In episode 205, Mike and James continue with their discussion on the use of A1c levels in type-2 diabetes. We discuss the variability in the measurement of A1c and given this, how tricky it is to use the A1c once therapy has been started. We also discuss the magnitude of the vascular benefit of therapies that change A1c and come to the conclusion that with all this confusion “minimally disruptive medicine” seems to make a lot of sense.

Show notes

1) The variability of the A1c test

http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/#11

2) Calculators for converting glucose to A1c and vice versa

Diabetic Med 2006;23:1151–4

In episode 204, James and Mike get into a discussion about the use of A1c levels for diagnosing and treating type-2 diabetes. We discuss screening recommendations and the impact an elevated A1c has on cardiovascular disease and other outcomes. At the end we realize the key message is that we have to let patients know that having an elevated A1c does not indicate impending doom.

Show notes

1) Impact of screening for type-2 diabetes

Lancet 2012;380:1741-8

2) Recommendations on screening for type 2 diabetes in
adults

CMAJ 2012;184 no.15 doi:10.1503/cmaj.120732

3) Hemoglobin A1c for the diagnosis of Type II Diabetes

Tools for practice

4) Lifetime risk of dialysis and blindness

Estimated benefits of glycemic control in microvascular complications
in type 2 diabetes

Ann Intern Med 1997;127:788-95

5) UKPDS risk engine

For the risks calculated in the podcast we used a version of
the UKPDS risk engine that is not presently publically available – UKPDS risk
engine v3.0b2

6) Risk of dialysis in type 2 diabetes

Diabetes Care 2003;26:2353-8

In episode 203, James and Mike go all PREMIUM and discuss three new studies. Vitamin D for the common cold, chelation therapy post-MI and the link between obesity and mortality. If you are reading this and you are a non-PREMIUM member, boy are you missing something.

 Show notes

1) Vitamin D for the cold

JAMA 2012;308:1333-9

2) Chelation post-MI RCT

JAMA 2013; 309: 1241-50

3) Obesity and mortality

JAMA 2013;309:71-82

In episode 202, Mike and James continue their testing deconstruction process. This week they take on bone mineral densities and discuss when (almost never) and when not to get these measurements. The podcast clocks in at a dense 44 minutes but the result is a real gem (mineral).

Show notes

1) OST – Osteoporosis Self-assessment Tool

Mayo Clin Proc 2003;78:723-7

Mayo Clin Proc. 2002;77:629-637

The Singapore Family Physician Jul-Sep 2003;29:12

MOH Osteoporosis clinical practice guidelines – Singapore
Mar 2002

Tools for practice – Screening for
Osteoporosis – Who Should Receive Bone Mineral Density Testing?

2) BMD plus age to get fracture risk

CMAJ 2002 167: S1-S34

Ost Int 2001 12:989-95

3) Remeasuring for risk assessment

Arch Intern Med 2007;167:155-60

4) Simpler tools for risk assessment

Arch Intern Med 2009;169:2087-94

5) Follow-up bone density after treatment

BMJ 2009;338;b2266

Tools for practice – Bone Mineral Density
– Too much of a good thing?