Postgraduate medicine
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Postgraduate medicine · May 2010
ReviewThe potential role of colesevelam in the management of prediabetes and type 2 diabetes mellitus.
Successful management of prediabetes and type 2 diabetes mellitus (T2DM) requires a multifaceted, multidisciplinary approach that involves patient education and support, lifestyle modification, and appropriate use of pharmacologic interventions with frequent monitoring and adjustment to ensure that target goals for hyperglycemia, dyslipidemia, and hypertension are achieved and maintained. Studies have shown that the bile acid sequestrant colesevelam HCl reduces hemoglobin A1c and low-density lipoprotein-cholesterol levels in patients with prediabetes and T2DM. This article briefly reviews current treatment guidelines for patients with prediabetes and T2DM and the potential role of colesevelam in the management of prediabetes and T2DM with oral antidiabetes agents.
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Postgraduate medicine · May 2010
Randomized Controlled TrialA systematic assessment of cardiovascular outcomes in the saxagliptin drug development program for type 2 diabetes.
The objective was to assess the relative risk (RR) for cardiovascular (CV) events across all 8 randomized phase 2/3 trials evaluating saxagliptin in patients with type 2 diabetes mellitus. ⋯ No increased risk of CV death/MI/stroke was observed in patients randomly assigned saxagliptin across a broad drug development program. Although this systematic overview has inherent and important limitations, the data support a potential reduction in CV events with saxagliptin. The hypothesis of CV protection with saxagliptin will be tested prospectively in a large randomized clinical outcome trial evaluating saxagliptin compared with standard of care in patients with type 2 diabetes at increased risk for CV events.
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Caring for critically ill patients requires rapid and accurate diagnosis followed by prompt interventions. The physical examination remains an important part of the assessment of such patients, but it has been shown to have a low sensitivity and specificity in judging left ventricular function and intravascular volume. Invasive hemodynamic monitoring has similarly been shown to have significant limitations and has failed to demonstrate a mortality benefit in several recent studies. ⋯ Focused TTE can be used as a screening and monitoring tool. Studies have shown that clinicians can be trained to determine left ventricular function, detect pericardial effusions, predict intravenous fluid responsiveness, and identify important valvular defects in a relatively short period. This article describes the indications for focused TTE, provides evidence that clinicians can be rapidly taught the technique, reviews how the focused studies affect management, and discusses the advantages and limitations of this tool.