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Management of hypoglycemia in older adults with type 2 diabetes.
This article highlights the issues faced by older people with T2D, the risk factors for hypoglycemia in this population, and the challenges faced by health care providers regarding glycemic management in this patient group. PMID: 30724638 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - February 8, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The single use of body mass index for the obesity paradox is misleading and should be used in conjunction with other obesity indices.
Authors: Chrysant SG, Chrysant GS Abstract Overweight and obesity in children and adults have significantly risen in the US and worldwide due to biological, environmental, and cultural drivers and account for about 2.1 billion people. In addition, obesity, even metabolically healthy, is a major risk factor for the metabolic syndrome, diabetes mellitus, dyslipidemia, and hypertension, all significant causes of cardiovascular disease (CVD), coronary heart disease (CHD) heart failure (HF) and stroke. However, despite these causative effects, overweight and obesity frequently, confer a protection in patients with estab...
Source: Postgraduate Medicine - January 12, 2019 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Practice Pearl: Liraglutide and Cardiovascular and Renal Events in Type 2 Diabetes.
Authors: Guthrie R Abstract Review of: Marso S, Daniels G, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322. Mann J, Orsted D, Brown-Frandsen K, et al. Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377: 839-848. This comprehensive research project, LEADER, led to two reports, one focusing on the effect of liraglutide on cardiovascular events, and the second one reporting on the renal effects on the same study population. The study group included 9340 patients with type 2 diabetes. Patients were required to have type 2 diabet...
Source: Postgraduate Medicine - January 21, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Canagliflozin and cardiovascular and renal events in type 2 diabetes.
This study expands the scope of SGLT-2 inhibitor therapy to prevent cardiovascular disease in diabetic patients beyond those with preexisting cardiovascular disease studied in the previous empagliflozin study, raising the question as to whether SGLT-2 inhibitor therapy should be considered appropriate for most, if not all, type 2 diabetes patients, not only to control hyperglycemia but also to reduce cardiovascular and renal events. PMID: 29297732 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - January 5, 2018 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Management of acute stroke.
Authors: Pryse-Phillips W, Yegappan MC Abstract Preview Regardless of cause, acute stroke is a devastating illness that demands immediate treatment to contain neurologic damage, plus long-term management to assure utmost rehabilitation. In this article, the authors describe the features of stroke from various causes and discuss current therapy. PMID: 29219708 [PubMed]
Source: Postgraduate Medicine - December 10, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Carotid artery stenosis.
Authors: Jaigobin CS, Perry JR Abstract Preview Many patients with significant carotid artery stenosis are candidates for endarterectomy, a procedure now proved to reduce the incidence of future stroke and death. In this article, Drs Jaigobin and Perry describe an approach to patients with both symptomatic and asymptomatic carotid stenosis and review current indications for surgical referral. They also emphasize the importance of recognizing and managing concurrent coronary artery disease. PMID: 29219707 [PubMed]
Source: Postgraduate Medicine - December 10, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Transient ischemic attacks.
Authors: Chaturvedi S, Hachinski V Abstract Preview All transient ischemic attacks are not created equal. However, they are a medical emergency, and all patients should be hospitalized for urgent evaluation of their risk for stroke or myocardial infarction. For optimal management, it must be determined whether an ischemic attack affects the anterior or posterior circulation. In this article, the authors review current medical options for stroke prevention and the indications for carotid endarterectomy. PMID: 29219705 [PubMed]
Source: Postgraduate Medicine - December 10, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Incorporation of PCSK9 inhibitors into prevention of atherosclerotic cardiovascular disease.
Authors: Wójcik C Abstract Primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has become recently more complex than ever, leaving the clinicians perplexed with outdated guidelines and emerging evidence about new LDL-C lowering therapies. 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines have focused on high intensity statin therapy for specific groups of patients, while abandoning long established LDL-C goals, a strategy which no longer seems valid. PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors have emerged as the add-on therapy...
Source: Postgraduate Medicine - September 9, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Usefulness of cardiometabolic index for the estimation of ischemic stroke risk among general population in rural China.
CONCLUSION: The strong and independent association of CMI with ischemic stroke in females, in comparison with the much lesser degree in males, provides further insight to better stratify by sex in investigations of ischemic stroke and solidly corroborates the potential role of ischemic stroke prevention targeted at CMI. PMID: 28870109 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - September 7, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cardiovascular benefits and safety of non-insulin medications used in the treatment of type 2 diabetes mellitus.
Authors: Yandrapalli S, Jolly G, Horblitt A, Sanaani A, Aronow WS Abstract Diabetes mellitus is a growing in exponential proportions. If the current growth trend continues, it may result in every third adult in the United States having diabetes mellitus by 2050, and every 10(th) adult worldwide. Type 2 diabetes mellitus (T2DM) confers a 2- to 3-fold increased risk of cardiovascular (CV) events compared with non-diabetic patients, and CV mortality is responsible for around 80% mortality in this population. Patients with T2DM can have other features of insulin resistance-metabolic syndrome like hypertension, lipid ab...
Source: Postgraduate Medicine - July 29, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

The evolving role of oral hormonal therapies and review of conjugated estrogens/bazedoxifene for the management of menopausal symptoms.
Authors: Parish SJ, Gillespie JA Abstract This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women's Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased th...
Source: Postgraduate Medicine - February 1, 2017 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Cardiovascular effects of dipeptidyl peptidase-4 inhibitor in diabetic patients with and without established cardiovascular disease: A meta-analysis and systematic review.
CONCLUSION: DPP-4is may have no cardiovascular protective effects in diabetic patients with coexisting CVD, while there is a lack of definitive evidence supporting the cardiovascular benefits of DPP-4is treatment among diabetic patients free of CVD history. PMID: 27813442 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - November 6, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A review of trazodone use in psychiatric and medical conditions.
Authors: Khouzam HR Abstract Trazodone is an antidepressant that is FDA-approved for the treatment of depression. It has been used by mental health and primary care providers for the treatment of multiple psychiatric and medical conditions .This review describes trazodone mechanism of action, formulation, dosage and adverse effects and then summarizes the beneficial effects of trazodone in the treatment of various psychiatric and medical conditions such as major depression, as well non-approved FDA indications such as insomnia,anxiety disorders, posttraumatic stress disorder, obsessive compulsive disorder, feeding ...
Source: Postgraduate Medicine - October 18, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Impact of bromocriptine-QR therapy on cardiovascular outcomes in type 2 diabetes mellitus subjects on metformin.
CONCLUSION: These findings suggest that in T2DM subjects on metformin, BQR therapy may represent an effective strategy for reducing CVD risk. PMID: 27687032 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - October 2, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Defining Metabolic Syndrome and Factors Associated with Metabolic Syndrome in a Poly-pharmaceutical Population.
CONCLUSION: The IDF definition for METs that makes allowance for treatment for each specific condition can lead to an overestimation in the prevalence of METs in population studies. Not including those medicated with normal results conversely underestimates the prevalence of METs. We have therefore proposed adjustments to BP and lipid measurements based on pooled mean effects from published systematic reviews to mitigate bias in future research on prevalence of METs. PMID: 27558757 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - August 27, 2016 Category: Internal Medicine Tags: Postgrad Med Source Type: research

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