ACP Diabetes Monthly
Welcome to this month's issue of ACP Diabetes Monthly, an update for internists published by the American College of Physicians.
In the News for the month of January 2017
ADA updates medical care standards for diabetes
Areas of the standards that were changed include classifying type 1 diabetes, setting thresholds for metabolic surgery, and emphasizing lifestyle management. More...
ACP releases updated guideline on oral pharmacologic treatment of type 2 diabetes
ACP recommended that clinicians prescribe metformin for type 2 diabetes when pharmacologic therapy is needed to improve glycemic control in a strong recommendation based on moderate-quality evidence. More...
Supplemental triglyceride-lowering therapy may lower CVD risk in statin-treated patients with diabetic dyslipidemia, study finds
The rate of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes was 27% lower in participants with dyslipidemia randomized to fenofibrate than among those randomized to placebo. More...
MKSAP quiz: Altered mental status with anorexia and vomiting
This month's quiz asks readers to evaluate a 74-year-old woman with several hours of altered mental status who developed anorexia 3 days ago and vomiting 2 days ago. More...
From Annals of Internal Medicine
Metformin use associated with improved outcomes in patients with historical contraindications
A systematic review found that metformin appeared to be associated with lower all-cause mortality in patients with moderate chronic kidney disease, congestive heart failure, or chronic liver disease with hepatic impairment. More...
From ACP Journal Club
In type 1 diabetes, adding liraglutide to insulin increased hypoglycemia and hyperglycemia with ketosis
The study authors concluded that the negative effects observed would limit clinical use of liraglutide in patients with type 1 diabetes. More...
From ACP Internist Weekly
Physician volume linked to diabetes care quality, study finds
The researchers found that higher ambulatory volume overall was associated with lower rates of appropriate eye exams, HbA1c testing, and LDL cholesterol testing, but higher diabetes-specific volume was associated with better care according to quality indicators. More...
Continuous glucose monitoring system approved to direct therapy, but daily fingersticks still needed
The G5 Mobile Continuous Glucose Monitoring System is now approved for patients and clinicians to use results directly from the device to make diabetes treatment decisions. More...
Spotlight on pioglitazone
Evidence on possible risks of pioglitazone, including bladder cancer, prostate cancer, and fractures, made the news in the past month. More...
Physician editor: David V. O'Dell, MD, FACP
About ACP Diabetes Monthly
ACP Diabetes Monthly is a weekly newsletter produced by the staff of ACP Internist. It is automatically sent to all College members who have an email address on file with ACP.
To sign up for ACP Diabetes Monthly, please click here.
Copyright © by American College of Physicians.
A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has severe COPD, previously with minimal exertional symptoms, but now notes activity-limiting shortness of breath when walking short distances. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratropium metered-dose inhaler. He has a 55-pack-year smoking history but quit when COPD was diagnosed. Following a physical exam, chest radiograph, and transthoracic echocardiogram, what is the most appropriate diagnostic test to perform next?
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