Primary Care Reports
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Diabetes Microvascular Complications
Diabetes mellitus is expensive, but most of the costs are attributed to complications and hospital care. This article will review the recommendations from the ADA 2017 Standards of Care for microvascular complications and relevant position statements, and will highlight preventive screening and clinical pearls for the primary care physician treating patients with diabetes.
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2017 Update on Adult Vaccinations
Vaccinations to directly prevent disease in adults likewise have reduced morbidity and mortality from a wide variety of viral and bacterial infections. This article will review the vaccines recommended for all adults as well as those vaccines recommended for special populations, such as immunosuppressed patients and pregnant women. In addition, the article will examine strategies that can be employed to increase vaccination rates in adults.
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Evaluation of Peripheral Neuropathy in the Diabetic Foot
Among the many types of peripheral neuropathy, diabetic peripheral neuropathy is the most common in the U.S. population. Despite the cause, its progression leads to loss of protective sensation, skin ulcerations, and chronic wounds, which in turn cause soft tissue and bone infections requiring amputation. All of these scenarios depend on the type of glycemic control of the patient, and vary by severity. Prevention, ultimately by understanding the pathophysiology of neuropathy and understanding the biomechanics of gait in relation to the foot, has been proven to significantly decrease morbidity with this disease.
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Hepatitis C Infection for Primary Care Providers
Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. Most people are asymptomatic, but for the majority of patients who become infected with hepatitis C, it becomes a long-term, chronic infection. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use, as there is no vaccine for HCV. With the forefront of direct-acting antiviral (DAA) agents, people can now be cured from HCV infection.
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Male Hypogonadism
Testosterone replacement therapy is a growing industry that deserves discussion between patients and their healthcare providers. Recently, many insights into new formulations, advertising, and potential risks have heightened the controversy surrounding low testosterone syndrome, appropriate diagnosis, and risks and benefits of testosterone supplementation. A plethora of non-regulated supplements termed “testosterone boosters” are being marketed directly to the public without adequate assessment. Therefore, it is important for healthcare providers to be familiar with how to conduct and interpret diagnostic tests as well as with appropriate use of TRT as established by various medical organizations, including the Endocrine Society. This review will discuss the definitions, pathophysiology, causes, clinical manifestations, appropriate diagnostic testing procedures, and the role of testosterone supplementation with currently available formulations, with special attention to efficacy and adverse effects in hypogonadism in men.
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Alzheimer’s Disease: What the Primary Care Physician Needs to Know
This article explores current medical approaches to Alzheimer’s dementia, the most common subtype of the known dementias or neurocognitive disorders. Preventive treatment is at the forefront of efforts to defeat this progressively impairing disorder; but to be effective, intervention must start well before symptoms begin. The role of the primary care provider in initiating vigorous and early preventive measures and applying appropriate pharmacologic and non-pharmacologic interventions at each stage of disease progression is reviewed and discussed.
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Pharmacologic Management of Type 2 Diabetes Mellitus: Part 2
This two-part series of articles will address pharmacological agents, except insulin, used to manage type 2 diabetes mellitus. Part 1 covered sodium glucose co-transporter-2 inhibitors, incretin-based therapies, amylin analog, and dopamine receptor agonists. Part 2 will focus on biguanides, thiazolidinediones, sulfonylureas, meglitinides, alpha-glucosidase inhibitors, and bile acid resins, as well as the authors’ treatment recommendations. Appendix A (http://bit.ly/2eyB4Px) is a comprehensive table of the effectiveness and costs of various combination therapies.
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Managing Type 2 Diabetes Mellitus: Part 1
MONOGRAPH: Covering sodium glucose co-transporter-2 inhibitors, incretin-based therapies, amylin analog, and dopamine receptor agonists.
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Acute Knee Pain
Many nontraumatic conditions affect the knee and can cause severe impairment and morbidity to patients. However, primary care physicians should feel comfortable in addressing and treating acute knee pain.
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Rosacea: Pathophysiology, Clinical Features, and Treatment
MONOGRAPH: Here's an in-depth guide for the primary care physician.