IMpact: News for Medical Students

Discover your future in Internal Medicine

The General Internist Career Path

Internal Medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.

More About Internal Medicine Careers

The Subspecialist Career Path

Subspecialists in internal medicine have chosen to receive additional, more in-depth training and board certification in the diagnosis and management of diseases of a specific type or diseases affecting a single organ system.

More About Subspecialty Careers

The Hospitalist Career Path

Hospitalists are providers who dedicate most of their career to the care of hospitalized patients. They focus on clinical management, with an added eye to quality, safety, and utilization.

More About Hospitalist Careers

My Kind of Medicine:
Real Stories of ACP Internists

David L. Katz, MD, MPH, FACPM, FACP

Dr. David L. Katz

Director, Yale University Prevention Research Center

Susan L. Turney, MD, MS, FACMPE, FACP

Dr. Susan L. Turney

CEO, Marshfield Clinic Health System

Farzanna S. Haffizulla, MD, FACP

Dr. Farzanna S. Haffizulla

Internist in Private Practice

Saad Z. Usmani

Dr. Saad Z. Usmani

Director of Clinical Research

Joshua M. Liao, MD

Dr. Joshua M. Liao

Internal Medicine Resident

Dr. Valerie J. Lang

Dr. Valerie J. Lang

Associate Professor of Medicine

Dr. David Fleming

Dr. David Fleming

ACP President with Dr. Robert Centor, ACP Chair, Board of Regents

Dr. Kent J. DeZee

Dr. Kent DeZee

Program Director, General Medicine Fellowship

Dr. Erik Wallace

Dr. Erik Wallace

Associate Dean

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Challenge your mind…


MKSAP 5 - Question of the Week

A 68-year-old woman is re-evaluated after laboratory studies show a fasting plasma glucose level of 113 mg/dL (6.3 mmol/L). She has a family history of type 2 diabetes mellitus.

On physical examination, blood pressure is 142/88 mm Hg and BMI is 29. Other vital signs and examination findings are normal.

She undergoes an oral glucose tolerance test, during which her 2-hour plasma glucose level increases to 135 mg/dL (7.5 mmol/L).

The most appropriate treatment for this patient is diet and exercise. She has impaired fasting glucose (IFG), defined as a fasting plasma glucose level in the range of 100 to 125 mg/dL (5.6 to 6.9 mmol/L), and should begin a program of intensive lifestyle change, including 30 minutes of exercise most days of the week and a calorie-restricted diet, to achieve weight reduction on the order of 7% of body weight.

Diet and exercise is the recommended approach for patients with either IFG or impaired glucose tolerance (IGT), the prediabetic states. The relative risk reduction (RRR) in the incidence of diabetes in patients with IGT associated with intensive lifestyle change is 58%.

Pharmacologic therapy with glucose-lowering drugs is not indicated for this patient with isolated IFG. In pharmacologic studies of diabetes prevention, acarbose therapy resulted in only a 25% RRR, which is inferior to that obtained with diet and exercise.

Metformin therapy is associated with an RRR of 31%, which is also inferior to the 58% RRR obtained with diet and exercise. Metformin therapy may be considered in patients with both IFG and IGT, who constitute a higher risk group. This patient does not have IGT (fasting plasma glucose level of 140 to 199 mg/dL [7.7 to 11.0 mmol/L] at the 2-hour mark of an oral glucose tolerance test) and so should not receive metformin.

Modulators of the renin-angiotensin axis, such as ramipril and other angiotensin-converting enzyme inhibitors, do not contribute to diabetes prevention.

Rosiglitazone and pioglitazone have been associated with 62% and 81% RRRs, respectively, in the incidence of diabetes. These agents, however, are not endorsed for routine pharmacologic use in patients with prediabetes because of their costs and adverse effects, including edema, increased fracture risk in women, and possible increased cardiovascular morbidity.

Key Point

  • Patients with prediabetes should be advised to adopt a program of lifestyle change to prevent progression to type 2 diabetes mellitus.
Q.Which of the following is the most appropriate treatment recommendation?
Abstract Competition

Abstract Competition

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Doctor's Dilemma

Doctor's Dilemma™

ACP's national medical jeopardy competition, held each year at ACP’s annual meeting, allows dozens of teams of residents and medical students from around the nation to compete for the coveted title of national champion.

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