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Evidence to Avoid Overtesting and Overuse in Diabetes Mellitus and Other Diseases - ...

Nov 15, 2020 - What can physicians do to avoid overuse? Start by asking the right questions.

American Family Physician : Editorials

https://www.aafp.org/afp/2020/1115/p583.html

Metformin to Prevent Diabetes in Patients at Increased Risk - Cochrane for Clinicians -... Restricted content. Login required.

Nov 1, 2020 - In patients at increased risk of developing type 2 diabetes, metformin reduces the risk (number needed to treat [NNT] = 7; 95% CI, 6 to 10) compared with counseling on standard diet and exercise.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2020/1101/p531.html

Cycled Hyperbaric Oxygen Improves the Healing of Diabetic Foot Ulcers - POEMs - ... Restricted content. Login required.

Oct 15, 2020 - Hyperbaric oxygen provided with a device that cycles oxygen from high pressure to low pressure increased the likelihood of complete healing of diabetic foot ulcers when combined with standard dressing and an offloading boot.

American Family Physician : POEMs

https://www.aafp.org/afp/2020/1015/od3.html

Management of Hypertriglyceridemia: Common Questions and Answers - American Family ... Restricted content. Login required.

Sep 15, 2020 - Hypertriglyceridemia, defined as fasting serum triglyceride levels of 150 mg per dL or higher, is associated with increased risk of cardiovascular disease. Severely elevated triglyceride levels (500 mg per dL or higher) increase the risk of pancreatitis. Common risk factors for ...

American Family Physician : Article

https://www.aafp.org/afp/2020/0915/p347.html

Thyroid Nodules: Advances in Evaluation and Management - American Family Physician Restricted content. Login required.

Sep 1, 2020 - Thyroid nodules can be detected by ultrasonography in up to 68% of the general population. They are typically benign and are often discovered incidentally. The primary goal of thyroid nodule evaluation is to determine whether it is malignant. After thyroid ultrasonography has been ...

American Family Physician : Article

https://www.aafp.org/afp/2020/0901/p298.html

Treatment of Subclinical Hypothyroidism: BMJ Rapid Recommendation - Practice Guidelines... Restricted content. Login required.

Sep 1, 2020 - Previous guidelines suggested that levothyroxine treatment may be appropriate with hypothyroid symptoms or a TSH level exceeding 10 mIU per L based on limited evidence. A recent large trial in older adults suggests that treatment shows no benefit in many areas and possible harm.

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2020/0901/p316.html

Paget Disease of Bone for Primary Care - American Family Physician Restricted content. Login required.

Aug 15, 2020 - Paget disease of bone is a benign disorder characterized by focal areas of increased bone turnover in one or more skeletal sites. It usually affects older adults, and men are at a higher risk than women. Any bone may be affected, but the disease has a high preference for the pelvis, ...

American Family Physician : Article

https://www.aafp.org/afp/2020/0815/p224.html

Continuous Glucose Monitoring in Type 2 Diabetes Is Not Ready for Widespread Adoption -...

Jun 1, 2020 - Although continuous glucose monitoring may benefit patients with type 1 diabetes mellitus, there is limited evidence that it offers similar benefits in patients with type 2 diabetes, regardless of whether they are taking insulin.

American Family Physician : Editorials

https://www.aafp.org/afp/2020/0601/p646.html

IDx-DR for Diabetic Retinopathy Screening - Diagnostic Tests: What Physicians Need to ... Restricted content. Login required.

Mar 1, 2020 - IDx-DR is a reliable screening tool used to diagnose diabetic retinopathy in the primary care office and may reduce barriers to screening and improve gaps in eye care for those with diabetes.

American Family Physician : Diagnostic Tests: What Physicians Need to Know

https://www.aafp.org/afp/2020/0301/p307.html

Linagliptin and Glimepiride Equally Effective for Adults with Type 2 Diabetes Mellitus ... Restricted content. Login required.

