Dr. Oteng

10/25/2026

Here's something we've been building at GENAK.

A head count tells you how many came on Sunday. It doesn't tell you who's been missing for a month, or who ought to get a call this week.

Attend is check-in and follow-up for churches. A QR code goes up on the screen or an usher holds one at the door. Members scan it with their own phone camera, and there's nothing for them to install. Leaders watch the count update live, and anyone who's been away shows up by name with how many weeks they've missed.

From there, Attend drafts a follow-up message. A leader reads it, edits it, and decides whether to send it. Nothing goes out automatically.

It's free for churches with up to 50 members. Have a look: https://www.attend.win

10/18/2026

10/18/2026

If you check your blood pressure at home and get a different number every time, you are not doing it wrong. You are probably just missing a system. In this Know Your Numbers video I walk through how to build a seven-day home blood pressure log your doctor can actually use.

We cover the right tool (a validated automatic upper-arm cuff, not the wrist or finger), how to prep in the 30 minutes before you measure, the posture that keeps readings honest, how to take two readings one minute apart, and how to log morning and evening pairs for seven days. Then we cover the safety line for very high readings and the three questions to bring to your next visit.

I do not give a personal target number in this video, and nothing here tells you to change a medication. Your personal blood pressure goals and monitoring plan belong with your own clinician.

Primary sources:
- American Heart Association. Monitoring Your Blood Pressure at Home. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home
- American Heart Association. My Blood Pressure Log (patient PDF).https://www.heart.org/en/-/media/Files/Health-Topics/High-Blood-Pressure/My-Blood-Pressure-Log.pdf

This content is for general education only. It is not a diagnosis or personal medical advice. Do not start, stop, or change any medication based on this video. Your personal targets and monitoring plan belong with a qualified healthcare professional who knows your history.

09/17/2026

A New Lipid Guideline Just Updated Two Tests. They Are Not the Same Test.

The VA and DoD just updated their joint guideline on managing cholesterol for heart disease risk, and buried in it is a distinction worth pulling out, because two different tests get mentioned side by side and they do not do the same job.

First, some context. This is a VA/DoD guideline, built around the population those systems actually serve: veterans and active-duty service members. That population skews male, skews older, and carries a higher baseline cardiovascular risk than the general public. A guideline written for that group is not automatically a guideline for everyone, even when the science behind it is solid. Keep that in mind as you read anything drawn from it, including this.

Here is the part that deserves precision. The guideline addresses two separate tests. Coronary artery calcium testing, a scan that measures calcium buildup in the heart's arteries, is suggested only for patients who have clinical uncertainty about their risk and whose calculated risk already falls in the intermediate-to-high range. It is conditional, aimed at a specific decision point, not a general screening recommendation. One-time lipoprotein(a) testing is different: it is recommended more broadly, to identify patients who carry an inherited, elevated cardiovascular risk that standard cholesterol panels can miss. These are two tools solving two different problems, and folding them into one blanket "get scanned and get your Lp(a) checked" message would flatten a distinction the guideline itself is careful to keep separate.

The guideline also updates treatment language for very high-risk patients, describing options like combination statin therapy, ezetimibe, PCSK9 inhibitors, bempedoic acid, and fibrates for people who cannot tolerate statins. That is a description of what the guideline recommends clinicians consider, not an instruction for you to start, stop, or switch anything on your own. And it is worth saying plainly: this is a VA/DoD update, distinct from the ACC/AHA and USPSTF guidance you may have seen referenced elsewhere. They are related conversations happening in parallel, not the same document.

What this means for you, whether or not you have any connection to VA or DoD care: if a clinician ever raises coronary calcium testing or Lp(a) testing with you, ask which question each one is trying to answer. One is about resolving uncertainty at a specific risk level. The other is about catching an inherited risk factor early. Neither is a step you take on your own initiative from a newsletter.

For educational and self-management support only. This is not medical advice. Always consult your healthcare team.

📩 Join the newsletter. Email [email protected] with the subject "Signup for Newsletter" and include your name.

Source: 2025 VA/DoD Clinical Practice Guideline for Lipid Management for Cardiovascular Disease Risk Reduction, synopsis published in Annals of Internal Medicine. PMID 42735406. https://pubmed.ncbi.nlm.nih.gov/42735406

Diabetes Action Layer can help you organize questions for a clinician or pharmacist conversation: https://diabeteslayer.com/?utm_source=facebook&utm_medium=organic_social&utm_campaign=creator_cardiometabolic&utm_content=2026-09-15-va-dod-lipid-calcium-lpa-daily-source

Educational information only. It does not replace your clinician, pharmacist, or individualized medical advice.

09/17/2026

A 2026 European Association for the Study of Diabetes guideline recommends that care teams routinely discuss and monitor the emotional weight of managing diabetes day to day, often called diabetes distress.

