Diabetes care

452 articles · Since 2004

Articles, page 7

MKSAP: 25-year-old woman with type 1 diabetes mellitus

September 22, 2018Sep 22, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years ago. Her HbA1c levels since diagnosis have ranged from 6.4% to 7.3%, with the most recent value at 7.3%. She reports eating a carbohydrate-consistent diet at each meal, with …

Conditions and diseases

MKSAP: 57-year-old man with type 2 diabetes mellitus

mksap

August 11, 2018Aug 11, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before …

Physician voices

A return to the problem-oriented SOAP note

Robert Centor, MD

July 22, 2018Jul 22, 20186

CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: "Medicare's historic proposal to change how it pays physicians." As always, we really will have a difficult time sorting out the unintended consequences of these changes,…

CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”

As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …

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Conditions and diseases

Patients are more than lab results

Johnathan Yao, MD, MPH

July 14, 2018Jul 14, 2018

I loved my endocrinology block in medical school. It was one of my favorite units. One hormone acts on another gland, which either induces a positive feedback releasing its successor hormone or a negative feedback blocking its predecessor. It was…

I loved the material so much that I reached out to an endocrinologist to shadow her. I wanted to see the power of what we were learning …

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Patients are more than lab results

Patient voices

A Black Panther for diabetics

Ariel Lawrence

April 27, 2018Apr 27, 2018

In mid-February, thousands flocked to the opening of Black Panther, a highly anticipated film for a multitude of reasons. The most salient of these is its depiction of an African king as Marvel’s and cinematic screen’s first culturally-affirming black superhero. In fact, Black Panther’s success is due to its emergence as a counter-narrative to painful and dysfunctional representations of black life. By normalizing the presence of black royals, diplomats, and …

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A Black Panther for diabetics

Physician voices

Computer algorithms don’t think like doctors

Richard Plotzker, MD

April 23, 2018Apr 23, 2018

Too often, residents want you to address something, so they don't have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID. For me, one example seemed rather routine: a diabetic…

Too often, residents want you to address something, so they don’t have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID.

For me, one example seemed rather routine: a diabetic with another medical illness. It wasn’t terribly well defined in the hospital records, but included atrial fibrillation and congestive failure at presentation. At day nine, with pressure from the DRG lady …

Conditions and diseases

MKSAP: 62-year-old man is evaluated during a routine visit

mksap

April 21, 2018Apr 21, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.

On physical examination, the patient is afebrile, blood pressure is 130/66 …

Conditions and diseases

MKSAP: 38-year-old man is evaluated during a periodic health maintenance visit

mksap

March 17, 2018Mar 17, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated during a periodic health maintenance visit. His friend was recently diagnosed with type 2 diabetes mellitus, and the patient…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old man is evaluated during a periodic health maintenance visit. His friend was recently diagnosed with type 2 diabetes mellitus, and the patient expresses interest in being screened. He is asymptomatic and reports no symptoms of polyuria or polydipsia. He exercises regularly. Medical and family histories are unremarkable. He takes no medications.

On …

Conditions and diseases

MKSAP 27-year-old woman with type 1 diabetes mellitus

mksap

February 10, 2018Feb 10, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 27-year-old woman is evaluated for management of her type 1 diabetes mellitus. She was diagnosed 10 years ago. She has no known complications…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 27-year-old woman is evaluated for management of her type 1 diabetes mellitus. She was diagnosed 10 years ago. She has no known complications from her diabetes. She eats a healthy diet and exercises an average of 60 minutes per day in the evening. She takes insulin glargine and insulin aspart. She is …

Conditions and diseases

MKSAP: 64-year-old man with diabetes

mksap

December 30, 2017Dec 30, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type …

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MKSAP: 64-year-old man with diabetes

Physician voices

What I learned as a house call physician

Renee Dua, MD

December 17, 2017Dec 17, 20172

As doctors, we simply want to spend more time with our patients. As a doctor for 13 years, and someone who now recruits doctors as a large part of my job, I’m witnessing the battle for more time with patients wage on, but there are no winners. Patients are waiting longer for hurried appointments. We spend more of what little time we have, prescribing and referring out because we’re racing …

Physician voices

Good doctoring transcends numbers

Linda Girgis, MD

November 20, 2017Nov 20, 20172

Measuring metrics is a common catch-phrase in health care. The goal of capturing certain data is to improve patient outcomes. But, as doctors, we were taught to treat the patient and not the numbers. While optimizing clinical outcomes is a needed goal with all the complexities in medical treatment currently, the system seems to have gone too far in its quest for targeted numbers.

If, for example, a patient suffers metastatic …

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Good doctoring transcends numbers

Conditions and diseases

MKSAP: 45-year-old man with type 2 diabetes mellitus

mksap

November 18, 2017Nov 18, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports no symptoms and takes no …

Physician voices

Being a doctor has saved my life

Christine Nedeau, MD

November 9, 2017Nov 9, 2017

I ran a 5K last weekend. I succumbed to peer pressure. The more others talked about running it, I decided I could be a runner too. My patients describe their HIIT workouts (high-intensity interval training, for those of you not…

I ran a 5K last weekend. I succumbed to peer pressure. The more others talked about running it, I decided I could be a runner too.

My patients describe their HIIT workouts (high-intensity interval training, for those of you not in-the-know), PiYo classes (Pilates-Yoga combination), increasing mileage for an upcoming duathlon/triathlon/marathon, and now I can proudly share my measly 5K experience with them. Of course, I will leave out the small …

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Being a doctor has saved my life

Conditions and diseases

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus

mksap

October 14, 2017Oct 14, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister,…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning.

On physical examination, temperature is 37.2 °C (99.0 °F), …

Health policy

Here’s how a glucometer turned this doctor against Medicaid for all

Seiji Yamada, MD, MPH

September 22, 2017Sep 22, 20178

In a recent Vox interview, Senator Brian Schatz (D-Hawaii) announced his plans to allow individuals without insurance to buy Medicaid coverage. As a family doctor caring for patients on Medicaid in Senator Schatz’s home state, I cannot support such a…

Medicare continues to be run by the federal government. In contrast, Medicaid programs are run by states. The trend in recent decades is for …

Medical education

How Hurricane Harvey changed this medical student

Ryan Jacobs

September 19, 2017Sep 19, 2017

When Hurricane Harvey swept through Texas, devastating millions of people, I was lucky to be in an area of Houston where the flooding did nothing more than confine me to my apartment for a few days. It hurt to see so many people suffering after reading the news and social media posts about people losing their homes, many of their belongings, and in some cases, their lives. As the flooding …

Conditions and diseases

MKSAP: 38-year-old woman with a HbA1c value of 9.1%

mksap

September 2, 2017Sep 2, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, obstructive sleep apnea, hypertension, and …

Health policy

Administrators who don’t see patients often make the most important decisions

Matthew Hahn, MD

August 27, 2017Aug 27, 201711

I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …

Physician voices

The health care quality debate has a myopic view

Hans Duvefelt, MD

August 10, 2017Aug 10, 2017

Medicine is a lot like grade school mathematics. The days are long gone when instantly knowing or quickly arriving at the right answer was enough. Now it’s all about showing your calculations. Process is everything. It’s almost like having the…

If you ask a patient with a given symptom, like tremor, lameness or a skin eruption, only a few questions and then conclude that they have …

Diabetes care

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