Tools for Practice #377 – How to slow the flow IV: Combined oral contraceptives
In premenopausal heavy menstrual bleeding due to benign etiology, do combined oral contraceptives (COC) improve patient outcomes?
About 80% of women on COC will see improvement in mean blood loss, compared to 40% on placebo. Additionally, their use of sanitary items is reduced by approximately half (compared to 20% for placebo), and hemoglobin improves. Levonorgestrel-containing intrauterine systems, however, are more effective. Read More
8 November 2024
Tools for Practice #376 Testosterone supplementation for men: Let’s (andro-)pause for a moment (Update)
What are the benefits and harms of testosterone supplementation in healthy men or those with age-related low testosterone?
Compared to placebo, testosterone may increase lean body mass by ~1.6kg in older men but has no consistent, meaningful impact on sexual function, strength, fatigue, or cognition. Testosterone does not increase prostate events, myocardial infarction or stroke, but pulmonary embolism (0.9% versus 0.5% placebo) and atrial fibrillation (3.5% versus 2.4% placebo) may be increased. Read More
25 October 2024
Tools for Practice #374 Vitamin D and Fracture Prevention: Not what it’s cracked up to be?
Does vitamin D prevent fragility fractures?
Vitamin D alone does not prevent fractures regardless of dose, vitamin D status or previous fracture. The combination of calcium and vitamin D might reduce the risk of total fractures from 11.5% to 10.9% and hip fractures from 1.8% to 1.5% over 9-84 months, but this benefit may be limited to women in long-term care. Adding calcium increases risk of renal calculi (2.1% to 2.5%). Read More
27 September 2024
Tools for Practice #373 Strategies for initiating insulin in type 2 diabetes
What is the optimal initial insulin for patients with type 2 diabetes?
For type 2 diabetes poorly controlled with oral agents, initiating biphasic insulin reduces HbA1C by ~0.1-0.2% more than basal insulin, but results in more weight gain and symptomatic hypoglycemia. It is unclear whether this is due to insulin type or total dose administered. Basal insulin is the simplest and likely best initial approach. No insulin has been shown to reduce cardiovascular events in randomized controlled trials (RCTs). Read More
13 September 2024
Tools for Practice #372 Mission Slimpossible Part 2: Oral GLP-1 agonists for weight loss
Are oral GLP-1 agonists effective for weight loss?
In adults with obesity, oral semaglutide in a new high-dose formulation (50mg daily; not available in Canada) can result in ~15% body weight loss at 68 weeks (versus 2% placebo), with 69% of people losing at least 10% of their body weight (versus 12% placebo). Mean weight loss with the currently available 14mg formulation is ~5%. Read More
30 August 2024
