Abstract：
:In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like peptide 1 receptor agonist when the A1C level is 9% or more, especially if the patient has symptoms of hyperglycemia or catabolism. Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached. A fasting and premeal blood glucose goal of 80 to 130 mg per dL and a two-hour postprandial goal of less than 180 mg per dL are recommended. Insulin use is associated with hypoglycemia and weight gain. Insulin analogues are as effective as human insulin at lowering A1C levels with lower risk of hypoglycemia, but they have significantly higher cost. Patients with one or more episodes of severe hypoglycemia (i.e., requiring assistance from others for treatment) may benefit from a short-term relaxation of glycemic targets. Several new insulin formulations have been approved recently that are associated with less risk of hypoglycemia compared with older formulations. The goals of therapy should be individualized based on many factors, including age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life.
journal_name
Am Fam Physicianjournal_title
American family physicianauthors
Howard-Thompson A,Khan M,Jones M,George CMsubject
Has Abstractpub_date
2018-01-01 00:00:00pages
29-37issue
1eissn
0002-838Xissn
1532-0650pii
d13298journal_volume
97pub_type
杂志文章abstract：:Rosacea is a common, but often overlooked, skin condition of uncertain etiology that can lead to significant facial disfigurement, ocular complications, and severe emotional distress. The progression of rosacea is variable; however, typical stages include: (1) facial flushing, (2) erythema and/or edema and ocular symp...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2002-08-01 00:00:00
abstract：:Early prophylaxis after exposure to human immunodeficiency virus (HIV) can reduce the risk of HIV infection 10-fold and should be recommended or offered after all parenteral exposures. The current recommendations from the Centers for Disease Control and Prevention call for the use of two nucleoside antiretroviral drug...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-02-01 00:00:00
abstract：:Postpartum hemorrhage, the loss of more than 500 mL of blood after delivery, occurs in up to 18 percent of births and is the most common maternal morbidity in developed countries. Although risk factors and preventive strategies are dearly documented, not all cases are expected or avoidable. Uterine atony is responsibl...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2007-03-15 00:00:00
abstract：:Endometrial cancer is the fourth most common cancer in women, accounting for approximately 6,000 deaths per year in the United States. It is more common in women who are older, white, affluent obese and of low parity. Hypertension and diabetes mellitus are also predisposing factors. Because any condition that increase...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1999-06-01 00:00:00
abstract：:Coronary angioplasty is an accepted method of revascularization in selected patients with coronary artery disease. Immediately after a successful angioplasty, initial management concentrates on the detection and treatment of coronary artery spasm and acute vessel closure, should these complications occur. Once the pat...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1990-01-01 00:00:00
abstract：:Henoch-Schönlein purpura is an acute, systemic, immune complex-mediated, leukocytoclastic vasculitis. It is characterized by a triad of palpable purpura (without thrombocytopenia), abdominal pain, and arthritis. Most patients have an antecedent upper respiratory illness. More than 90 percent of Henoch-Schönlein purpur...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2009-10-01 00:00:00
abstract：:A 56-year-old man, who had previously been treated for arthritis of the hands, was admitted to the hospital because of abdominal pain and fever. Physical examination, laboratory tests and liver biopsy led to the diagnosis of hemochromatosis. The patient's brother, who had also been treated for arthritis, was then foun...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1987-06-01 00:00:00
abstract：:Genital herpes affects over 30 million persons in the United States. Genital herpes has three distinct presenting syndromes, depending on the patient's immune status with regard to the herpes simplex virus. Current diagnostic strategy relies on clinical findings and the selective use of viral culture. Acyclovir is the...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1995-01-01 00:00:00
abstract：:Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths in the United States. When a pregnant patient presents with first-trimester bleeding or abdominal pain, physicians should consider ectopic pregnancy as a possible cause. The patient history, physical examination...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2014-07-01 00:00:00
abstract：:Alzheimer disease is the most common form of dementia, affecting nearly one-half [corrected] of Americans older than 85 years. It is characterized by progressive memory loss and cognitive decline. Amyloid plaque accumulation, neurofibrillary tau tangles, and depletion of acetylcholine are among the pathologic manifest...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2011-06-15 00:00:00
abstract：:While abdominoperineal resection with permanent colostomy is still required for most distal [corrected] rectal cancers, sphincter-saving local treatment by means of local excision, electrocoagulation or endocavitary contact radiation can be used for some highly selected distal tumors. Local treatment avoids a permanen...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-10-15 00:00:00
abstract：:The incidence of Lyme disease is increasing, and the disease is spreading geographically. Prompt diagnosis requires recognition of characteristic signs and symptoms of infection with the spirochete Borrelia burgdorferi. In more than half of cases, erythema migrans is the earliest sign of Lyme disease. Although less fr...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1992-05-01 00:00:00
abstract：:Many patients expect to undergo screening tests for cancer. In evaluating screening procedures, physicians must take into account the known effects of lead time, length and screening biases, all of which can result in an overestimation of the benefits of screening. The gold standard by which a screening test is evalua...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2001-02-01 00:00:00
