uremia: Chronic Kidney Disease as a Cryptic Gateway for Opportunistic Neuroinvasion by John Cunningham Virus | Annals of Internal Medicine: Clinical Cases

Progressive multifocal leukoencephalopathy (PML), a devastating demyelinating central nervous system infection caused by John Cunningham virus (JCV) reactivation, typically occurs in profound immunosuppression. Chronic kidney disease (CKD) induces a state of “immunoparalysis” through uremic toxin-mediated T-cell dysfunction yet remains an underrecognized risk factor for PML. We present a 72-year-old man with end-stage renal disease who developed subacute expressive aphasia and confusion. Magnetic resonance imaging showed demyelinating white matter lesions, and cerebrospinal fluid confirmed JCV DNA, establishing PML. This case highlights CKD as a cryptic immunosuppressive state predisposing to PML and emphasizes the importance of considering PML in patients with CKD presenting with new, progressive neurologic deficits.

Resolution of Hypokalemia and Hypotension With Tacrolimus and Extrarenal Transplantation in Gitelman Syndrome | Annals of Internal Medicine: Clinical Cases

Gitelman syndrome (GS) is characterized by genetic mutations in the sodium chloride cotransporter (NCC), leading to renal potassium, sodium, and magnesium wasting. Calcineurin inhibitors recapitulate familial hyperkalemic hypertension, with gain of function of the NCC. Whether calcineurin inhibition can overcome fluid/electrolyte dyscrasias in GS is unknown. We describe a patient with GS initiated on tacrolimus, a calcineurin phosphatase inhibitor, after orthotopic heart transplantation. Potassium supplementation and potassium-sparing diuretics were discontinued with no consequential hypokalemia, and hypotension and hypomagnesemia also improved. This case provides proof of concept that calcineurin inhibitors may help overcome clinical sequelae of loss of function of NCC in GS.

Acute Amiodarone-Induced Pulmonary Toxicity: Presentation and Management | Annals of Internal Medicine: Clinical Cases

This case report describes a 68-year-old man who developed acute hypoxic respiratory failure 2 weeks after initiation of amiodarone and mexiletine treatment for ventricular arrhythmia. The case underscores the diagnostic challenge of differentiating pulmonary edema from acute amiodarone-induced pulmonary toxicity and the importance of clinical context when interpreting imaging findings. Management involved immediate discontinuation of amiodarone and initiation of high-dose intravenous steroids followed by a prolonged oral taper, resulting in rapid clinical improvement. This case further illustrates the potential for oral amiodarone to cause multiorgan toxicity.

Unveiling the Link: Exploring the Association Between Cancer and Leukocyte Chemotactic Factor 2 (ALECT2) Amyloidosis | Annals of Internal Medicine: Clinical Cases

We present a case of a 53-year-old Hispanic man with mantle cell lymphoma who developed progressive decline in estimated glomerular filtration rate despite no previous kidney disease or predisposing conditions. Findings of a renal biopsy revealed leukocyte chemotactic factor 2 (ALECT2) amyloidosis. Remarkably, after treatment of his lymphoma, the patient's estimated glomerular filtration rate normalized. Given the correlation between the patient's cancer and the improvement in kidney function after treatment, we hypothesize that his lymphoma may have acted as a trigger for ALECT2 amyloidosis through 1 or more potential mechanisms, including dysregulated Wnt/β-catenin signaling, tumor-related inflammatory pathways, or a second hit on an underlying genetic predisposition.

Successful Pregnancy in a Patient With Advanced Cystic Fibrosis Lung Disease and Burkholderia cenocepacia Colonization | Annals of Internal Medicine: Clinical Cases

Cystic fibrosis (CF) affects multiple aspects of health, including reproduction and fertility. This report details a case of a 38-year-old woman with several complications from her CF, including advanced CF lung disease, pancreatic exocrine insufficiency, asthma, and airway colonization with Burkholderia cenocepacia, who became pregnant and successfully delivered a baby boy without significant complications. This was an unplanned pregnancy 4 years after initiation of elexaftor/tezacaftor/ivacaftor therapy, a CF transmembrane conductance regulator modulator therapy that has significantly improved various health outcomes in patient populations with CF, including the reproductive health of women.

Aerosols flowed from one bed to another in shared hospital rooms | ACP Hospitalist

Warning on pneumothorax with enteral access system | ACP Hospitalist

In type 2 diabetes, SGLT2 inhibitors reduce all-cause, but not cardiovascular, mortality vs. GLP-1 RAs

SGLT-2 revisited: Diabetes management in chronic kidney disease

Annals On Call: Technology to improve diabetes management

In the Clinic: Type 2 Diabetes

Spotlight on depression in diabetes

Reconciling conflicting diabetes guidance

Annals On Call: Expenditures after bariatric surgery

The latest on inpatient glucose control

GLP-1 RA plus SGLT-2 inhibitor vs. either drug alone reduces HbA1c and SBP

New guideline from Endocrine Society offers guidance on lipid management