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More Vaccines Target Common Cancers, Not Deadliest

More Vaccines Target Common Cancers, Not Deadliest

Vaccine development efforts currently focus on cancers with a higher incidence rather than those with a higher mortality rate, according to a recent University of Michigan study. As a result, cancer vaccinations today may not best serve the needs of cancer patients tomorrow. The cancers with the highest number of active clinical trials in 2011 are melanoma (40), breast (34), lung (30), prostate (22), and brain (20). And the five cancers with the highest 5-year mortality are: lung (186,000) pancreatic (40,000) colon (35,000) breast (21,000) liver and bile duct (21,000) While there are currently 90 therapeutic vaccines in development against these 5 types of cancer, there are 146 vaccines targeting cancers with lower 5-year mortality. “This mismatch is unfortunate for patients,” says Matthew Davis, M.D., M.A.P.P., associate professor of pediatrics, internal medicine, and public policy at the University of Michigan Health System and Gerald R. Ford School of Public Policy. “Cancers with higher mortality currently have fewer vaccines in development. For therapeutic vaccines to make the biggest difference in cancer care, development must focus more on high-mortality tumors.” Physician’s Weekly wants to know… Where do you think vaccination development funds would be best...

Managing Charcot Foot in Diabetes

Despite the passing of 140 years since first being described, little is known about Charcot foot as a lower-extremity complication of diabetes. Charcot foot occurs in about 1% of patients with diabetes, the most common disease associated with Charcot foot. In January 2011, the American Diabetes Association and American Podiatric Medical Association called together an international group of 18 leading experts to develop a consensus on the definition, diagnosis, and medical and surgical treatments of the Charcot foot in diabetes. The consensus was subsequently published in the September 2011 issue of Diabetes Care. Recognizing & Diagnosing Charcot Foot Neuropathy is an essential element of Charcot foot. Also, nearly 50% of patients recall some type of trauma, which is many times trivial in nature and has caused no pain. Patients tend to walk on this non-painful, traumatized foot, which then becomes highly inflamed. This can lead to focal osteopenia, collapse of the arch, and bone fractures. “Early diagnosis is the most important way to prevent complete destruction and amputation of the foot.” When considering a Charcot foot diagnosis, clinicians should look for a red, hot, swollen foot. The Charcot foot can be so hot that physicians will observe a palpable difference between extremities as high as 10° F. A difference between feet greater than 4° F with a dermal thermometer is considered significant for inflammation. Early diagnosis is the most important way to prevent complete destruction and amputation of the foot. If a foot is diagnosed by deformity, damage within the foot has already occurred, placing patients at risk for amputation. Imaging should support the clinical diagnosis. The first diagnostic test...

Improving Adherence to Diabetes Treatments

Research has shown that taking medications and making lifestyle changes to manage diabetes can be challenging for patients. In general, diabetes self-management behaviors are multidimensional; for example, clinical studies indicate that adherence is better for medication use than it is for lifestyle changes, such as diet and exercise. At the same time, adherence to diabetes medications is still suboptimal. “Only about one-third of patients with diabetes are doing most of the things they need to do to manage their disease,” says Martha M. Funnell, MS, RN, CDE. “As health professionals, we have to move beyond blaming patients for being ‘nonadherent’ and learn how to work more effectively with them.” Diabetes Self-Management Matters The Diabetes Attitudes, Wishes, and Needs Study demonstrated that diabetes self-management is less than optimal and that psychosocial issues play a pivotal role in diabetes self-management. Identifying key factors and strategies associated with self-management practices is critical to improving outcomes in diabetes. These include demographic, psychological, and social factors as well as healthcare provider and system factors and disease- and treatment-related factors (Table 1). “As health professionals, we have to move beyond blaming patients for being ‘non-adherent’ and learn how to work more effectively with them.” “When working with patients, we should consider these factors during visits,” says Funnell. “Psychological and emotional factors are particularly important because they have a significant impact on diabetes management. Recognizing the potential risk factors allows us to better determine the optimal approaches to take with patients and helps lay the groundwork for patient-centered collaboration (Table 2).” When assessing self-management, Funnell notes that providers cannot assume patients are taking their medications appropriately. “We...

