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Metformin in Overweight Adolescents With Type 1 Diabetes
An increasing number of individuals with type 1 diabetes are overweight or obese. Among adults with type 1 diabetes, metformin treatment reduces daily insulin requirement but not hemoglobin A1c levels. In a multicenter, randomized, placebo-controlled trial that enrolled 140 overweight adolescents with type 1 diabetes, Libman and colleagues found that the addition of metformin to insulin treatment did not improve glycemic control after 6 months.
Author Audio Interview and Continuing Medical Education
Vericiguat in Patients With Worsening Chronic Heart Failure
Augmentation of the nitric oxide–soluble guanylate cyclase–cyclic guanosine monophosphate (cGMP) pathway is a potential therapeutic target for worsening chronic heart failure. In a randomized trial involving 456 patients with worsening chronic heart failure and reduced ejection fraction, Gheorghiade and colleagues found that compared with placebo, oral vericiguat—a soluble guanylate cyclase stimulator—did not have a significant effect on change in the N-terminal pro-B-type natriuretic peptide level at 12 weeks but was well tolerated.
Cesarean Delivery Rate, Neonatal, and Maternal Mortality
Based on older analyses, the World Health Organization (WHO) has recommended a cesarean delivery rate of 10 to 15 per 100 live births to optimize maternal and neonatal outcomes. In an analysis of the most recently available data (2005 to 2012) from all 194 WHO member states, Molina and colleagues found that national cesarean delivery rates of up to 19 per 100 live births were associated with lower maternal and neonatal mortality among the WHO member states. In an Editorial, D’Alton and Hehir discuss strategies to achieve an appropriate cesarean delivery rate.
Editorial and Related Article
Author Video Interview and Continuing Medical Education
Planned Cesarean Delivery and Adverse Child Health Outcomes
In a population-based data-linkage study involving more than 321 000 term singleton first-born offspring born between 1993 and 2007, Black and colleagues found that planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription, and all-cause death by age 21 years.
CPAP, Mandibular Advancement Devices, and Blood Pressure
In a systematic review and meta-analysis of data from 51 randomized trials (4888 patients), Bratton and colleagues investigated the effect of continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) on blood pressure control among patients with obstructive sleep apnea. The authors report that compared with an inactive control, both CPAP and MADs were associated with blood pressure reduction—with no significant difference in blood pressure outcomes between the 2 therapies.
Clinical Review & Education
Dose-Finding Clinical Trials in the Drug Development Process
Dose-finding clinical trials are a key component of the drug development process. This JAMA Guide to Statistics and Methods article by Viele and Connor considers statistical methods used to analyze data in dose-finding clinical trials. Underlying assumptions, potential limitations, and interpretation of results of dose-response models are discussed.
Stomatitis, Cutaneous Bullae, and Renal Failure
A 64-year-old African American woman presented for evaluation of mouth sores, skin blisters, and crusted plaques on her scalp. The patient denied recent medication use. Physical examination revealed erosive stomatitis and round-to-oval bullae, erosions, and hyperpigmented patches on her trunk and extremities. Laboratory evaluation revealed an elevated serum creatinine level. Hyaline casts and protein were noted on urinalysis. What would you do next?
From The Medical Letter: Evolocumab
This Medical Letter on Drugs and Therapeutics article provides information about evolocumab—a subcutaneously injected PCSK9 inhibitor approved as an adjunct to diet and maximally tolerated statin therapy for adults with familial forms of hypercholesterolemia or clinical atherosclerotic cardiovascular disease who require additional lowering of low-density-lipoprotein cholesterol. Clinical trial results and information on dosage, administration, and adverse effects are summarized.
Highlights. JAMA. 2015;314(21):2205–2207. doi:10.1001/jama.2014.12117
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