Abstract:
:Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and is associated with poor clinical outcomes, including an increased risk of all-cause and cardiovascular mortality, as well as adverse economic and social effects. Slowing the development and progression of CKD remains an unmet clinical need in patients with T2DM. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are widely used for the management of T2DM and have effects beyond glucose lowering that include cardiovascular benefits and potential renoprotective effects. Although the glucose-lowering efficacy of these agents is dependent on renal function, the cardiovascular and renal benefits of SGLT2 inhibition appear to be maintained to estimated glomerular filtration levels as low as 30 mL/min/1.73 m2. Clinical evidence has indicated that these agents can reduce the risk of development or worsening of albuminuria, a marker of renal damage, through a range of mechanisms. These include blood pressure lowering, reduction of intraglomerular pressure and hyperfiltration, modification of inflammatory processes, reduction of ischemia-related renal injury, and increases in glucagon levels. The blood pressure-lowering effect of SGLT2 inhibitors is maintained in people with CKD and could further contribute to reduced renal burden, as well as potentially offering synergistic effects with antihypertensive therapies in these patients. Several cardiovascular outcomes trials (CVOTs) have included renal endpoints, adding to the growing evidence of the potential renoprotective effects of these agents in patients with T2DM. Several ongoing dedicated renal outcomes trials will provide further guidance on the potential clinical role of SGLT2 inhibitors in slowing the development and progression of renal impairment in individuals with T2DM.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Davidson JAdoi
10.1080/00325481.2019.1601404subject
Has Abstractpub_date
2019-05-01 00:00:00pages
251-260issue
4eissn
0032-5481issn
1941-9260journal_volume
131pub_type
杂志文章,评审abstract::Management of pain syndromes clearly requires a multidimensional approach and involves social, psychologic, and somatic factors. At the Behavioral Medicine/Pain Therapy Center of Jewish Hospital, St Louis, most patients significantly increase social and physical activity using the combined approach outlined. A majorit...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11697831
更新日期:1983-05-01 00:00:00
abstract::Benign essential tremor can be distinguished from parkinsonism by its rapid frequency, the involvement of voice and head, and the common finding of a positive family history. Essential tremor is less incapacitating than parkinsonism and less inexorably progressive. Propranolol (Inderal) is the best therapy available a...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1982.11715961
更新日期:1982-01-01 00:00:00
abstract::GRATEFUL MED is a computer program for searching the medical literature, designed with the novice in mind. It contains an extensive list of medical subject headings, so the user does not have to page through an index of key words before starting the search. Because of its efficiency and ease of operation, the program ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700124
更新日期:1988-01-01 00:00:00
abstract::In the next 30 years, the average age of the population will continue to increase, as will the prevalence of dementia. The management of advanced dementia requires the careful orchestration of communication, prognostication, patient care, and caregiver education. Understanding the specific tools available to establish...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2014.10.2826
更新日期:2014-10-01 00:00:00
abstract::In public whirlpools, low disinfectant levels and inadequate monitoring are clearly a public health concern. Implementing guidelines published by the Centers for Disease Control seems to be the most reasonable approach to preventing dermatitis in persons who use these facilities. Physicians should be on the alert for ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1991.11701042
更新日期:1991-09-01 00:00:00
abstract::Prolongation of survival of children with acute leukemia by systemic therapy has brought a marded increase in incidence of CNS leukemia. In mice inoculated with leukemia cells, CNS i nfiltrates are rare unless life is prolonged by chemotherapy. Available evidence seems to indicate that leukemic cells in the CNS in mos...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11716526
更新日期:1976-01-01 00:00:00
abstract::The role of reflux in the development of esophagitis, stricture, and Barrett's esophagus is well recognized. However, reflux is not an infrequent cause of atypical chest pain, chronic pulmonary disorders, and pharyngeal and laryngeal changes. Increased insight into the pathogenesis of reflux and the relationship betwe...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1996-04-01 00:00:00
abstract::Part 1, which begins on page 64, discusses diagnosis of rheumatic disease by radiography. The most popular laboratory tests in rheumatic disease are nonspecific and include those based on the formation of autoantibodies. Rheumatoid factor assays actually are of little diagnostic help in rheumatoid arthritis, but antin...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715082
更新日期:1979-03-01 00:00:00
abstract::No single therapeutic agent has been found to be universally effective for rheumatoid arthritis, so regimens using combinations of drugs have become the rule. Recently, several new agents with unique mechanisms of action have been introduced and found to produce various degrees of clinical benefit. Among these agents ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1999.10.1.703
更新日期:1999-10-01 00:00:00
abstract::Most changes that occur in the aging face are related to gravity working on skin that is becoming progressively thinner, drier, and less elastic. Exposure to sunlight hastens these changes, and protection from the sun is the only proved way to delay them. Dermabrasion, chemabrasion, and collagen implant (Zyderm) injec...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1984.11698794
更新日期:1984-11-15 00:00:00
abstract::Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly spread all over the globe from China. Pleural involvement is not common; around 5-10% of patients can develop pleural effusion and little is known about the involvement of pleural str...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2020.1838817
更新日期:2020-10-27 00:00:00
abstract::Maternal peripartum complications continue to be a significant problem in the United States, even among previously healthy women. The problems include peripartum bleeding, infection, hypertension, and thromboembolic disease. Primary care physicians are often called upon to treat these conditions. An awareness of the a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-02-01 00:00:00
abstract::Hyponatremia (serum sodium <135 mEq/L) is a common electrolyte disorder in community or hospitalized patients. Serum sodium levels should be corrected at a proper rate in patients with hyponatremia, since overcorrection of serum sodium levels is related to devastating neurologic consequences, such as the osmotic demye...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1186488