Conference Highlights: CHEST 2011

New research presented at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, from October 22-26 in Honolulu addressed many important topics in pulmonary, critical care, and sleep medicine. The features below highlight just some of the studies that emerged from the meeting. » Pain Common for Pulmonologists Performing Bronchoscopy » Guideline Effects on CRBSI  » An Effective Computer Model for Smoking Cessation  Pain Common for Pulmonologists Performing Bronchoscopy The Particulars: Much attention has been paid to ergonomics and overuse injury in gastroenterology and surgery settings. However, little attention has been paid on other medical specialties, such as bronchoscopy. Data Breakdown: Researchers in New York gave an online questionnaire to 132 pulmonologists to assess pain and injury while performing bronchoscopy. Nearly 40% reported experiencing pain while operating a bronchoscope. Among this group, 22% reported recurring pain, which mostly occurred in the shoulder, back, wrist, neck, and thumb. This pain appeared to be associated with overuse and height less than 5’7″. Only 38% of pulmonologists who felt pain attempted to modify their workspace. Take Home Pearl: Interventions may be needed to prevent musculoskeletal injuries among pulmonologists who perform bronchoscopies. Guideline Effects on CRBSI [back to top] The Particulars: The Institute of Health Improvement Bundle was created in 2006 as a guideline to help hospitals reduce catheter-related bloodstream infection (CRBSI) rates. Whether this goal has been achieved remains uncertain. Data Breakdown: An investigation from researchers in Tampa retrospectively reviewed 895 patient charts for people admitted to two hospitals who required a central venous catheter (CVC) between 2007, when the guidelines were first released, and 2010. The rate of CRBSIs decreased from 4.38 per...

Blood Conservation in Surgery

Surgical procedures account for the transfusion of almost 15 million units of packed red blood cells (RBCs) every year in the United States. “There has been intense interest in blood conservation and minimizing blood transfusion over the past several years, but the number of annual transfusions is increasing,” says Victor A. Ferraris, MD, PhD. “At the same time, the blood donor pool has stabilized or slightly decreased.” Perioperative bleeding that requires RBC transfusion is especially common during cardiac operations, which consume as much as 10% to 15% of the nation’s blood supply. Evidence suggests that this figure is rising, largely because of the increasing complexity of cardiac surgical procedures. “An important part of blood resource management is recognizing patients’ risk of bleeding and subsequent blood transfusion.” In the March 2011 Annals of Thoracic Surgery, the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists published an update to their 2007 blood conservation clinical practice guidelines. Certain features of blood conservation and management of blood resources have been updated or added. The guidelines provide updates in the preoperative management of dual antiplatelet treatment, pharmacotherapy to increase RBC volume or to reduce blood loss, and the use of blood derivatives. They also provide updated strategies to manage blood salvage, information on the use of minimally invasive procedures to reduce perioperative bleeding and need for blood transfusion, and strategies for blood conservation associated with extracorporeal membrane oxygenation and cardiopulmonary perfusion. The use of topical agents for hemostasis and the optimal usefulness of team interventions in blood management are also discussed in the guideline update. Emphasizing Preoperative Risk Assessments The Society of Thoracic...

Protecting Against CVD in Type 2 Diabetes

Clinicians should take an active role in helping their patients with type 2 diabetes protect themselves from developing cardiovascular disease, or CVD, in the future. Cardiovascular disease (CVD) has been well documented as a major cause of morbidity and mortality for individuals with diabetes. Adults with diabetes have a two- to four-fold higher risk of CVD when compared with those without diabetes. “The common conditions coexisting with type 2 diabetes—especially hypertension and dyslipidemia— are clear risk factors for CVD,” says Craig D. Williams, PharmD. “Diabetes itself also confers independent risk of CVD.” The association among diabetes, hypertension, and dyslipidemia has been known for many decades, and researchers are continuing to collect more data about the interconnectedness of diabetes and heart disease. There has also been an increased appreciation of the impact of obesity on CVD. The concept that these metabolic abnormalities can cluster in many individuals has led to greater efforts to prevent and treat these conditions, especially in patients with diabetes. Assessing Risk of CVD in Diabetes There are many approaches for estimating the risk of diabetes and CVD. One such tool—Diabetes PHD (Personal Health Decisions), which is available online at www.diabetes.org—is of particular value for this task for both clinicians and patients. Diabetes PHD is an easy-to-use internet program made available by the American Diabetes Association. It can be used to explore the effects of a wide variety of interventions, including weight loss, smoking cessation, and the addition of medications. It has been studied and validated extensively across many types of clinical trials, and it incorporates most known CVD risk factors. Research suggests that such risk assessment tools are rarely used...
Kids with High IQ More Likely to Use Drugs