abstract：:Persons whose experienced or expressed gender differs from their sex assigned at birth may identify as transgender. Transgender and gender-diverse persons may have gender dysphoria (i.e., distress related to this incongruence) and often face substantial health care disparities and barriers to care. Gender identity is ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2018-12-01 00:00:00
abstract：:Patients with type 2 diabetes (formerly known as non-insulin-resistant diabetes) have a significantly increased risk of developing cardiovascular disease. Once clinical cardiovascular disease develops, these patients have a poorer prognosis than normoglycemic patients. By inducing endothelial changes, hyperglycemia co...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-12-15 00:00:00
abstract：:Hearing loss is a common problem that can occur at any age and makes verbal communication difficult. The ear is divided anatomically into three sections (external, middle, and inner), and pathology contributing to hearing loss may strike one or more sections. Hearing loss can be categorized as conductive, sensorineura...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2003-09-15 00:00:00
abstract：:Bowenoid papulosis usually appears as small papules on the penis or vulva. Histologically, these lesions display the atypia of Bowen's disease (squamous cell carcinoma in situ). Bowenoid papulosis is now considered to be a sexually transmitted disease, probably caused by human papillomavirus type 16. Malignant transfo...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1988-07-01 00:00:00
abstract：:The differential diagnosis of eyelid erythema and edema is broad, ranging from benign, self-limiting dermatoses to malignant tumors and vision-threatening infections. A definitive diagnosis usually can be made on physical examination of the eyelid and a careful evaluation of symptoms and exposures. The finding of a sw...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2007-12-15 00:00:00
abstract：:Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. Etiologies of microscopic hematuria range from incidental causes to life-threatening urinary tract neoplasm. The lack of evidence-based imaging guideli...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2006-05-15 00:00:00
abstract：:The rapidity with which heparin anticoagulation is achieved is essential to a positive clinical outcome in patients with deep venous thrombosis or pulmonary embolus. However, adequate anticoagulation is frequently not achieved, either as a result of dosing regimens that do not take heparin kinetics into account or bec...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-12-01 00:00:00
abstract：:The principal means of evaluating perimenopausal bleeding is endometrial biopsy performed in the office. With the rising incidence of endometrial cancer, an accurate diagnosis is imperative. Outpatient endometrial biopsy is well accepted by patients, provides ample tissue for histologic examination and has good diagno...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1986-02-01 00:00:00
abstract：:Acute diarrhea in adults is a common problem encountered by family physicians. The most common etiology is viral gastroenteritis, a self-limited disease. Increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea. A history and physical examination evaluating for ri...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2014-02-01 00:00:00
abstract：:Patients with variceal or other gastrointestinal hemorrhage require aggressive resuscitative measures and early diagnosis for optimal therapy. A number of nonsurgical endoscopic modalities, such as laser therapy, sclerotherapy, heater probe and electrocoagulation (monopolar or bipolar), are available to arrest and som...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1986-10-01 00:00:00
abstract：:The family physician often provides the first and only medical intervention for fingertip injuries. Proper diagnosis and management of fingertip injuries are vital to maintaining proper function of the hand and preventing permanent disability. A subungual hematoma is a painful condition that involves bleeding beneath ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2001-05-15 00:00:00
abstract：:Historically, osteopathic physicians have made an important contribution to the primary care workforce. More than one half of osteopathic physicians are primary care physicians, and most of these are family physicians. However, the proportion of osteopathic students choosing family medicine, like that of their allopat...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2005-08-15 00:00:00
abstract：:Tricyclic antidepressants have anticholinergic, adrenolytic and quinidine-like activity. These actions result in a variety of cardiac and blood pressure effects. Tricyclic antidepressants can reverse the antihypertensive effect of guanethidine and clonidine. Orthostatic hypotension may be increased with diuretics and ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1979-07-01 00:00:00
abstract：:Family physicians can effectively help their patients stop smoking by using brief intervention and simple office organizational procedures. Intervention involves asking all patients about smoking, advising smokers to stop, assisting with self-help materials, establishing a date for quitting, possibly prescribing nicot...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1990-10-01 00:00:00
abstract：:Menière's disease may be the underlying cause of dizziness, which is a common presenting complaint. This disease is differentiated from other causes of dizziness by its classic constellation of four symptoms; dizziness characterized as episodic spinning or whirling vertigo; fluctuating, low-frequency sensorineural hea...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-03-01 00:00:00
abstract：:Bordetella pertussis is a highly contagious bacterium known to cause pertussis (whooping cough) and is transmitted via airborne droplets. Although childhood vaccination has dramatically reduced reported pertussis cases, the incidence of the disease has increased over the past 20 years, most notably in previously immun...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2006-08-01 00:00:00
abstract：:Causes of congestive heart failure include hypertension, coronary artery disease, alcohol abuse and valvular heart disease. Two-dimensional echocardiography with Doppler examination is excellent for identifying valvular heart disease. While noninvasive screening for coronary artery disease may seem cost-effective, the...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1990-09-01 00:00:00
