Because routine levothyroxine treatment is not recommended for SCH, it is certainly not warranted in individuals with URR TSH. For all patients with URR TSH, it is reasonable to determine serum TSH every 1-2 yr.

Increased circulating levels of nonesterified free fatty acids (NEFA) have been observed in such hyperinsulinemic states as obesity, impaired glucose tolerance, diabetes, and dyslipidemia where they have been causally linked to the development of insulin resistance and hyperinsulinemia. The concentration of NEFA in plasma is believed to have direct modifying effects on insulin secretion and clearance. It remains controversial whether acute increases in NEFA potentiate insulin secretion in human subjects. We studied the effect of an acute elevation of NEFA during lipid‐heparin infusion compared to a glycerol‐only control on glucose‐stimulated insulin secretion and clearance during a 120‐min hyperglycemic (10 mM) clamp in 7 healthy normoglucose‐tolerant volunteers. The metabolic clearance rate of C‐peptide (MCRCP) was measured in each subject during the study by simultaneous infusion of C‐peptide. Insulin secretion rate (ISR) was calculated from deconvolution of C‐peptide data after correction for the rate of C‐peptide infusion. Clearance rate of insulin (MCRINS) was calculated based upon endogenous ISR. Plasma glucose (mg/dL): basal (90‐115 min) 90.2 ± 2.8 vs. 90.2 ± 2.3; clamp (150‐240 min) 180.5 ± 2.8 vs. 180.9 ± 1.3. Plasma insulin (pmol/L): prebasal (fasting) 29.6 ± 10.0 vs. 29.8 ± 10.6; basal (90‐115 min) 30.1 ± 9.2 vs. 34.5 ± 12.1; second phase clamp (210‐240 min) 127.6 ± 18.2 vs. 182.5 ± 17.3*. Plasma NEFA (mM): prebasal 0.47 ± 0.08 vs. 0.52 ± 0.09; basal 0.35 ± 0.05 vs. 0.98 ± 0.02*; clamp (122‐240 min) 0.06 ± 0.02 vs. 0.77 ± 0.06*. ISR (pmol/min): prebasal 72.7 ± 7.5 vs. 72.0 ± 7.9; second phase clamp (210‐240 min) 268.5 ± 27.2 vs. 200.2 ± 23.7. MCRINS (mL/min): prebasal 3393 ± 488 vs. 3370 ± 511; clamp 2284 ± 505 vs. 1214 ± 153* (*p < 0.05 glycerol vs. intralipid/heparin). This study demonstrates that acute NEFA elevation causes hyperinsulinemia due to a significant decrease in systemic insulin clearance without increasing rates of insulin secretion.

The prevalence of obesity has increased to pandemic levels worldwide and is related to increased risk of morbidity and mortality. Metabolic comorbidities are commonly associated with obesity and include metabolic syndrome, pre-diabetes, and type 2 diabetes. Even if the prevalence of obesity remains stable until 2030, the anticipated numbers of people with diabetes will more than double as a consequence of population aging and urbanization. Weight reduction is integral in the prevention of diabetes among obese adults with pre-diabetes. Lifestyle intervention and weight reduction are also key in the management of type 2 diabetes. Weight loss is challenging for most obese patients, but for those with diabetes, it can pose an even greater challenge due to the weight gain associated with many treatment regimens. This article will review optimal treatment strategies for patients with comorbid obesity and type 2 diabetes. The role of anti-obesity agents in diabetes will also be reviewed. This literature review will provide readers with current strategies for the pharmacologic treatment of obesity and diabetes with a focus on the weight outcomes related to diabetes treatments.

With increasing life-expectancy of patients with diabetes mellitus, awareness of DAN and its implications to older adults is needed in primary care. Consistent screening and appropriate treatment of DAN in older adults with diabetes mellitus is essential in helping to maintain functional status and avoid adverse events.