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New Guidelines for Diabetic Neuropathy

The prevalence of neuropathy among those with diabetes has been estimated to be as high as 50%. Painful diabetic neuropathy (PDN), which tends to affect the feet and legs, has been estimated to affect roughly 16% to 20% of the more than 25 million people in the United States who are living with diabetes. The condition often goes unreported and even more are untreated, with an estimated 40% of patients not receiving care for PDN.  A Need for Guidance for Diabetic Neuropathy “Painful diabetic neuropathy is a big problem for all healthcare providers who treat patients with diabetes,” says John D. England, MD, FAAN. “There are increasingly more drugs being developed and brought to market that can be used for treating diabetic neuropathy. For a busy practitioner, it’s often difficult to keep up with all of the new evidence and to decide what a rational, tiered approach should be to treatment.” Part of the issue is the volume of literature on the topic. In 2007, when members of the American Academy of Neurology (AAN) felt there was a need to update guidelines for the treatment of PDN, the process started with more than 2,200 papers. Of them, 463 were deemed relevant and 79 were highly pertinent to the guidelines. Since then, many more studies have emerged. Physicians should refer to the AAN guidelines to learn which drugs have the best scientific evidence supporting their use to treat PDN. — John D. England, MD, FAAN In the May 17, 2011 issue of Neurology, the AAN published its first evidence-based guidelines on use of a range of pharmacologic and non-pharmacologic treatments...

Racial & Ethnic Disparities in CAD

Previous research has shown that there appears to be disparate care among different racial and ethnic populations, especially in the treatment of coronary artery disease (CAD). Clinical studies also suggest that there are differences in the use of evidence-based medicine among these different racial and ethnic groups. According to published data, minorities with acute coronary syndromes are more likely to receive sub-standard care. It has been shown throughout the medical literature that racial and ethnic minorities often receive evidence-based treatments less frequently than Caucasians. Other studies show that minorities are often treated at facilities that are not as adept at adhering to composite performance measures. The Get With the Guidelines-CAD (GWTG-CAD) quality improvement program, provided by the American Heart Association and American Stroke Association, is designed to enhance hospital adherence to guidelines when managing CAD patients. The program employs a set of performance, quality, and reporting measures to track the quality of care at an institution, and it has been proven to improve adherence to evidence-based care of patients hospitalized with CAD. A part of the GWTG-CAD program is directed toward improving ethnic and racial disparities among CAD patients to the point where care is defect-free. The concept of defect-free care is a critical component in the GWTG-CAD program. At its core, defect-free care is intended to ensure that every patient receives all of the interventions for which they’re eligible. These interventions are also known as performance measures because their use in CAD patients is supported by well-grounded scientific evidence. Therefore, performance measures are well-suited for public reporting to compare hospitals and pay-for-performance initiatives. Quality Improvement Programs Work In...

Emerging Drug Options: Adolescent Depression

Approximately 2 million adolescents between the ages 12 and 17 in the United States have suffered a serious bout of depression within the past year. Major depressive disorder (MDD) in adolescents is debilitating; about half of these patients will have continued problems with depression as they enter adulthood. Compounding the problem is the fact that few treatment options have been effective and well-tolerated in this patient group. In March 2009, the FDA approved a supplemental New Drug Application for escitalopram (Lexapro, Forest Laboratories, Inc.) as acute and maintenance treatment for MDD in adolescents aged 12 to 17. The SSRI is only the second antidepressant to be approved for the treatment of MDD in adolescents, the first of which was fluoxetine (Prozac, Eli Lilly and Co.). Encouraging Data After observing improvements in adults with MDD taking escitalopram, investigators more recently undertook several studies to assess efficacy in adolescents with MDD. The FDA’s most recent approval for use in adolescent depression was supported by two placebo-controlled studies, one conducted in adolescents taking the drug and the other conducted in children and adolescents taking citalopram (Celexa, Forest Laboratories, Inc.). In an 8-week flexible-dose, placebo-controlled study that compared escitalopram 10 mg/day or 20 mg/day to placebo in adolescents in 2008, those receiving escitalopram had statistically significant greater improvements from baseline when compared with placebo, based on the Children’s Depression Rating Scale-Revised (CDRS-R). In another 8-week, flexible-dose, placebo-controlled study, children and adolescents aged 7 to 17 treated with racemic citalopram 20 mg/day or 40 mg/day had statistically significant greater improvements from baseline on the CDRS-R when compared with patients treated with placebo. Positive results...
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