Mar 1, 2020 - This study found that linagliptin is noninferior to glimepiride for reducing the risk of cardiovascular death, myocardial infarction, and stroke in adults with type 2 diabetes at an increased risk of cardiovascular disease.

American Family Physician : POEMs

https://www.aafp.org/afp/2020/0301/p309a.html

Hirsutism in Women - American Family Physician

Aug 1, 2019 - Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. Although many conditions can lead to hirsutism, polycystic ovary syndrome and idiopathic hyperandrogenism account for more than 85% of cases. Less ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0801/p168.html

Should Adults with Prediabetes Be Prescribed Metformin to Prevent Diabetes Mellitus? ...

Aug 1, 2019 - Discussing with patients the pros and cons of medications for borderline glucose values could distract us from more important topics such as lifestyle changes, smoking cessation, and blood pressure control. Time is the most valuable resource in a physician-patient partnership, and there...

American Family Physician : Editorials: Controversies in Family Medicine

https://www.aafp.org/afp/2019/0801/p136.html

Should Adults with Prediabetes Be Prescribed Metformin to Prevent Diabetes Mellitus? ...

Aug 1, 2019 - High-quality evidence supports metformin use for diabetes prevention among younger or more obese individuals or for women with a history of gestational diabetes. Clinicians should consider prescribing metformin, in addition to intensive lifestyle interventions, in accordance with ...

American Family Physician : Editorials: Controversies in Family Medicine

https://www.aafp.org/afp/2019/0801/p134.html

Dapagliflozin in High-Risk Type 2 Diabetes Reduces Hospitalization for Heart Failure ...

Aug 1, 2019 - The only cardiovascular benefit to treatment with dapagliflozin was a reduction in the likelihood of hospitalization; 125 patients would need to be treated for 10 years to prevent one hospitalization.

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0801/p184.html

Semaglutide (Ozempic) for Type 2 Diabetes Mellitus - STEPS - American Family Physician

Jul 15, 2019 - Semaglutide can be added to existing treatment to improve glycemic control and induce weight loss. It may also protect against cardiovascular outcomes in patients with type 2 diabetes and established cardiovascular disease.

American Family Physician : STEPS

https://www.aafp.org/afp/2019/0715/p116.html

Omega-3 Oil Does Not Reduce Serious Cardiovascular Events for Patients with Diabetes ...

Jul 15, 2019 - In this study, there was no significant difference in the likelihood of a composite vascular outcome or all-cause mortality in patients given an omega-3 fatty acid supplement compared with those given an olive oil placebo.

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0715/p120.html

Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention - American Family Physician

Jun 15, 2019 - Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. Screening for early DKD is best done ...

American Family Physician : Article

https://www.aafp.org/afp/2019/0615/p751.html

Benefits and Harms for Low-Dose Aspirin in Patients with Diabetes Mellitus - POEMs - ...

Jun 1, 2019 - The 7,740 patients who took low-dose aspirin experienced 51 fewer vascular deaths, nonfatal myocardial infarctions, or nonfatal ischemic strokes; 29 fewer transient ischemic attacks; and 44 fewer revascularizations than patients who took placebo over a mean of 7.4 years.

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0601/p718.html

Denosumab for Reducing Risk of Fractures in Postmenopausal Women - Medicine by the ...

May 1, 2019 - Denosumab appears to be effective in reducing the risk of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis. Treatment with denosumab does not increase the risk of cancer or death but might increase the risk of infection. However, more studies are required.

American Family Physician : Medicine by the Numbers

https://www.aafp.org/afp/2019/0501/od1.html

Aromatase Inhibitors Such as Letrozole (Femara) vs. Clomiphene (Clomid) for Subfertile ...

May 1, 2019 - When treated with letrozole, subfertile women with PCOS who are trying to conceive have increased chances of pregnancy (number needed to treat [NNT] = 11) and live birth (NNT = 10) compared with those treated with clomiphene.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2019/0501/p545.html

Statins Ineffective for Primary Prevention of Cardiovascular Disease in Patients 75 ...

