Haemoglobin rst injection of adrenaline (epinephrine)) in a dose of 200mg slowly intravenously or intramuscularly buy discount geriforte syrup 100 caps on line, for haemolysis cheap 100 caps geriforte syrup otc. Gram staining and culture of sputum but cough is should be identied and avoided buy 100 caps geriforte syrup mastercard. Most patients will unproductive in one-third of patients, and negative wish to carry self-adminstration preassembled pens results are common, particularly if antibiotics have containing adrenaline (epinephrine) for intramuscu- been given. Pleural uid, if present, should be aspirated for by C1 esterase deciency (autosomal dominant). It responds to danazol prophylaxis Management and fresh frozen plasma (or if available plasma de- rived C1 inhibitor) to correct the deciency during. In uncomplicated pneu- Pneumonia monia,treatmentisusuallystartedwithoralamoxicillin or a macrolide (erythromycin or clarithromycin). In Community-acquired pneumonia affects approxi- severe pneumonia intravenous therapy is given, often mately 510/1000 adults per year. One in 1000 re- usingacombinationofamacrolide(erythromycin)and quires hospitalisation, and mortality in these patients a second- or third-generation cephalosporin (cefurox- is around 10%. The choice of antibiotics should takeaccountoflocalguidelines,whichwilltakeaccount Clinical presentation of other factors, including the incidence of Clostridium difcile enteritis. The likely causa- Pneumococcal pneumonia is the most common bacte- tive agent cannot be predicted from clinical ndings. Hepatitis, encephalitis, renal failure and hae- and those with pre-existing lung disease. Treatment is with tetracycline or presents acutely with fever, pleuritic pain and rust- erythromycin. It causes both lobar and broncho- Viral pneumonia in children is commonly due to pneumonia. A polysaccharide pneu- is a respiratory virus which produces syncytium for- mococcal vaccine is available for those at high risk. Infection may be shouldbegivenatleast2weeksbeforesplenectomyand indistinguishable from acute bacterial bronchitis or before chemotherapy. It may complicate Acute viral pneumonia in adults is less common inuenzal pneumonia, and this makes it relatively butoccursduringepidemicsofinuenza. It also occurs ache and myalgia are followed after a few days by dry in patients with underlying disease, which prevents a cough and chest pain. The viruses sequent bronchiectasis are relatively common ofmeasles,chickenpoxandherpeszostermaydirectly complications. The diagnosis is conrmed by a rise in Legionnaires disease was rst described in a group specic antibody titre. The caus- Aspiration pneumonia comes in two main varie- ative Gram-negative bacillus ourishes in the cooling ties, differentiated from each other by the type of uid waters of air conditioners and may colonise hot-water aspirated and the circumstances in which it occurs. It begins as an inuenza-like Aspiration of gastric contents may produce a severe illness with fever, malaise and myalgia, and proceeds chemical pneumonitis with considerable pulmonary with cough (little sputum), dyspnoea and sometimes oedema and bronchospasm (Mendelson syndrome). The acute respiratory distress and shock can be very Diarrhoeaandvomitingarecommonandrenalfailure rapidlyfatalandverydifculttotreat. Examination shows consolidation that in states of reduced consciousness such as general usually affects both lung bases. X-ray changes may anaesthesia, drunks and when gastric lavage (for drug persist for more than 2 months after the acute illness. Erythromycin or ciprooxacin are the antibiotics of Aspiration of bacteria from the oropharynx may choice, but the mortality remains high. The bacteria,apartfrom Bacteroides, are near- moniae or psittacosis) should be suspected in all ly all penicillin-sensitive and amoxicillin (or ampicil- patients who develop pneumonia that does not re- lin) with metronidazole are the antibiotics of choice spond to standard antibiotics. The clinical picture resembles bacterial of the cardia, and in patients with diverticula or pha- pneumonia, although cough and sputum are absent ryngeal pouch. Recurrent bacterial pneumonia in the absence of Respiratory symptoms and signs and X-ray chronic bronchitis arouses suspicion of: changes (patchy consolidation with small effusions). It is transmitted in the excrement of infected Respiratory disease 117 Opportunistic infection of the lungs occurs in patients. Twice- sputum is foul and purulent and there is a high dailyposturaldrainagewillhelpemptydilatedairways polymorph cell count. Antibiotics, as for chronic bronchitis, are Investigation given for acute infections and exacerbations. Treat- Sputum is sent for Gram stain and culture, and blood ment is unnecessary in the absence