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7 January 2014 Annals of Internal Medicine Tip Sheet

Below is information about an article being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Mediterranean diet reduces diabetes incidence without calorie restriction, exercise, or weight loss

Older patients at high risk for heart disease who follow a Mediterranean diet rich in extra-virgin olive oil (EVOO) do not need to restrict calories, increase exercise, or lose weight to prevent diabetes, according to an article being published in Annals of Internal Medicine http://www.annals.org/article.aspx?doi=10.7326/M13-1725. Lifestyle interventions that induce weight loss have been shown to decrease incident diabetes to as low as 50 percent. Researchers sought to determine if following a Mediterranean diet could reduce incident diabetes without counting calories, increasing physical exercise, or losing weight. More than 3,500 older adults without diabetes and at high risk for cardiovascular disease were randomly assigned to a Mediterranean diet supplemented with either EVOO or mixed nuts or to a low-fat control diet. Participants in the Mediterranean diet groups primarily ate fruits, vegetables, whole grains, and fish. Their diets were rich in fats from EVOO or mixed nuts. Participants in the control group were instructed to reduce dietary fat intake from all sources. Dieticians provided periodic training sessions to help patients adhere to their diets and participants in all three groups were not required to restrict calorie intake or increase physical activity. After four years, participants following the Mediterranean diets had a substantial reduction in the risk for type 2 diabetes compared to those in the control group. Researchers conclude that a Mediterranean diet may have public health implications for diabetes prevention because it is palatable and sustainable.

2. Survey: General internists ‘uncomfortable’ caring for childhood cancer survivors

A survey of general internists being published in Annals of Internal Medicine http://www.annals.org/article.aspx?doi=10.7326/M13-1941 found that, on average, internists are ‘somewhat uncomfortable’ caring for childhood cancer survivors (CCSs). There are about 350,000 CCSs living in the United States and this population continues to expand. CCSs are more than three times likely to suffer from chronic conditions and 80 percent of these patients receive care from a primary care physician (PCP) in their community. Researchers surveyed 1,110 general internists to determine their attitudes and knowledge about caring for CCSs. The survey showed that many general internists are unfamiliar with surveillance guidelines but are willing to care for CCSs, preferably in collaboration with a cancer center (less than 6 percent said they prefer to care for CCSs without cancer center collaboration). Fifty one percent of the internists surveyed reported having cared for at least one CCS. Of those, 72 percent did not receive a summary of the treatment that was provided during the childhood cancer treatment, one of the tools they deemed most important to caring for a CCS. The other important tool was access to guidelines. Almost 90 percent of the internists who responded to the survey indicated that even though they are generally uncomfortable caring for CCSs, they are willing to care for the population, or they already do. The authors of an accompanying editorial suggest that educational initiatives may help PCPs gain a greater knowledge of established screening recommendations for CCSs and the free resources available to help them care for these patients. They write that caring for CCSs is a shared responsibility between pediatric oncology care providers, patients, and internists. Pediatric oncologists need to prepare patients for the transition into adult care so that they may become their own health advocates.