Apr 1, 2019 - In this retrospective study, statin treatment in patients 75 years or older without preexisting CVD did not change the likelihood of developing CVD or reduce any-cause mortality. However, patients 75 to 84 years of age with diabetes mellitus benefitted from treatment. These results ...

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0401/p461.html

Abaloparatide (Tymlos) for Osteoporosis - STEPS - American Family Physician

Feb 15, 2019 - Abaloparatide is a safe and effective medication used to reduce the likelihood of vertebral and nonvertebral fractures in women at high risk. However, it is expensive and requires daily injections. It has not been evaluated for its effect on decreasing hip fractures.

American Family Physician : STEPS

https://www.aafp.org/afp/2019/0215/p260.html

NPH Insulin: Fewer Episodes of Severe Hypoglycemia Than Analogs and Less Than One-Half ...

Jan 1, 2019 - This study found that compared with expensive long-acting insulin analogs costing two to 10 times as much, NPH insulin results in a similar number of episodes of severe hypoglycemia (if not fewer) that result in emergency department visits and hospitalizations.

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0101/p53a.html

Oral Contraceptives and Antiandrogens Most Effective for Hirsutism Pharmacotherapy - ...

Jan 1, 2019 - Combination oral contraceptive pills (OCPs) are an excellent treatment option for women desiring medical therapy for hirsutism. Based on this meta-analysis, an accompanying practice guideline recommends adding an antiandrogen, such as finasteride (Propecia), if there is an inadequate ...

American Family Physician : POEMs

https://www.aafp.org/afp/2019/0101/p55.html

Preventing or Delaying Type 2 Diabetes Mellitus with Diet and Exercise - Cochrane for ...

Dec 1, 2018 - There is moderate-quality evidence that in patients with impaired glucose tolerance (IGT) defined by an abnormal 75-g two-hour glucose tolerance test, implementing changes in diet and adding physical activity together can prevent or delay the development of type 2 diabetes.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2018/1201/p643.html

Type 2 Diabetes Mellitus: ACP Releases Updated Guidance Statement on A1C Targets for ...

Nov 1, 2018 - This guidance statement from the American College of Physicians (ACP) aims to help physicians achieve appropriate A1C targets via medication for nonpregnant patients with type 2 diabetes based on a review of six health care organization guidelines.

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2018/1101/p613.html

High-Dose vs. Standard-Dose Heparin for VTE Prophylaxis in Obese Patients - FPIN's Help...

Jun 1, 2018 - In most patients weighing more than 220 lb (100 kg), high-dose heparin prophylaxis (7,500 units subcutaneously three times per day) does not further reduce the risk of VTE compared with standard-dose heparin (5,000 units subcutaneously two or three times per day).

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2018/0601/od2.html

Gender-Dysphoric/Gender-Incongruent Persons: Treatment Recommendations from the ...

May 1, 2018 - Gender-dysphoric/gender-incongruent persons require a safe and effective hormone regimen. These recommendations are an update to the clinical practice guideline on endocrine treatment of transsexual persons published in 2009 by the Endocrine Society.

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2018/0501/p608.html

Duration of Bisphosphonate Therapy - FPIN's Help Desk Answers - American Family Physician

Apr 1, 2018 - Oral bisphosphonates significantly reduce clinical fracture risk at four years in women with postmenopausal osteoporosis (T-score less than −2.5). Treatment beyond five years is associated with further reductions in fractures in women with persistent femoral neck T-scores less than −2.5.

American Family Physician : FPIN's Help Desk Answers

https://www.aafp.org/afp/2018/0401/od1.html

DPP-4 Inhibitors and GLP-1 Receptor Agonists for Prevention or Delay of Type 2 Diabetes...

