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FOR THE PRESS

1 September 2009 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656, or visit www.annals.org. Past highlights are accessible as well.

1. Mediterranean Diet Trumps Low-fat Diet for Diabetes Management

Patients on Low-Carbohydrate Mediterranean Diet Avoided Medication, Lost More Weight, and Decreased Some Coronary Risk Factors
In one of the longest-term randomized trials of its kind, researchers compared the effects of a Mediterranean-style diet versus a typical low-fat diet for diabetes management. The trial was designed to assess the effectiveness, durability, and safety of the two diets on the need for diabetes medications in overweight patients with newly-diagnosed type 2 diabetes. Researchers randomly assigned 215 patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years. Nutritionists and dietitians counseled both groups in monthly sessions for the first year and bimonthly sessions for the next three years. After four years, 44 percent of patients in the Mediterranean-style diet group required antihyperglycemic drug therapy compared to 70 percent in the low-fat diet group. Patients in the Mediterranean diet group also experienced greater weight loss and an improvement in some coronary risk factors.

2. For Three Common Illnesses, Retail Clinics Provide Quality Care at a Lower Cost

Health clinics located in retail stores such as pharmacy, discount, or grocery chains provide a new model for urgent care. These types of clinics appeal to consumers because they require no appointments, have convenient hours, and offer diagnosis and treatment of common conditions. However, concerns exist about the cost, rate of misdiagnosis, overuse of antibiotics, and decreased delivery of preventive care at these clinics. Researchers compared the cost and quality of care received at retail clinics for 2,100 patients (700 each) with ear infection, pharyngitis (sore throat), and urinary tract infection with that received at other care settings in Minnesota. They found that overall costs of care were substantially lower at retail clinics than at urgent care centers and emergency departments. In addition, prescription costs and quality scores were similar to that of physician offices and urgent care centers. The researchers also found that patients at retail clinics were as likely to receive preventive care as were patients who visited other care settings.

3. In an Era of Less Media Scrutiny, John F. Kennedy Hid Serious Health Problems from the Public

At the age of 43, John F. Kennedy was the youngest man ever elected president. During his campaign and presidency, the media portrayed him as the epitome of youth and vigor. However, a recent review of Kennedy's White House medical records, as well as correspondence from his physicians, reveals that Kennedy had the most complex medical history of any U.S. president. Unbeknownst to the public, Kennedy was diagnosed with Addison's disease, a rare endocrine disorder in which the adrenal glands do not produce enough of the hormone cortisol. Later, when Kennedy was a senator, he was found to have hypothyroidism. During the 1960 campaign for the presidency, Kennedy's physician denied the Addison's diagnosis and deflected further probes with a carefully-worded statement to the media. Today, with newly available evidence, researchers can plausibly conclude that Kennedy had a rare unifying autoimmune endocrine disorder called polyendocrine syndrome type II, or APS II, which is characterized by the coexistence of hypothyroidism and Addison's disease, among other conditions.

Early Online Release:

4. Statin Medication in Combination with another Cholesterol-Lowering Agent Does Not Improve Clinical Outcomes over High-dose Statin Therapy Alone

More than 28 million Americans have some form of cardiovascular disease. Physicians commonly prescribe statin therapy to lower LDL cholesterol levels. Lowering bad cholesterol levels helps to prevent the blockage of an artery that can lead to heart attack and stroke. However, only one third of all patients are able to lower their LDL cholesterol to appropriate levels, and proportionally fewer with established coronary heart disease are able to do so. For this reason, physicians recognize a critical need to identify effective treatment strategies for individuals requiring intensive lowering of cholesterol. Treatment options for these individuals include an increased dose of statin medication alone or the use of a statin in combination with another lipid-modifying agent of another class. Ezetimibe, niacin, bile acid sequestrants, fibrates, and omega-3 fatty acids are available treatment options for combination with statins. To compare the benefits and risks of high-dose statin monotherapy with combination statin therapy in adults at risk for coronary disease, researchers analyzed 102 published studies and found no benefit of combination therapy for mortality, heart attack, stroke, and revascularization procedures over high-dose statin therapy alone in individuals requiring intensive lipid lowering.


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