Patient Care Endocrinology & Cardiology - October 2007 - (Page 28)

ClinicalClips JOHN J. RUSSELL, MD, Contributing Editor Associate Director, Family Medicine Residency, Abington Memorial Hospital, Abington, Pa. Dr Russell and colleagues abstract current reports and studies from evidence-based medical literature and provide commentary relevant to primary care. I Does self-monitoring of blood glucose improve control? Farmer A, Wade A, Goyder E, et al. Impact of self monitoring of blood glucose in the management of patients with noninsulin treated diabetes: open parallel group randomised trial. BMJ. 2007;335(7611):132. Epub 2007 Jun 25. I Antiplatelets versus combination therapy for peripheral vascular disease Warfarin Antiplatelet Vascular Evaluation Trial Investigators, Anand S, Yusuf S, Xie C, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med. 2007;357(3):217-227. The investigators tested whether glycemic control in patients with non-insulin-treated type 2 diabetes improves with either self-monitoring of blood glucose—with or without instruction in the use of the findings for self-care—or with standardized usual care. In this study, 453 patients with diabetes (mean age 65.7 years) for a median duration of 3 years and a mean hemoglobin A1c (HbA1c) level of 7.5% were randomized into 3 groups. In the control group (n = 152), patients received standardized usual care and had their HbA1c levels measured every 3 months. In addition to standardized usual care, the second group (n = 150) measured their own blood glucose and were told to contact their doctors to interpret the results. In addition to the care given to the second group, patients in the third arm (n = 151) received extra training in interpreting and applying the results to enhance a healthy lifestyle. Impact for clinicians At 12 months the differences in HbA1c levels among the 3 groups (adjusted for baseline HbA1c level) were not statistically significant (P = .12). Although self-monitoring of blood glucose might not make a difference in HbA1c levels as has been reported in other studies, it does allow our patients to identify hypoglycemic events. S. Scott Paist, MD Lancaster General Hospital, Lancaster, Pa. While antiplatelet agents have been shown to reduce risk of death from MI and cerebrovascular disease, this study evaluated the role of oral anticoagulants in peripheral arterial disease (PAD). A total of 2161 patients were randomly assigned to either combination therapy (an antiplatelet agent plus an anticoagulant) or an antiplatelet agent alone. The first coprimary outcome was MI, stroke, or death from cardiovascular causes. The second added severe ischemia requiring invasive intervention to the other end points. Impact for clinicians In patients receiving combination therapy, 12.2% experienced a first coprimary outcome and 15.9% a second coprimary outcome after 35 months. In patients on antiplatelet agents alone, 13.3% experienced a first coprimary outcome and 17.4% a second coprimary outcome. Life-threatening bleeding was more likely with combination therapy than with antiplatelet agents alone (4.0% versus 1.2%). The researchers concluded that combination therapy is no more effective than an antiplatelet agent alone in PAD. Christopher V. Chambers, MD Jefferson Medical College, Thomas Jefferson University Philadelphia, Pa. Clinical Clips is adapted from Clinical Update, which is formatted for Palm OS devices and delivered electronically. Contact the publisher at http://www.redi-reference.com/ beweek.htm for information on how to subscribe. Clinical Clips Panel Jonathan D. Beck, MD Christopher V. Chambers, MD Jeff Kirchner, DO Matthew Mintz, MD David Nicklin, MD S. Scott Paist, MD Charles A. Pohl, MD 28 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY www.patientcareonline.com http://www.redi-reference.com/biweek.htm http://www.redi-reference.com/biweek.htm http://www.patientcareonline.com

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Patient Care - Endocrinology & Cardiology - October 2007 Research Digest Contents Medicine in the News Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes Using Troponins to Evaluate Cardiac Injury The 15-Minute Visit Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - October 2007

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