Young-onset diabetes linked to higher risk of hospitalization for mental illness before age 40

January 14, 2019

1. Young-onset diabetes linked to higher risk of hospitalization for mental illness before age 40

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1900

URLs go live when the embargo lifts

Young-onset diabetes, which is defined as onset before age 40, is associated with a higher risk of being hospitalized for mental illness compared with those who develop diabetes later in life. Those with young-onset diabetes also faced increased hospitalizations for any reason across their lifetime. Findings from a population-based cohort study are published in Annals of Internal Medicine.

Young-onset diabetes is a heterogeneous and aggressive phenotype associated with increased risk for death and complications compared with usual-onset diabetes. Its prevalence is increasing rapidly worldwide, especially in Asian populations, where 1 in 5 adults with type 2 diabetes has young-onset disease. Young-onset diabetes is associated with poorly-controlled risk factors, yet its effect on hospitalization rates is not known.

Researchers at The Chinese University of Hong Kong examined two large cohorts of Chinese adults with type 2 diabetes to determine the effects of age at onset and modifiable risk factors on hospitalization during the working lifespan, or ages 20 to 75. Using the Hong Kong Diabetes Registry, the researchers computed hospitalization rates for both cohorts. They found that adults with young-onset diabetes, had excess hospitalizations across their lifespan compared with persons with usual-onset diabetes, but also found a previously unknown link between young-onset diabetes and hospitalization for mental illness. According to the researchers, these findings suggest that efforts to prevent diabetes early in life are crucial. In addition, there is an urgent need to find ways to control cardiometabolic risk factors while focusing on mental health.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Juliana C.N. Chan, MD, please contact Jackie Chan at jackiechan@cuhk.edu.hk.

2. ACP issues ethical guidance on genetic testing, telemedicine, end-of-life care, human subjects research, and more in its latest Ethics Manual

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2160

Editorial: http://annals.org/aim/article/doi/10.7326/M18-3120

URLs go live when the embargo lifts

The American College of Physicians (ACP) issues ethical guidance on genetic testing, telemedicine, and end-of-life care, human subjects research, and more in its latest Ethics Manual. Published as a supplement in Annals of Internal Medicine, the 7th edition of ACP's Ethics Manual reaffirms ethical tenets of medicine and reexamines their application in changing circumstances.

The Ethics Manual is intended to facilitate the process of making ethical decisions in clinical practice, teaching, and medical research, and to describe and explain underlying principles of ethics, as well as the physician's role in society and with colleagues. New or significantly expanded sections include precision medicine and genetic testing, research and protection of human subjects, telemedicine, electronic communications, social media and online professionalism, electronic health records, and physician volunteerism. The manual also revisits issues that are still very pertinent and in which ACP has maintained long-standing positions, such as on end-of-life care and physician-assisted suicide, physician-industry relations, and complementary and integrative care.

A continuing medical education (CME) quiz and a maintenance of certification (MOC) module are available at http://www.annals.org for ACP members and subscribers to Annals of Internal Medicine. ACP also offers ethics case studies for CME credit and MOC points.

The ACP Ethics Manual is developed primarily for doctors but has been widely used by educators, policymakers, and patients, and is often cited in medical and ethical literature. The first ACP Ethics Manual was published in 1984. This seventh edition is an update of the 2012 sixth edition and was developed by ACP's Ethics, Professionalism, and Human Rights Committee. ACP's Board of Regents reviewed and approved the manual.

Media contact: For an embargoed PDF or to interview someone from ACP, please contact Steve Majewski at smajewski@acponline.org or 215-351-2514.

3. Man's monthly sweating episodes caused by undiagnosed seizures

Abstract: http://annals.org/aim/article/doi/10.7326/L18-0425

URLs go live when the embargo lifts

A man's monthly episodes of excessive sweating were found to be triggered by temporal lobe seizures that were previously undiagnosed. The brief case report is published in Annals of Internal Medicine.

Excessive sweating is common and frequent causes include obesity, anxiety, or hyperthyroidism, among many other common conditions. Cyclic sweating is different because it occurs in cycles that are regularly repeated.

Clinicians from Advocate Aurora Health Care and Ascension Wisconsin saw a 60-year-old man complaining of spontaneous episodes of sweating that had started 3 years earlier. A series of tests ruled out common causes. During an office visit, the patient had an episode of severe sweating observed directly by the clinicians. Altered responsiveness during the sweating event suggested a seizure, so the clinicians scheduled a 7-day ambulatory EEG to begin a few days before his next expected cluster of sweating episodes. The EEG showed left temporal lobe activity suggesting a seizure. After treatment with anti-seizure medications, the patient has only had one episode of sweating in the last year and a half. According to the authors, these findings suggest that seizures should be considered in the differential diagnosis of cyclic conditions with autonomic symptoms, such as sweating or nausea and vomiting.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Mark K. Chelmowski, MD, please contact him directly at mchelm81@gmail.com.

Also New in this issue:

Inpatient Notes: Caregiver Engagement in Hospital Medicine--The Next Frontier

Molly J. Horstman. MD, and Eduardo Salas, PhD

Annals for Hospitalists

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3614

Annals Consult Guys - Low Risk for Postoperative Myocardial Infarction: What Do We Really Know?

Geno J. Merli, MD; Howard H. Weitz, MD

Annals Consult Guys

Abstract: http://annals.org/aim/article/doi/10.7326/W18-0028

Annals On Call: Understanding Gout Pathophysiology

Robert Centor, MD

Annals On Call Podcast

Abstract: http://annals.org/aim/article/doi/10.7326/A18-0012
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American College of Physicians

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