of symptoms. Chest X-ray shows round lesions which Surgery is rarely indicated unless there is uncon- usually have a uid level, and serial X-rays monitor trolled bleeding because the disease is seldom limited progress. Patients with severe copytoexcludeobstructionandtoobtainabiopsyand disease may develop respiratory failure. Treatment Pneumothorax Antibiotic therapy is given according to sensitivities Aetiology and continued until healing is complete. In resistant cases, repeat- Spontaneous pneumothorax ed aspiration, antibiotic instillation and even surgical This is the most common type and usually occurs in excision may be required. Dyspnoea rapidly increases in tension Bronchiectasis pneumothorax and the patient becomes cyanosed. The classical signs are diminished movement on the Bronchiectasis means dilatation of the airways. It only affected side with deviation of the trachea to the other becomes of clinical signicance when infection and/ side. There is hyperresonance to percussion and re- or haemoptysis occurs within these dilatated airways. Pneumothoraces are best diagnosed by seeing a lung edge on X-ray; it is Aetiology clearest on an expiratory lm (Fig. Familial spontaneous pneumothorax is ide channel on the apical surface of airway and other associated with mutations in the folliculin gene. Itpredominantlyaffectsthe Management (of spontaneous pancreas and respiratory tract, leading to pancreatic insufciency and lung damage from recurrent chest pneumothorax) infections. Secondary bronchiectasis or lung abscess Often no therapy is required if the pneumothorax is may result. Indicationsforaspirationofairare: Persistent productive cough is associated initially with Staphylococcus aureus, Haemophilus inuenzae. Other manifestations are meconium ileus in Aspirate using a 16-gauge cannula and three-way tap. When the lung is re-expanded, X-ray the With improved survival cystic brosis is a disease chest. Mostmalesare sterile and maybe removedand, ifnot, suction shouldbe applied women subfertile. Rarely, a continuing air leak persists from the lung into the pleural space (bronchopleural stula). Choice is guided by sensitivity of isolated The patient is usually a cigarette smoker, sometimes organisms but often includes an aminoglycoside with tobacco-stained ngertips. Dyspnoea, cen- maintenance antibiotic therapy have to be weighed tral chestache and pleuritic pain, and slowly resolving against the risks of antibiotic resistance. The patient may also present with Athough macrolide antibiotics are not directly ac- inoperable disease.
If it is unilateral it is Lateral rectus palsy (6th nerve) greater towards the side of the destructive lesion buy geriforte syrup. It is secondary to an inability to x objects and focus Superior oblique palsy (4th nerve) with one or both eyes because of partial blindness 100 caps geriforte syrup amex. Absent taste 52 Neurological system sensation in this distribution indicates that a facial Weber test nerve paresis must be caused by a lesion above this level purchase cheapest geriforte syrup. Thusthismaybeobservedinherpeszosterofthe Place a vibrating tuning fork on the middle of the geniculate ganglion (Ramsay Hunt syndrome) but not patients forehead. Dizziness and giddiness Air conduction is normally better than bone Dizziness and giddiness are common neurological conduction. True vertigo suggests a disorder of the brainstem (vascular disease or demyelination), Rinne test labyrinthitis or Menieres disease. Transient dizziness is rare- Ask the patient: ly associated with temporal lobe epilepsy. Often no Is it louder behind (with the tuning fork on the mas- organic cause is found. Negativeisabnormalandimpliesconductive Vertigo refers to unsteadiness with a subjective sen- (air) deafness in that ear. Vertigo results from disease of the inner ear, Apraxia is the inability to perform complex and 8th nerve or its connections in the brainstem. It Dysarthria occurs with lesions of the parietal cortices connected by the corpus callosum. In dysarthria there is an inability to articulate properly because of local lesions in the mouth or disorders of the muscles of speech. Certainneurologicaldisorders pro- duce typical dysarthric features such as the scanning Patterns of motor loss in the speech of cerebellar dysfunction or the monotonous limbs high-pitched tones observed in pseudobulbar palsy. Lower motor neuron lesions Dysphasia and aphasia Thereis reducedor absentpowerwith markedmuscle These are disorders of the symbolic aspects of lan- wasting. The lesion affects the motor distribution of people and 50% of left-handed people, the left hemi- the spinal root or peripheral nerve. Upper motor neuron lesion Pure expressive (motor) dysphasia results from lesions in the postero-inferior part of the