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SGLT-2 inhibitors are the first class of drugs to target renal glucose reabsorption as a means of reducing hyperglycemia in type 2 diabetes mellitus.
Developed by a faculty of renowned, international diabetes experts led by Julio Rosenstock, MD, this 2-part educational activity will provide clinicians with an interpretation of recent clinical data, and explore the potential role of SGLT-2 inhibitors in diabetes care.
This continuing medical education activity is jointly sponsored by Albert Einstein College of Medicine of Yeshiva University and Haymarket Medical Education and supported by an educational grant from Bristol-Myers Squibb. The first component of this 2-part educational activity, the clinical monograph will provide endocrinologists, cardiologists, and general practitioners who manage the care of patients with type 2 diabetes with the latest data on the SGLT-2 inhibitors. Four international diabetes experts will further elucidate the future role of the SGLT-2 inhibitors in the T2DM treatment arsenal. Recommendations Grading ? Initiate insulin therapy according to recommendations in position statement. The graph above shows VA medical center scores compared with non-VA hospital scores for patients who are diabetic and were screened for kidney disease or have kidney disease. What is this measure?Diabetic nephropathy (kidney disease associated with diabetes) affects approximately 40% of type 1 and type 2 diabetic patients. What are we measuring?Generally, diabetes patients age 18 to 75 should receive a test for nephropathy on a yearly basis. Why is this important?Diabetic nephropathy develops in, at most, 40% of patients with diabetes, even when high glucose levels are maintained for long periods of time. In Ethics, Research, and IRBs ā€“ Part I, I wrote about the way the different classifications are used to suggest what amount of evidence supports different treatment recommendations. The farther to the left and higher on the chart, the better the evidence supporting the treatment and the greater the effect of treatment. The farther to the right and the lower on the chart, the more laughable worse the evidence supporting the treatment and the less likely there is any beneficial effect of the treatment. LOE A (Level Of Evidence A), so the Estimate of certainty (precision) of the treatment effect is large.
The purpose of this blog is to frighten, intimidate or cause emotional distress to those who intend to keep EMS from improving.
If we are interested in the truth, we should question everything - especially anything we take for granted. Squatting in between those on the side of reason and evidence and those worshipping superstition and myth is not a better place. Imagine a world in which we are all enlightened by objective truths rather than offended by them.
Just because science doesn't know everything doesn't mean you can fill in the gaps with whatever fairy tale most appeals to you. The basic trouble, you see, is that people think that "right" and "wrong" are absolute; that everything that isn't perfectly and completely right is totally and equally wrong. There appears to be in mankind an unacceptable prejudice in favor of ancient customs and habitudes which allows practices to continue long after the circumstances, which formerly made them useful, cease to exist. All things are poison and nothing is without poison, only the dose permits something not to be poisonous.
What is not true, as everyone knows, is always immensely more fascinating and satisfying to the vast majority of men than what is true - H.L.
Every valuable human being must be a radical and a rebel, for what he must aim at is to make things better than they are. Few people are capable of expressing with equanimity opinions which differ from the prejudices of their social environment.

The prestige of government has undoubtedly been lowered considerably by the prohibition law. I call these things cargo cult science, because they follow all the apparent precepts and forms of scientific investigation, but they're missing something essential, because the planes don't land.
If you've made up your mind to test a theory, or you want to explain some idea, you should always decide to publish it whichever way it comes out. If a reasonable launch schedule is to be maintained, engineering often cannot be done fast enough to keep up with the expectations of originally conservative certification criteria designed to guarantee a very safe vehicle.
Official management, on the other hand, claims to believe the probability of failure is a thousand times less. For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.
The only way to have real success in science, the field Iā€™m familiar with, is to describe the evidence very carefully without regard to the way you feel it should be. I don't know anything, but I do know that everything is interesting if you go into it deeply enough. So, to test the prevailing intellectual standards, I decided to try a modest (though admittedly uncontrolled) experiment: Would a leading North American journal of cultural studies . Common sense in matters medical is rare, and is usually in inverse ratio to the degree of education.
The desire to take medicine is perhaps the greatest feature which distinguishes man from animals. Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world. The foundation of morality is to have done, once and for all, with lying; to give up pretending to believe that for which there is no evidence, and repeating unintelligible propositions about things beyond the possibilities of knowledge. My business is to teach my aspirations to conform themselves to fact, not to try and make facts harmonise with my aspirations. There is no such thing on earth as an uninteresting subject; the only thing that can exist is an uninterested person. Good taste, the last and vilest of human superstitions, has succeeded in silencing us where all the rest have failed.
Men become superstitious, not because they have too much imagination, but because they are not aware that they have any.
If we are uncritical we shall always find what we want: we shall look for, and find, confirmations, and we shall look away from, and not see, whatever might be dangerous to our pet theories.
It is difficult to get a man to understand something, when his salary depends upon his not understanding it! The ultimate result of shielding men from the effects of folly is to ?ll the world with fools.
Political language ā€” and with variations this is true of all political parties, from Conservatives to Anarchists ā€” is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.
Emerging data strongly suggest that this novel drug class will, in the very near future, have a role to play in diabetes management.
A detailed explanation of the unique mechanisms of action and the safety and tolerability profiles of this drug class will be provided, and the results of key clinical trials will be discussed.
A ? Unless the episode of DKA is mild, regular insulin by continuous intravenous infusion is preferred. For this measure, a higher percentage indicates a higher quality of care, with 100 percent being the target.

It increases the risk of death, mainly from cardiovascular causes, and is defined by increased urinary albumin excretion (UAE) in the absence of other renal diseases.
The percents in the graph above show the number of diabetic patients who received the recommended screening, or who already showd signs of kidney disease.
The size of the treatment effect is categorized as Class I through Class III, focusing on Class IIb.
A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. For nothing is more destructive of respect for the government and the law of the land than passing laws which cannot be enforced.
In these situations, subtly, and often with apparently logical arguments, the criteria are altered so that flights may still be certified in time.
One reason for this may be an attempt to assure the government of NASA perfection and success in order to ensure the supply of funds. The first principle is that you must not fool yourself, and you are the easiest person to fool.
Science is the highest personification of the nation because that nation will remain the first which carries the furthest the works of thought and intelligence.
In this way it is only too easy to obtain what appears to be overwhelming evidence in favor of a theory which, if approached critically, would have been refuted.
Thus, it is important that health care providers who treat patients with diabetes are aware of the most recent data on these agents and the implications for clinical practice. Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies.
Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. It is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. It is an open secret that the dangerous increase of crime in the United States is closely connected with this. They therefore fly in a relatively unsafe condition, with a chance of failure of the order of a percent (it is difficult to be more accurate).
The other may be that they sincerely believed it to be true, demonstrating an almost incredible lack of communication between themselves and their working engineers. After history and physical examination, obtain arterial blood gases, complete blood count with differential, urinalysis, blood glucose, blood urea nitrogen (BUN), electrolytes, chemistry profile, and creatinine levels STAT as well as an electrocardiogram. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Even though randomized trials are not available, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease.
Therefore, to avoid the occurrence of cerebral edema, follow the recommendations in the position statement regarding a gradual correction of glucose and osmolality as well as the judicious use of isotonic or hypotonic saline, depending on serum sodium and the hemodynamic status of the patient.

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