Only a small proportion of individuals with type 1 diabetes treated with multiple daily insulin injections use continuous glucose monitoring (CGM) devices. Beck and colleagues assessed the effectiveness of CGM in adults with type 1 diabetes treated with multiple daily insulin injections in a randomized clinical trial involving 158 patients. The authors report that compared with usual care consisting of self-monitored blood glucose management and multiple daily insulin injections, use of CGM resulted in greater lowering of hemoglobin A1c (HbA1c) levels over 24 weeks. In an Editorial, Davidson discusses whether CGM is feasible for most patients with diabetes.
Editorial and Related Article
In an open-label crossover randomized clinical trial that enrolled 161 adults with type 1 diabetes who were treated with multiple daily insulin injections and had HbA1c levels of 7.5% or greater, Lind and colleagues compared glycemic control when using CGM vs conventional management. The authors report that among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of CGM for 26 weeks resulted in a mean HbA1c level that was 0.43% lower than that achieved with conventional treatment.
Mokdad and colleagues examined US county-level trends and differences in mortality from 29 cancers in analyses of national data from 1980 to 2014. Based on their analysis of more than 19.5 million cancer deaths recorded between 1980 and 2014, the authors found that overall cancer mortality declined 20.1% between 1980 and 2014. However, the authors identified distinct clusters of counties with particularly high cancer mortality, which varied geographically by type of cancer. In an Editorial, Wheeler and Basch discuss use of regional cancer surveillance data to inform and support effective public health interventions.
This US Preventive Services Task Force (USPSTF) recommendation statement addresses screening for obstructive sleep apnea among asymptomatic adults seen in primary care. Based on a review of the evidence on the accuracy, benefits, and potential harms of screening for obstructive sleep apnea, the USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for obstructive sleep apnea in asymptomatic adults. In an Editorial, Redline discusses the prevalence of obstructive sleep apnea and the need to improve recognition of the disorder.
Author Audio Interview and CME
Jonas and colleagues summarize findings from the USPSTF review of the evidence from 110 studies (46 188 total participants) that addressed primary care–relevant questions regarding screening for obstructive sleep apnea among asymptomatic adults. Studies evaluating the accuracy of screening questionnaires or prediction tools, the diagnostic accuracy of portable monitors, and the association between apnea-hypopnea index and health outcomes were included. The authors report that the available evidence could not establish with certainty that potential screening tools are accurate or have clinical utility. It is not established that continuous positive airway pressure and other treatments reduce mortality or improve health outcomes, except for modest improvement in sleep-related quality of life.
This JAMA Clinical Guidelines Synopsis article by Cohen and Davis summarizes the 2015 American Thyroid Association Management Guidelines for Adult Patients With Thyroid Nodules and Differentiated Thyroid Cancer. The guidelines provide recommendations on a variety of topics, including which thyroid nodules to biopsy, when to proceed to surgery, the extent of surgery (including use of lobectomy for certain low-risk cancers), and when patients with differentiated thyroid cancer should receive additional treatment such as radioactive iodine.
Highlights. JAMA. 2017;317(4):333-335. doi:10.1001/jama.2016.12965