Joint Letter to Senate Appropriations Committee on Funding for FDA Tobacco Oversight Activities

Joint Letter to Senate Appropriations Subcommittee Supporting Matching House Appropriations Funding for the Centers for Disease Control and Prevention (CDC) for FY2020

Joint Letter to Reps. DeLauro and Granger Opposing Efforts to Restrict FDA Authority to Regulate Tobacco Products

Joint Letter to Representatives Bera and Buschon in Opposition to the Holding Providers Harmless from Medicare Cuts During COVID-19 Act

Joint Letter to Rep. Blunt Rochester Supporting Quit Because of COVID-19 Act

Joint Letter to President-Elect Biden Urging the Appointment of Physicians in National Health Leadership Roles

Joint Letter to ONC Regarding Health Data, Technology, and Interoperability (HTI-1) Proposed Rule

Joint Letter to the Office of Civil Rights Regarding Breach Reporting Responsibilities

Joint Letter to the National Council of State Boards of Nursing Regarding the Advanced Practice Registered Nurse Compact

Joint Letter to National Governors Association Urging Enhanced Collaboration With Community-Based Primary Care Physicians

The Effect of 4:3 Intermittent Fasting on Weight Loss at 12 Months: A Randomized Clinical Trial: Annals of Internal Medicine: Vol 178, No 5

Background: Long-term (≥12 months) randomized trials evaluating the efficacy of intermittent fasting (IMF) as a dietary weight loss strategy are limited. Furthermore, no studies have compared IMF versus daily caloric restriction (DCR) when both interventions are provided in the context of a guidelines-based behavioral weight loss program. Objective: To compare the effects of 4:3 IMF versus DCR on changes in weight at 12 months, with comprehensive behavioral support provided to both groups. Design: Randomized clinical trial. (ClinicalTrials.gov: NCT03411356) Setting: Denver, Colorado, and surrounding metropolitan area. Participants: Adults aged 18 to 60 years with body mass index (BMI) of 27 to 46 kg/m2. Intervention: The IMF group was instructed to restrict energy intake by 80% on 3 nonconsecutive days per week, with ad libitum intake (no restriction) the other 4 days (4:3 IMF). The DCR group was instructed to reduce daily energy intake by 34% to match the weekly energy deficit of 4:3 IMF. Both groups received a high-intensity comprehensive behavioral weight loss program that included group-based behavioral support and a recommendation to increase moderate-intensity physical activity to 300 minutes per week. Measurements: The primary outcome was change in body weight (in kilograms) at 12 months. Results: Of the 165 (4:3 IMF, n = 84; DCR, n = 81) randomly assigned participants (mean age, 42 years [SD, 9]; mean BMI, 34.1 kg/m2 [SD, 4.4]; 73.9% female), 125 completed the trial. In an intention-to-treat analysis, 4:3 IMF showed greater reductions in weight than DCR at 12 months (mean difference, 2.89 kg [95% CI, 5.65 to 0.14 kg]; P = 0.040). Limitation: Limited generalizability. Conclusion: Compared with DCR, 4:3 IMF resulted in modestly greater weight loss among adults with overweight or obesity enrolled in a 12-month, high-intensity, comprehensive behavioral weight loss program. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases.

Annals for Educators - July 2024

Thyroid Function Reference Intervals by Age, Sex, and Race: A Cross-Sectional Study: Annals of Internal Medicine: Vol 178, No 7

Background: Current clinical practice uses a one-size-fits-all approach to define reference intervals for the results of diagnostic tests about thyroid function. This approach does not recognize subgroup differences according to age, sex, or race. Objective: To identify age-, sex-, and race-specific reference intervals for the common diagnostic tests that measure thyroid function and to examine how these new reference intervals reclassify persons into disease categories when compared with current reference intervals. Design: Cross-sectional analysis. Setting: Data from the U.S. NHANES (National Health and Nutrition Examination Survey) supplemented with data from a multicenter Chinese study. Participants: A nationally representative sample from NHANES aged 20 years or older (n = 8308) supplemented with a Chinese database of routine health checkups from 49 hospitals in 10 provinces aged 18 years or older (n = 314 302). Measurements: The thyroid function reference interval was defined as the interval of diagnostic indicator levels from the 2.5th (lower limit) to the 97.5th (upper limit) percentile by age, sex, and race subgroups. Results: In 8308 NHANES participants, the 97.5th percentile levels of thyroid-stimulating hormone (TSH) increased with age, whereas total triiodothyronine (TT3) levels declined with age and total thyroxine (TT4) levels were stable across different ages. Women had higher TT4 levels, and White participants had higher TSH levels. Using current reference intervals, the prevalence of subclinical hypothyroidism increased from 2.4% for ages 20 to 29 years to 5.9% for ages 70 years and older. In contrast, using age-, sex-, and race-specific reference intervals reclassified 48.5% of persons with subclinical hypothyroidism as normal, especially women and White participants, and reclassified 31.2% of persons with subclinical hyperthyroidism as normal, especially women, Black participants, and Hispanic participants. When compared with the findings from U.S. participants, many of the findings from 314 302 Chinese participants were similar. Limitation: Cross-sectional data; sample size limitations for subgroup. Conclusion: These findings should help establish more accurate reference intervals for thyroid diseases and facilitate development of a consensus about how to define and manage those diseases. Primary Funding Source: National Key Research and Development Program of China and National Natural Science Foundation.