It is a European guideline, not a universal standard or a replacement for what a US clinic already does. Its management recommendations are conditional. Psychological support is considered for adults with type 1 and type 2 diabetes. Continuous glucose monitoring and automated insulin delivery are discussed specifically for adults with type 1 diabetes.

The ADA has separate 2026 guidance calling for annual distress screening. That is parallel guidance, not an ADA endorsement of the EASD document.

This is not a self-diagnosis tool. It is a prompt for care teams to ask about the day-to-day burden during a visit.

Persistent distress, depression, anxiety, or thoughts of self-harm need assessment by an appropriate clinician. For urgent safety concerns, seek immediate local crisis or emergency help.

Turn diabetes guidance into practical daily actions with Diabetes Action Layer: https://diabeteslayer.com/?utm_source=facebook&utm_medium=organic_social&utm_campaign=creator_cardiometabolic&utm_content=2026-09-16-easd-diabetes-distress-daily-source

Educational information only. It does not replace your clinician, pharmacist, or individualized medical advice.

Source: European Association for the Study of Diabetes guideline on diabetes distress, 2026. PMID 42744915. https://pubmed.ncbi.nlm.nih.gov/42744915

09/15/2026

"Plant-Based" Is Not One Diet. A New Study Shows Why That Matters.

Two people can both call themselves plant-based eaters and be doing very different things for their heart. A new meta-analysis, pooling 22 articles from 19 prospective cohort studies and more than 846,000 people, makes that split visible in the numbers, and it is worth understanding before "plant-based" gets used as a stand-in for "healthy" in your feed this week.

Start with what kind of evidence this is. These are observational cohort studies, meaning researchers followed large groups of people over time and looked for associations between diet patterns and cardiovascular outcomes. That is valuable evidence, but it is not a randomized trial, and it cannot establish that diet caused the outcomes seen. Association, not causation, is the honest frame here.

Now the actual finding, and it is more interesting than a single number. Researchers scored diets on a spectrum from healthful plant-based to unhealthful plant-based. A healthful plant-based pattern, built around whole grains and produce like vegetables, fruits, nuts, and legumes, was linked to lower cardiovascular disease risk. An unhealthful plant-based pattern, leaning more on refined grains and sugary drinks, plus other processed plant foods, was linked to higher cardiovascular disease risk. Same broad label, opposite directions. Treating "plant-based" as one uniform category with one uniform benefit would erase the exact distinction this study is built to show.

One more thing worth being precise about: this analysis found no significant association between plant-based eating patterns and stroke risk specifically. If you see a headline this week claiming plant-based diets cut stroke risk, that headline is not describing this study. The associations that did hold up were for cardiovascular disease and coronary heart disease broadly, not stroke on its own.

None of this means a specific diet plan is required, or that eating this way alone is sufficient for managing cardiovascular risk. Diet is one lever among several, alongside physical activity, sleep, blood pressure, blood glucose, and whatever your own clinician is tracking with you. What this study does offer is a useful filter for reading nutrition claims generally: before you credit or blame "plant-based" for anything, ask what quality of plant-based is actually being described. The label alone is not the whole story.

For educational and self-management support only. This is not medical advice. Always consult your healthcare team.

📩 Join the newsletter. Email [email protected] with the subject "Signup for Newsletter" and include your name.

Plant-based diet and CVD/CHD/stroke risk: systematic review and meta-analysis of prospective cohort studies, 22 articles from 19 cohorts, n=846,589. Nutrients (MDPI). PMID 42738951. https://pubmed.ncbi.nlm.nih.gov/42738951

Turn diabetes guidance into practical daily actions with Diabetes Action Layer: https://diabeteslayer.com/?utm_source=facebook&utm_medium=organic_social&utm_campaign=creator_cardiometabolic&utm_content=2026-09-15-plant-based-diet-quality-daily-source

Educational information only. It does not replace your clinician, pharmacist, or individualized medical advice.

09/15/2026

A Kidney-Protection Drug Class Just Got a Bigger Confirmation, With Two Warnings Attached

A new meta-analysis pooled 13 randomized controlled trials, nearly 50,000 patients, to ask how well SGLT2 inhibitors protect the kidneys in people with chronic kidney disease. This is not a new discovery. It is a confirmatory synthesis, adding statistical weight to what earlier landmark trials in this drug class had already shown. That distinction matters, because "confirms prior evidence" and "brand-new finding" get reported very differently, and only one of those is accurate here.

The numbers are genuinely large. Pooling the trials, the risk of progressing to end-stage kidney disease was reduced by 30 percent. All-cause mortality dropped by 20 percent, cardiovascular mortality by 21 percent, and heart failure-related hospitalization by 26 percent. For a drug class already widely used in diabetes and heart failure care, seeing that scale of benefit hold up across a pooled dataset this large is a meaningful confirmation, not a footnote.

