- Posted August 6, 2013 by Irl B. Hirsch, MDOver the past six months we have had more questions than answers about the risk of incretin therapy (DPP-4 inhibitors and GLP-1 agonists) and the increased risks for both pancreatitis and pancreatic carcinoma. The discussion seems to have resolved to an interim and perhaps temporary conclusion based on the recent American Diabetes Association Scientific Sessions in Chicago in June.At that conference Dr.
- Posted January 17, 2013 by Irl B. Hirsch, MDDr. Leahy’s comments are right-on target. Some further observations by another endocrinologist who can’t determine who the best patient for this new class of drugs will be:1. The advisory committee had problems with the bump in LDL-cholesterol. True, this is a surrogate, not a true “outcome” that will be determined in the CANVAS study. But do you recall the last time we had this debate with a diabetes drug?
- Posted March 8, 2012 by Irl B. Hirsch, MDTags:Primary care physicians are expected to be experts on dozens of different disease states despite the fact that each medical problem continues to evolve, with new understanding of the disease itself and its treatments. Frankly, I see this as a near impossible task since as an endocrinologist I can barely keep up with diabetes (in reality I can’t).
- Posted October 5, 2011 by Irl B. Hirsch, MDTags:It is difficult to forget the dramatic controversy that occurred in the summer of 2009 when four observational studies were published in the journal Diabetologia three of which suggested an association between insulin glargine and certain forms of cancer.  While this particular relationship is still not completely resolved, the bulk of evidence thus far does not support this initial concern.
- Posted April 20, 2011 by Irl B. Hirsch, MDTags:
While traveling to the American College of Physicians meeting last week in San Diego, I read an interesting article sent to me from the Corpus Christi Caller-Times by Dr. Stephen Ponder. The article examined the reasons why a recently published study concluded that doctors who recently completed their training knew so little about diabetes. Dr.
- Posted December 1, 2010 by Irl B. Hirsch, MD
Even after the elimination of troglitazone from the market over ten years ago due to an increased risk of severe liver toxicity, the two remaining thiazolidinediones, rosiglitazone and pioglitazone, have been watched more closely than most new drugs on the market. It was quite clear these agents could result in weight gain, fluid retention, and even pulmonary edema. The use of insulin with thiazolidinedione treatment roughly doubles the incidence of edema and amount of weight gain, compared with either drug alone. But then the reported side effects worsened.
- Posted September 22, 2010 by Irl B. Hirsch, MDTags:
A 55-year-old woman with known dyslipidemia and hypertension mentions she has new-onset nocturia for the past three months.
Her exam is notable for a blood pressure of 124/74 and BMI of 32 kg/m2. No retinopathy is noted. Her urinalysis shows a 3-plus glycosuria but no signs of infection and no albuminuria. Subsequent tests reveal a fasting glucose of 175 mg/dL with an HbA1c of 9.3%. Renal and hepatic function are normal with LDL-cholesterol measured at 90, HDL-cholesterol at 35, and triglycerides at 195.
- Posted August 1, 2010 by Irl B. Hirsch, MD
As an endocrinologist at a large diabetes clinic, I see many patients with type 2 diabetes. However, I see very few patients early after their diagnosis--the typical patient seen by most primary care physicians. Due to a tremendous amount of new information on the impact of beta cell dysfunction in this population of patients, I saw my participation in this project as an important opportunity to work with my primary care colleagues.
I also appreciate the difficulty and frustration.