Tuesday, February 7, 2017

Cardiovascular Outcomes Trials (CVOT) in Diabetes drugs

IN 2008, FDA required future diabetes medications be evaluated in light of Cardiovascular risk.

GLP-1: LEADER trial - Liraglutide

DPP4i:

SGLT2I: EMPA-REG - Empagliflozin

Comparison of LEADER and EMPA-Reg here.

Overview of studies here:


Perioperative Evaluation for Noncardiac Surgeryl

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Choosing Wisely:

The Choosing Wisely program is focused on avoiding wasteful or unnecessary medical test, treatments and procedures.   Started by the ABIM Foundation, and now including 70 partner medical societies (including the AAFP), Consumer Reports, AARP and other consumer oriented groups.  Each medical society in the program maintains lists for Clinicians of practices to be questioned.  The program also maintains lists for patients of good patient friendly resources from the specialty societies and Consumer Reports.

You can search the Clinician lists at: http://www.choosingwisely.org/clinician-lists/

You can find the 15 AAFP Recommendations here.

You can find all 5 recommendations from the American College of Cardiology here.

Wednesday, January 6, 2016

Hypertension, Diabetes, Hyperlipidemia Resource: January 2016

Resources updated to support the January 2016 Guidelines discussion for new Family Medicine Residents:

Hypertension2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Additional Resources: 
American Family Physician: POEMsJNC 8 Report on Prevention, Evaluation and Treatment of Hypertension
AAFP: 2014 Hypertension Guideline Stands to Simplify Treatment, Says Expert

Hyperlipidemia2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
American Heart Association: CV Risk Calculator
AAFP: New Guidelines Propose Significant Shift in Cholesterol Management

Diabetes: American Diabetes Association: Standards of Medical Care in Diabetes—2015
(including the new Abridged Standards for Primary Care Providers)
American Association of Clinical Endocrinologists: AACE Comprehensive Diabetes Management Algorithm 2015
Additional Resources: 
National Diabetes Education Program2012 Diabetes Numbers at a Glance
CDC Diabetes Data & Trends

In addition, there are a number of "apps" that I think can be of use in clinic:

1) Agency for Healthcare Research & Quality: electronic Preventive Service Selector (ePSS)
2) Shots by STFM (Society or Teachers of Family Medicine)
3) American Heart Association/American College of Cardiology  ASCVD Risk Calculators (online)

ASCCP 2013 Consensus Guidelines on the Management of Women with Abnormal Cervical Cancer Screening Tests and Cancer Precursors

The 2013 guidelines from the American Society for Colposcopy and Cervical Pathology on how to deal with almost any abnormal Pap or HPV testing result can be found at:
http://www.asccp.org/Guidelines-2/Management-Guidelines-2

If you are the type of person who likes to skip right to the facts, you can find the PDF of the algorithms at:
http://www.asccp.org/Portals/9/docs/ASCCP%20Management%20Guidelines_August%202014.pdf

If you have questions on how to deal with abnormal cervical pathology/screening results, this is the place to start the search.

Thursday, October 1, 2015

Errata for my presentations at 2015 AAFP FMX!


My Big Blue Friend and I would like to make you aware of some corrections, additions and explanatory materials from my presentations on Diabetes at the 2015 Family Medicine Experience!  These were sessions CME031 & 032: Diabetes Update 2015: New Trends in an Old Disease.

Slide 31: ACOG Gestational Diabetes Recommendations:
Under the heading "Start medication if" the last line should read "-2-hour 120 mg/dL"

Slide 32: Prevent Diabetes STAT
The url listed no longer works (though it did in the past and remains in the STAT program handouts).  The working URL is: here 

Slide 61: DPP-4 Inhibitors:
Additional Information: on 8-28-15, the FDA issued a Drug Safety Communication noting that rare patients using DPP-4 inhibitors had experienced severe disabling joint pain.  The onset of pain occurred from one day to several years after starting the medication.  The pain usually resolved within one month of stopping the DPP-4i medication.

If you have any further recommendations or have discovered additional errors, please send them to me at peter.ziemkowski@gmail.com.

Thank you,
Pete

Monday, July 13, 2015

2015 Clinical Guideline Resources

Resources updated to support the 2015 Guidelines discussion for new Family Medicine Residents:


Hypertension2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Additional Resources: 
American Family Physician: POEMsJNC 8 Report on Prevention, Evaluation and Treatment of Hypertension
AAFP: 2014 Hypertension Guideline Stands to Simplify Treatment, Says Expert

Hyperlipidemia2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
American Heart Association: CV Risk Calculator
AAFP: New Guidelines Propose Significant Shift in Cholesterol Management

Diabetes: American Diabetes Association: Standards of Medical Care in Diabetes—2015
(including the new Abridged Standards for Primary Care Providers)
American Association of Clinical Endocrinologists: AACE Comprehensive Diabetes Management Algorithm 2015
Additional Resources: 
National Diabetes Education Program2012 Diabetes Numbers at a Glance
CDC Diabetes Data & Trends

In addition, there are a number of "apps" that I think can be of use in clinic:

1) Agency for Healthcare Research & Quality: electronic Preventive Service Selector (ePSS)
2) Shots by STFM (Society or Teachers of Family Medicine)
3) American Heart Association/American College of Cardiology  ASCVD Risk Calculators (online)