1. DIABETES JOURNAL CLUB FEBRUARY 16, 2012 Margaux Añel-Tiangco, MD

2. Common comorbidities

3. Hearing Impairment  Both high and low/mid frequency is increased 2x  Likely from neuropathy ± vascular disease  High frequency loss Associated with CHD and peripheral neuropathy  Low/mid frequency loss Associated with low HDL and poor health status

4. Obstructive Sleep Apnea  4-10x high in those with obesity  Prevalence in DM Type 2 up to 23% and in obese DM Type 2, up to 80%  Treatment effect on glycemic control is mixed

5. Fatty Liver  DM associated with nonalcoholic chronic liver disease and hepatocellular CA  Improved DM and lipid control improve NAFLD

6. Low Testosterone In Men  Obesity is a major confounder  Screening and treatment of men without symptoms is not recommended

7. Periodontal Disease  More severe but not more prevalent  Treatment effect on glycemic control is mixed

8. Cancer  DM (possibly only type 2 diabetes) is associated with increased risk of cancers of:  Liver  Pancreas  Endometrium  Colon/rectum  Breast  Bladder  May be 2 o to shared risk (obesity, age, physical inactivity) or from hyperinsulinemia/hyperglycemia  Age-appropriate screening recommended

9. Fractures  DM Type 1 associated with osteoporosis  DM Type 2 associated with  risk of hip fx despite higher BMD  Avoid TZDs in those at risk for fractures

10. Cognitive impairment  Higher risk of cognitive decline  Faster rate of cognitive decline  Increased risk of dementia  Effects of hyperglycemia and insulin on the brain and currently being studied

11. Common Co-morbidities in DM Type 1  Thyroid dysfunction  B12 deficiency  Celiac disease  Periodic screening in the absence of symptoms has been recommended but effectiveness and optimal frequency are unclear  Definitely screen if symptomatic

12. Noninsulin Therapies for Hyperglycemia in DM type 2

16. Questions?