The Journal of family practice
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At the end of the activity, participants will be able to: Identify the risks of kidney disease and their consequences in patients with type 2 diabetes (T2D). Appropriately screen for the presence of chronic kidney disease (CKD) in patients with T2D. Initiate evidence-based therapy to slow the progression of kidney disease in patients with T2D and CKD. Become familiar with the novel nonsteroidal mineralocorticoid receptor antagonist finerenone and its role in the treatment of patients with T2D and CKD.
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Insomnia is a distinct disorder that is common, yet underrecognized and undertreated in primary care. Treating insomnia has been shown to improve outcomes, including reduced risk of developing cardiovascular and mental health disorders. Insomnia is influenced by the brain's regulation of sleep and wake, which are mutually exclusive events. ⋯ Additionally, these medications have no evidence of rebound insomnia or withdrawal, and little to no abuse potential. Daridorexant is the newest DORA, has an ideal half-life of 8 hours, and has demonstrated continued efficacy over a 12-month period. Selection of pharmacologic agent should be based on the patient's comorbid conditions, treatment goals and preferences, and other clinical characteristics.
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After reading this review article, participants should be able to: Prepare the practice for continuous glucose monitoring (CGM). Understand options available to the practice for professional (practice-owned) and personal (patient-owned) CGM. Locate and interpret CGM data, using the ambulatory glucose profile (AGP), to determine if the patient is achieving targets established by the International Consensus on Time in Range. Modify a patient's treatment plan based on CGM data to improve patient outcomes.
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This review identifies clinical scenarios-such as unstable or displaced fractures, major tendon ruptures, and significant mechanical issues-that likely warrant surgical consultation.
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Randomized Controlled Trial
Does use of continuous or flash glucose monitors decrease hypoglycemia episodes in T2D?
NO. In adults with insulin-treated type 2 diabetes (T2D), continuous glucose monitoring (CGM) and flash glucose monitoring (FGM) do not decrease symptomatic hypoglycemia episodes (strength of recommendation [SOR], B) but do lower time in hypoglycemia (SOR, C; disease-oriented evidence). ⋯ FGM, in which glucose levels are sent on demand to a device, did not significantly reduce hypoglycemic episodes (SOR, B; 1 small RCT and 1 prospective study). Hypoglycemia duration was reduced significantly with FGM in a 6-month RCT (SOR, B) but not in a 1-year prospective study (SOR, B).