Family Medicine Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped family medicine practice.

Type 2 Diabetes First-Line Therapy

Beyond metformin

Sulfonylureas → UKPDS metformin (1998) → EMPA-REG/LEADER/CREDENCE → GLP-1/SGLT2 first-line

Sprint to 120

JNC 7 (140/90) → JNC 8 relaxation → SPRINT (2015) → ACC/AHA 130/80 → elderly

Expanding the net

High-risk only → JUPITER broadened → risk calculator debates → shared decision-making

Earlier and smarter screening

Fixed ages → CRC 50→45 (USPSTF 2021) → breast age debates → cervical HPV-primary

The case against routine imaging

Image-first → evidence against → red flag criteria → Choosing Wisely