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FOR THE PRESS

Annals of Internal Medicine Tip Sheet
January 3, 2017


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. The American College of Physicians recommends metformin for type 2 diabetes

New recommendations are an update to ACP’s 2012 clinical practice guideline

Free content: http://annals.org/aim/article/doi/10.7326/M16-1860

Physicians should prescribe metformin to patients with type 2 diabetes when medication is needed to improve high blood sugar, the American College of Physicians (ACP) recommends. The evidence-based clinical practice guideline is published today in Annals of Internal Medicine. If a second oral medication is needed to improve high blood sugar, ACP recommends that physicians consider adding either a sulfonylurea, thiazolidinedione, SGLT-2 inhibitor, or DPP-4 inhibitor to metformin. The American Academy of Family Physicians has endorsed the guideline.

“Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications,” said Nitin S. Damle, MD, MS, MACP, president, ACP. “The escalating rates of obesity in the U.S. are increasing the incidence and prevalence of diabetes substantially. Metformin has the added benefit of being associated with weight loss.”

“Adding a second medication to metformin may provide additional benefits,” Dr. Damle said. “However, the increased cost may not always support the added benefit, particularly for the more expensive, newer medications. ACP recommends that clinicians and patients discuss the benefits, adverse effects, and costs of additional medications.”

ACP updated its 2012 guideline on the comparative effectiveness and safety of oral medications for the treatment of type 2 diabetes because of several new studies evaluating medications for type 2 diabetes as well as recent FDA approvals of several new medications.

ACP’s clinical practice guidelines are developed through a rigorous process based on an extensive review of the highest quality evidence available, including randomized control trials and data from observational studies. ACP also identifies gaps in evidence and direction for future research through its guidelines development process.

2. Metformin associated with reduced mortality in patients with moderate kidney disease, congestive heart failure, or chronic liver disease

Study findings support recent changes in metformin labeling

Abstract: http://annals.org/aim/article/doi/10.7326/M16-1901
Editorial: http://annals.org/aim/article/doi/10.7326/M16-2712

Metformin use in patients with moderate chronic kidney disease (CKD), congestive heart failure (CHF), or chronic liver disease (CLD) is associated with improvements in key clinical outcomes, including death. This conclusion supports recent changes in metformin labeling. The evidence review is published in Annals of Internal Medicine.

Metformin is widely recommended as a first-line treatment for type 2 diabetes because it is more effective, less expensive and is associated with fewer adverse effects compared with other therapies. However, it had been contraindicated for patients with some chronic conditions due to concerns about how the medication is metabolized. Literature reviews conducted in recent years showed no clear link between metformin use and lactic acidosis, so warning labels were changed. Since more people are likely to be prescribed metformin, it’s important for prescribers to understand clinical outcomes for patients in previously contraindicated populations.

Researchers reviewed available literature to synthesize data on outcomes of metformin in patients with CKD, CHF, and CLD with hepatic impairment. On the basis of limited evidence, metformin seems to be associated with reduced all-cause mortality in these patients. It also may be associated with reduced CHF readmissions in patients with moderate CKD or CHF and lower hypoglycemia incidence in patients with moderate CKD. The researchers found no evidence that the risks associated with metformin exceed those of other antihyperglycemic medications in these populations. According to the authors, these findings support recent FDA labeling changes, point toward areas for future research, and may help inform clinical practice and revision of clinical guidelines.

3. Survey: More than 1 in 5 U.S. gun owners acquires a firearm without background check

Abstract: http://annals.org/aim/article/doi/10.7326/M16-1590
Editorial: http://annals.org/aim/article/doi/10.7326/M16-2819

Twenty-two percent of current U.S. gun owners who acquired a gun within the last 2 years did so without a background check. This number is down from 40 percent in 1994. The results of a national survey are published in Annals of Internal Medicine.

While universal background checks are favored by more than 90 percent of all Americans, most states do not require them for firearm sales between private parties. Because even the most basic information about background checks is not routinely collected, researchers have relied on national surveys to estimate the proportion of U.S. gun owners who obtain firearms without a background check.

For the first time since 1994, researchers sought to update and extend information about where, when, and how current U.S. gun owners acquired their most recent firearm and whether a background check was involved. Using a probability-based online national survey, researchers asked more than 1,600 gun owners where and when the acquired their last firearm, if they purchased the firearm, and whether, as part of that acquisition, they underwent a background check or were asked to show a firearm license or permit. They found that while fewer people are purchasing firearms without a background check compared to over 20 years ago, millions of people are still able to do so, and the proportion was much higher for those living in states without regulations on private firearm sales.

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