A special theme issue of the Journal of the American Medical Association (JAMA) released this week examines a variety of issues that will impact the treatment and prevention of diabetes, one of the most troubling epidemics in the United States and around the globe.
Studies look at such timely topics as:
- The rate of remission for patients who undergo bariatric surgery. This study, which included long-term follow-up of obese patients with type 2 diabetes, found that bariatric surgery was associated with more frequent diabetes remission and fewer complications than among patients who received usual care.
- Risk of death associated with the addition of insulin for patients receiving metformin. This study found that among patients with diabetes who were receiving metformin, the addition of insulin compared with a sulfonylurea was associated with an increased risk of nonfatal cardiovascular outcomes and all-cause death.
- Insulin use and out-of-pocket costs. This study found that the use of insulin among patients with type 2 diabetes increased from 10 percent in 2000 to 15 percent in 2010, and out-of-pocket expenditures per prescription increased from a median of $19 to $36. The authors point to a large increase in the use of insulin analogs among privately insured patients.
- Gene variant associated with type 2 diabetes. This study of more than 3,700 Mexican and U.S. Latino individuals identified a gene variant that was associated with a five-fold increase in the prevalence of type 2 diabetes, suggesting the importance of heightened screening among this population. Latino populations have one of the highest rates of diabetes worldwide.
New JAMA Viewpoints and editorials examine such issues as comparative effectiveness research and outcomes for diabetes treatment, interpreting hemoglobin A1c values and addressing the burden of diabetes.
“Reduction of diabetes disease burden will require early identification of those at risk, implementation of effective preventive strategies and ongoing management of metabolic factors known to contribute to the development of diabetes complications,” Elizabeth R. Seaquist, MD, writes in her Viewpoint piece.
The AMA is aiming to do just that through its Improving Health Outcomes initiative, which focuses on type 2 diabetes and heart disease.
An AMA partnership with the YMCA of the USA is centered on making connections between the clinic and the community. Pilots underway in Delaware, Indianapolis and Minnesota’s Twin Cities are exploring a three-step process that includes screening for prediabetes, refering patients with prediabetes to the YMCA’s Diabetes Prevention Program and implementing a feedback loop so physicians can incorporate patients’ experiences into their care plans.
The YMCA program is part of the Centers for Disease Control and Prevention’s National Diabetes Prevention Program, a community-based lifestyle change program based on research that reduced new cases of diabetes for the majority of at-risk patients.
