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Beverly G. Tchang, MD

@BevTchangMD

May 4 • 5 tweets • 4 min read Twitter logo

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https://twitter.com/endojorm/status/1654224072979660800

Interesting to see anti #obesity and #diabetes #medication management from the perspective of PharmDs

I'm always pro-collaborative care!

Here are some learning points and fact checks:

#AACE2023 #endocrine #endocrinology #pharmacology

1/

https://twitter.com/endojorm/status/1654224072979660800

- "Tirzepatide is a dual agonist"
👉It ↑GIP activity but GLP-1R agonism is less than that of endogenous GLP-1
- "Hypoglycemia is not a concern if you're not on insulin"
👉Risk of hypoglycemia ~1.4% vs. 0.2% in placebo in SURMOUNT-1

nejm.org/doi/full/10.10…

2/

- "In this pt with uncontrolled #diabetes, A1c 7.4, we decreased glargine by 10% [when we started tirzepatide]"

👉 Not sure where the evidence is here, but the SURPASS-5 trial protocol reduced basal by 20% in participants with baseline A1c<8

jamanetwork.com/journals/jama/…

3/

@DianeMIsaacs shared a useful graphic to help pts self-titrate. Anyone have the citations?

Personally, I am pretty aggressive at ↓insulin preemptively when starting a GLP1/GLP1+GIP, and modifying #nutrition if/when pts see high glucoses

4/

"In a patient with eGFR 40, SGLT2i is great for CKD protection but give little A1c reduction"

👉 True that A1c reduction ↓ as eGFR ↓ but this pooled analysis still saw a 0.4 ↓ in eGFR 30-59

kidney-international.org/article/S0085-…

5/5

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More from @BevTchangMD

Beverly G. Tchang, MD

@BevTchangMD

May 4

Packed room with Richard J. Auchus, MD, PhD, FACE on #adrenal #hypertension

- drugs can cause false negative screens but not false positive screens
- you can probably just treat with mineralocorticoid antagonist instead of going through the diagnostic steps

#AACE2023

1/

This is such an excellent talk that I don’t have much commentary to add. Just sharing high yield slides!

2/

Read 7 tweets

Beverly G. Tchang, MD

@BevTchangMD

May 4

@DrKarlNadolsky

@DrKarlNadolsky presents the overarching themes and calls to action of @TheAACE 's new #obesity guidelines:

#AACE2023
1/

@ConscienHealth

👉Reduce #WeightStigma
The bidirectional relationship between #weightbias and #obesity is unequivocal

I'm moved by the enormous consensus among multiple professional societies, MDs PhDs MPHs experts etc, on how important this is

@ConscienHealth @scottkahan
2/

👉Refocus on the Psychological Health and Social Determinants of Health

3/

Read 5 tweets

Beverly G. Tchang, MD

@BevTchangMD

May 3

@alpanashuklamd

@alpanashuklamd takes the stage at the @ColumbiaMed @WeillCornell #Obesity Conference

@alpanashuklamd

@alpanashuklamd et al examined the effect of macronutrient sequencing (carbs first vs carbs last) in ppl with diabetes, prediabetes, or gestational diabetes

This study looked at those with prediabetes:
dom-pubs.onlinelibrary.wiley.com/doi/abs/10.111…

2/

Among those with prediabetes, we saw significant differences in glucose, insulin, ghrelin, and GLP-1 -- all favoring the "carbohydrates-last" food order

3/

Read 5 tweets

Beverly G. Tchang, MD

@BevTchangMD

May 3

@KevinH_PhD

Always a pleasure to listen to @KevinH_PhD discuss his testing of hypotheses in contributors to #obesity
1/

Many people remember his 14-day study of ultra processed foods (UPF) vs unprocessed foods (n=20) that found energy intake was ~500 kcal/d LESS with unprocessed meals

cell.com/cell-metabolis…
2/

Details you might not know:
- Groups were not matched for type of sugar
- No hint of a difference in insulin sensitivity between groups based on OGTT results
- Groups were not matched for beverage amount (and implication for speed of food intake)

3/

Read 7 tweets

Beverly G. Tchang, MD

@BevTchangMD

May 3

@bcorkey

Ready for an #obesity #research disruptor?
@bcorkey 's studies on hyperinsulinemia and inflammation are a perennial favorite

1/

We often focus on slow or fast metabolism but there isn't enough talk on *energy efficiency*. See how much additional Δkcal is required (beyond that calculated) to effect 10% weight Δ: nejm.org/doi/full/10.10…

2/

@bcorkey

"We ignore this important variable: involuntary control of energy metabolism" - @bcorkey

3/

Read 7 tweets

Beverly G. Tchang, MD

@BevTchangMD

May 3

@ColumbiaMed

Tony Ferrante MD PhD of @ColumbiaMed providing an excellent systems based overview of the "metabolic" complications of #obesity and potential mechanisms: lipotoxicity, inflammation, adipokines

Some highlights:

1/

Neurology:
Check out this relationship where higher BMI is associated with ↑ risk of #dementia EXCEPT in age >70 when it's better to be in "overweight" category

👉Aiming for a "normal BMI" is not the best goal for everyone
2/

Unsurprising relationships between #CVD and #obesity
3/

Read 6 tweets

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