New Insight with Dr. Veeral Sheth

Diabetes Dialogue

Don’t Miss a Beat

Crisis Point

Patrick Campbell is the managing editor of HCPLive. Formerly the editorial lead of Endocrinology Network, Practical Cardiology, and Rheumatology Network, Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. He now helps to lead coverage in each of these respective areas for HCPLive. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter with the Pocono Record in Stroudsburg, PA, and Star News Group in Manasquan, NJ. He also touts experience in multimedia, having spent time as a multimedia specialist with NJ Advance Media and multimedia coordinator at the Pocono Record. Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

The American College of Physicians (ACP) has released updated clinical recommendations for adults with 

, with the organization now recommending use of SGLT2 inhibitors and GLP-1 receptor agonists as second-line options to metformin in light of the 

, the new recommendations call for clinicians to consider use of SGLT2 inhibitors or GLP-1 receptor agonists as second-line therapy to metformin in adults with type 2 diabetes and inadequate glycemic control, with an additional recommendation to avoid adding a DPP-4 inhibitor to metformin as second-line therapy in adults with type 2 diabetes and inadequate glycemic control to reduce morbidity and all-cause mortality.

“As additional pharmacological treatments become available for the treatment of Type 2 diabetes, it’s critical for us to examine their effectiveness, the harms and benefits as well as costs in order to provide the best treatment for our patients,” said Carolyn J. Crandall, MD, MS, an internal medicine physician at the University of California Los Angeles School of Medicine and the chair of the Guidelines Committee.

 “Adding a second medication to metformin for patients with inadequate glycemic control may provide additional benefits but the added benefit on important clinical outcomes may be minimal in relation to the high cost, particularly for the more expensive, newer medications.”

The first recommendation from the ACP outlines SGLT2 inhibitors and GLP-1 receptor agonist as second-line therapies to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control. This recommendation included the caveat that clinicians should consider an SGLT 2 inhibitor to reduce the risk for all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure and consider a GLP-1 receptor agonist to reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke. No such caveats were included with the second recommendation, which recommended against adding a DPP-4 inhibitor because the evidence review indicated this class did not reduce morbidity or all-cause mortality.

The basis of the recommendations made by the ACP in their latest update were based on the results of a comprehensive systematic review and network meta-analysis on the topic Conducted by Timothy Wilt, MD, MPH, and 10 colleagues, the systematic review and network meta-analysis sought to provide an overview of the effectiveness, comparative effectiveness, and harms of SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, and long-acting insulins as both monotherapies and as combination therapy in adults with type 2 diabetes mellitus

Limiting their review to randomized controlled trials 52 weeks in length or greater published from 2010 through January 2023 with at least 500 adult participants with type 2 diabetes. A total of 130 publications from 84 randomized controlled trials were included. Of note, certainty of evidence (CoE) of these trials was assessed using the GRADE framework.

When compared to usual care, results suggested SGLT2 inhibitors and GLP-1 receptor agonists reduce all-cause mortality (high CoE) and major adverse cardiovascular events (moderate to high CoE), SGLT2 inhibitors reduce progression of chronic kidney disease and heart failure hospitalizations and GLP-1 receptor agonists reduce stroke (high CoE), and SGLT2 inhibitors reduce serious adverse events and severe hypoglycemia (high CoE). An accompanying cost-effectiveness performed as part of the process for drafting these recommendations concluded GLP-1 receptor agonist and SGLT2 inhibitors were viewed as being of low value as first-line therapies but could provide intermediate value when added to metformin or other background as compared to adding nothing.

In their announcement of the new recommendations, the ACP underlined the guidance issue by the organization emphasize shared decision-making, recognizing that each patient's needs and circumstances are unique. Additionally, clinicians are encouraged to consider individual patient characteristics like age, comorbidities, and personal preferences when discussing a treatment plan for type 2 diabetes.

“Primary care physicians provide care for more than 90% of patients with type 2 diabetes mellitus,” wrote Fatima Syez, MD, MSc, in an accompanying editorial.

 “Thus, it is essential that they are familiar with the clinical effectiveness and cost-effectiveness of the growing number of medications used to treat [type 2 diabetes mellitus].”

Qaseem A, Obley AJ, Shamliyan T, Hicks LA, Harrod CS, Crandall CJ. Newer pharmacologic treatments in adults with type 2 diabetes: A clinical guideline from the American College of Physicians. 

. Published online April 19, 2024. doi:10.7326/m23-2788

American College of Physicians. ACP issues clinical recommendations for newer pharmacological treatments of adults with type 2 diabetes. ACP issues clinical recommendations for newer pharmacological treatments of adults with Type 2 diabetes | ACP Online. April 19, 2024. Accessed April 19, 2024. https://www.acponline.org/acp-newsroom/acp-issues-clinical-recommendations-for-newer-pharmacological-treatments-of-adults-with-type-2.