Kids with High IQ More Likely to Use Drugs

Children with high IQ scores at age 5 may be significantly more likely to use illegal drugs in adolescence and adulthood, according to a recent study published online in Journal of Epidemiology & Community Health. Recent reports have linked high childhood IQ scores with excess alcohol intake and alcohol dependency in adult life, so the investigators sought to explore possible associations with illegal drug use. The researchers analyzed data from nearly 8,000 participants with IQ scores assessed at the age of 5 and 10 from a British Cohort Study, which measured the use of drugs and socioeconomic factors to age 30. Higher IQ scores at age 5 were associated with an increased use of cannabis by age 16 in both sexes, and an increased use of cannabis and cocaine in women and amphetamine and ecstasy use in men by age 30. Furthermore, the association remained strong even after adjusting for psychological distress during adolescence and life-course socioeconomic position. The study authors observed that individuals with high IQs tend to score well on tests of stimulation-seeking and openness to experiences, and alcohol and illegal drugs may fulfill desires for novelty and stimulation. They also note that drug use may be used to ward off boredom or cope with peer stigmatization. Physician’s Weekly wants to know… Do you believe it’s a common misconception that a high IQ is associated with healthy behaviors? Have you frequently observed illegal drug use in highly intelligent...
Medicare Will Cover Heart Disease Counseling

Medicare Will Cover Heart Disease Counseling

The Centers for Medicare and Medicaid Services (CMS) announced it will now cover the cost of one office visit per year for Medicare patients in an effort to prevent cardiovascular disease (CVD). CVD is the leading cause of death in this country, with more than 2 million Americans experiencing a heart attack or stroke every year. The decision by CMS will hopefully contribute to its prevention, which is the key to controlling the soaring cost of heart disease—a figure that reached $450 billion in 2010, according to a new policy statement from the American Heart Association. According to CMS, intensive behavioral therapy comprising the CVD risk reduction visit should consist of one of the following three components: Encouraging aspirin use for the primary prevention of cardiovascular disease when the benefits outweigh the risks for men age 45-79 years and women 55-79 years. Screening for high blood pressure in adults age 18 years and older. Intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age and other known risk factors for cardiovascular and diet-related chronic disease.   Physician’s Weekly wants to know… How valuable do you think primary prevention is in cardiovascular...
Will No Co-Pay Improve Medication Adherence?

Will No Co-Pay Improve Medication Adherence?

Will full health plan coverage of prescription medications improve patient adherence to post-discharge treatment regimens, resulting in better outcomes and reduced costs? That has been the big theory recently tested in the MI FREEE trial (Post-Myocardial Infarction Free Rx Event and Economic Evaluation) recently published in the New England Journal of Medicine. Nearly 6,000 post-myocardial infarction (MI) patients were randomized to either full prescription coverage or usual prescription coverage for statins, β-blockers, ACE inhibitors, or ARBs. For the primary outcome of revascularization plus major cardiac events combined, the difference was not statistically significant. However, enhanced prescription coverage slightly improved medication adherence and first major vascular events, and decreased patient spending without increasing overall health costs. The rate of adherence increased for all drug categories with full prescription coverage: ACE inhibitor or ARB increased from 35.9% to 41.1% β-blocker increased from 45% to 49.3% Statins increased from 49% to 55.1% Although the study is positive overall, it reveals that cost is not the only barrier to better patient adherence to post-MI drug regimens. In an accompanying editorial, Columbia University’s Lee Goldman, MD,  and Harvard University’s Arnold Epstein, MD, write that “perhaps the most sobering findings were both the low baseline adherence and the small improvement in adherence in what should have been a highly motivated group of patients after myocardial infarction.” Physician’s Weekly wants to know… Is reducing or eliminating the costs of highly beneficial medicines still a key component of increasing adherence? What else, if anything, can be...
Top 50 Cardiovascular Hospitals for 2012

Top 50 Cardiovascular Hospitals for 2012

Thomson Reuters has released its 13th annual report identifying the nation’s best providers of cardiovascular service. Selected from more than 1,000 hospitals, those chosen have better risk-adjusted survival, lower complications, and fewer readmissions. The top 50 hospitals distinguish themselves from the rest due to the fact that they: had 23% fewer deaths. had a 40% lower rate of heart failure complications. maintained lower 30-day readmission rates for heart attack and heart failure. spent an average of $4,000 less per bypass surgery case. discharged bypass patients almost a full day sooner. increased their use of internal mammary artery for CABG surgeries from 88% to 96%. View the Reuters list of top cardiovascular...

