Medication Options in Newly Diagnosed Type 2 Diabetes

Over a dozen years ago, when I was a medical student, treatment of type 2 diabetes was very simple. There was only one family of oral diabetes medicine -- sulfonylureas. In patients for whom the sulfonylureas failed, the only option was insulin injections. Sulfonylureas suffer from two serious side effects. They cause weight gain, an especially frustrating problem since weight loss is so important in diabetes. They can also cause blood sugar levels to become too low (hypoglycemia) which can have...
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Management of Menopausal Symptoms

Yesterday's issue of the New England Journal of Medicine had a very helpful review article: Management of Menopausal Symptoms. (The full text is available even to non-subscribers.) The article reviews the existing evidence about the prevalence of symptoms related to menopause and the risks and benefits of various treatments. I summarize the article below. The symptoms most associated with menopause are v...
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DHEA and Testosterone Don’t Help Elderly Patients

Antiaging is the latest wellness craze, with many supplements promising to turn back the clock and help people feel younger.  Very few antiaging supplements have received rigorous attention. Dehydroepiandrosteone (DHEA) and testosterone are two hormones widely promoted as antiaging supplements which were investigated in a randomized double-blind study published last month in the New England Journal of Medicin...
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An Oral Antibiotic Reduces the Symptoms of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a very common chronic condition.  The most common symptoms of IBS are crampy abdominal pain, painful diarrhea or constipation, and abdominal bloating.  The cause of IBS is unknown.  Many of my patients suffer from it.  The National Institute of Diabetes and Digestive and Kidney Diseases has an informative website about the symptoms, diagnosis and treatment of IBS. Last month the...
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An Interaction between Aspirin and Ibuprofen

About a month ago the FDA released a warning about an interaction between very commonly used medications:  aspirin and ibuprofen. Many patients have been instructed to take low dose aspirin (81 mg daily) for heart attack or stroke prevention.  Aspirin prevents heart attacks and strokes by binding to an enzyme in platelets called cyclooxegenase (COX) and preventing its normal function.  COX is essential for...
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A Vaccine to Prevent Shingles

Zostavax, a vaccine to prevent shingles, has recently been approved by the FDA and reviewed by The Medical Letter. Shingles (also called herpes zoster) is a very painful illness involving blisters that occur in a stripe-like pattern on one side of the body.  Shingles can only happen in people who have had chicken pox.  The virus that causes chicken pox, varicella zoster virus (VZV), stays in the in sensory nerve cells of the infect...
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Chantix is Modestly Helpful for Quitting Smoking

Quitting smoking is probably the hardest thing I ask my patients to do.  Many patients try to quit multiple times before finally being able to quit permanently.  Smoking is a frustrating and profound addiction. A new medication has recently been approved for smoking cessation.  The medication is varenicline and is being marketed under the brand name Chantix.  Its efficacy was studied in three randomized blinded trials that were all published...
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Horse Chestnut Seed Extract Is Effective for Symptoms of Venous Insufficiency

Chronic venous insufficiency is a very common and very uncomfortable condition. It occurs when the valves in the veins of the legs become leaky, leading to leg swelling, pain and itching. When severe, skin breakdown can occur. The most effective treatment is compression stockings, which can be uncomfortable and difficult to use. An effective oral medication would be a major advance in terms of convenience. Horse chestnut seed extract (HCSE) is a herbal remedy sometimes used for venous insuffici...
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Lipitor Helps Prevent a Second Stroke

An important study in this week's New England Journal of Medicine expands what we know about the benefits of cholesterol lowering medications. Statins, a family of cholesterol lowering medications which include Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin), have already been proven to have many benefits. We al...
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