frontal lobe There is reduced or absent power, with wasting in (Brocas area). The plantar dysphasia there is a specic defect in recognition and response is upgoing. There is failure to understand the meaning of knee exion and ankle dorsiexion than in their words although the motor aspects of speech are pre- antagonist movements. This can produce uent dysphasia when the patient responds to questions with meaningless Consequently a hemiplegic person tends to walk with responses. Bulbar and pseudobulbar palsies Proximal myopathy The symptoms of dysarthria, dysphagia and nasal regurgitation result from paralysis of the 9th, 10th and Proximal muscle wasting and weakness seen in 12th cranial nerves. Acquired dyslexia (difculty in reading), dysgra- Patterns of sensory loss in phia(difcultyinwriting)anddyscalculia(difcultyin calculating) are features of lesions in the posterior the limbs parietal lobe. Agnosia denotes damage to the contra- Peripheral neuropathy lateral sensory cortex and is the inability to under- stand or recognise objects and forms in the presence Reduction or absence of vibration and position senses of normal peripheral sensation. Tactile agnosia is not only suggest dorsal column loss but also may be most common. Visual agnosia describes the inability part of a mixed sensorimotor peripheral neuropathy. In 23% of people, the ulnar nerve supplies all the Spinothalamic loss without dorsal hand muscles. Sensory loss may be very limitedbecausethemedianandulnarnerveterritories Dissociated sensory loss is a feature of spinal cord overlap the radial territory. Lateral cutaneous nerve of the Cerebral cortical lesions thigh Astereognosis and dysgraphaesthesia occur with par- Compression causes meralgia paraesthetica, a syn- ietal sensory loss. Isolated peripheral nerve lesions Lateral popliteal lesion Median nerve lesion (carpal tunnel syndrome) The lateral popliteal (common peroneal) nerve sup- plies the peroneal muscles which dorsiex and evert Patients with carpal tunnel syndrome complain of the foot. The nerve may be damaged as it passes over tinglingandnumbnessofthengersand/orweakness the head of the bula, resulting in foot-drop. There of the thumb, which are at their worst on waking and may be sensory loss over the outer aspect of the leg relieved by hanging the arm downwards. Pain at the exor aspect of the wrist may occasionally radiate up to the elbow and, exception- ally, as far as the shoulder. Cerebellar incoordination Ulnar nerve lesion Cerebellar incoordination is characterised by ipsilat- The ulnar nerve supplies all the small muscles of the eral intention tremor, past-pointing and failure of hand except three of the four muscles of the thenar rapid repetitive coordinated movements (dysdiado- eminence. It is associated with truncal ataxia, the wrist or in the ulnar groove at the elbow. The ring and little ngers still place the limbs accurately by looking at them; Neurological system 55 tests are performed with the eyes open and the eyes Sensory (dorsal column) ataxia closed. When the patients coordination is worse with the eyes closed than with them open they are A high stepping gait. Fingernose Steppage (drop-foot) gait and heelshin tests are normal when the patient There is no dorsiexion of the foot as it leaves the can see but incoordinate when they cannot. The pelvis drops on each side as the leg leaves the Combined lower and upper motor ground due to myopathic changes in the pelvic neuron lesions muscles. Classically this is seen in sub- acute combined degeneration of the cord (severe Tremors vitamin B12 deciency) and hereditary ataxias such as the hereditary spinomuscular ataxias (including A tremor is a rhythmic oscillating movement of a limb Friedrichs ataxia). Increased muscle tone and spas- or part of a limb and may be seen at rest or in action. Examination of the feet reveals pes cavus due to the combined motor This is best seen with the arms outstretched and is neuron effects. Hemiplegia Exaggerated physiological tremor Theaffectedlegisrigidanddescribesasemicirclewith the toe scraping the oor (circumduction). The arms tend to be held exed Essential tremor and characteristically do not swing. Dystonia refers to slow sinuous writhing move- mentsofthefaceandlimbs,especiallythedistalparts. Asterixis In torsion spasm (dystonia) the movements are This is the apping tremor associated with metabolic similar but slower and affect the proximal parts of the disorders. Diabetes mellitus, thyroid disease syndromes and polycystic ovary syndrome are common, most. The emphasis of the examination of the endocrine system should be dictated by the particular organ system that appears to be involved. Trousseaus sign maintaining the cuff at above systolic pressure for 3 min induces carpal spasm of. Chvosteks sign tapping over the facial nerve anterior to the ear induces ipsilateral twitching of. To demonstrate this, the patient should be T establish stocking sensory neuropathy if given a sip of water to hold in the mouth and then appropriate swallow when asked. Often the clinical T unilateral solitary nodules problem relates to their size, which may produce. The major symptoms of musculoskeletal detailed examination of the musculoskeletal system.
Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin re-uptake Aydin S buy generic geriforte syrup 100caps line, Unal D order 100caps geriforte syrup free shipping, Erol H et al purchase geriforte syrup online. A 4-year follow-up of a randomized prospective study Bagatell C J, Heiman J R, Rivier J E et al. Health Technol Assess 2003;7(40):111p Chinese Journal of Urology 1992;13(6):453-455. Synopsis: 2005 Annual combined use of ibutilide as an active control with Meeting of the American Society of Andrology. Sildenafil and sexual dysfunction associated America and treatment with sildenafil citrate with antidepressants. Testosterone use in men with sexual dysfunction: a Berner M M, Kriston L, Harms A. Mayo Clin Proc dose regimen randomized controlled trials administering the 2007;82(1):20-28. Prospective study of phosphodiesterase inhibitor for the treatment of penile sodium nitroprusside in pharmacologically induced erection. Correlations between the safety of sildenafil for male erectile dysfunction: hormones, physical, and affective parameters in aging urologic Experience gained in general practice use in England outpatients. Eur Neurol comparison of the effects of nebivolol and atenolol 1994;34(3):155-157. The reliability of clinical and biochemical assessment in symptomatic late-onset Brake M, Loertzer H, Horsch R et al. Eur J effective treatment for lower urinary tract symptoms secondary Endocrinol 1997;137(1):34-39. Erectile dysfunction and of idiopathic erectile dysfunction in men with the priapism. A comparative review of apomorphine formulations for erectile dysfunction: Recommendations for use in the elderly. Hyperprolactinemia and sexual function in phosphodiesterase type 5 inhibitors for erectile dysfunction. Am J Cardiol associated with testosterone replacement in middle- 2003;92(9A):26M-36M. Relationship between patient self-assessment of erectile dysfunction and the sexual health inventory Brooks D P, Giuliano F. Sexual function does testosterone administration and visual erotic stimuli on not change when serum testosterone levels are nocturnal penile tumescence in normal men. Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male Carey M P, Johnson B T. Efficacy of tadalafil for the treatment of erectile dysfunction at 24 and 36 hours after dosing: A randomized Carey Michael P, Wincze John P, Meisler Andrew W. Erratum: Erectile response with vardenafil in sildenafil nonresponders: A Chen J, Greenstein A, Kaver I et al. Effect of evaluation better predicts the degree of erectile dysfunction than oral administration of high-dose nitric oxide donor L- the response to intracavernous alprostadil testing. The additive erectile recovery effect of brain-derived Cawello W, Schweer H, Dietrich B et al. Pharmacokinetics of neurotrophic factor combined with vascular prostaglandin E1 and its main metabolites after intracavernous endothelial growth factor in a rat model of neurogenic injection and short-term infusion of prostaglandin E1 in patients impotence. Vacuum constriction Efficacy and safety of on- demand oral tadalafil in the device and topical minoxidil for management of impotence. Cavernous nerve Prevalence of erectile dysfunction in Asian reconstruction to preserve erectile function following non-nerve populations: A meta-analysis. Prevalence of hypogonadism in the aging Chatterjee R, Andrews H O, McGarrigle H H et al. Cavernosal male and male erectile dysfunction in Asia-Pacific arterial insufficiency is a major component of erectile countries. Management of erectile dysfunction by combination therapy with testosterone and sildenafil in recipients of high-dose Chew K K, Stuckey B G A. Nuclear penogram: Non-invasive technique to monitor and record effect of Chew K K, Stuckey B G A, Thompson P L. Erectile pharmacologically-induced penile erection in impotence dysfunction, sildenafil and cardiovascular risk. Management of premature ejaculation -- a (Viagra) in patients with cardiovascular disease. Circulation comparison of treatment outcome in patients with and 1999;99(1):168-177. Efficacy and after medical therapy for prolactin and adrenocorticotropic safety of sildenafil citrate in the treatment of erectile hormone co-producing pituitary macroadenoma without dysfunction in patients with ischemic heart disease. Effect of sildenafil on renin secretion in Contreras