Goals

Screening for Prediabetes and Type 2 Diabetes

Bethie Seay — Thu, 26 Aug 2021 05:00:00 +0000

Date Added:

August 26, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jama.2021.12531

The U.S. Preventive Services Advisory Committee recommends screening nonpregnant adults aged 35 – 70 with BMI >25 for prediabetes and diabetes. While there is no recommendation regarding how often to screen, they mention that every 3 years seems reasonable based upon the evidence they reviewed.

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IMPORTANCE An estimated 13% of all US adults (18 years or older) have diabetes, and 34.5%
meet criteria for prediabetes. The prevalences of prediabetes and diabetes are higher in older
adults. Estimates of the risk of progression from prediabetes to diabetes vary widely, perhaps
because of differences in the definition of prediabetes or the heterogeneity of prediabetes.
Diabetes is the leading cause of kidney failure and new cases of blindness among adults in the
US. It is also associated with increased risks of cardiovascular disease, nonalcoholic fatty liver
disease, and nonalcoholic steatohepatitis and was estimated to be the seventh leading cause
of death in the US in 2017. Screening asymptomatic adults for prediabetes and type 2
diabetes may allow earlier detection, diagnosis, and treatment, with the ultimate goal of
improving health outcomes.
OBJECTIVE To update its 2015 recommendation, the USPSTF commissioned a systematic
review to evaluate screening for prediabetes and type 2 diabetes in asymptomatic,
nonpregnant adults and preventive interventions for those with prediabetes.
POPULATION Nonpregnant adults aged 35 to 70 years seen in primary care settings who have
overweight or obesity (defined as a body mass index 25 and 30, respectively) and no
symptoms of diabetes.
EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for
prediabetes and type 2 diabetes and offering or referring patients with prediabetes to
effective preventive interventions has a moderate net benefit.
CONCLUSIONS AND RECOMMENDATION The USPSTF recommends screening for prediabetes
and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians
should offer or refer patients with prediabetes to effective preventive interventions.
(B recommendation)

Author/s:

US Preventative Services task Force

Standards of Medical Care in Diabetes

Brian Desmarais — Thu, 19 Nov 2020 17:37:56 +0000

Date Added:

November 19, 2020

Journal/Publication:

Diabetes Care

Publication Date:

January 1, 2020

Issue:

Volume:

URL:

Standards of Medical Care in Diabetes

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.2337/dc20-Sint

MeSH

diabetes mellitus, type 2

diabetes mellitus, type 1

risk reduction behavior

Longitudinal Studies

This is the 2020 version of the ADA guidelines. James W. Mold, MD, MPH

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Not available.

Using Insulin to Treat Poorly Controlled Type 2 Diabetes in 2020

John Bayhi — Tue, 26 May 2020 20:43:16 +0000

Date Added:

May 26, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

May 22, 2020

Volume:

Online ahead of print

URL:

Using Insulin to Treat Poorly Controlled Type 2 Diabetes in 2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2020.1303

Keywords

PMID (1):

32442246

MeSH

Sodium-Glucose Transporter 2 Inhibitors

hypoglycemic agents

insulin

glycated hemoglobin a

dipeptidyl-peptidase IV inhibitors

Metformin

diabetes mellitus, type 2

Glucagon-Like Peptide-1 Receptor

Thiazolidinediones

A potentially useful decision algorithm for management of patients with Type 2 diabetes, which includes early consideration of use of basal insulin in patients with A1c > 9%. James W. Mold, MD, MPH

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No abstract available

Author/s:

Hirsch, IB, Gaudiani, LM

Clinical Practice Guideline: Ménière's Disease Executive Summary

John Bayhi — Mon, 18 May 2020 22:07:40 +0000

Date Added:

May 18, 2020

Journal/Publication:

Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery

Publisher:

Sage Publishing

Publication Date:

April 1, 2020

Issue:

Volume:

162

Pages:

415-434

URL:

Clinical Practice Guideline: Ménière's Disease Executive Summary

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1177/0194599820909439

Keywords

Meniett device

electrocochleography

endolymphatic hydrops

endolymphatic sac decompression

fluctuating aural symptoms

gentamicin

labyrinthectomy

sensorineural hearing loss

sodium-restricted diet

vestibular testing

PMID (1):

32267820

MeSH

A 2020 guideline for diagnosis and management of Meniere’s Disease from the American Academy of Otorhinolaryngology. James W. Mold, MD, MPH

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OBJECTIVE:

Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

PURPOSE:

The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

Author/s:

Basura, GJ, Adams, ME, Monfared, A, Schwartz, SR, Antonelli, PJ, Burkard, R, Bush, ML, Bykowski, J, Colandrea, M, Derebery, J, Kelly, EA, Kerber, KA, Koopman, CF, Kuch, AA, Marcolini, E, McKinnon, BJ, Ruckenstein, MJ, Valenzuela, CV, Vosooney,A, Walsh, SA, Nnacheta, LC, Dhepyasuwan, N, Buchanan, EM

Summary of Revisions: Standards of Medical Care in Diabetes—2020

John Bayhi — Sat, 14 Mar 2020 19:35:38 +0000

Date Added:

March 14, 2020

Journal/Publication:

Diabetes Care

Publisher:

American Diabetes Association

Publication Date:

January 1, 2020

Issue:

Supplement 1

Volume:

Pages:

S4-S6

URL:

Summary of Revisions: Standards of Medical Care in Diabetes—2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.2337/dc20-Srev

Keywords

PMID (1):

