Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

5 January 2010 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. In the Short Term, Quitting Smoking Creates Dramatic Increase in Type 2 Diabetes Risk

Cigarette smoking is a well-established risk factor for developing type 2 diabetes. Therefore, quitting smoking should reduce the risk. However, smoking cessation can be associated with weight gain, and being overweight is a significant risk factor for type 2 diabetes. To test the hypothesis that smoking cessation increases short term diabetes risk, researchers conducted a prospective cohort study of 10,892 middle-aged adults enrolled in the Atherosclerosis Risk in Communities Study who did not have diabetes. In nine years of follow-up, patients who smoked had a higher risk for diabetes than those who never smoked. Smokers who recently quit had higher short-term risk for diabetes than ex-smokers and continuing smokers for about three years. This excess risk disappeared by 12 years. Researchers conclude that smokers who quit should receive advice about avoiding weight gain and about diabetes prevention and early detection.

2. Spoon Size Contributes to Dosing Errors with Liquid Medicine

While experts consistently recommend against it, most people still use kitchen spoons when pouring liquid medicine for themselves and their families. Spoon dosing has been identified as one of the three major causes of dosing errors and pediatric poisonings. Researchers sought to determine if dosing errors varied with spoon size. During cold and flu season, they asked 195 university students who were recent patients at a university health clinic to dose 5 mL of cold medicine onto a teaspoon first, and then onto a medium-sized tablespoon and a larger spoon in randomized order. After pouring, the participants were asked to rate their confidence in their accuracy. The participants were confident that they had poured the right amount of liquid. However, the researchers found that participants underdosed by 8.4 percent when using the medium-sized spoon and overdosed by 11.6 percent when using the larger spoon. While the clinical implications for these dosing errors in a 5 mL serving of medicine may be minimal, the dosing error is likely to accumulate over time. Experts encourage patients and caregivers to use appropriate measuring tools when administering liquid medicine.

3. Expert Panel Releases 2010 Adult Immunization Schedule, Stresses Importance of Vaccination

Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the recommended Adult Immunization Schedule to ensure that the schedule reflects the most current scientific knowledge of vaccines and vaccine preventable disease. Vaccines have been demonstrated to be among the most effective strategies for preventing illness in individuals as well as for protecting the health of the public. The ACIP recommends several important changes to the adult immunization schedule:

According to researchers, the importance of vaccines cannot be overemphasized. A complete summary of the new schedule is available at www.annals.org and at the CDC website. The schedule was approved by the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians.

4. Antiretroviral Adherence Associated with Lower Health Care Costs

The advent of combination antiretroviral therapy (ART) has significantly reduced morbidity and mortality from HIV/AIDS. Combination therapy usually consists of taking several drugs with different mechanisms of action at the same time. Adherence means taking the drugs exactly as prescribed, which can be challenging with this type of regimen. Research shows that patients who take ART exactly as prescribed do better than those who miss doses. However, it is not known whether good adherence also lowers health care costs. Researchers studied pharmacy data for 6,833 HIV-infected adults enrolled in a special AIDS program in South Africa who started ART between 2000 and 2006. They found that high adherence to ART was associated with lower mean monthly direct health care costs, particularly reduced hospitalization costs. The researchers suggest that timely and practical ART adherence monitoring and interventions are needed for all HIV/AIDS programs, as higher adherence is associated with lower health care costs and better patient outcomes.