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Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program

The Obesity/Diabetes Epidemic: Adiposopathy & ‘Obesity’- The New Disease! Weight Management in Obesity and DM: Emphasis on  New Medical Therapies. Part 9 *. Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate,

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Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program

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  1. The Obesity/Diabetes Epidemic:Adiposopathy & ‘Obesity’- The New Disease!Weight Management in Obesity and DM: Emphasis on  New Medical Therapies Part 9* Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania *Part 9 of 9

  2. 0. In Metabolic Syndrome-consider Incretins/ SGLT-2 inh. 1. 3-4 non-insulin agents before consider insulin a. Not SU/GLINIDE b. AACE first Tier/ Second Tier Principle c. Beta cell- incretin/SGLT-2 Inh/ Pio d. Resistance- Pio/ metformin e. Other- bromocriptine-QR, colsevalam F. EARLY TRIPLE THERAPY 2. Incretins Before Pioglitazone- then don’t gain weight from pioglitazone 3. Ranolazine, SGLT-2 inh to minimize/prevent edema from pioglitazone 4.. GLP-1 RA’s and SGLT-2s have added wt. loss benefit 5. GLP-1 RA’s preferred over DPP-4 in ‘right patient’ 6. GLP-1 RA’s always before start Insulin, even a short trial- Weight Reduction Issues- Non -Insulin

  3. Weight Reduction Issues- Insulin 1.Unless ‘sick’, avoid insulin if not following NCS diet2. Keep Non-Insulin treatments as start basal- Keep on Incretin/SGLT-2 inhibitor (others) when add insulinif do so only ~10% need bolus. If on insulin- as start NCS diet, decrease 25% if was having hypoglycemia decrease 25%add incretin , GLP-1 preferred – dec. insulin as do so add SGLT-2 inhibitor- decrease insulins 25% add pioglitazone, metformin, if possible May be able to stop insulin, lose weight Thus new patients who come to me on insulin <40 units/d, not on diet, hypoglyemia , episodes, I stop insulin start diet GLP-1 RA and SGLT-2 inhibitor

  4. Summary • Epidemiology and Economics of obesity/diabetes-costly • Perspectives on Obesity- culture • Consequences of Obesity, Prediabetes, Obesity • Obesity/ Diabetes Risk Factors, • Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. • Medical Benefits to Weight Loss • Treatment-CDC’s diabetes prevention program and other Evidence-Based Interventions- We can do Better, We must do better

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