Primary Care Corner with Geoffrey Modest MD: Metformin, CKD, and death

By: Dr. Geoffrey Modest  A rather unusual quick-and-dirty study was just published looking at the relationship between metformin use and mortality, as well as lactic acidosis, in those with severe chronic kidney disease, CKD. This study was based on a window of time until 2009, when metformin was used in Taiwan without restriction in those with renal disease (See doi.org/10.1016/S2213-8587(15)00123-0). The […]

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Primary Care Corner with Geoffrey Modest MD: PPIs associated with MIs???

By: Dr. Geoffrey Modest There was a recent article published online and hitting the press regarding a possible association between the use of proton-pump inhibitors (PPIs) and subsequent MIs (see DOI:10.1371/journal.pone.0124653​). The article was unusual in that it used a new technique for medical research: data-mining.  The bottom line is that if there were a real association between PPI use […]

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Primary Care Corner with Geoffrey Modest MD: Tight diabetes control and cardiovasc disease– followup of the VA study

By: Dr. Geoffrey Modest The Veterans Affairs Diabetes Trial (VADT) was one of the triumvirate published around 2009, along with the ACCORD and ADVANCE trials, which looked at intensive glycemic control and cardiovascular outcomes. These trials basically found that intensive control did not help and perhaps hurt: the ACCORD trial achieved an A1c of 6.4% in the […]

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Primary Care Corner with Geoffrey Modest MD: NYTimes – more drug company shenanigans

By: Dr. Geoffrey Modest There was a rather poignant editorial in the NY Times on June 8th, pointing out 2 clever (though, incidentally, illegal) ways the drug companies help boost their profits by preventing/delaying the transition to generics: Buying off the competition — the example of Provigil: the drug company (Cephalon) first sued 4 generic […]

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Primary Care Corner with Geoffrey Modest MD: DPP-4 inhibitors and cardiovascular outcomes

By:  Dr. Geoffrey Modest New Engl J of Med just had a large study on the cardiovascular effects of sitagliptin (see DOI: 10.1056/NEJMoa1501352). Background: sitigliptin is a DPP-4 inhibitor (dipeptidyl peptidase 4 inhibitor), which functions by decreasing the degradation of incretins (and thereby increasing glucose-mediated endogenous insulin secretion and suppressing glucagon levels). But there were concerning […]

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Primary Care Corner with Geoffrey Modest MD: New STD treatment guidelines

By: Dr. Geoffrey Modest The CDC just updated their guidelines on the treatment of sexually transmitted diseases (see here). They offer the usual advice to do detailed risk assessment for STDs and HIV, counseling about prevention, making sure immunizations are up to date (eg HPV, hepatitis A and B — they do limit hepatitis A vaccine […]

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Primary Care Corner with Geoffrey Modest MD: IMPROVE-IT trial ezetimibe

By: Dr. Geoffrey Modest So, at long last, the IMPROVE-IT trial has been published: the one comparing simvastatin plus ezetimibe vs simvastatin alone in high-risk patients (this was the study that came out as the block-buster, high-profile study at the Am Heart Assn meetings last November –7 months ago!!!, but was notably not published simultaneously, for remarkably opaque reasons….. see DOI: […]

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