Conference Highlights: Anesthesiology 2011

The American Society of Anesthesiologists’ annual meeting, Anesthesiology 2011, held on October 15-19 in Chicago, was a comprehensive education program in anesthesiology, focusing on transforming patient safety through science and innovation. The news items below highlight just some of the studies that emerged from the meeting. » Less Propofol Required for Obese Children » Certain Behaviors Lead to Poor Pediatric Surgical Outcomes  » Identifying Women at Risk for Cesarean Pain » Risk Factors for Labor Pain » Anesthetics & Postoperative Delirium in the Elderly  Less Propofol Required for Obese Children The Particulars: The Particulars: Information regarding the appropriate doses for many anesthetics in obese children is lacking. Anesthesiologists must decide whether a dose should be based on actual or lean body weight in a population for whom 75% of excess body weight consists of drug distribution-altering fat tissue. Propofol can cause low blood pressure, prolonged sleepiness, and decreased breathing. Data Breakdown: Researchers measured responses in 40 obese and 40 non-obese children 20 seconds after they received propofol. To bring about unconsciousness at the beginning of surgery, obese children needed 2 mg/kg of propofol. Normal weight children required 3.2 mg/kg of propofol to bring about unconsciousness. Take Home Pearl: Obese children appear to require 50% to 60% less propofol than normal weight children to initiate anesthesia at the beginning of surgical procedures. Certain Behaviors Lead to Poor Pediatric Surgical Outcomes [back to top] The Particulars: Determining the coping, distress, and anxiety behaviors of children and their parents prior to surgery can be challenging during anesthesia induction and following surgery. The Perioperative Adult Child Behavioral Interaction Scale (PACBIS) is thought to provide real-time measurements for determining...

Rural & Urban Differences in Surgeries

Previous investigations have shown that there are disparities in healthcare services provided to rural and urban residents. Removing these disparities has become a national priority because good healthcare shouldn’t depend on where people live. Disparities in care to rural residents can have important implications for how healthcare resources are allocated. For example, patient outcomes are typically better with hospitals and surgeons performing higher volumes of given procedures. Outlying rural hospitals may be performing lower volumes of these procedures, but it’s important to balance this with the need for these procedures if there are no nearby hospitals and surgeons. Rural Vs Urban Settings In an effort to better understand the association between receipt of greater and lesser discretionary surgeries among residents in rural versus urban settings, my colleagues and I conducted an analysis that was published in the May 2011 Archives of Surgery. In this analysis, we analyzed disparities between settings by looking at the incidences of several elective procedures (lumbar spine fusion, total hip and knee replacement surgery, and prostatectomy) as well as that of less discretionary procedures (abdominal aortic aneurysm repair [AAA], aortic valve replacement, non-incidental appendectomy, open reduction and internal fixation of the femur, and carotid endarterectomy [CEA]). According to our findings, rural Medicare beneficiaries were significantly more likely than their urban counterparts to undergo a wide variety of surgical procedures. These procedures ranged from those that were generally more discretionary, especially total joint replacement surgery and lumbar spine fusion, to those that were generally less discretionary, including CEA and appendectomy. The magnitude of this difference was also important to note. Rural patients were at least 20% more...

