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Reading the Tea Leaves

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Morning Report: Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Twice a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Larry David would insist we’ve missed our “Happy New Year” window, but we haven’t emailed you since last year, so we feel compelled to say it: Happy New Year to you! Further channeling Larry, we hope 2022 is a “pretty, pretty, pretty good” year.

ADA’s Updated Standards of Medical Care

GUIDELINE GUIDANCE

It’s that time of year again. As reliably as Tom Brady secures a spot in the playoffs every winter, the American Diabetes Association (ADA) releases its annual updates to the Standards of Medical Care in Diabetes. This year’s recommendations offer several key changes.

First-line therapy

In years past, choosing metformin as first-line therapy for patients with type 2 diabetes mellitus (T2DM) has been a no-brainer, like choosing Bill Belichick as your hoodie stylist. This year, the ADA says, “Not so fast!” When selecting first-line treatment, consider comorbidities (eg, ASCVD, heart failure, and chronic kidney disease) as well as cost. See the updated pharmacologic treatment algorithm for patients with T2DM.

Screening

To cast a wider net, the ADA recommends screening all adults 18 years or older with overweight, obesity, or other risk factors, and screening all adults starting at age 35.

Diabetes in pregnancy

The ADA suggests screening women for gestational diabetes in the preconception stage if they have risk factors, and screening all pregnant women with risk factors before 15 weeks.

Technology

You’ll find several updates to the diabetes technology section. Here are just a few:

  • Provide blood glucose monitoring to all continuous glucose monitor (CGM) users for CGM calibration, for verification of blood glucose, and as a backup if CGM is unavailable
  • Offer either real-time or intermittently scanned CGMs to patients on multidose insulin injections or a continuous subcutaneous insulin infusion
  • Recommend insulin pens over syringes for most patients

Check out the full list of updates here. You may also be interested in the following article and associated commentary, which undoubtedly informed the ADA’s updated recommendations:

Hot Take—Chili Peppers May Lower Mortality Risk

DIETARY DIGEST

Consuming hearty amounts of chili peppers is often a bold choice—like picking Adele, Aretha, or Whitney from the karaoke menu. But according to a new study, patients looking to improve (and spice up) their diet in 2022 may want to add this pungent produce to their grocery list.

Researchers conducted a review and meta-analysis to answer the burning question of whether regular chili intake improves mortality risk, a theory affirmed by previous nonrandomized studies. This latest review yielded only four eligible studies (from a pool of >4,000), but they included both observational and randomized controlled trials.

The pooled analysis revealed the following:

  • A link between high consumption of chili peppers and lower relative risk of all-cause (13%), cardiovascular (17%), and cancer-related mortality (8%)
  • No association between chili pepper consumption and stroke
  • A lack of evidence to determine the amount and form of chili pepper consumption that are most beneficial

What gives chili peppers their superpower?

Capsaicin. It’s the chemical compound found in chili peppers that is believed to confer cardioprotection, weight loss, and anti-tumorigenic effects. (It also binds to pain receptors and is responsible for that familiar cry of “Get me milk—quick!”)

As with most dietary studies, caveats abound, but ultimately this study shows that adventurous patients looking for a health boost may want to add chili peppers to the menu—if tolerability isn’t an issue (a big if in this case).

Rapid-Fire COVID-19 Updates

COVID QUICK HITS

One Way to Boost Your Patient’s Breast Cancer Survival Odds

CANCER CONCLUSIONS

Do you offer integrative services to your patients with breast cancer? According to a study involving nearly 5,000 patients with newly diagnosed breast cancer, access to these services enhances a patient’s five-year survival odds.

What are integrative services?

Integrative services comprise many practices, but the five highlighted in this study (and most adopted) were exercise counseling, nutrition counseling, psycho-oncology support, chaplain services, and patient support groups. Studies have already demonstrated the benefits of these services on quality of life, but their association with survival rates has been largely unknown.

This study stratified the participants’ treatment institutions into low, low-mid, mid-high, and high, based on their level of education, support, and provision of integrative therapies. The five-year survival rate for those in the low-mid group was three times higher than for those in the low group. The mid-high group saw a 48% improvement over the low group. However, the results for the high group (with the greatest focus on services) didn’t show a change, possibly because the sickest patients may have chosen an institution with a more holistic approach.

Key takeaway

Based on these findings, the recommendation from the authors is to offer all patients with breast cancer at least the five practices noted above plus meditation, if not other integrative services as well. These recommendations don’t apply solely to oncologists. Primary care clinicians can incorporate these integrative services into their practices, or refer out, to give their patients with breast cancer the best chance for survival.

Did You Know?

That (1) the man who developed Botox (for medical use) passed away last month at the age of 89 and (2) he never intended the drug to be used to erase wrinkles? Dr. Alan Brown Scott, an ophthalmologist from California, was seeking a novel treatment for eye disorders, such as strabismus and blepharospasm, when he was introduced to a toxin derived from the bacterium Clostridium botulinum. Other scientists had discovered and isolated the deadly botulinum toxin, but Dr. Scott was the first credited with leveraging its paralyzing qualities for medical purposes.

Forty years ago, he took a bold risk by injecting botulinum toxin into the eye muscles of a patient who’d undergone several failed operations for double vision. Great success! Instead of earning a medical malpractice lawsuit, he earned the title “Father of Botox.”

Decades later, botulinum toxin would be used to treat not only eye disorders but also migraines, hair loss, urinary incontinence, and drooling—but it would be used most prominently to iron out wrinkles. Ironically, Dr. Scott was not a proponent of this last application, calling it a “charming, slightly frivolous use.” Despite Dr. Scott’s dismissal of botulinum toxin’s cosmetic purposes, its use as an elixir to rewind the clock seems here to stay, with more than seven million people opting for this “charming” treatment each year.

Reality Check—Will Virtual Reality Permeate Healthcare?

EMERGING TRENDS

For obvious reasons, real life has been a challenge the past couple of years, so it’s no wonder the virtual reality (VR) industry has been erupting faster than Mentos in a Diet Coke. With advances in VR technology and increased user adoption, these simulated experiences may soon have implications for telemedicine as well—if patients are comfortable with the modality. And according to a fascinating new study, some patients may be ready.

Researchers pitted face-to-face human interactions against VR interactions with a “realistic motion avatar”—a doppelganger so accurate a spouse would do a double take. Approximately 50 undergraduate psychology students were asked to engage with both modalities (real and VR) for two types of conversations: an informal “getting to know you” chat and a more intimate structured interview requiring self-disclosures. The students then rated their experiences.

Keepin’ it real—the salient findings from the study:

  • Most—but not all—participants preferred face-to-face interactions
  • 30% preferred discussing negative personal experiences with a VR avatar
  • No significant differences were found in levels of “enjoyment, understanding, self-disclosure, comfort, and awkwardness”
  • Face-to-face interactions came out on top in the category of perceived “closeness”
  • Eye contact was similar between groups but there was a slight nod to face-to-face interactions

In general, the social interactions were rated similarly across the two modalities. This finding led the authors to speculate on the future use of VR for telehealth, specifically mental health therapy, especially for patients less comfortable in the traditional setting.

If we’re reading the tea leaves correctly, you may one day find yourself treating patients in a virtual world. According to one of the study authors, Dr. Shane Rogers, “This technology has the potential for broad application across a number of areas such as casual conversation, business, tourism, education and therapy.”

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

  • Alissa Scott, Lead Author
  • Aylin Madore, MD, MEd, Author and Editor
  • Shira Page, RN, NP, Author and Editor

Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com and let us know how we’re doing.

Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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