Use of Intensive Insulin Therapy for the Management of Glycemic Control in Hospitalized Patients

Using Innovation to Reform Medicare Physician Payment

Formularies and Pharmacy Benefit Management, Reinventing Managed Care Series

The Paperless Medical Office: Digital Technology's Potential for the Internist

Ambulatory Care Formularies and Pharmacy Benefit Management by Managed Care Organizations

Approaches to Address the Sustainable Growth Rate (SGR)

ACP response letter to the April 27, 2012 request by the U.S. House of Representatives Committee on Ways and Means to offer input on physician payment reforms, May 23, 2012

ACP Response to SFC on Chronic Care Policies

ACP's Comments regarding ONC's Draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs

ACP Comments on National Academies" (NASEM) Call for Federal Policies that Contribute to Racial and Ethnic Health Inequities

Physical Fitness Among Swedish Military Conscripts and Long-Term Risk for Type 2 Diabetes Mellitus: A Cohort Study: Annals of Internal Medicine: Vol 164, No 9

Background: Early-life physical fitness has rarely been examined in relation to type 2 diabetes mellitus (DM) in adulthood because of the lengthy follow-up required. Elucidation of modifiable risk factors at young ages may help facilitate earlier and more effective interventions. Objective: To examine aerobic capacity and muscle strength at age 18 years in relation to risk for type 2 DM in adulthood. Design: National cohort study. Setting: Sweden. Participants: 1 534 425 military conscripts from 1969 to 1997 (97% to 98% of all men aged 18 years nationwide) without prior type 2 DM. Measurements: Aerobic capacity and muscle strength (measured in watts and newtons per kilogram of body weight, respectively) were examined in relation to type 2 DM identified from outpatient and inpatient diagnoses from 1987 to 2012 (maximum age, 62 years). Results: 34 008 men were diagnosed with type 2 DM in 39.4 million person-years of follow-up. Low aerobic capacity and muscle strength were independently associated with increased risk for type 2 DM. The absolute difference in cumulative incidence of type 2 DM between the lowest and highest tertiles of both aerobic capacity and strength was 0.22% at 20 years of follow-up (95% CI, 0.20% to 0.25%), 0.76% at 30 years (CI, 0.71% to 0.81%), and 3.97% at 40 years (CI, 3.87% to 4.06%). Overall, the combination of low aerobic capacity and muscle strength was associated with a 3-fold risk for type 2 DM (adjusted hazard ratio, 3.07 [CI, 2.88 to 3.27]; P < 0.001), with a positive additive interaction (P < 0.001). These associations were seen even among men with normal body mass index. Limitation: This cohort did not include women and did not measure physical fitness at older ages. Conclusion: In this large cohort of Swedish male military conscripts, low aerobic capacity and muscle strength at age 18 years were associated with increased long-term risk for type 2 DM, even among those with normal body mass index. Primary Funding Source: National Institutes of Health.

Prevalence and Management of Obesity in U.S. Adults With Type 1 Diabetes

Prevalence and Management of Obesity in U.S. Adults With Type 1 Diabetes

Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes

Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes

First-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists

First-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists

First-Line Therapy for Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists

Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors Versus Metformin

Cardiovascular Outcomes in Patients Initiating First-Line Treatment of Type 2 Diabetes With Sodium–Glucose Cotransporter-2 Inhibitors Versus Metformin

Massive Left Ventricular Aneurysm After Inferior Infarction | Annals of Internal Medicine: Clinical Cases

True ventricular aneurysm is a rare complication of myocardial infarction. After a 53-year-old man presented late with an inferior ST-segment elevation myocardial infarction, he was found to have a massive posterobasal left ventricular aneurysm. Cardiac magnetic resonance imaging volumetric analysis highlighted the hemodynamic significance of the aneurysm. As the result of persistent symptomatic heart failure, the patient underwent surgical resection of the aneurysm and placement of a pericardial patch with excellent results at follow-up.

Cryptococcal Meningoencephalitis in an HIV-Negative Host Infected With COVID-19: A Case Report | Annals of Internal Medicine: Clinical Cases

We report a rare case of cryptococcal infection in an immunocompetent adult who initially presented with altered sensorium and acute COVID-19 infection. The suspected diagnosis was encephalopathy due to pneumonia; however, the patient developed new neurologic deficits, warranting further investigation, which revealed cryptococcal meningoencephalitis. HIV testing was negative, but CD4 lymphocytopenia was seen, which resolved after treatment for both COVID-19 and cryptococcal meningoencephalitis. This case illustrates the importance of considering uncommon scenarios in which an opportunistic infection such as cryptococcal meningoencephalitis may present. It also demonstrates the need to frequently consider alternative diagnoses, particularly in the pandemic era.

