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.
Diabetes Control Skids off the Road
Remember the infamous Super Bowl LI, in which the Atlanta Falcons mounted a 28-3 lead against the New England Patriots in the third quarter? It was, surely, an insurmountable lead. Falcon fans were high-fiving and texting each other congratulations. Then touchdown by touchdown, the Pats erased all the Falcons’ momentum and hopes of victory.
Something similar is transpiring in the world of diabetes, but obviously the stakes are much higher. A cross-sectional analysis of NHANES data from 1999 to 2018 on US adults with diabetes revealed disappointing findings.
The study, published in The New England Journal of Medicine, aimed to determine trends in diabetes treatment and risk factor control. In other words, how well have we been managing blood glucose, lipids, and blood pressure in patients with diabetes? At first, fairly well! For the initial 10 years of the study, the percentage of people with diabetes achieving glycemic control (HbA1c <7), lipid control (non-HDL cholesterol <130 mg/dL), and blood pressure control (<140/90 mm Hg) steadily rose:
- Glycemic control: 44.0% → 57.4%
- Lipid control: 25.3% → 52.3%
- Blood pressure control: 64.0% → 72.1%
- Control of all risk factors combined: 9% → 24.9%
However, around 2010, the wheels of positive momentum began to skid.
What happened in the 2010s?
The decade that introduced us to skinny jeans, selfie sticks, and an unrelenting barrage of superhero movies also ushered in a wave of declining or plateauing diabetes control. And by 2018, blood glucose control dropped to 50.5% (from 57.4%), lipid control improved modestly to 55.7% (from 52.3%), blood pressure control decreased to 70.4% (from 72.1%), and all three combined dropped to 22.2% (from 24.9%). With this downward or flattening trend in risk factor control, we will surely see an upward trend in diabetes-related illness and death.
This article gives us a lot to unpack regarding these data trends and possible catalysts for the momentum shift. More to come on how to refocus our efforts. We may need Coach Belichick to give another halftime speech for the ages to get us back on track.
Apologies to our Falcons fans for dredging up any painful memories.
Healthcare Trivia Question
The incidence of deep veinous thrombosis (DVT) and pulmonary embolism (PE) is on the rise in the United States. That increase is most likely due to the growing prevalence of obesity and the aging baby boomer population. However, increasing cases of DVT in otherwise healthy adolescents have also been reported.
What adolescent (and adult) hobby could be a risk factor for DVT?
Answer at the bottom of the newsletter.
As if your patients with osteoporosis didn’t have enough to worry about, a longitudinal study revealed an increased risk between osteoporosis, low bone density, or a previous vertebral fracture and hearing loss in women. And, despite collective finger crossing among the researchers, bisphosphonate therapy failed to mitigate this risk. (Bisphosphonates had previously shown prevention of noise-induced hearing loss in mice.)
Researchers looked at 144,000 women from two studies, the Nurses’ Health Study (NHS) and the NHS II, with a follow-up period of up to 34 years. Results from the NHS showed that women with osteoporosis had a 14% relative risk increase in hearing loss when compared with women without osteoporosis. In the NHS II, women with osteoporosis or low bone density experienced an even greater relative increase: 30%.
Here’s the fascinating part
A previous vertebral fracture was associated with an even higher relative risk of hearing loss: 31% in the HNS and 39% in the NHS II. BUT, a previous hip fracture did NOT correlate with an increased risk. The authors note, “The discordant findings between these skeletal sites may reflect differences in composition and metabolism of bones in the spine and hip and could provide insight into the pathophysiological changes in the ear that may lead to hearing loss.”
What causes the link between osteoporosis and hearing loss? Maybe…
- Bone loss could also occur within structures in the ear
- The imbalances related to bone formation and resorption found in osteoporosis could cause changes in ionic metabolism, potentially leading to hearing loss
The message is clear: routinely screen for hearing loss in all patients but especially this patient population. We don’t need to remind you that early detection leads to more successful management of hearing loss.
Results of CV Study Eggs-actly What We Hoped
You know that feeling of holding your breath when a new study comes out about coffee or red wine? For many, the same goes for eggs. Will we be told to eschew all eggs or to bake at least one quiche a day?
For generations, the egg’s high cholesterol content has made it an easy target for claims about increased risk of heart disease. Fortunately, we have eggs-cellent news to share! A meta-analysis revealed that eating eggs is not associated with an increased risk of cardiovascular events, at least over a span of 12 years. In fact, consuming more than one egg per day was associated with an 11% decrease in relative risk of developing coronary artery disease. Yes! Break out the whisks! But before we do, let’s keep in mind the possibility that egg consumption could be confounded by other healthy habits.
Nevertheless, the take-away here is to assure your patients that egg consumption is not only safe but may even be beneficial. Eggs-traordinary! (That was the last dad joke, we swear. Happy Father’s Day weekend to all you dads out there!)
