The Medical clinics of North America
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With the concept of patient-centered care in mind, this article outlines the current diabetes medications available for glucose lowering and the characteristics of each of these medications that need to be considered in shared decision-making for durable and effective therapy. Important patient characteristics such as weight, risk for hypoglycemia, cost, social determinants of health, and medical literacy need to be considered. The evidence-base informing the use of antihyperglycemic agents has changed dramatically due to 2008 FDA guidance for cardiovascular safety and cardiorenal protection with antihyperglycemic agents. New evidence supports an approach to diabetes management that addresses pre-existing cardiorenal disease.
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Obesity is a treatable chronic disease. Primary care providers play an essential role in diagnosis, treatment, and comprehensive care of patients with obesity. In recent years, treatment approaches have rapidly evolved, increasing effective and safe therapies. In this review, we provide practical information on the care of patients with obesity with a focus on antiobesity pharmacotherapy within the context of currently available therapeutic modalities such as intensive lifestyle interventions and bariatric surgery.
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Med. Clin. North Am. · Nov 2021
ReviewPrimary Hyperaldosteronism: Approach to Diagnosis and Management.
Hyperaldosteronism is a relatively more common disorder than previously recognized. Patients with hyperaldosteronism are at high risk for cardiovascular events. ⋯ Medical therapy using optimal doses of mineralocorticoid receptor antagonists can control symptoms and normalize plasma renin activity. The long-term outcome of patients treated with either surgical or optimal medical therapy appears similar.
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Med. Clin. North Am. · Nov 2021
ReviewEvaluation and Management of Elevated Parathyroid Hormone Levels in Normocalcemic Patients.
Primary hyperparathyroidism is a common endocrine disorder. It used to present as a highly symptomatic disease before the advent of the multichannel autoanalyzer, now usually presenting as mild asymptomatic hypercalcemia. ⋯ It is important to exclude causes of secondary hyperparathyroidism. This review will focus on the evaluation and management of elevated parathyroid hormone levels in normocalcemic patients.
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Thyroid nodules may be discovered in a variety of settings. Familiarity with their management is important for medical specialists. Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. ⋯ Most nodules can be accurately diagnosed on cytopathology, but some may require additional molecular testing to evaluate risk of malignancy. Patients with malignant lesions require additional investigation before referral to an experienced thyroid surgeon. Those who have benign lesions may require monitoring by periodic ultrasound to identify nodules requiring reevaluation.