Top 20 Research Studies of 2017 for Primary Care Physicians

Mark H. Ebell, MD, MS; Roland Grad, MD, MSc,

Disclosures

Am Fam Physician. 2018;97(9):581-588. 

In This Article

Diabetes Mellitus and Thyroid Disease

Three POEMs addressed the management of type 2 diabetes (Table 3).[17–20] In Study 8, a well-designed U.S. randomized trial confirmed what had been previously observed in a number of European studies: routine self-monitoring in patients with type 2 diabetes who are not taking insulin does not improve any clinical outcomes.[17] Patients should have a glucometer and can use it when they are sick or symptomatic from diabetes, but routine use is not needed. Study 9 is a long-term follow-up to the landmark ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial. Like the ACCORD trial, it found that although patients randomized to tighter glycemic control had lower mean A1C levels, they also continued to have a greater risk of cardiovascular events.[18] Study 10 is a systematic review of the accuracy of A1C levels and fasting glucose levels at identifying patients with an abnormal glucose tolerance test. Neither test was sensitive (25% to 49%), although fasting glucose levels were more specific, providing moderately strong evidence for abnormal glucose tolerance when elevated.[19] The final study in this group, Study 11, provides guidance on how to treat patients with subclinical hypothyroidism. This randomized trial of patients 65 years and older with moderately elevated thyroid-stimulating hormone levels but no or minimal symptoms found that if the level is between 4.6 and 10.0 mIU per mL, it often normalizes on repeat testing, and treating this group does not improve symptoms.[20]

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