Craving an egg dish? Check out our favorite frittata recipe.
How many psychiatrists does it take to change a lightbulb?
Only one, but the lightbulb has to WANT to change.
What’s the Best Intervention for Long-Term Relief of Chronic Back Pain?
Researchers set out to determine which interventions for chronic back pain (>3 months) led to meaningful pain relief—a 30% reduction in pain was deemed the magic number. They conducted 15 individual systematic reviews of individual interventions and included 63 trials totaling >16,000 participants. Here’s how several interventions fared against the control:
- Exercise (mostly guided by a physiotherapist): More effective, with sustained benefit of up to 48 weeks (number needed to treat [NNT=7])
- Oral nonsteroidal anti-inflammatory drugs (NSAIDs): More effective while patients were taking them (NNT=6)
- Duloxetine: More effective (NNT=10), but discontinuation due to adverse effects was more common than control
- Opioids: More effective (NNT=16), but discontinuation due to adverse effects was more common than control
- Spinal manipulation: More effective, but lower quality evidence (NNT=6)
- Topical capsaicin: More effective despite superficial burning, but lower quality evidence (NNT=6)
- Acupuncture: Equal to control (in higher quality studies)
- Corticosteroid injections: Equal to control (poor quality studies)
Based on the available data, exercise was the winner as it was the only intervention to provide sustained benefit (up to 48 weeks)!
Who needs needles, pills, and creams when good ol’ fashioned sweat can help do the job (at least with the help of a physiotherapist). Some patients will love this study’s findings, while others may not. Remind patients of the myriad benefits of exercise in addition to chronic back pain relief: heart disease risk reduction, weight control, improved mental health, and so on!
Five Steps to a More Inclusive Practice
In honor of Pride Month, we want to share five practical tips from Medical Economics for making your healthcare practice more welcoming to members of the lesbian, gay, bisexual, transgender, or queer (LGBTQ) community. Given the known health disparities that exist in this patient population, we all need to do our part to foster a healthcare environment that puts patients who identify as LGBTQ at ease. Without further ado, here’s a list—some of which you may already be doing—that may help you build loyalty and trust with this community:
- Don’t expect perfection on day one. Even though your intentions are good, you may make a mistake in your communication. It’s okay to acknowledge that you don’t know all the nuances of the LGBTQ community. The important thing is to continually educate yourself.
- Don’t be afraid to ask about sexual orientation and gender identity (SOGI). In fact, it’s important that you do! Many online resources can help you start the conversation about SOGI.
- Develop an intake form that avoids binary answers and uses inclusive language. Ask for sex assigned at birth, their preferred name, the name on their health insurance, and their preferred pronoun, and ask your staff to review these forms before addressing patients. Here is a resource to help you create a more inclusive form.
- Incorporate LGBTQ welcoming cues in your office and on your website. For your waiting room, consider LGBTQ magazines, educational brochures on LGBTQ health risks, and a nondiscrimination statement. For your website, avoid showing images of only traditional families; incorporate images of two men or two women.
- Be sensitive to older LGBTQ patients. Consider that this patient group grew up in an era when homosexuality was less accepted. Be aware of this historical context so that you can provide trauma-informed and affirming care.
Chances are, you’re already taking some of these steps, but we can all find ways to improve. Continually working toward establishing a more inclusive environment is key to engaging the LGBTQ community in their healthcare and ultimately improving outcomes.
What Does PA Stand For? You Thought You Knew…
The AAPA HOD (American Academy of PAs House of Delegates) voted 198 to 68 to change the name “physician assistant” to “physician associate.”
What’s in a name?
The new appellation is meant to empower PAs and add relevance and impact to their profession. As most of you have already heard, while this is a win for the AAPA, the change remains a controversial issue. Where do you stand?
Healthcare Trivia Answer
As you know, DVTs and PEs are often caused by long periods of sedentation, a major requisite for avid video gamers. Encourage your gamers (of all ages) to hit pause and give their legs a stretch. Defeating Ender Dragon can always wait.
Interested in more healthcare news? Here are some other articles we don’t want you to miss:
- Changing the Equation: Researchers Remove Race From a Calculator for Childbirth
- Want to Reduce Your Depression Risk? Wake Up an Hour earlier
- COVID-19 Vaccines Could Be Available for Kids as Young as 6 Months Old Starting This Fall
- Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures
- Are people with metabolically healthy obesity really healthy? A prospective cohort study of 381,363 UK Biobank participants
- Eligibility for cervical cancer screening exit: Comparison of a national and safety net cohort
- FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014
Subscribe to Morning Report
Not your typical medical newsletter… We get it, you see a lot of medical newsletters, so hear us out. This newsletter is intended to be fun, refreshing, and informative!
Every other week, we’ll highlight important medical news, sprinkled with some witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.