1. More than 80% of American adults with type 2 diabetes meet treatment criteria for GLP-1 RAs or SGLT2is but most are not getting them
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3051
URL goes live when the embargo lifts
A brief research report found that more than 80 percent of U.S. adults and nearly all Medicare beneficiaries with type 2 diabetes (T2D) would meet the criteria to use either glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or sodium–glucose cotransporter-2 inhibitors (SGLT2is), but only 3.7 percent of those adults meeting the criteria used GLP-1 RAs and 5.3 percent of those adults meeting the criteria used SGLT2is. However, at current drug pricing, using these 2 new medications as first-line agents among all eligible patients with T2D may not be cost-effective. The report is published in Annals of Internal Medicine .
The 2022 consensus report from the American Diabetes Association and European Association for the Study of Diabetes recommended using GLP-1 RAs among persons with T2D who have established or are at high risk for atherosclerotic cardiovascular disease (ASCVD) and using SGLT2is among those with T2D who have established ASCVD, chronic kidney disease, or heart failure or are at high risk for ASCVD. Clinical studies have shown that both GLP-1 RAs and SGLT2is yield additional clinical benefits compared with older treatments in reducing body weight and progression of cardiovascular disease (CVD) and chronic kidney disease.
Researchers from the Centers for Disease Control and Prevention and Emory University conducted an analysis of 1,330 nonpregnant adults aged 20 years or older in NHANES (National Health and Nutrition Examination Survey) with T2D. Based on their analysis, the authors estimate that 82.3 percent of, or 22.4 million, American adults with T2D per year would meet the recommended criteria to use the 2 medications. However, only 1 in 10 of them used either of these medications between 2017 and 2020, a period when these 2 medications were not recommended as first-line therapy to many patients now eligible in the 2022 guidelines. These medications have a substantially higher cost than current first-line medications, and current cost would have to decrease by 70 percent for these to be cost-effective as first-line agents.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with the corresponding author, Shichao Tang, PhD, please email Jenna Mink at kti1@cdc.gov .
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2. Internal Medicine Physicians Call for Policies that Would Protect Patient Access to Reproductive Health Care Services
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3316
Patients need to be able to access comprehensive reproductive health services without undue government interference, including abortion, says the American College of Physicians (ACP) in a new policy paper published in Annals of Internal Medicine . Reproductive Health Policy in the United States: An ACP Policy Brief, details new recommendations to protect patient access to care through the freedom to travel to seek medical care and ability to receive prescription medication in the mail or via other shipping and delivery services and opposes efforts to criminalize the practice of medicine and restrict access to care.
ACP’s recommendations oppose government restrictions that would erode equitable access to reproductive health care services, including family planning, sexual health information, the full range of medically accepted forms of contraception, and abortion. ACP also opposes criminal or civil penalties for providing or otherwise facilitating clinically appropriate health care services that meet the standard of care. The recommendations specifically denounce regulations that allow private citizens to have the ability to enforce state laws and the use of personal health information to prosecute or penalize individuals. Finally, ACP affirms that individuals should have access to high-quality health care regardless of where they live; including the ability to have legally prescribed drugs shipped and delivered, and the freedom to travel across state or U.S. borders to access health care services.
The authors from ACP say they are particularly alarmed by restrictions on reproductive services that would subject physicians to stiff criminal penalties for providing, or even simply making a referral for abortion care. ACP stresses that patients need to know that their physicians can provide them with the medical care and advice that they need, while physicians need to be free to care for our patients in accordance with their own clinical judgment and based on clinical evidence and the standard of care, without being threatened with punitive laws
The recommendations are an update and expansion of ACP’s paper, Women’s Health Policy in the United States, that was published in Annals in 2018.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with someone from ACP, please email Jacquelyn Blaser at jblaser@acponline.org .
3. Fewer surveillance MRIs may be appropriate for patients with incidental pituitary lesions
Abstract: https://www.acpjournals.org/doi/10.7326/M22-1728
A cohort study of persons with incidental pituitary microadenomas found that approximately two-thirds of the microadenomas remained unchanged or decreased in size over time. These findings suggest that less frequent pituitary magnetic resonance imaging (MRI) surveillance for patients with incidental pituitary microadenomas may be safe. The findings are published in Annals of Internal Medicine .
Incidental pituitary lesions are common, and their estimated prevalence is 10 to 38.5 percent in radiological studies. With increased use of brain imaging techniques, more pituitary lesions have been identified, including asymptomatic solid or cystic lesions called incidentalomas. These lesions are categorized as macro- versus microadenomas. Most are microadenomas. However, how frequently these incidental lesions should be monitored by serial pituitary MRI remains unclear.
Researchers from Brigham and Women's Hospital and Harvard Medical School conducted a cohort study of 177 persons with pituitary microadenomas who received more than 1 MRI. The authors report that 78 patients experienced no change in the size of the microadenoma over time, 49 experienced an increase in size, 34 experienced a decrease in size, and 16 experienced an increase then decrease in size. The authors report that among the 28 percent of microadenomas that increased in size, the maximal size increase was 6 mm. They add that their findings suggest that although a subgroup of patients displayed an increase in tumor size over the study period, the tumor growth rates were slow and the increases in size were limited. According to the authors, their findings suggest that less frequent pituitary MRI surveillance for patients with incidental pituitary microadenomas may be safe.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org . To speak with the corresponding author Le Min, MD, PhD, please email Haley Bridger at hbridger@partners.org .
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Also new in this issue:
Data Sharing Enters a New Era
Howard Bauchner, MD; Mary M. McDermott, MD; and Atul J. Butte, MD, PhD
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3479
Annals of Internal Medicine
Data/statistical analysis
People
Recommended and prevalent use of glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter-2 inhibitors in a national population-based sample
28-Feb-2023