Welcome to this month’s edition of Comp Medical News, an essential update series. The birth of telemedicine, personalized medicine in the pain management arena and the NIH’s “woman problem” are your health headlines heading into January 2016.
First, type 2 diabetes continues to dominate headlines as more and more Americans are diagnosed with the disease:
“Lifestyle Community Intervention Program” for Type 2 Diabetes Prevention Also Works in Office Setting
Researchers from The Ohio State University, publishing in Preventing Chronic Disease, used the Diabetes Prevention Program (DPP) in a university workplace to assess whether it would be as successful as community-based intervention. The study population was 35 individuals considered to be “prediabetic” and at high risk for the disease. Three months after a 16-week intervention, mean weight loss was greater in the intervention group than in a similarly sized control group, which received usual care. The treatment group also had significantly greater reductions in waist circumference, fasting glucose, and systolic and diastolic blood pressure versus the control group. The DPP has been studied in churches, hospitals, and YMCAs, since its completion in 2002 and it has generally shown to be effective and even to make long-term financial sense.
Read more about the study via MedPage Today here.
Once-a-week Diabetes Meds are Similar in Safety and Effectiveness
A recent evidence review found that there are few differences between the newer diabetes treatment medications that can be taken just once a week. Past studies of the drugs known as glucagon-like peptide-1 receptor agonists – or GLP-1RAs – have found that the medications improve blood sugar control and reduce body weight, but researchers said that no research had compared the various versions head-to-head. Publishing in the Annals of Internal Medicine, the study authors analyzed data from 34 trials that included a total of 21,126 participants taking one of the five GLP-1RAs. They found that the drugs (three of which are currently on the market and two in development) performed similarly in reducing blood sugar, as well as heart disease risk factors like high blood pressure, cholesterol and inflammation. The risk of dangerous blood sugar lows known as hypoglycemia was also similar among people taking all five drugs.
Read more via Reuters here.
Next, the U.S. health system takes some good news with the bad:
America’s Health Rankings Annual Report Shows Progress
Americans are making meaningful progress on key health metrics including smoking less and leading less sedentary lifestyles, but rising rates of overdoses, obesity, and diabetes, among other factors, signal serious challenges, according to United Health Foundation’s 26th “America’s Health Rankings Annual Report: A Call to Action for Individuals & Their Communities.” On the positive side, smoking rates decreased five percent in the last year alone, from 19 to 18.1 percent of adults, and have declined 39 percent since 1990. Further, rates of sedentary behavior (adults who reported no physical activity in the last 30 days) declined 11 percent from 25.3 percent to 22.6 percent of adults. However, drug-related deaths (prescription or otherwise) jumped four percent over the last year, from 13 to 13.5 deaths per 100,000 people. Self-reported obesity and diabetes have continued their unabated climb as well.
Read the full report here.
NIH Neglecting to Ensure that Clinical Trials Account for Sex Differences
The National Institutes of Health (NIH) have been required by Congress to include women in the clinical trials it funds to test medical treatments for the last 22 years, however, a new report indicates that the agency is not adequately examining outcomes by sex to see whether men and women are affected differently by what is being tested. This conclusion came from a recent Government Accountability Office (GAO) review, which found that the NIH fails to make available usable information regarding which studies have separated results by sex and what those results are. NIH “does not maintain, analyze or report summary data to oversee whether analysis of outcomes by sex are planned or conducted,” the U.S. GAO wrote. Further, as Kaiser Health News notes, this is not the first time that the GAO has scolded the NIH for its implementation of the requirement to include women in research trials. In 2000, it said that the agency needed to do a better job ensuring “that certain clinical trials be designed and carried out to permit valid analysis by sex.” The agency has 60 days to formally respond.
Continuing into the New Year, alarm bells about opioids sound, as some seek actionable answers:
Study Finds that Nearly All Patients Still Receive Opioids After Overdose, Reasons Uncertain
Researchers associated with the Boston Medical Center used Optum, a national commercial insurance claims database, to identify almost 3,000 patients who experienced a nonfatal overdose between 2000 and 2012 while taking long-term opioids prescribed for chronic pain not related to cancer. Just over 90 percent of these patients continued to receive prescription opioids after the overdose. More than half got the prescription from the same doctor and there were 212 second overdoses during the study period – a full seven percent of the original group. Doctors speaking with Reuters in reaction to the study said that prescribers may not know that a patient has overdosed since a widespread system for medical records doesn’t exist in the U.S. and tools such as prescription monitoring databases are inconsistent, especially across state lines. The study authors emphasized that simply stopping a patient’s prescription after an overdose is unlikely to solve the problem and that tapering and addiction treatment may be necessary.
Read more from Reuters here.
Personalized Medicine Could Help Predict Addiction Before it Starts
The growing field of “personalized medicine,” which aims to tailor treatment to an individual’s genetic and lifestyle factors in order to better predict and achieve desired outcomes, could help doctors identify patients that are more likely to abuse opioid medications. According to a review by Inna Belfer, MD, PhD of the University of Pittsburgh School of Medicine published in Pain Medicine News, “the particular concern in pain medicine is remarkable interindividual variability in patient response to treatment, specifically to opioids […] Currently, a physician’s ability to identify a patient who will develop an addiction to a pain medication is limited, since it is based on subjective self-reported data of personal and family medical histories as well as environmental factors. Even accurately provided, these data represent only a portion of the array of important risk factors influencing the development of addiction.” New theories are seeking to create a usable “genetics of pain” system, as some studies point to at least a 50 percent genetic component of susceptibility to general drug addiction, and for opiates, the genetic component may exceed 70 percent.
Read the entire essay via Pain Medicine News here.
Finally, telemedicine, an increasingly popular method of doctor/patient communication has unsure origins:
Jay Sanders, MD – How ‘A Stupid Idea’ Gave Birth to Telemedicine
Jay Sanders, MD, often called “The Father of Telemedicine,” for his work introducing telehealth in the Southeast in the 1970s, can remember the day that telemedicine was conceived, and by whom. To Sanders, the true father of telemedicine is Kenneth Byrd, MD. Sanders penned his recollections for an article on MedPage Today, explaining that the entire notion stemmed from traffic jams and poor resident pay at Massachusetts General Hospital in Boston.
Read the piece here.
Image Credit: Pacific Standard “Making it Personal: Geneticist Michael Synder Puts a Face on Personalized Medicine” – LONELY/SHUTTERSTOCK