Drake T, Landsteiner A, Langsetmo L, et al. Newer pharmacologic treatments in adults with type 2 diabetes: A systematic review and network meta-analysis for the American College of Physicians. 

. Published online April 19, 2024. doi:10.7326/m23-1490

Schousboe JT, Landsteiner A, Drake T, et al. Cost-effectiveness of newer pharmacologic treatments in adults with type 2 diabetes: A systematic review of cost-effectiveness studies for the American College of Physicians. 

. Published online April 19, 2024. doi:10.7326/m23-1492

Syed FZ. Pharmacologic Treatments in Adults With Type 2 Diabetes: Cost-Effectiveness and Comorbidity Considerations. 

. Published online April 19, 2024. doi:10.7326/M24-0861

Articles

The American College of Physicians released new recommendations for the management of type 2 diabetes with inadequate glycemic control using metformin or other first-line therapies. 

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

Type 2 Diabetes

Obesity Management

Obesity Management condition center page, resources on the topics of medical news and expert insight into clinical weight management can be found. Content includes articles, interviews, videos, podcasts, and breaking news on obesity research, treatment, and drug development.

Internal Medicine

Internal Medicine condition center page, resources on the topics of medical news and expert insight into internal medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on internal medicine research, treatment, and drug development.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

ACP's New Type 2 Diabetes Guidance Recommends SGLT2is, GLP-1 RAs as Second-Line to Metformin

Silas Inman joined MJH Life Sciences® in early 2011 as one of the company's first web editors, on the website OncLive.com. Throughout his tenure at MJH, Silas has been accountable for several organic launches of highly successful brands, including Targeted Oncology™ and NeurologyLive®, and for quickly transforming acquisitions into high-functioning business units. In 2014, he integrated CURE® Media Group into the MJH portfolio, quickly growing the online traffic, launching new offerings, and streamlining the brand’s print strategy. He continued this trend in 2019 with the acquisition of the UBM Life Sciences brands, which includes brands such as Medical Economics®.

Several case studies are emerging for the use of artificial intelligence (AI) to help improve patient literacy and education, according to findings presented at the 2024 American College of Physicians Internal Medicine Meeting.

 ChatGPT effectively and accurately modified chronic kidney disease (CKD) text into patient friendly and easily readable information, providing the potential to substantially improve patient literacy. In another presentation,

 on applying augmented intelligence and machine learning, a presenter showed an effective case study of translating their discharge instructions from medical abbreviations and text into a patient friendly format.

 completed by Oscar Pena, MD, and Monika Mishra, MD, both at the Hartford HealthCare St. Vincent's Medical Center, researchers identified 33 questions and answers specific to CKD that were related to risk factors, disease, and forms of kidney replacement therapy. For each, they prompted ChatGPT to "make the text readable for someone at 6th grade or below." The output from the artificial intelligence (AI) tool were then tested against Flesh Kincaid grade level (FKGL) test to assess the final reading level and whether the process effectively converted the medical text into an easily readable format.

"Our study demonstrated that ChatGPT, an artificial intelligence tool, can make medical information on CKD more comprehensible and more accessible to everyone, regardless of their literacy levels," the authors wrote in their poster. "This shows that Al has the potential not only to convey information effectively but also to tailor it to specific audiences.”

The text that was used for the simplification process was from a recompilation of materials from the National Kidney Foundation website. The reading level varied on each of the 33 answers at baseline. The average original reading level for these answers was grade 9.1 (confidence interval [CI], 8.3-10, standard deviation [SD], ± 2.4). After the ChatGPT modifications, the reading level average was grade 7.0 (CI, 6.5-7.6, SD ± 1.6), per the FKGL test.

The original readability score varied significantly from answer to answer, with the most complicated reaching grade nearly to grade 17 in complexity. The most dramatic improvement was seen on a question originally scored at a reading level of grade 11.8. In this example, ChatGPT modified the answer to a grade 5.2 reading level. Each result represented a statistically significant improvement in readability (

"By using Al to enhance readability, we can increase awareness and understanding of CKD among the general public, especially those who may find traditional medical information too complicated," the authors noted. "Our research indicates that incorporating Al into health communication strategies can improve public health literacy and enable individuals to make informed decisions about their well-being."

 Ivana Jankovic, MD, Adjunct Clinical Assistant Professor, Division of Endocrinology, Diabetes and Clinical Nutrition Oregon Health & Sciences University, presented similar success translating medical jargon into patient friendly output. This case study was in diabetes and sought to change medical notes into a grade 8 reading level.

