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This Week in JAMA
June 22 2011

This Week in JAMA

JAMA. 2011;305(24):2493. doi:10.1001/jama.2011.880

Rheumatoid arthritis (RA) and psoriasis are associated with an increased risk of insulin resistance and diabetes, and there is some evidence that anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) may reduce these risks. In a retrospective cohort study of 13 905 patients with rheumatoid arthritis or psoriasis, Solomon and colleagues Article assessed the risk of incident diabetes associated with use of specific disease-modifying medications. The authors report that the adjusted risk of diabetes was lower among patients who initiated treatment with a tumor necrosis factor inhibitor or hydroxychloroquine compared with other nonbiologic DMARDs. In an editorial, Bongartz and Kudva Article discuss the possible pleiotropic effects of specific anti-inflammatory agents.

de Boer and colleagues assessed temporal changes in the prevalence of diabetic kidney disease in the United States in an analysis of data from the National Health and Nutrition Examination Surveys. The authors found that between 1988 and 2008 the prevalence of diabetic kidney disease increased in direct proportion to the prevalence of diabetes, and among persons with diabetes, the prevalence of diabetic kidney disease did not change despite increased use of diabetes-related medications.

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Among patients with ST-elevation myocardial infarction (STEMI) who require interhospital transfer for primary percutaneous coronary intervention (PCI), a door-in to door-out time (DIDO) of less than 30 minutes—the duration of time from arrival to discharge at the first hospital—is recommended. In a retrospective cohort study of 14 821 patients with STEMI who were transferred for primary PCI, Wang and colleagues found that DIDO of less than 30 minutes was observed in only 11% of patients and was associated with shorter reperfusion delays and lower in-hospital mortality.

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In an analysis of data from 5366 participants in the Health Professionals Follow-Up Study who were diagnosed with prostate cancer between 1986 and 2006, Kenfield and colleagues assessed the association of cigarette smoking and smoking cessation with mortality and biochemical evidence of cancer recurrence. The authors report that smoking at the time of diagnosis was associated with increased all-cause, cardiovascular- and prostate cancer–specific mortality, and prostate cancer recurrence. Men who had quit smoking 10 or more years prior to diagnosis had prostate cancer–specific mortality and recurrence risks similar to those who never smoked.

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Some recent data suggest that compared with placebo or standard care, statin therapy—particularly intensive-dose therapy—may be associated with an excess risk of incident diabetes. In a pooled analysis of data from 5 randomized controlled trials that compared intensive-dose statin therapy with moderate-dose statin therapy, Preiss and colleagues found that intensive-dose therapy was associated with an increased risk of new-onset diabetes over a mean (SD) follow-up of 4.9 (1.9) years.

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“Why am I busting my butt to save his? Why am I losing sleep over this guy?” From “Sleepless.”

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A new guideline issued by the American Academy of Neurology outlines the use of effective pharmacologic and nonpharmacologic therapies for treating painful diabetic neuropathy.

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Vitamin D, cardiovascular disease, and diabetes

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Risks of direct-to-consumer cardiac screening

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Health advocacy organizations and evidence-based medicine

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Physician assistants: one less doctor in the house

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Onward—Dr DeAngelis’ farewell editorial

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Join Gordon D. Schiff, MD, Wednesday, July 20, from 2 to 3 PM eastern time to discuss addressing diagnostic delays and communication across institutions. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 15-year-old athlete who experienced a sports-related concussion? Go to www.jama.com to read the case. Submit your response by July 3 for possible online posting.

For your patients: Information about diabetes.

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