A Collaborative Approach to Managing Depression & Diabetes

Published studies have demonstrated that many patients with diabetes and cardiovascular disease (CVD) often have comorbid depression. In individuals with diabetes or CVD, depression has been linked to poor self-management of their physical health, an increased risk for complications, and higher morbidity. Due to feelings of helplessness and hopelessness that accompany depression, the management of these patients is often more complicated than for those who are not depressed. Compounding the problem is that complications of diabetes and CVD can exacerbate any previously existing depression. Exploring a New Depression Intervention In the December 30, 2010 New England Journal of Medicine, my colleagues and I published data from a randomized controlled trial in which we tested a primary care intervention called TEAMcare. In this intervention, nurses worked together with patients and healthcare teams to manage care using evidence-based guidelines for both depression and physical diseases together. The TEAMcare intervention involved having nurse care managers coach patients, monitor disease control and depression, and work with patients’ primary care physicians (PCPs) to make changes in medications and lifestyle when treatment goals were not reached. Nurses were supervised weekly by psychiatrists and PCPs who made recommendations about medication changes that nurses then communicated to patients’ PCPs. “Patients who received the TEAMcare intervention were significantly less depressed, and also had improvements in blood glucose, LDL cholesterol, and systolic blood pressure levels.” Working collaboratively, nurses and patients set realistic step-by-step goals for reducing depression as well as blood glucose, blood pressure, and cholesterol levels. To reach the goals set forth in the TEAMcare intervention, nurses regularly monitored patients’ mental and physical health and offered recommendations to patients’ PCPs...

Managing Diabetes in Older Adults

This Physician’s Weekly feature was completed in cooperation with the experts at the American Diabetes Association. Published research suggests that approximately 30% of people older than 65 have either diagnosed or undiagnosed diabetes, and the disease is of increasing concern for the aging population. It is expected that its incidence will grow rapidly in the coming decades as older individuals are living longer. “When compared with older adults without diabetes, those with the disease have higher rates of premature death, functional disability, and coexisting illnesses,” explains Medha N. Munshi, MD. These coexisting illnesses include coronary heart disease, stroke, peripheral vascular disease, renal failure, neuropathy, and retinopathy. In addition, older adults with diabetes are at greater risk for polypharmacy, depression, cognitive impairment, urinary incontinence, injuries from falls, and persistent pain. The care of older adults with diabetes can be challenging for physicians because of clinical and functional differences from patient to patient, Dr. Munshi says. “Some older individuals develop diabetes at an earlier age and may have complications by this time. Others develop the disease at an older age and present with a few diabetes-related complications.” Frailty, diabetes-related comorbidities, and other underlying chronic conditions are other important considerations for some older patients. Furthermore, the activity levels and comorbidities experienced by older adults vary considerably depending on each individual patient. Studies have shown that the life expectancy is highly variable for older patients, but often longer than clinicians realize. An Important Patient Population According to the American Diabetes Association’s Standards of Medical Care in Diabetes—2011, providers caring for older adults with diabetes must take the diversity of older patients into consideration when setting and...
Diabetics ‘Tearing Up’ Over New Test

Diabetics ‘Tearing Up’ Over New Test

There may be new hope for patients with diabetes who dread the frequent blood draws and finger pricks required to monitor their blood glucose levels. A new electrochemical sensor device may be able to measure blood sugar levels from tears instead of blood, according to a report in Analytical Chemistry. This new pain-free device uses tear glucose levels as an accurate reflection of blood sugar levels. An advance such as this could spare more than 350 million diabetes patients the discomfort of pricking their fingers for drops of blood to use in traditional blood sugar tests — a responsibility many consider painful enough to discourage regular testing. Physicians often struggle to encourage patients to stay on top of their diabetes care. Devices that offer an alternative to the hand-held meters may increase testing compliance. Physician’s Weekly wants to know… Do you struggle to keep your diabetic patients on their treatment regimen? Will an advance like this increase compliance?...
Autism Spectrum Disorders Diagnoses Vary Widely

Autism Spectrum Disorders Diagnoses Vary Widely

Best-estimate clinical diagnoses of pediatric patients with autism spectrum disorders (ASDs) appear to vary widely across regions, according to a study published online in Archives of General Psychiatry. Diagnostic instruments have been valuable for ASDs by helping to define populations, merge samples, and compare results across studies. However, the use of best-estimate clinical diagnoses has been the gold standard in ASD evaluation. An observational study analyzed 12 university-based research sites, including 2,102 participants (mostly male) between ages 4 and 18 who had a clinical diagnosis of an ASD. Although there was consistent use of standardized measures and similar distributions of scores across sites, the proportion of children assigned to one of three ASD categories (autistic disorder, pervasive developmental disorder-not otherwise specified, and Asperger syndrome) varied significantly between sites. The biggest factors in diagnosis included verbal IQ, language level, and core features of autism (communication and repetitive behaviors). However, clinicians at each site used the available information and set cut-offs on certain measures to establish a diagnosis differently. Physician’s Weekly wants to know… Do you feel the diagnosis of autism spectrum disorders varies within your medical community? Could insurance coverage play a role in the diagnosis...