L N, Masini A M, Danna M M et al. Ann Chir Gynaecol Canadian Journal of Psychiatry - Revue Canadienne de 1996;85(3):247-250. Randomized clinical trial hyperprolactinemia in male patients consulting for comparing transurethral needle ablation with transurethral sexual dysfunction. Br J Sex Med 2007;4(5):1485 resection of the prostate for the treatment of benign prostatic 1493. Can Pharm J screening of hypogonadism in patients with sexual 2004;272(7299):608-610. Tolerability and safety profile of sildenafil citrate (Viagra) in Latin American patient populations. Caverject, a new licensed prostaglandin preparation for use in erectile dysfunction. Patient-partner satisfaction with intracavernous medication supported Collazos J, Martinez E, Mayo J et al. Journal of Acquired Immune Deficiency Syndromes: Urology & Nephrology 1999;31(2):257-262. Comparison of the New erectile dysfunction by an external ischiocavernous Cardioselective Beta-Blocker Nebivolol with Bisoprolol in muscle stimulator. Acute and prolonged effects of sildenafil on brachial artery flow- Dang G, Matern R, Bivalacqua T J et al. Treatment of male intracavernous injections and penile prostheses in impotence: a new option. Influence of the method of papaverine and phentolamine intracavernosal intracavernous injection on penile rigidity: a possible injection. Design and auto-injector system: a multicentre double-blind evaluation of nitrosylated alpha-adrenergic receptor antagonists placebo-controlled study. Dutasteride: A novel dual inhibitor of 5a-reductase for benign prostatic Degirmenci B, Acar M, Albayrak R et al.
Concurrent addition of 2 ering A1C best 100 caps geriforte syrup, with comparable effects on hypoglycemia risk and antihyperglycemic agents (+/- insulin) to metformin therapy may weightalthough basal-bolus regimens were modestly more e- be considered in settings of more severe hyperglycemia order geriforte syrup with paypal. Insulin Treatment in Type 2 Diabetes Use of long-acting basal insulin analogues (insulin detemir trusted 100 caps geriforte syrup, insulin glargine, insulin degludec) in those already on antihyperglycemic A combination of noninsulin antihyperglycemic agents and insulin agents reduces the relative risk of symptomatic and nocturnal hypo- often effectively controls glucose levels. Adding insulin to noninsulin hypoglycemia respectively (112); and rates of 26% vs. Insulin degludec has been and less hypoglycemia than that seen when non-insulin associated with lower rates of overall and nocturnal hypoglyce- antihyperglycemic agents are stopped and insulin is used alone mia compared to glargine U-100 (82,84,113). When insulin is used in type 2 diabetes, the insulin mia unawareness or moderate chronic renal failure) to insulin regimen should be tailored to achieve good metabolic control while degludec or glargine U-100. With intensive glycemic control, there degludec was associated with a signicantly lower rate of the is an increased risk of hypoglycemia, but this risk is lower in people primary endpoint of overall symptomatic hypoglycemic episodes with type 2 diabetes than in those with type 1 diabetes. The proportions of patients with of insulin administration (continuous subcutaneous infusion vs. The Trial Comparing Car- between insulin glargine and cancer has not been substantiated in diovascular Safety of Insulin Degludec versus Insulin Glargine in review of clinical trial data for either glargine or detemir (36,139,140). Insulin degludec may thus be considered over glargine U-100 [Grade B, Level 2 (2)]. If glycemic targets are not achieved using healthy behaviour interven- tions alone within 3 months, antihyperglycemic therapy should be added ered over glargine U-100 if reducing hypoglycemia is a priority (116). Ecacy and rates of hypoglycemia are similar between glargine Metformin should be chosen over other agents due to its low risk of hypo- U-100 and detemir (117). Aside from effects of some antihyperglycemic agents on the occur- rence of hypoglycemia and weight, there are adverse effects unique 4. Metformin can cause diarrhea, which tends to resolve over time and is minimized with Treatment Advancement in People with Type 2 Diabetes in Whom starting at a low dose and subsequent slow titration of the dosage. Glycemic Targets are Not Achieved with Existing Antihyperglycemic Medication Extended-release metformin can also be used to improve tolerabil- ity in individuals experiencing gastrointestinal side effects with 5. Dose adjustments to and/or addition of antihyperglycemic medications immediate-release metformin (118121). Metformin is also asso- should be made in order to attain target A1C within 3 to 6 months ciated with an approximate 2-fold increased incidence of vitamin [Grade D, Consensus]. If glycemic targets are