Strategies to Address Racial and Ethnic Disparities in Health and Health Care for Chronic Conditions: An Evidence Map of Research From 2017 to 2024: Annals of Internal Medicine: Vol 178, No 1

Background: Racial and ethnic disparities in health and health care persist in the United States, adversely affecting outcomes in prevention and treatment of chronic conditions among adults. Purpose: To map interventions aimed at reducing racial and ethnic disparities and improving health outcomes in the prevention and treatment of chronic conditions in adults. Data Sources: Searches of MEDLINE, CINAHL, and Scopus from January 2017 to April 2024, supplemented with gray literature. Study Selection: U.S.-based studies of interventions targeting racial and ethnic disparities in adults with chronic conditions. Data Extraction: Information on intervention types, targets, outcomes, study designs, study settings, chronic conditions, and delivery personnel was extracted and categorized. Data Synthesis: Among 174 unique studies, 12 intervention types were identified, with self-management support and patient navigation the most common. Most interventions targeted patient behaviors; few studies addressed disparities directly or focused on underrepresented racial and ethnic marginalized groups. Limitations: The lack of standardized terminology and the underrepresentation of certain racial and ethnic groups limit the evidence base. Although the literature search accurately reflects the current state of the literature, it also limits the body of evidence by excluding health disparities research conducted before January 2017, so significant findings from earlier studies may have been overlooked. Conclusion: The literature highlights diverse interventions targeting health disparities, but few studies evaluated their effectiveness in reducing the health disparities gaps. There is an urgent need for research focused on underrepresented racial and ethnic groups, particularly in promising areas such as patient navigation for cancer and diabetes self-management. Future research should prioritize robust study designs to assess the long-term effect and broader applicability of interventions, thus helping organizations and stakeholders to tailor strategies to community-specific needs. Primary Funding Source: Agency for Healthcare Research and Quality.

How Would You Treat This Inpatient With Type 2 Diabetes Mellitus? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Management of hospitalized patients with type 2 diabetes mellitus (T2DM) presents unique challenges. Two recently released guidelines, one from the American Diabetes Association and the other from the Endocrine Society, provide useful recommendations and evidence review to inform the care of medical inpatients with T2DM. These guidelines mostly agree, although there are slight differences in their recommendations. In these rounds, 2 expert diabetologists discuss their approach to inpatient management of T2DM, specifically regarding inpatient glycemic goals on the medical ward, the use of noninsulin antihyperglycemic medications, and patient safety strategies for patients receiving long-acting insulin. They conclude with recommendations for Mr. D, a real patient with T2DM admitted with a recurrent foot infection.

Shortfalls in Follow-up Albuminuria Quantification After an Abnormal Result on a Urine Protein Dipstick Test

Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes: A Popular but Questionable Approach to Improve Public Health

Type 2 Diabetes

Type 2 diabetes (T2D) is a prevalent disease that increases risk for vascular, renal, and neurologic complications. Prevention and treatment of T2D and its complications are paramount. Many advancements in T2D care have emerged over the past 5 years, including increased understanding of the importance of early intensive glycemic control, mental health, social determinants of health, healthy eating patterns, continuous glucose monitoring, and the benefits of some drugs for preventing cardiorenal disease. This review summarizes the evidence supporting T2D prevention and treatment, focusing on aspects that are commonly in the purview of primary care physicians.

Contraception

Contraception counseling and provision are vital components of comprehensive health care. An unplanned pregnancy can be particularly challenging for patients with chronic illness. Internal medicine physicians are uniquely positioned to assess pregnancy readiness and provide contraception, as they often intersect with pregnancy-capable patients at the moment of a new diagnosis or when providing ongoing care for a chronic medical condition. A shared decision-making counseling approach engages patients, ensures patient-centered care, and supports their choice of a contraceptive method that aligns with their reproductive plans and medical needs.

Migraine

Migraine affects about 1 billion people worldwide, and up to 15% of adults in the United States have migraine attacks in any given year. Migraine is associated with substantial adverse socioeconomic and personal effects. It is the second leading cause of years lived with disability worldwide for all ages and the leading cause in women aged 15 to 49 years. Diagnostic uncertainty increases the likelihood of unnecessary investigations and suboptimal management. This article advises clinicians about diagnosing migraine, ruling out secondary headache disorders, developing acute and preventive treatment plans, and deciding when to refer the patient to a specialist.