更新日期:2016-06-01 00:00:00
abstract::Technical advances over the past few years have rapidly increased the possibilities for filmless radiology services provided by PACS. Such systems are also financially feasible for many healthcare practices, primarily because of the goals achieved through increased efficiency and improved patient care. In coming years...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2001.06.960
更新日期:2001-06-01 00:00:00
abstract::Bleeding from esophagogastric varices carries a high mortality rate. Active variceal bleeding can usually be temporarily controlled medically with a combination of intravenous vasopressin and nitroglycerin, with balloon tamponade, or with endoscopic sclerotherapy. Because of the high likelihood of recurrence, long-ter...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700924
更新日期:1991-05-01 00:00:00
abstract::The prevalence of chronic kidney disease (CKD) has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular (CV) morbidity and mortality remain high among patients with CKD. Although CKD is a progressive and irreversible...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2018.1481714
更新日期:2018-06-01 00:00:00
abstract::Myasthenia gravis most commonly affects the ocular muscles. Abnormal fatigability of the involved muscle groups is the most remarkable feature of the physical examination. Recent studies have demonstrated that a thymus-derived antibody plays a role in the pathogenesis of myasthenia gravis, which is now thought to be a...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715218
更新日期:1979-08-01 00:00:00
abstract::While a wide variety of thyroid function tests are currently available, all are sometimes abnormal in patients without thyroid disease. To interpret test results properly, the clinician needs to be aware of factors altering thyroid function tests. In every instance, the clinician needs to begin by asking whether the p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-04-01 00:00:00
abstract::A 65-year-old woman presented to the hospital with weight loss and diarrhea. A diagnosis of thyroid storm was established by the presence of fever, lethargy, tachycardia, heart failure (HF), and abnormal thyroid function tests. An acute coronary syndrome (ACS) was suspected because of anteroseptal ST-segment elevation...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2009.05.2012
更新日期:2009-05-01 00:00:00
abstract::Genetic syndromes that convey a significant risk of breast cancer are responsible for a small but significant percentage of these cancers. However, the vast majority of breast cancers occur in women with no family history of the disease. Nongenetic risk factors include age, previous breast disease, breast tissue densi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2004.10.1595
更新日期:2004-10-01 00:00:00
abstract::The majority of patients can be easily weaned from mechanical ventilation, but a substantial minority pose considerable difficulty. In such cases, the cause of ventilator dependency should be identified and correctable factors should be rectified. An organized plan of management, a team approach, optimal pulmonary and...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700795
更新日期:1991-01-01 00:00:00
abstract::Research suggests that depression is a risk factor for the development and progression of cardiovascular disease (CVD) and that there is a strong link between depression and poor outcomes following a cardiovascular event. It has also provided evidence that depressed patients are less likely to follow recommendations t...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2003.suppl32.191
更新日期:2003-12-01 00:00:00
abstract::All patients with chronic stable angina presumed to be due to coronary artery disease should undergo exercise stress testing early in evaluation for evidence of high-risk coronary disease. If the exercise stress test shows early positive findings, patients should undergo cardiac catheterization to exclude left main co...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699599
更新日期:1986-11-01 00:00:00
abstract::The goal of screening for colorectal cancer is to find early, asymptomatic cancers and adenomatous polyps that are 1 cm or more in diameter or that are villous or tubulovillous histologically. A study using fecal occult blood testing with rehydration and no sigmoidoscopy found that deaths from colorectal cancer can be...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract::On the basis of currently available information, the following recommendations can be made for treating osteoporosis. Women with no contraindications should maintain a total calcium intake of 1,000 mg daily before menopause and 1,500 mg daily after menopause. Calcium supplementation should be considered adjunct treatm...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1990.11704612
更新日期:1990-03-01 00:00:00
abstract::Even modest alcohol ingestion can increase the risk of steatosis, and long-term, excessive consumption can lead to alcoholic hepatitis and eventually cirrhosis. Most patients with clinically significant alcoholic liver disease have histologic findings typical of all three conditions. The only clearly beneficial treatm...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.04.462
更新日期:1998-04-01 00:00:00
abstract::High blood pressure is unquestionably a risk factor for premature morbidity and mortality, especially from coronary artery disease and stroke. Risk of clinical manifestations of coronary artery disease increases dramatically if other risk factors, such as a history of cigarette smoking, hypercholesterolemia, left vent...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11704482
更新日期:1989-11-01 00:00:00
abstract::Solitary pulmonary nodules are usually identified on routine chest radiographs in asymptomatic patients. Most nodules have a benign cause, but bronchogenic carcinoma, metastases, and other malignant processes are important causes as well and must be excluded in differential diagnosis. Plain chest radiography, computed...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1996-02-01 00:00:00
abstract::Tests to measure the volume of gastric contents are necessary to determine the nature of a gastric emptying disorder. The conditions that can affect gastric emptying are as varied as peptic ulcer disease, achlorhydria, viral and bacterial infections of the stomach, diabetes, scleroderma, anorexia nervosa, and CNS lesi...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1987.11699726
更新日期:1987-02-15 00:00:00
abstract::Currently, surveillance or risk-oriented follow-up of patients in the individual practice setting may be the most efficacious means of reducing the morbidity and mortality associated with selected types of cancer. Intervention into carcinogenesis or alteration of the natural history of cancer requires a clear understa...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11699112
更新日期:1985-09-01 00:00:00