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Treatment Trends for Type 2 Diabetes

The burden of diabetes is expected to increase over the next few decades in the United States, with about one in three American adults projected to be at risk for developing the disease by 2050. Diabetes has also been linked to a considerable economic burden, with annual direct medical expenditures for treating and managing the disease totaling nearly $250 billion in 2012. Most of the medical expenditures for diabetes are attributable to hospitalizations and physician services, but the costs of prescription therapies are also significant. With the high prevalence and burden of diabetes, the disease has become a ripe target for pharmaceutical development. “During the past decade, several important changes in the diabetes marketplace have occurred,” explains G. Caleb Alexander, MD, FACP. For example, in the early 2000s, glitazones were rapidly adopted for use, but subsequent evidence suggested that these agents were associated with cardiovascular risks. In turn, this led to substantial declines in the use of glitazones during the latter half of the decade.  In addition, new long-acting insulins and several new classes of therapies have emerged to treat type 2 diabetes, including injectable incretin mimetics such as glucagon-like peptide 1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium glucose cotransporter 2 (SGLT-2) inhibitors. The costs of these medications can be high, but clinicians appear to be interested in using them because of their novel mechanisms of action and potential promise in helping to improve glycemic control among those with type 2 diabetes.   Examining Recent Patterns Over the past 2 decades, clinical investigations have examined changes in the treatment of diabetes. These analyses identified several important trends,...

The American Psychiatric Association 2011 Annual Meeting

The American Psychiatric Association’s 2011 annual meeting was held May 14-18 in Honolulu. The features below highlight some of the news emerging from the meeting. » Depression Screening May Reduce Future Clinic Visits » Examining Atypical Antipsychotic Use in Children » Sulfonylureas May Have Antidepressant Effects » Type of Media Affects Sleep Patterns for Teens » Views on Depression From PCPs & Psychiatrists  Depression Screening May Reduce Future Clinic Visits The Particulars: The United States Preventive Services Task Force has recommended screening patients with certain physical diagnoses for depression on the basis of previous studies showing an increased risk. However, little evidence is available demonstrating that these screenings lead to improved outcomes. The recommendation has recently been criticized for its lack of proven cost-effectiveness. Data Breakdown: Researchers screened patients with certain physical diagnoses—including cardiovascular diseases, type 2 diabetes, COPD, and obesity—for depression. The PHQ-9 was administered to study participants. Patients whose screening results indicated at least mild depression showed no significant difference in the number of visits during the following year, compared with the year before. However, among those with negative screenings, the average number of visits declined after the screening. In the year before screening, the average number of clinic or hospital visits was 2.8 for non-depressed patients, compared with 2.7 after the screening. About 30% of positive screens led to actual contact with a nurse or psychiatrist. Among patients who had follow-up engagement, 44% had full remission and 29% had significant improvement in PHQ-9 scores. Take Home Pearls: Depression screening in patients with chronic physical diseases appears to reduce subsequent clinic visits. However, more research is needed as this finding...
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