CONTINUING FEATURES

If your practice is anything like mine, information technology (IT) issues have become almost as important as clinical ones. With that in mind, we are introducing a new feature in this issue of postgraduate medicine. Beginning on page 80 are several articles on technology innovation reprinted from our sister publication, Healthcare Informatics. We hope these articles help you better navigate the IT landscape.

We've also reintroduced excerpts from Harrison's Online, the esteemed repository of clinical medicine and research information, which many of you found valuable in the past. I'm also particularly pleased to present a great lineup of clinical articles in this issue.

Our symposium on type 2 diabetes, by David S. H. Bell and Kathleen L. Wyne, includes two articles that review and update current diabetic treatment and management. Based on current studies, the articles describe a logical sequence of prescribing oral agent combinations and insulin to optimize diabetic control with fewer side effects and better patient compliance. The authors also discuss the importance of attaining hemoglobin A1c levels of less than 7% to maximize cardiovascular benefits.

With the increasing obesity of our population, and thus our patients, the progression of glucose intolerance to a diagnosis of type 2 diabetes has become a huge problem. The first article in the symposium emphasizes the early initiation of oral diabetes treatment to decelerate the decline of beta cell function. My approach with patients who have abnormal glycosylated hemoglobin levels has changed. I used to allow for a trial period of weight loss and exercise alone, but now I tend to prescribe oral agents at an earlier point in time. Although most patients eagerly agree to lose weight and get into shape with exercise, in reality they often don't follow through with any long-term lifestyle changes.

The authors' discussion of low-dose combination therapy when initial diagnosis of diabetes is confirmed is also helpful. So many new diabetic drugs have been introduced that it has become extremely difficult to sort out what is best for patients.

In my practice, patients with a new diagnosis of diabetes are referred to a dietitian and also for diabetic education. If I have difficulty helping patients maintain normal hemoglobin A1c levels with use of oral agents, I refer them to an endocrinologist for management. I don't pretend to be an expert in diabetes management, and I feel that the disease requires?\and that patients deserve?\the support and knowledge of an endocrinologist.

Also in this issue of postgraduate medicine we review the diagnosis and management of peripheral arterial disease as well as chronic hepatitis B; stress the important of cardiac risk assessment for concomitant hypertension and dyslipedemia; discuss screening tests to assess possible problems in the perioperative period in patients who abuse alcohol; and take a look at exciting possibilities for diagnosing cancer by genomic profiling. You may find the articles on thyroid imaging and back pain diagnosis valuable as well.

This is the second issue of postgraduate medicine in its relaunch as a Vendome Group publication. We welcome your feedback on how we are doing and how we can make the publication more useful to you.

Send comments or suggestions to pgm@thecoghlangroup.com

Nancy B.Cockson
Internal Medicine Physician
Sharpe, Cockson, and Associates
Edina, Minnesota