Apr 1, 2018 - There is only limited-quality evidence that at-risk patients taking GLP-1 receptor agonists are less likely to progress to diabetes (number needed to treat [NNT] = 23). Serious adverse events were more likely in patients taking GLP-1 receptor agonists than in patients taking placebo ...

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2018/0401/p437.html

Screening for Thyroid Cancer: Recommendation Statement - U.S. Preventive Services Task ...

Mar 15, 2018 - The USPSTF recommends against screening for thyroid cancer in asymptomatic adults.

American Family Physician : U.S. Preventive Services Task Force

https://www.aafp.org/afp/2018/0315/od1.html

Screening for Thyroid Cancer - Putting Prevention into Practice - American Family ...

Mar 15, 2018 - A 45-year-old Korean American woman comes to your office for a wellness visit. She has a history of allergic rhinitis, and her family history is significant for diabetes mellitus in her father. She describes her health as good and has no concerns.

American Family Physician : Putting Prevention into Practice

https://www.aafp.org/afp/2018/0315/p406.html

Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions ...

Feb 15, 2018 - Measurement of vitamin D levels and supplementation with oral vitamin D have become commonplace, although clinical trials have not demonstrated health benefits. The usefulness of serum 25-hydroxyvitamin D levels to assess adequate exposure to vitamin D is hampered by variations in ...

American Family Physician : Article

https://www.aafp.org/afp/2018/0215/p254.html

Vitamin D Screening and Supplementation in Primary Care: Time to Curb Our Enthusiasm - ...

Feb 15, 2018 - Evidence for vitamin D screening and supplementation in adults shows that these commonplace practices have virtually no established health benefits.

American Family Physician : Editorials

https://www.aafp.org/afp/2018/0215/p226.html

Long-Term Use of Bisphosphonates Increases the Risk of Fractures in Older Women - POEMs...

Jan 1, 2018 - In this cohort study, older women at a high risk of fractures who used oral bisphosphonates for 10 to 13 years had a higher risk of fractures than women who used bisphosphonates for only two years.

American Family Physician : POEMs

https://www.aafp.org/afp/2018/0101/p53a.html

Home Glucose Monitoring Offers No Benefit to Patients Not Using Insulin - POEMs - ...

Dec 15, 2017 - Home glucose monitoring of patients in primary care does not improve A1C scores or quality of life over one year in patients who are not taking insulin.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1215/od4.html

Glucose Management in Hospitalized Patients - American Family Physician

Nov 15, 2017 - Glucose management in hospitalized patients poses challenges to physicians, including identifying blood glucose targets, judicious use of oral diabetes mellitus medications, and implementing appropriate insulin regimens. Uncontrolled blood glucose levels can lead to deleterious effects ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1115/p648.html

Treatment of Subclinical Hypothyroidism Ineffective in Older Adults - POEMs - American ...

Oct 15, 2017 - Treatment of patients with a minimally elevated thyrotropin (thyroid-stimulating hormone) level did not result in any improvement in symptoms. If patients present with a thyrotropin level between 4.6 and 10 mIU per L, repeat the test because the levels often normalize (this occurred in ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1015/od3.html

Newer Oral Hypoglycemics Do Not Increase or Decrease Mortality - POEMs - American ...

Oct 15, 2017 - This seems like a strange question considering that the goal is to decrease mortality with drug therapy. Nevertheless, this study showed that the new kids on the diabetes block—exenatide (Byetta), dulaglutide (Trulicity), sitagliptin (Januvia), saxagliptin (Onglyza), and others—do not ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/1015/od2.html

Testosterone Therapy: Review of Clinical Applications - American Family Physician

Oct 1, 2017 - Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians. There is conflicting evidence on the benefit of male testosterone therapy for age-related declines in testosterone. Physicians should not measure ...