For the input, Jankovic included discharge instructions (abbreviated in the prompt as D/C). The input included several common abbreviations, such as BID, BG, qAC, QIDHS, and PCP and the prompt was again a simple "please write this following instructions at an eight grade level." The response not only simplified the instructions for a patient but also included addition tips, such as setting phone reminders and keeping a blood sugar log.

“It did a really good job of breaking this down for the patient. Not only did it do this but without me asking, it gave tips,” Jankovic said. “It can make your job faster and easier. It can take things to the level of your patient without you expending effort for it.”

Pena, O, Mishra M. ChatGPT in CKD: Using Artificial Intelligence for Health Literacy. Poster presented at: ACP Internal Medicine Meeting; April 19, 2024; Boston, MA. https://annualmeeting.acponline.org/ Accessed April 19, 2024.

Pandita D, Chen J, Jankovic, I. Applying Augmented Intelligence and Machine Learning in Your Practice. Session presented at: ACP Internal Medicine Meeting; April 19, 2024; Boston, MA. https://annualmeeting.acponline.org/ Accessed April 19, 2024.

Large language model AI tools like ChatGPT quickly, easily, and effectively modified dense medical information into grade 6 to 8 reading levels. 

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

ChatGPT Effectively Modifies Medical Notes to Patient-Friendly Formats

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This ACP Conference interview featured a discussion with Inouye about gaps in knowledge regarding patients experiencing delirium during hospitalization.

Sharon K. Inouye, MD, MPH: Why is Delirium During Hospitalization Not Taken Seriously?

In another segment of her interview at the 

2024 American College of Physicians (ACP) Internal Medicine Meeting

 in Boston, Sharon K. Inouye, MD, MPH, MCAP, delved further into the major talking points of her presentation ‘Delirium During Hospitalization.’

Inouye is known for her work as professor of medicine at Harvard Medical School, as well as her work as Milton and Shirley F. Levy Family chair and director of the Aging Brain Center of the Hinda and Arthur Marcus Institute for Aging Research. Additionally, Inouye serves as editor-in-chief of JAMA Internal Medicine.

, Inouye had detailed some of the major takeaways from her discussion, highlighting changes over time that have occurred in teaching medical students and clinicians about the serious problem of delirium faced by many older adults who have been hospitalized. Here, she was asked about what is keeping assessments of delirium from being more widely implemented.

“I think the reason people say they can't do it is they claim they don't have time,” Inouye said. “But now we've created this ultra-brief assessment method, widely available and free of charge. We feel like we're eliminating that excuse, but people don't know about it. Spreading the word, I think, is really, really important.”

Inouye expressed that she hoped ACP could circulate the assessment widely so that, at least, the message about the use of the assessment is known more widely to internists.

“The other part of it is that, I think you're right, there isn’t an imperative to recognize delirium,” Inouye explained. “Because people, first of all, don't realize it's preventable. People often think, ‘oh, there's nothing to do once an older person becomes confused or anybody becomes confused.’ But there is so much to be done in terms of both optimizing care…nutrition, hydration, making sure that the person is getting mobilized and ready to go home as soon as possible.”

Inouye added that laboratories must also not be in disarray and that medical conditions are under control. She noted that delirium is often a barometer for other things going wrong, which Inouye believes many clinicians do not accept or fully understand.

“There's still some of this thinking that I told you I experienced 35 years ago, thinking ‘well, delirium is just inevitable and it's just going to happen to older adults when they're sick, so there's nothing that can be done.’ We really want to counter that thinking. And I think more and more hospitals are realizing this and they're starting to realize that these patients who get confused in the hospitals are costing them a lot of money.”

For additional information on the presentation topic, view the full interview segment posted above. Other 

The quotes contained in this interview were edited for the purposes of clarity.


Videos

Geriatrics

Geriatric medicine condition center page is a comprehensive resource for clinical news and insights on frequent geriatric-related diseases and conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for sleep disorder, dementia, Alzheimer's disease, and more.

Experts discuss the warnings regarding IL-17 blockers and inflammatory bowel disease.

Understanding Biologics for Patients With IBD

In discussing the issue of inflammatory bowel disease (IBD) in patients receiving IL-17 blockers, the experts acknowledge the cautionary language in package inserts based on early studies. While there was initial concern about potential exacerbation of IBD with IL-17 blockers, subsequent real-world data have not shown increased or worsened IBD symptoms. Their approach to managing patients with a history of or suspected IBD involves thorough screening, including personal and family history, and symptoms such as bloody stools or nocturnal bowel movements. They also highlight the importance of distinguishing between irritable bowel syndrome (IBS) and IBD, as patients may confuse the two.