31862743

MeSH

Sodium-Glucose Transporter 2 Inhibitors

Diabetic Ketoacidosis

Ficus

Glucagon-Like Peptide-1 Receptor

glycated hemoglobin a

cardiovascular diseases

Consensus

Farmers

Cystic Fibrosis

Transients and Migrants

Pharmaceutical Preparations

depression

Smell

Patient Comfort

electronic nicotine delivery systems

Blood Glucose Self-Monitoring

celiac disease

follow-up studies

Latent Autoimmune Diabetes in Adults

seasons

social determinants of health

Standard of Care

Time-to-Treatment

united states food and drug administration

risk reduction behavior

Centers for Disease Control and Prevention

glucagon-like peptide 1

anxiety disorders

Feeding and Eating Disorders

thyroid diseases

Infections

This is a three-page summary of the 2020 updates to the ADA Guidelines for Type 2 diabetes. James W. Mold, MD, MPH

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No abstract available.

Bisphosphonates for Postmenopausal Osteoporosis

John Bayhi — Sat, 19 Oct 2019 14:38:56 +0000

Date Added:

October 19, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 17, 2019

URL:

Bisphosphonates for Postmenopausal Osteoporosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.15781

Keywords

post-menopausal osteoporosis

bisphosphonates

antiresorptive agents

PMID (1):

31621799

MeSH

Bone Density Conservation Agents

Raloxifene Hydrochloride

Risedronate Sodium

Alendronate

Osteoporosis, Postmenopausal

Selective Estrogen Receptor Modulators

Gatroesophageal Reflux

Estrogens

vitamin D deficiency

Peptic Ulcer

risk reduction behavior

A short, sweet review of how, when, and for how long to treat postmenopausal osteoporosis. James W. Mold, MD, MPH

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Bisphosphonates are the first-line pharmacologic treatment for postmenopausal osteoporosis and the most commonly prescribed medication for this condition.1 Bisphosphonates, classified as antiresorptive agents, have a very high affinity for bone mineral and bind to hydroxyapatite crystals on bony surfaces, where they inhibit osteoclast-mediated bone resorption.

Author/s:

Ensrud, KE, Crandall, CJ

Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States: The STEP UP Randomized Clinical Trial

Brian Desmarais — Wed, 11 Sep 2019 19:46:36 +0000

Date Added:

September 11, 2019

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA

Publication Date:

September 9, 2019

URL:

Effectiveness of Behaviorally Designed Gamification Interventions With Social Incentives for Increasing Physical Activity Among Overweight and Obese Adults Across the United States: The STEP UP Randomized Clinical Trial

Type:

Practice Management Reviews and Guidelines

DOI (1):

10.1001/jamainternmed.2019.3505.

Keywords

weigh loss programs

competition

MeSH

Wearable Electronic Devices

Economics, Behavioral

Goals

motivation

body mass index

Adding competition to a weight loss program enhanced and sustained its effectiveness. James W. Mold, MD, MPH

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IMPORTANCE:

Gamification, the use of game design elements in nongame contexts, is increasingly being used in workplace wellness programs and digital health applications. However, the best way to design social incentives in gamification interventions has not been well examined.

OBJECTIVE:

To assess the effectiveness of support, collaboration, and competition within a behaviorally designed gamification intervention to increase physical activity among overweight and obese adults.

DESIGN, SETTING, AND PARTICIPANTS:

This 36-week randomized clinical trial with a 24-week intervention and 12-week follow-up assessed 602 adults from 40 states with body mass indexes (calculated as weight in kilograms divided by height in meters squared) of 25 or higher from February 12, 2018, to March 17, 2019.

INTERVENTIONS:

Participants used a wearable device to track daily steps, established a baseline, selected a step goal increase, were randomly assigned to a control (n = 151) or to 1 of 3 gamification interventions (support [n = 151], collaboration [n = 150], and competition [n = 150]), and were remotely monitored. The control group received feedback from the wearable device but no other interventions for 36 weeks. The gamification arms were entered into a 24-week game designed using insights from behavioral economics with points and levels for achieving step goals. No gamification interventions occurred during follow-up.

MAIN OUTCOMES AND MEASURES:

The primary outcome was change in mean daily steps from baseline through the 24-week intervention period.

RESULTS:

A total of 602 participants (mean [SD] age, 39 [10] years; mean [SD] body mass index, 30 [5]; 427 [70.9%] male) were included in the study. Compared with controls, participants had a significantly greater increase in mean daily steps from baseline during the intervention in the competition arm (adjusted difference, 920; 95% CI, 513-1328; P < .001), support arm (adjusted difference, 689; 95% CI, 267-977; P < .001), and collaboration arm (adjusted difference, 637; 95% CI, 258-1017; P = .001). During follow-up, physical activity remained significantly greater in the competition arm than in the control arm (adjusted difference, 569; 95% CI, 142-996; P = .009) but was not significantly greater in the support (adjusted difference, 428; 95% CI, 19-837; P = .04) and collaboration (adjusted difference, 126; 95% CI, -248 to 468; P = .49) arms than in the control arm.

CONCLUSIONS AND RELEVANCE:

All 3 gamification interventions significantly increased physical activity during the 24-week intervention, and competition was the most effective. Physical activity was lower in all arms during follow-up and only remained significantly greater in the competition arm than in the control arm.

TRIAL REGISTRATION:

ClinicalTrials.gov identifier: NCT03311230.

Author/s:

Patel, M.S., Small, D.S., Harrison, J.D., Fortunato, M.P., Oon, A.L., Rareshide, C.A.L., Reh, G., Szwartz, G., Guszcza, J., Steier, D., Kalra, P., Hilbert V.