Managing Pediatric Septic Shock

Those who undergo major surgical procedures or who have certain medical hardware placed, such as a central line, are at increased risk for infection and subsequent septic shock. Despite the growing knowledge of this problem, overall recognition in pediatric patients remains relatively low among physicians. To address this issue, my colleagues and I published a study in the May 16, 2011 issue ofPediatrics to describe strategies that have been effective at our institution to improve the management of pediatric septic shock. Recognizing & Treating Septic Shock Early Studies have shown that early recognition and early, aggressive, goal-directed treatment can improve clinical outcomes for children with septic shock. For each additional hour of persistent shock, the mortality risk increases twofold. It’s critical that clinicians become aware of the warning signs of pediatric septic shock. For example, they should be on the lookout for key vital signs, such as age-appropriate heart rate, respiratory rate, and blood pressure. Signs and symptoms include fever, tachycardia, tachypnea, altered mental status, and poor perfusion that may be manifested by cool skin or decreased capillary refill. Hypotension would be a late finding. Developing Protocols for Septic Shock Each hospital should develop its own systems and protocols for recognizing pediatric patients with septic shock. A key note from our study in Pediatrics was that all patients presenting to the ED who met criteria for three or more of the above symptoms or who met any one item and had low blood pressure met our protocol for septic shock. Although most patients in the protocol did not have septic shock, we wanted to cast a wide net to be able to...

Making the Communication-Quality Care Link

Rapid fire delivery of critical information between clinicians is commonplace in the ED, but most departments rarely plan and assess the effectiveness of their communication methods. Research has indicated that more than half of all sentinel events—death or permanent injury due to treatment delays—occur in EDs, according to the Joint Commission. Analyses have shown that communication is the root cause for the majority of these events. “Few investigations have looked into how communication of information within the ED can be optimized,” says Shari Welch, MD, FACEP. In an effort to examine communication practices within the ED and assess strategies that may improve these efforts, the Emergency Department Benchmarking Alliance, which comprises 412 EDs in the United States, began to study its member’s communication strategies. The initiative demonstrated that most EDs use a variety of low and high-tech methods for communication (Table 1). In the 1980s, the whiteboard was commonly used to display and convey information within the ED. Now, that trend has given way to computerized systems, according to Dr. Welch. “Physicians and nurses could circle something on a whiteboard to denote importance, but the tracking screens that are used frequently now do not give the same visual cues.” Many EDs have begun using overhead paging more frequently. However, in the average ED, according to the World Health Organization, the decibel level of noise is often too high, causing stress for both staff and patients. Emergency Department Size & Needs “Smaller EDs are much more efficient with their communications than larger ones,” Dr. Welch says. “Larger EDs can be burdened by their structure. Many have long hallways, no central...

The Role of DPP-4 Inhibitors in Diabetes

Over the past several years, new drugs have emerged to expand our treatment armamentarium for type 2 diabetes, and these products have enhanced our understanding of the pathophysiology of type 2 diabetes. Newer therapies include the incretin class. The development of two products in the this class, glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, has demonstrated safe, effective, and beneficial effects that include lower fasting glucose and postprandial glucose, reduction of A1C, and lower risk for hypoglycemia. How DPP-4 Inhibitors Work DPP-4 is an enzyme that degrades endogenous GLP-1. While GLP-1 receptor agonists increase GLP-1 amounts and activity, DPP-4 inhibitors raise endogenous GLP-1 by inhibiting GLP-1 degradation. Levels of DPP-4 are increased by approximately six-fold. This results in increased insulin secretion, as well as a reduction of glucagon stimulation, which then results in improved fasting and postprandial glucose and improvements in A1C. There are currently just a couple of DPP-4 inhibitors available in the United States, but other agents are currently under FDA review. In clinical research, DPP-4 inhibitors have been well tolerated. An important consideration for patients who use these medications is that they are weight neutral and have been associated with a low risk of hypoglycemia. DPP-4 inhibitors are available for once-daily oral administration. This may improve adherence to drug regimens. They are also available in fixed-dosed combination with metformin, which may also be cost-effective and further improve patient adherence. The long-term safety of DPP-4 inhibitors is continuing to accumulate in medical research. Ongoing trials are addressing efficacy of this drug class as well as its role in cardiovascular disease safety. Clinicians should review...
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