1. Task Force recommends screening overweight or obese adults for abnormal blood sugar
Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-2345
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The U.S. Preventive Services Task Force recommends screening overweight and obese adults between the ages of 40 and 70 for abnormal blood sugar. Patients found to have high blood sugar should be referred to intensive behavioral counseling interventions to promote a healthy diet and regular exercise. The recommendation is published in Annals of Internal Medicine.
Type 2 diabetes is a potentially debilitating disease that has risen in prevalence over the past 15 years. In 2012, 12 percent of American adults had diabetes and 37 percent had abnormal blood sugar levels that put them at increased risk for developing diabetes. Abnormal blood sugar levels occur when the body does not consistently break down and use sugar, but it is not yet severe enough to be classified as type 2 diabetes. For people with abnormal blood sugar, changes in their lifestyle, such as eating healthier and exercising more often, have been proven to help prevent or delay the onset of type 2 diabetes.
This is an update of the 2008 USPSTF recommendation statement in which the USPSTF recommended screening for diabetes in asymptomatic adults with hypertension. At that time, the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening in adults without hypertension. Since the previous recommendation, six new lifestyle intervention studies have shown consistent benefit of lifestyle modifications to prevent or delay progression to diabetes and longer-term follow-up has increased confidence that such interventions can improve clinical outcomes. This new body of evidence led the USPSTF to conclude that there is moderate net benefit to measuring blood glucose in adults who are at increased risk for diabetes.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with someone from the USPSTF, please contact Nicole Raisch at newsroom@uspstf.net.
2. Heath care costs soar at end-of-life for families dealing with dementia
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0381
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Dementia places a much larger financial burden on families in the last 5 years of life than cancer, heart disease, and other conditions, especially among the social groups least prepared to cope, according to a study published in Annals of Internal Medicine.
Not enough is known about the cost of end-of-life care for persons with different medical conditions. Researchers used data from the Health and Retirement Study (HRS) to examine the social costs and financial risks faced by Medicare beneficiaries 5 years before death. They considered various social costs associated with disease, such as government spending (Medicare), private insurance, out-of-pocket expenditures, and informal care. They also examined how these spending components varied across four disease groups: dementia, cancer, heart disease, and other conditions.
The researchers found that total social costs for Medicare patients with dementia was $250,000 per person in the last 5 years of life, which is 57 percent greater than social costs associated with death from other conditions. Families of patients with dementia also had to pay a greater proportion of family assets for end-of-life care than families of patients without dementia. Those who were unmarried, were black, and had less than a high school education were disproportionately affected. The authors suggest that these findings could inform discussions on Medicare policy.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Amy Kelly, please contact Sasha Walek at sasha.walek@mountsinai.org or 646-605-5945.
3. Urinary biomarkers unreliable for diagnosing bladder cancer
Free content: http://www.annals.org/article.aspx?doi=10.7326/M15-0997
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-2445
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Urinary biomarkers miss a substantial proportion of patients with bladder cancer and are falsely positive in others, according to an article in Annals of Internal Medicine.
Bladder cancer is the fourth most commonly diagnosed cancer in U.S. men and the tenth most commonly diagnosed cancer in U.S. women. Urine-based biomarkers have been developed as potential alternatives or adjuncts to cystoscopy for the diagnosis of bladder cancer. Five such biomarkers have been approved by the U.S. Food and Drug Administration: quantitative or qualitative nuclear matrix protein 22 (NMP22); qualitative or quantitative bladder tumor antigen (BTA); florescent in situ hybridization (FISH); fluorescent immunohistochemistry (ImmunoCyt [Scimedx]); and Cxbladder (Pacific Edge Diagnostics USA).
Researchers reviewed 57 published studies to ascertain the accuracy of the five FDA-approved urinary biomarkers for diagnosis of bladder cancer in adults who have signs or symptoms of bladder cancer or are undergoing surveillance for recurrent disease. They found that urinary biomarkers had sensitivities for bladder cancer that ranged from 0.57 to 0.82 and specificities that ranged from 0.74 to 0.88. Their sensitivity seemed to be particularly poor for low-stage and low-grade tumors. Diagnostic accuracy may be slightly higher for initial diagnosis of bladder cancer in patients with signs and symptoms than for surveillance. The author of an accompanying editorial cautions that these biomarkers should not replace current methods for diagnosing bladder cancer.
Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. Roger Chou, please contact Amanda Gibbs at gibbam@ohsu.edu or Elisa Williams at willieli@ohsu.edu or 503-494-8231.
4. Early invasive treatment for acute coronary syndromes associated with better outcomes, but don't change practice yet
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0303
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-2490
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The use of an early invasive treatment strategy was associated with a lower risk for cardiac death and rehospitalization for myocardial infarction compared with conservative invasive approach, according to a retrospective cohort study published in Annals of Internal Medicine. However, the authors of an accompanying editorial suggest that more research is needed before clinicians change practice.
Clinical trials have shown that an early invasive strategy for acute coronary syndromes is associated with better outcomes than a conservative approach. Using national health care data from Denmark, researchers sought to determine if this would be true in real world practice. The researchers compared outcomes for patients hospitalized for the first time with acute coronary syndromes who had a diagnostic coronary angiography within 72 hours (early invasive treatment strategy) with those who had coronary angiography more than 3 days later or not at all (conservative invasive approach).
The researchers found evidence that an early invasive approach was associated with a decreased risk for adverse cardiac events, including cardiac death. However, the study has weaknesses with regard to the quality of patient data and strength of analytic methods. For now, the editorialists caution that clinical practice should not be influenced by comparative effectiveness studies using observational data.
Note: For an embargoed PDF or for lead author contact information, please contact Cara Graeff. To reach the lead editorialist, Dr. Harlan Krumholz, please contact Karen Peart at karen.peart@yale.edu or 203-432-1326.
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Also in this issue:
New Orleans Rises Anew: Community Health After Katrina
Karen B. DeSalvo, MD, MPH, MSc
Ideas and Opinions
http://www.annals.org/article.aspx?doi=10.7326/M15-2284
Long-Term Prognosis of Early Repolarization With J-Wave and QRS Slur Patterns on the Resting Electrocardiogram: A Cohort Study
Vedant S. Pargaonkar, MD; Marco V. Perez, MD; Akash Jindal, BS; Maya B. Mathur, MS; Jonathan Myers, PhD; and Victor F. Froelicher, MD
Original Research
http://www.annals.org/article.aspx?doi=10.7326/M15-0598
Journal
Annals of Internal Medicine