American Family Physician : Article

https://www.aafp.org/afp/2017/1001/p441.html

Treating Aging with Testosterone - Editorials - American Family Physician

Oct 1, 2017 - Most patients on testosterone are being treated for normal symptoms of aging. Given that the diagnostics are questionable and the benefits are unconvincing, the risks of testosterone, some of which may be life-threatening, are not worth taking.

American Family Physician : Editorials

https://www.aafp.org/afp/2017/1001/p428.html

Diabetes Self-Management: Facilitating Lifestyle Change - American Family Physician

Sep 15, 2017 - Healthy eating and increased physical activity can prevent or delay the onset of diabetes mellitus and facilitate diabetes management. Current guidelines recommend long-term weight loss of 5% to 7% of body weight and 150 minutes of at least moderate-intensity physical activity per week ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0915/p362.html

Bariatric Surgery Improves Quality of Life and Results in More Weight Loss Than ...

Jun 15, 2017 - Bariatric surgery using Roux-en-Y gastric bypass or sleeve gastrectomy was more effective than intensive medical therapy at improving quality of life and helping patients lose weight and reduce the need for medications. Anemia was more common with sleeve gastrectomy, and approximately ...

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0615/p805.html

Subclinical Hyperthyroidism: When to Consider Treatment - American Family Physician

Jun 1, 2017 - Subclinical hyperthyroidism is defined by a low or undetectable serum thyroid-stimulating hormone level, with normal free thyroxine and total or free triiodothyronine levels. It can be caused by increased endogenous production of thyroid hormone (e.g., in Graves disease, toxic nodular ...

American Family Physician : Article

https://www.aafp.org/afp/2017/0601/p710.html

Testosterone Does Not Improve Cognition in Memory-Impaired Older Men with Low ...

Jun 1, 2017 - Testosterone supplementation for men 65 years or older with age-associated memory impairment and a low baseline testosterone level was not associated with significant improvements in memory or other cognitive functions.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0601/p733a.html

Semaglutide Reduces CV Events in High-Risk Patients with Type 2 Diabetes Mellitus - ...

Mar 15, 2017 - Semaglutide significantly reduced the composite outcome of CV death, nonfatal myocardial infarction, and nonfatal stroke (number needed to treat [NNT] = 43 over 2.1 years). It was generally well tolerated, and it reduced body weight by approximately 6.4 to 9.5 lb (2.9 to 4.3 kg).

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0315/p396.html

Detrimental Effect of Tight Glucose Control on CV Mortality Persists Over Nine Years - ...

Mar 15, 2017 - The initial Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, which compared standard treatment with intensive control, found that despite good intentions, cardiovascular (CV) and overall mortality are significantly higher when blood glucose levels are lower.

American Family Physician : POEMs

https://www.aafp.org/afp/2017/0315/od2.html

Radioactive Iodine Therapy vs. Antithyroid Medications for Graves Disease - Cochrane ...

Mar 1, 2017 - Radioactive iodine therapy and antithyroid medications produce similar health-related quality-of-life outcomes in patients with Graves disease. Radioactive iodine therapy is an appropriate choice for patients who prefer definitive treatment.

American Family Physician : Cochrane for Clinicians

https://www.aafp.org/afp/2017/0301/p292.html

ADA Updates Standards of Medical Care for Patients with Diabetes Mellitus - Practice ...

Jan 1, 2017 - The American Diabetes Association (ADA) recently updated its standards of care to provide the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Key changes in the 2016 update include new screening recommendations, clarification of ...

American Family Physician : Practice Guidelines

https://www.aafp.org/afp/2017/0101/p40.html

Diabetes Mellitus: Management of Gastrointestinal Complications - American Family ...

Dec 15, 2016 - Gastrointestinal disorders are common complications of diabetes mellitus and include gastroparesis, nonalcoholic fatty liver disease, gastroesophageal reflux disease, and chronic diarrhea. Symptoms of gastroparesis include early satiety, postprandial fullness, nausea, vomiting of ...

American Family Physician : Article

https://www.aafp.org/afp/2016/1215/p980.html

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