Articles related to Family Medicine/General Practice

Other than anterior cervical and occipital lymphadenopathy, the physical examination and vitals are unremarkable. The patient is also requesting HIV pre-exposure prophylaxis initiation. HIV testing negative. What’s the best management?

Per the Standards, “diabetes management in older adults requires regular assessment of medical, psychological, functional, and social domains. Older adults with diabetes have higher rates of premature death, functional disability, accelerated muscle loss, and coexisting illnesses … and … are also at greater risk for several common geriatric syndromes, such as polypharmacy, cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, and frailty. All these can impair their self-management.”

In a study including 73 meta-analyses and 8,601 unique articles, sugar consumption was associated with 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes. Endocrine/metabolic outcomes included weight gain, ectopic fat accumulation, obesity, and cardiovascular disease, which were largely attributed to excessive consumption of fructose containing sugars.

In this meta analysis of 40 eligible trials involving 35,548 participants and seven diet programs, only the Mediterranean and low-fat diet showed effectiveness in in lowering all cause and CV mortality. Notably, their preventive value increased with increasing CV risk. Diets (with number of studies) included in the meta-analysis:

In a study of patients with DM2, 75 years old and over, continuous glucose monitoring revealed that 65% had glucose level two times below range (<54 mg/dL during ≥15 consecutive minutes) between midnight and 6 a.m. Fewer than half of the patients detected the hypoglycemic episode via self-monitoring. Because hypoglycemia episodes are associated with long-term complications, continuous glucose monitoring (CGM) could be used to improve care in these patients.

From side effect to mechanism of action to patient acceptance to managing insurance hurdles, this collection of expert points from the February Endocrine Society meeting is a helpful synopsis of need-to-know items for PCPs.