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A comprehensive review of the literature on DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors has resulted in small changes to the medication roadmap of the type 2 diabetes mellitus standard of the Dutch College of General Practitioners. SGLT-2 inhibitors and GLP-1 receptor agonists may have benefits related to cardiovascular outcomes in patients with high cardiovascular risk, especially in those who have experienced a cardiovascular event. However, ascribing effectiveness related to cardiovascular outcomes on the basis of a single cardiovascular safety trial is premature. Metformin, sulfonylurea derivatives and insulin are still the cornerstone of type 2 diabetes mellitus treatment in primary care.

In general practice, lower urinary tract symptoms (LUTS) in men are usually not attributable to specific disorders. Prostate cancer is rarely the cause of LUTS. Education, counselling, and non-pharmaceutical advice form the basis for treatment of LUTS. Only when these measures do not relieve the patient's symptoms sufficiently, drug therapy could be considered. Alpha-blockers are the drugs of first choice and are also recommended when transurethral catheterization is needed for acute urinary retention. The effect of medication on LUTS is limited and largely based on placebo effect. The effectiveness of prostate cancer screening is a subject of debate; therefore patients asking for a PSA test should be informed about the benefits and harms of measuring PSA before having a test. A PSA value > 4 ng/ml, or abnormal results on digital rectal examination should prompt further diagnostic evaluation.

A small number of points in the NHG practice guideline 'Atrial fibrillation' have been reviewed; this has important consequences for general practice. The risk of ischaemic CVA in patients with atrial fibrillation is determined using a new risk score (CHA2DS2-VASc). The target value of the resting ventricular frequency has been increased from a maximum of 90 to a maximum of 110 beats per minute. Oral anticoagulants are indicated in almost all patients aged 65 years and older with atrial fibrillation; the only group in whom antithrombotic medication is not indicated is men under the age of 75 with no cardiovascular comorbidity. Acetylsalicylic acid for the prevention of thrombo-embolism is only indicated if oral anticoagulants are contra-indicated. The new oral anticoagulants (NOACs) have very limited use in the prevention of a thrombo-embolism in general practice.

Objective: Determination of both the feasibility and the result in terms of cardiovascular risk factors of self-measurement of waist circumference by apparently healthy people. We also investigated the prevalence of metabolic syndrome in a population of patients aged 20-69 years in IJsselstein, the Netherlands., Design: Cross-sectional survey., Methods: All patients aged 20-69 years in the care of a group of General Practitioners (GPs) in IJsselstein, the Netherlands, who were not known to have diabetes, hypertension or dyslipidaemia (n = 11,862), received a tape measure and instructions by mail with the request to measure their waist circumference. Those with an increased waist circumference (> 88 and > 102 cm for women and men, respectively) were invited to undergo investigations to determine whether they conformed to the NCEP ATP III criteria for metabolic syndrome. The prevalence of metabolic syndrome was determined by a combination of these results with file studies of those with already known risk factors for cardiac and vascular disease., Results: The total response rate was 62%. The intraclass correlation between the waist circumference measured by the respondents and by the investigators was 0.80 (p < 0.05). 473 new cases of metabolic syndrome were detected among 1721 persons with an increased waist circumference on self-measurement, 40 % in people younger than 45 years. The total prevalence among those aged 20-69 years in IJsselstein was 15.5%. Only 39% of the people with the metabolic syndrome were already known to have risk factors., Conclusions: A GP initiated screening system for metabolic syndrome, in which self-measurement of waist circumference was the first step, proved to be feasible and reliable. A substantial group of people aged less than 45 years and at increased cardiovascular risk were also detected using this method of population screening.