Study suggests that diabetes can be accurately diagnosed from a single blood sample

Annals of Internal Medicine Tip Sheet

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. Study suggests that diabetes can be accurately diagnosed from a single blood sample
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0091
Editorial: http://annals.org/aim/article/doi/10.7326/M18-1477
URLs go live when the embargo lifts

A combination of elevated fasting glucose and HbA1c levels from a single blood sample was found to be accurate for diagnosing diabetes. This is significant because current guidelines state that a second blood test, conducted a separate point in time, is requited to confirm a diagnosis of diabetes. Findings from a prospective cohort study are published in Annals of Internal Medicine.

Glucose has been the standard measure of diagnosis of diabetes and current guidelines recommend repeated testing to confirm an elevated fasting glucose or hemoglobin A1c level. Whether glucose and HbA1c from a single point in time can be used in combination to diagnosis diabetes has been uncertain.

Researchers from Johns Hopkins Bloomberg School of Public Health evaluated a single fasting blood sample for 12,268 participants without diagnosed diabetes enrolled in the Atherosclerosis Risk in Communities (ARIC) study to determine the prognostic value of a single-sample confirmatory definition of undiagnosed diabetes. Patients in the ARIC study were enrolled between 1987 and 1989 with 25 years of follow-up for incident diabetes, cardiovascular outcomes, kidney disease and mortality. The researchers found that a single fasting blood sample showing both elevated glucose and HbA1c levels was strongly predictive of a subsequent diagnosis of diabetes (almost everyone meeting the definition eventually developed diabetes) and was also strongly associated with complications of diabetes (cardiovascular disease, kidney disease, peripheral artery disease, and mortality).

According to the researchers, this new approach to diagnosis could prove useful in clinical practice because it would eliminate the need for a second patient visit for a second blood draw and because the HbA1c test result could be used to guide treatment.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Elizabeth Selvin, PhD, MPH, please contact Barbara Benham at bbenham1@jhu.edu.

2. Drug treatment associated with a significant reduction in death risk following opioid overdose
Abstract: http://annals.org/aim/article/doi/10.7326/M17-3107
Editorial: http://annals.org/aim/article/doi/10.7326/M18-1397
URLs go live when the embargo lifts

A new study found that treatment with buprenorphine or methadone after a nonfatal overdose was associated with a 40 to 60 percent reduction in all-cause and opioid-related mortality. However, the medications were significantly underused, with only 3 in 10 individuals receiving an FDA-approved medication for treatment of opioid use disorder after surviving an overdose. Findings from a cohort study are published in Annals of Internal Medicine.

Patients who survive an opioid overdose are at an increased risk for subsequent nonfatal and fatal events. Engaging such persons in treatment may be effective in limiting fatalities, but data on the association between drug treatment of opioid use disorder and mortality after a nonfatal overdose are limited.

Researchers from Boston Medical Center and Boston University School of Medicine used a Massachusetts public health database to study the association between use of medications for opioid use disorder, or nonuse of such medications, and mortality among 17,568 opioid overdose survivors. Patients who were administered drug treatment took one of three FDA-approved medications: methadone, buprenorphine, or naltrexone. In the 12 months after a nonfatal overdose, 11 percent of the patients enrolled in methadone maintenance treatment, 17 percent received buprenorphine, and 6 percent received naltrexone. Among the entire cohort, mortality was 4.7 deaths per 100 person-years and opoioid-related mortality was 2.1 deaths per 100 person-years. Compared with no drug treatment, methadone was associated with decreased all-cause mortality and opioid-related mortality. Buprenorphine was associated with decreased all-cause mortality and opioid-related mortality. No associations between naltrexone and all-cause mortality or opioid related mortality were identified, most likely because of how infrequently it was administered.

According to the authors, these findings suggest that medication is effective for reducing opioid deaths but is severely underutilized.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Marc R. Larochelle, MD, MPH, please contact, Jenny Eriksen Leary at Jenny.Eriksen@bmc.org.

3. Survivors of gun crimes pay emotional cost
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0365
URLs go live when the embargo lifts

Victims of crimes committed with firearms suffer greater distress compared to victims of crimes involving other weapons or no weapons at all. As such, persons victimized with a firearm may require special attention with regard to their emotional well-being. Findings from a brief research report are published in Annals of Internal Medicine.

Firearms were involved in over 250,000 victimizations in 2015. Firearm violence has been understudied, and as a result, the consequences of firearm violence are only partially understood. In particular, the mental health consequences specific to the presence of a firearm during a violent victimization are not known.

Researchers from the University of California, Davis used data from the National Crime Victimization Survey to assess the relationship between firearm involvement during a violent victimization and the prevalence of severe distress and social functioning problems attributed to that victimization. Survey participants had experienced a violent crime within the previous 6 months and were asked to detail the physical and emotional consequences of their victimizations. Using this information, researchers compared the prevalence of severe distress attributed to the victimization and problems in respondents' social life, including their job, their schoolwork, and interactions with family or friends by whether the victimization involved a firearm, a different weapon, such as a knife, or no weapon.

The researchers found that a greater proportion of people reported experiencing severe distress as a result of the victimization when the victimization involved a firearm (39 percent), as compared to people victimized with different weapons (31 percent) and no weapons (24 percent).Differences in the prevalence of reported social life problems were smaller and not statistically significant.

These findings suggest firearm violence has unique negative impacts on mental health and people victimized with a firearm may require special attention. These findings also highlight the emotional costs that could be avoided by investing in efforts to prevent firearm violence.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Rose Kagawa, PhD MPH, please contact her directly at rkagawa@ucdavis.edu.

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