The athlete's hip and groin.

Groin and hip injuries are seen in athletes who perform quick directional changes and cutting movements. Because forces generated through athletic performance are transferred through the hip, injuries to these areas may limit athletes with mild pain or lead to career-ending injuries. The anatomy of the hip and groin is complex and symptoms often overlap. This article discusses some athletic causes, but other medical conditions may be associated with hip and groin pain as well. Updates in evaluation and treatment are discussed for adductor strains, hip osteoarthritis, femoroacetabular impingement, sports hernia, osteitis pubis, and obturator nerve entrapment.

Comparison of hemoglobin A1c goal achievement with the addition of pioglitazone to maximal/highest tolerated doses of sulfonylurea and metformin combination therapy.

OBJECTIVES: It has been proposed that the combination of thiazolidinedione (TZD) therapy to metformin and sulfonylurea is beneficial due to each medication having a unique mechanism of action. Within the Veterans Affairs Hospital, specific criteria of use define when TZD therapy can be initiated. Most patients who receive TZD therapy have failed other medications prior to use. The primary objective of this study was to determine the percentage of patients achieving the American Diabetes Association (ADA) goal hemoglobin A1c (A1c) of less than 7% with the addition of pioglitazone to the maximal/highest tolerated doses of sulfonylurea and metformin combination therapy. METHODS: This was a six healthcare system retrospective, descriptive, analysis of type 2 diabetic patients (DM-2). Patients must have received the maximal/highest tolerated doses of sulfonylurea and metformin combination therapy and have been TZD naïve or off TZD therapy for a minimum of 6 months, a baseline A1c greater than 7%, a repeat A1c at 3 and 6 months available, and deemed medication compliant. RESULTS: We evaluated 98 total patients. The percentage of veteran patients achieving ADA goal A1c of less than 7% after the addition of pioglitazone reached statistical significance at both 3 and 6 months post TZD initiation. The mean reduction in A1c post-pioglitazone initiation was 0.67% (SD ± 0.92) and 0.78% (SD ± 0.94) at 3 and 6 months, respectively. CONCLUSION: The addition of pioglitazone to veteran patients who were already receiving maximal/highest tolerated doses of sulfonylurea was able to achieve a higher percentage in with the ADA goal A1c of less than 7%. Initiating pioglitazone in patients with an A1c of 9% or greater did not reach statistical significance in achieving an A1c less than 7%. The initial starting dose of pioglitazone 30 mg can be considered as compared to 15 mg daily if contraindications do not exist.