本期AMA节目中，Peter深入探讨了改善代谢健康和治疗糖尿病的常用药物，包括SGLT-2抑制剂、二甲双胍和GLP-1激动剂。他评估了这些药物的有效性，以及它们在生活方式干预中的应用潜力。此外，Peter还分析了他汀类药物的使用与胰岛素抵抗和2型糖尿病风险之间的关系，探讨了潜在的因果途径，并提供了降低风险的策略。节目还讨论了监测他汀类药物不良反应以及评估调整的必要性，最终权衡了降低apoB水平的他汀类药物益处与对整体代谢健康的风险。

💊Peter探讨了用于改善代谢健康的药物，以及他汀类药物与胰岛素抵抗之间的关系。节目深入分析了SGLT-2抑制剂的工作原理，以及它们如何帮助管理2型糖尿病。

📜Peter回顾了SGLT2抑制剂的发展历史，从最初的发现到现在的应用。节目还比较了各种FDA批准的SGLT2抑制剂，并探讨了它们在血糖控制之外的其他有益作用。

🛡️节目探讨了SGLT2抑制剂作为潜在的衰老保护分子的可能性，并讨论了与SGLT2抑制剂相关的副作用和风险。此外，节目还讨论了治疗糖尿病和改善代谢健康的药物、生活方式干预措施及其他注意事项。

🌱Peter分析了二甲双胍作为糖尿病前期患者的治疗工具，并比较了二甲双胍与生活方式干预措施的差异。节目还比较了GLP-1激动剂在血糖控制和体重减轻方面与二甲双胍和SGLT2抑制剂的差异。

📊节目深入探讨了他汀类药物的使用与发生胰岛素抵抗和2型糖尿病风险之间的关系。节目讨论了他汀类药物诱导胰岛素抵抗和糖尿病的可能机制，以及潜在的缓解策略。此外，节目还讨论了如何监测他汀类药物的不良反应并评估调整的必要性，最终权衡了他汀类药物使用的益处和风险。

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In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use.

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We discuss:

Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00]; SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15]; The history of SGLT2 inhibitors – from discovery to the current state [10:15]; Comparing the various FDA-approved SGLT2 inhibitors [15:00]; Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15]; Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45]; The side effects and risks associated with SGLT2 inhibitors [31:45]; Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45]; Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00]; How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15]; Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30]; Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30]; How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45]; Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30]; Parting thoughts [1:20:45]; and More.

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