not achieved with existing antihyperglycemic medi- sured periodically in people taking metformin or with signs or symp- cation(s), other classes of agents should be added to improve glycemic toms of deciency (such as impaired proprioception or peripheral control. Progression of nephropathy [Grade B, Level 2 (141) for empagliozin; increased risk of fractures compared to other agents that is pre- Grade C, Level 3 (54) for canagliozin]. Insulin may be used at any time in the course of type 2 diabetes Canagliozin treatment is associated with an increased risk of frac- [Grade D, Consensus] (see Appendix 9. Examples of Insulin Initiation tures (54,132) and a twofold increased risk of amputations (54). There considered over premixed insulin or bolus only regimens, if lower risk is evidence of a higher risk of bladder cancer with pioglitazone in of hypoglycemia and/or weight gain are priorities [Grade B, Level 2 (101)]. In adults with type 2 diabetes treated with basal insulin therapy, if lower risk of hypoglycemia is a priority: receptor agonists have been shown to promote the development a. Insulin glargine U-300 may be considered over insulin glargine Author Disclosures U-100 to reduce overall and nocturnal hypoglycemia [Grade C, Level 3 (116)]. MacCallum reports per- bolus insulin) should be added if glycemic targets are not achieved sonal fees from Janssen and Novo Nordisk, outside the submitted [Grade D, Consensus]. Effect of a multifactorial inter- pared to additional insulin [Grade A, Level 1A (27,93,94)]. Association of an intensive life- style intervention with remission of type 2 diabetes. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk 13. Bolus insulin may be initiated using a stepwise approach (starting observational study. Lower baseline glycemia reduces to achieve similar A1C reduction with lower hypoglycemia risk apparent oral agent glucose-lowering ecacy: A meta-regression analysis. Dia- compared to initiating a full basal-bolus injection regimen [Grade B, betes Care 2006;29:21379. The effect of oral antidiabetic agents on A1C levels: A systematic review and meta-analysis. Early combination therapy for the treat- therapy with insulin or insulin secretagogues should be counselled about ment of type 2 diabetes mellitus: Systematic review and meta-analysis. Dia- the prevention, recognition and treatment of hypoglycemia [Grade D, betes Obes Metab 2014;16:41017. Initial combination therapy with canagliozin plus metformin versus each component as monotherapy for drug- 16. Sick Day inhibitors and metformin versus metformin monotherapy in type 2 diabe- Medication List. Initial combination of empagliozin and cal procedures, and during acute infections and serious illness to reduce linagliptin in subjects with type 2 diabetes. Initial combination therapy with metformin, pioglitazone and exenatide is more effective than sequential add-on therapy in subjects with new-onset diabetes. Simultaneous glyburide/metformin therapy is superior to component monotherapy as an initial pharmacological treatment for type 2 diabetes. Effect of early addition of rosiglitazone to sulphonylurea therapy in older type 2 diabetes patients (>60 years): The Rosiglitazone Early vs. Improvement in glycaemic control with rosiglitazone/metformin xed-dose combination therapy in patients with Targets for Glycemic Control, p. S104 metformin xed-dose combination therapy compared with monotherapy with Weight Management in Diabetes, p. S124 either rosiglitazone or metformin in patients with uncontrolled type 2 dia- Type 2 Diabetes in Children and Adolescents, p. S255 glucose control with metformin on complications in overweight patients with Diabetes in Older People, p. Diabetes medications as monotherapy Relevant Appendices or metformin-based combination therapy for type 2 diabetes: A systematic review and meta-analysis. Types of Insulin vascular outcomes in patients with type 2 diabetes and coronary artery disease. Use of thiazolidinediones and the adverse events associated with glucose-lowering drugs in patients with risk of bladder cancer among people with type 2 diabetes: A meta-analysis. Alogliptin after acute coronary ecacy in the treatment of type 2 diabetes: A meta-analysis of randomised syndrome in patients with type 2 diabetes. Saxagliptin and cardiovascular out- on glycaemic control, hypoglycaemia and weight change in patients with comes in patients with type 2 diabetes mellitus. Diabetes Care 2015;38:1145 antidiabetic drug regimens added to metformin monotherapy in patients with 53. N Engl J Med 2017; sulfonylureas for patients with type 2 diabetes: Accumulated evidence from 55. Semaglutide and cardiovascular outcomes inhibitors added to insulin therapy in type 2 diabetes: A systematic review with in patients with type 2 diabetes.