A single negative colonoscopy associated with long-lasting and significantly reduced cancer incidence

May 25, 2020

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. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. A single negative colonoscopy associated with long-lasting and significantly reduced cancer incidence and mortality
Study findings suggest that CRC screening interval might safely be extended

Abstract: https://www.acpjournals.org/doi/10.7326/M19-2477
URL goes live when the embargo lifts

Having a single negative high-quality screening colonoscopy was associated with reduced colorectal cancer (CRC) incidence and mortality (by 84 percent and 90 percent, respectively) for up to 17.4 years. These findings suggest that the currently recommended 10-year screening interval could safely be extended. Findings from an observational study are published in Annals of Internal Medicine.

Current guidelines recommend a 10-year interval between negative screening colonoscopies for average-risk adults. This recommendation is based on estimates of time between adenoma and carcinoma, as well as extrapolations from studies assessing colonoscopy sensitivity. A lack of long-term data makes it challenging to determine the optimal screening interval following a normal colonoscopy.

Researchers from The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland studied a screening registry for 165,887 individuals to assess the long-term risk for CRC and death from CRC after high- and low-quality single negative screening colonoscopy. The researchers found that a single negative screening colonoscopy was associated with a significantly reduced CRC incidence and mortality over more than 17 years of follow-up, but only high-quality colonoscopy provided a profound and stable reduction in both CRC incidence and mortality throughout follow-up period. High quality was key for the profound long-term efficacy of screening colonoscopy in the proximal colon, and among women. The researchers point out that these findings are of paramount importance, because previous reports have questioned the efficacy of colonoscopy in the proximal colon and of screening sigmoidoscopy in women. These findings suggest that the currently recommended 10-year interval for screening colonoscopy is safe and could potentially be extended.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Nastazja Dagny Pilonis, MD, nastazja@gmail.com.

2. Aldosterone production is a common and unrecognized cause of high blood pressure

Abstract: https://www.acpjournals.org/doi/10.7326/M20-0065
Editorial: https://www.acpjournals.org/doi/10.7326/M20-1758
URL goes live when the embargo lifts

Findings from a cross-sectional study published in Annals of Internal Medicine implicate the hormone aldosterone as a common and unrecognized contributor to hypertension.

Hypertension affects more than 1.5 billion people worldwide and is arguably the leading preventable cause of heart disease and stroke. Primary aldosteronism is a condition where the adrenal glands produce too much of the hormone aldosterone, which causes high blood pressure and cardiovascular disease. Primary aldosteronism has traditionally been considered to be an uncommon cause of hypertension, however, the findings of this study show that it is much more common than previously recognized.

Researchers from four academic medical centers (including Brigham and Women's Hospital, University of Alabama, University of Virginia, and University of Utah) studied patients with normotension (n = 289), stage 1 hypertension (n = 115), stage 2 hypertension (n = 203), and resistant hypertension (n = 408) to determine the prevalence of excess aldosterone production and primary aldosteronism. They found that there was a continuum of excess aldosterone production that paralleled the severity of blood pressure. Importantly, most of this excess aldosterone production would have not been recognized by currently recommended diagnostic approaches. According to the authors, this finding supports the need to redefine primary aldosteronism from a rare disease to, instead, a common syndrome that manifests across a broad severity spectrum and may be a primary cause of hypertension. Since generic medications that block the deleterious effects of aldosterone already exist and are easily available, these findings suggest that using these drugs more frequently to treat hypertension may be an effective way to lower the risk of cardiovascular disease.

The author of an accompanying editorial, Professor John Funder, who currently chairs the international guidelines for the diagnosis and management of primary aldosteronism, called the study a "game changer" and indicated that these findings should trigger a "radical reconstruction" of current clinical practice and guideline recommendations.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Anand Vaidya, MD, MMSc, please contact Elaine St. Peter at estpeter@bwh.harvard.edu.

3. Liraglutide provides excellent glucose control in patients with type 2 diabetes and cirrhosis, but should we optimize the prevention of variceal bleeding?

Abstract: https://www.acpjournals.org/doi/10.7326/L20-0041
URL goes live when the embargo lifts

The glucagon-like peptide-1 (GLP-1) agonist drug, liraglutide, seems to provide excellent glucose control in patients with type 2 diabetes who are also taking a beta-blocker, specifically propranolol, to prevent bleeding from esophageal varices due to cirrhosis, but it seems to hamper the pharmacological effects of beta-blockers. A case report is published in Annals of Internal Medicine.

When using beta-blockers to prevent bleeding from esophageal varices, clinicians use the resting heart rate as a guide, as these therapies lower heart rate. GLP-1s are used to treat diabetes because they lower blood glucose levels and are especially useful when the patient is obese and has nonalcoholic fatty liver disease, but they are known to increase heart rate, although not significantly. No data are available on the concomitant treatment with GLP-1 analogues and β-blockers in patients with cirrhosis and diabetes.

Researchers from University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy studied 18 consecutive patients with cirrhosis who were receiving propranolol to prevent variceal bleeding while also receiving liraglutide for uncontrolled type 2 diabetes. Liraglutide provided optimal control of blood glucose, HbA1c and body weight, but the researchers observed a lack of optimal effect of beta-blockers on heart rate after starting a GLP-1 receptor agonist. However, in this small cohort no increase in bleeding rate was observed. The researchers propose a mechanistic molecular explanation of how a GLP-1 receptor agonist might prevent beta-adrenergic receptor blockade.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Ranka Vukotic, MD, PhD, please email directly to ranka.vukotic2@unibo.it or ranka81@yahoo.it.

American College of Physicians

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.