Now the part that has to travel with those numbers, not trail behind them. The same analysis found a near-doubling of diabetic ketoacidosis risk and a meaningfully higher risk of volume depletion, meaning dehydration-type effects, on this drug class. Those are not minor asterisks next to the kidney and mortality benefits. They are the tradeoff side of the same ledger, and reporting the upside without the downside would misrepresent what this analysis actually found.

Diabetic ketoacidosis is a medical emergency, and there is one detail about it on this drug class that catches people off guard: it can happen even when blood glucose looks normal or close to normal, a pattern called euglycemic DKA. That means the usual "my sugar isn't that high, so I'm fine" reasoning does not reliably apply here. If you are on this medication and notice nausea, vomiting, abdominal pain, unusual fatigue, or difficulty breathing, that combination warrants urgent medical attention, regardless of what your glucose meter says. Volume depletion is a lower-grade but still real risk worth mentioning to your prescriber, especially if you are also managing blood pressure medication or have had dehydration episodes before.

One methods note for the record: the search covered Cochrane CENTRAL, PubMed, and PubMed Central, then added Google Scholar on top of that. Google Scholar is a broader, less curated database than the other three, so it is worth naming as a minor caveat on an otherwise well-built systematic review.

None of this is a reason to start, stop, or switch anything on your own. It is a reason to know what to watch for if this medication is already part of your care, and to ask your pharmacist or prescriber how the benefit and the risk apply to your specific situation.

For educational and self-management support only. This is not medical advice. Always consult your healthcare team.

📩 Join the newsletter. Email [email protected] with the subject "Signup for Newsletter" and include your name.

Meta-analysis of SGLT2 inhibitors and chronic kidney disease progression/mortality outcomes, 13 RCTs, n=49,931. Frontiers in Pharmacology. PMID 42741446. https://pubmed.ncbi.nlm.nih.gov/42741446

Diabetes Action Layer can help you organize questions for a pharmacist or prescriber conversation: https://diabeteslayer.com/?utm_source=facebook&utm_medium=organic_social&utm_campaign=creator_cardiometabolic&utm_content=2026-09-15-sglt2i-ckd-dka-daily-source

Educational information only. It does not replace your clinician, pharmacist, or individualized medical advice.

09/04/2026

Ozempic, Mounjaro, Wegovy, and Zepbound: Can they treat Everything? Migraine too?

09/03/2026

A diabetes headline can be technically accurate and still easy to overread.

This week, two FDA-related stories point to the same habit: read past the first sentence.

The FDA authorized a wearable that continuously tracks interstitial glucose and ketones for people age 2 and older with diabetes. It sends both readings to a phone and can alert the wearer when ketones rise into a concerning range. FDA's review included six performance studies with more than 600 participants.

That authorization addresses measurement. It did not establish that the device prevents diabetic ketoacidosis, hospitalization, or death. For sick days, it may support an existing plan from a care team. It does not replace one.

The same careful reading matters for the August 28 Mounjaro indication. The FDA approved tirzepatide to reduce the risk of cardiovascular death, nonfatal heart attack, or nonfatal stroke in adults with type 2 diabetes who are at high risk for those events.

In SURPASS-CVOT, tirzepatide was noninferior to dulaglutide for major cardiovascular events: 12.2% versus 13.1%, HR 0.92, 95.3% CI 0.83 to 1.01. Superiority was not established, P=0.09.

Turn diabetes guidance into practical daily actions with Diabetes Action Layer: https://diabeteslayer.com/?utm_source=facebook&utm_medium=organic_social&utm_campaign=creator_cardiometabolic&utm_content=2026-08-w5-dual-glucose-ketone-tirzepatide-headline-newsletter

Educational information only. It does not replace your clinician, pharmacist, or individualized medical advice.

08/28/2026

A1C matters. I would never tell someone to ignore it.

But it is one part of a larger conversation about cardiovascular-kidney-metabolic risk. Blood pressure and cholesterol belong in that conversation. Kidney information, weight trends, medicines, or your personal history may change what your care team wants to discuss.

Before your next preventive or diabetes follow-up visit, make a one-page note. Add the results you already have, with their dates. Include your current medicine and supplement list. Then write the questions you do not want to forget.

One useful question is: "What does my A1C mean in the context of the rest of my history, and what should we follow next?"

This is visit preparation, not a self-diagnosis checklist or a universal test panel. A qualified clinician or pharmacist can help you decide what applies to you.

Turn diabetes guidance into practical daily actions with Diabetes Action Layer: https://diabeteslayer.com/?utm_source=facebook&utm_medium=organic_social&utm_campaign=creator_cardiometabolic&utm_content=2026-08-24-w35-ckm-dashboard

Educational information only. Do not start, stop, change, or dose a medicine based on this post.