Colitis Associated With Sevelamer Carbonate: A Case Report | Annals of Internal Medicine: Clinical Cases

Sevelamer carbonate is an anion-exchange, nonabsorbable resin that is commonly used to treat hyperphosphatemia in patients with advanced chronic kidney disease and end-stage renal disease. It is generally well-tolerated with only mild gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and constipation. There have been few case reports of gastrointestinal mucosal injury resulting from sevelamer crystal deposition. The severity of presentation varies from acute inflammation to polyp formation, necrosis, ulceration, and intestinal perforation. We report a 77-year-old woman with end-stage renal disease who was found to have mucosal injury from sevelamer crystal deposition resulting in colitis and ulceration.

Case of Ibuprofen-Induced Liver Injury | Annals of Internal Medicine: Clinical Cases

Drug-induced liver injury (DILI) resulting from nonsteroidal anti-inflammatory drugs (NSAIDs) is a rare phenomenon; however, several cases have been reported in the literature and the LiverTox database. For ibuprofen in particular, only 22 cases have been reported, and the mechanism for liver injury is unclear. In this report, we discuss a case of ibuprofen-induced liver injury to highlight the evaluation of NSAID-induced DILI, as well as the likely mechanism of injury.

Immune Checkpoint Inhibitor-Induced Polyarthritis: A Case Series | Annals of Internal Medicine: Clinical Cases

Immune checkpoint inhibitors (ICIs) have revolutionized cancer care; however, they are associated with ICI-related adverse events (ICI-AEs). Polyarthritis is a rare ICI-AE. Here we describe 2 patient cases of ICI-induced polyarthritis, induced by nivolumab/ipilimumab and sasanlimab for melanoma and urothelial cancer, respectively. Both patients had a medical history of nonrheumatological autoimmune disease, developed symptoms within 8 weeks of ICI, and had negative autoantibodies. Symptoms resolved with glucocorticoids. Neither patient discontinued their anticancer therapy. These cases add to the literature on ICI-induced polyarthritis. As ICIs become the standard of care, clinicians should familiarize themselves with their adverse effects.

Medical Management of Emphysematous Gastritis | Annals of Internal Medicine: Clinical Cases

A 95-year-old man presented to the hospital with altered mental status, sepsis, and coffee-ground emesis. His chest radiograph showed gas along the lesser curvature of the stomach, prompting abdominal computed tomography, which demonstrated intramural gastric air. This patient's clinical presentation and computed tomography findings were suggestive of emphysematous gastritis (EG). He was successfully managed with an intravenous proton-pump inhibitor and broad-spectrum antibiotics. Details of the case are presented to encourage the early diagnosis of EG, which may make conservative management more successful.

Achromobacter Hepatic Abscess Several Months After Laparoscopic Cholecystectomy: A Case Report and Review of Literature | Annals of Internal Medicine: Clinical Cases

Achromobacter xylosoxidans is a rare pathogen that causes opportunistic and nosocomial infections in immune-compromised patients. After a cholecystectomy, dropped stones can serve as nidus for abscess formation. We describe a rare case of hepatic abscess caused by Achromobacter xylosoxidans in a 40-year-old immune-competent woman who had a laparoscopic cholecystectomy 9 months previously.

A Case of Isolated Cardiac Sarcoidosis: An Underdiagnosed Disease With Little Diagnostic Consensus | Annals of Internal Medicine: Clinical Cases

Sarcoidosis is a rare cause of cardiomyopathy and can be missed when there is no pulmonary involvement. We present the case of a 55-year-old woman with isolated cardiac sarcoidosis who presented with symptoms of worsening intermittent dyspnea, weight gain, and lower extremity swelling. Cardiac evaluation showed a nonischemic cardiomyopathy secondary to an inflammatory cause. Cardiac magnetic resonance and positron emission tomography scans were performed that led to the diagnosis of isolated cardiac sarcoidosis. Recent updates in diagnostic criteria have allowed the use of imaging modalities alone to confirm the diagnosis in place of biopsy.

High Radial Nerve Palsy Resulting From Massage | Annals of Internal Medicine: Clinical Cases

Nerve palsies can lead to devastating outcomes that frighten patients. The limited availability in the published literature of information regarding nerve palsies can be disconcerting to patients and primary care physicians alike. This case report identifies this mechanism of injury and follows the path of recovery. A high radial nerve palsy resulting from a deep tissue massage about the shoulder recovered in 6 to 8 weeks. With the apparent increase of massage parlors in our society, the frequency of such events may increase. By providing references regarding such injuries, clinicians can better reassure patients as to expected outcomes.

An Unusual Cause of Acute Abdominal Pain: A Case Report and Review of the Diagnostic Reasoning | Annals of Internal Medicine: Clinical Cases

Spontaneous bladder rupture is a rare cause of acute abdominal pain. This case report reviews the clinical presentation of a patient with this unusual disorder and discusses the steps that the clinician used to reach the diagnosis. The concept of how clinicians use problem representations and illness scripts to arrive at a differential diagnosis, and ultimately a diagnosis, is discussed.