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：:The term "shoulder instability" constitutes a spectrum of disorders that includes dislocation, subluxation and laxity. Anterior instability is the most common form of glenohumeral instability and may be associated with nerve injury. The diagnosis of anterior, posterior or multidirectional instability is based on a tho...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1999-05-15 00:00:00
abstract：:The head and neck contain a number of spaces that can be invaded by organisms of the mouth or by spread of cervical osteomyelitis. Infection in these spaces may progress from superficial infection to cellulitis to the formation of an abscess requiring immediate drainage. Spread of infection between spaces depends on a...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1991-09-01 00:00:00
abstract：:The spondyloarthropathies include ankylosing spondylitis, reactive arthritis (including Reiter's syndrome), psoriatic arthritis, inflammatory bowel disease-associated spondyloarthropathy, and undifferentiated spondyloarthropathy. These diseases are linked by their association with the HLA-B27 gene and by the presence ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2004-06-15 00:00:00
abstract：:Pregnant women commonly use over-the-counter medications. Although most over-the-counter drugs have an excellent safety profile, some have unproven safety or are known to adversely affect the fetus. The safety profile of some medications may change according to the gestational age of the fetus. Because an estimated 10...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2003-06-15 00:00:00
abstract：:The physician needs to know the signs, symptoms and recommended treatments of drug overdoses. Overdose of hallucinogens usually does not require drug therapy. Overdose of amphetamines ("uppers") may be complicated by the presence of PCP, a dissociative substance. It is important for the physician to be familiar with t...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1986-03-01 00:00:00
abstract：:Down syndrome (trisomy 21) is the most commonly recognized genetic cause of mental retardation. The risk of trisomy 21 is directly related to maternal age. All forms of prenatal testing for Down syndrome must be voluntary. A nondirective approach should be used when presenting patients with options for prenatal screen...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-08-15 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：:Skin laceration repair is an important skill in family medicine. Sutures, tissue adhesives, staples, and skin-closure tapes are options in the outpatient setting. Physicians should be familiar with various suturing techniques, including simple, running, and half-buried mattress (corner) sutures. Although suturing is t...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2008-10-15 00:00:00
abstract：:Osteoporosis is the most common bone disorder in the United States. Bone mass is decreased, and porosity and fragility are increased. Dual-beam photon absorptiometry is currently considered the best detection technique. Prevention involves increased calcium intake and avoidance of diets high in protein and phosphates,...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1985-11-01 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 birth of twins can be an exciting and challenging experience for a family. However, circumstances unique to the relationship between the twin and the family and the relationship between the twins themselves may exacerbate existing problems or create new ones. Parents are often overwhelmed by the amount of time and...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1994-03-01 00:00:00
abstract：:The classic modes of heat loss affecting the newborn are conduction, convection, radiation and evaporation. The disproportionate ratio of surface area to body weight (SA/BW) of the premature infant is the basis of inefficient heat conservation, combined with a blunted metabolic response. Hypothermia leads to hypoxemia...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1977-11-01 00:00:00
abstract：:Respiratory difficulty is a common presenting complaint in the outpatient primary care setting. Because patients may first seek care by calling their physician's office, telephone triage plays a role in the early management of dyspnea. Once the patient is in the office, the initial goal of assessment is to determine t...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2003-11-01 00:00:00
abstract：:The protein-sparing modified fast is a safe and effective method for losing a large amount of weight relatively quickly. This diet should be used in combination with an exercise program, behavior modification and patient education. Caloric intake is in the range of 400 to 800 per day. Candidates for the diet should be...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1990-11-01 00:00:00
abstract：:Atrial fibrillation is the arrhythmia most commonly encountered in family practice. Serious complications can include congestive heart failure, myocardial infarction, and thromboembolism. Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or di...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2002-07-15 00:00:00
abstract：:Two large kindreds manifesting the "cancer family syndrome" have been studied. Genetic and biologic studies reveal markers which have important implications for cancer detection, control and prevention. Valuable markers may be found in the major histocompatibility system, HL-A. The presence of carcinoembryonic antigen...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1975-03-01 00:00:00
abstract：:Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, e...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2004-11-01 00:00:00
abstract：:Patients with seasonal affective disorder have episodes of major depression that tend to recur during specific times of the year, usually in winter. Like major depression, seasonal affective disorder probably is underdiagnosed in primary care settings. Although several screening instruments are available, such screeni...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2006-11-01 00:00:00
abstract：:Suspect this common syndrome in young women who are pregnant or on oral contraceptives, in menopausal women, in patients performing unaccustomed repetitive manual activity, in those on hemodialysis and in those with endocrine abnormalities. Diagnosis requires precise neurologic examination and electrodiagnostic studie...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1981-11-01 00:00:00
abstract：:Osteoporosis is characterized by low bone mineral density and a deterioration in the microarchitecture of bone that increases its susceptibility to fracture. The World Health Organization defines osteoporosis as a bone mineral density that is 2.5 standard deviations or more below the reference mean for healthy, young ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2004-10-01 00:00:00
abstract：:Although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed history, physical examination, and laboratory assessment of selected serum hormone levels can usually identify the underlying cause. Primary amenorrhea, which by definition is failure to reach menarche, i...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2013-06-01 00:00:00
abstract：:The prevalence of childhood obesity in the United States has risen dramatically in the past several decades. Although 25 to 30 percent of children are affected, this condition is underdiagnosed and undertreated. Hormonal and genetic factors are rarely the cause of childhood obesity; unnecessary diagnostic evaluations ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1999-02-15 00:00:00
abstract：:Common superficial oral lesions include candidiasis, recurrent herpes labialis, recurrent aphthous stomatitis, erythema migrans, hairy tongue, and lichen planus. Recognition and diagnosis require taking a thorough history and performing a complete oral examination. Knowledge of clinical characteristics such as size, l...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2007-02-15 00:00:00
abstract：:The incidence of skin cancer is increasing by epidemic proportions. Basal cell cancer remains the most common skin neoplasm, and simple excision is generally curative. Squamous cell cancers may be preceded by actinic keratoses-premalignant lesions that are treated with cryotherapy, excision, curettage or topical 5-flu...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2000-07-15 00:00:00
abstract：:Poisoning is a common cause of morbidity and mortality in the United States, with several million episodes reported annually. Acute medication poisonings account for nearly one half of all poisonings reported in the United States and should be considered in persons with an acute change in mental status. The initial ap...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2010-02-01 00:00:00
abstract：:New evaluation and management codes were created by the Current Procedural Terminology (CPT) Editorial Panel to ensure more accurate and consistent reporting of physician services. The new hospital inpatient codes describe three levels of service for both initial and subsequent care. Critical care services are reporte...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1992-03-01 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：:The practicality of the office spirometer as an effective, inexpensive diagnostic device is well established. It can be used in a matter of seconds by minimally trained office personnel. Two basic parameters can be quickly and accurately measured: forced vital capacity (FVC), a test of volume indicative of restrictive...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1980-04-01 00:00:00
abstract：:Gait disorders in the elderly are common and in most cases cannot be treated medically or surgically. Therefore, treatment often relies on ambulatory devices such as canes, crutches, and walkers. Before selecting a device, the patient should be evaluated to define whether one or both upper extremities are required to ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2003-04-15 00:00:00
abstract：:Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians sh...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2012-03-15 00:00:00