Despite the low prevalence of IBD in psoriasis patients and the relatively rare occurrence of IBD exacerbation with IL-17 blockers, the dermatologists exercise caution, particularly in patients with a confirmed diagnosis of IBD. They may avoid prescribing IL-17 blockers in such cases or closely monitor patients with a family history of Crohn's disease. While acknowledging the rarity of IBD exacerbation with IL-17 blockers, the experts prioritize patient safety and consider alternative biologic options for individuals with a history of or increased risk for IBD, including TNF blockers or other targeted therapies. Their approach reflects a balanced assessment of available evidence and individual patient factors to optimize treatment outcomes while minimizing potential risks.

Video synopsis is AI-generated and reviewed by HCPLive® editorial staff.

Peer Exchange

HCPLive® Peer Exchange panel discussions feature authoritative insights, opinions, and perspectives on important issues facing today's care professionals.

Inflammatory Bowel Disease

On the HCPLive inflammatory bowel disease page, resources on the topics of medical news and expert insight into IBD can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBD and more.

Gastroenterology

Gastroenterology condition center page is a comprehensive resource for clinical news and insights on digestive and GI conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for 

, IBS and IBD, Crohn's disease, and more.

importance of collaboration with infectious disease specialists for patients with tuberculosis, while highlighting the low reactivation rates in newer agents.

Infectious Diseases and Biologic Treatment Selection

In patients with a positive test for tuberculosis (TB), the experts discuss their approach to treatment initiation with IL-17 and IL-23 blockers. They note that while TB monitoring remains a standard practice, the risk of TB reactivation with these biologics is low based on available evidence. Annual TB testing is not routinely recommended after treatment initiation due to the lack of signal for TB reactivation in meta-analyses of IL-17 and IL-23 blockers.

Regarding patients with a positive TB test and negative chest X-ray, they emphasize the importance of individualized patient care and collaboration with infectious disease specialists. Waiting for TB prophylaxis to take effect, typically four weeks, before starting systemic agents for psoriasis is considered prudent; in urgent cases such as active psoriatic arthritis, treatment initiation may be expedited. For patients with active TB, the experts recommend initiating anti-TB treatment and waiting before considering systemic biologic therapy. They highlight the need to adhere to label recommendations, which advise against starting biologics during active infections. Overall, their approach prioritizes patient safety and adherence to established guidelines while ensuring timely and effective management of psoriasis and psoriatic arthritis.

Experts emphasize the importance of collaboration with infectious disease specialists for patients with tuberculosis, while highlighting the low reactivation rates in newer agents.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

TJ Chao and Kristine Kucera, PA’s discuss the changing treatment algorithms of plaque psoriasis with the arrival of novel agents such as the TYK2 inhibitors. 

Ophthalmology

Ophthalmology page, resources on the topics of medical news and expert insight into ophthalmic disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on eye disease research, treatment, and drug development.

Impact of the Expanding Treatment Landscape on the Treatment Algorithm of Plaque Psoriasis

Providers in rheumatology, dermatology and gastrointestinal disease talk about how they are selecting between the various adalimumab biosimilars available for their patients.

Biosimilars

Selecting Between Adalimumab Biosimilars for Your Patients

Abigail Brooks is an assistant editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

In recognition of World IBS Day, we spoke with Jeffrey Roberts about what led him to found the holiday in 2019 and took a closer look at the continued marginalization of the condition.

Irritable Bowel Syndrome

On the HCPLive irritable bowel syndrome page, resources on the topics of medical news and expert insight into IBS can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBS, IBD, and more.

Putting Patients First: Breaking Stigma, Dispelling Misconceptions to Improve IBS Care

A clinical pharmacist and specialists in rheumatology, dermatology, and gastrointestinal disease share strategies in how to increase the uptake of adalimumab biosimilar among providers.

Strategies to Increase Adalimumab Biosimilar Uptake in Clinical Practice

Advances practice providers in dermatology discuss the safety data on the novel TYK2 inhibitor deucravacitnib. 

Safety Data on Deucravacitinib

Dermatologists Drs Tina Bhutani and Scott Boswell and patient Kanya Oul discuss unpredictable nature of generalized pustular psoriasis (GPP) and management of flares and GPP between flares.

Unpredictable Nature of Generalized Pustular Psoriasis (GPP) and Treatment

Dermatologists Drs Tina Bhutani and Scott Boswell discuss use of spesolimab to treat generalized pustular psoriasis (GPP) flares.

Spesolimab for Treatment of Generalized Pustular Psoriasis (GPP) Flares

During this Q&A interview, Crandall discussed the takeaways from her portion of an ACP conference presentation on current clinical guidelines in type 2 diabetes.


Carolyn J. Crandall, MD: Key Guideline Updates for Type 2 Diabetes

In this interview at the ACP conference, Inouye discussed some of the major reasons for her presentation titled ‘Delirium During Hospitalization.’

Discussing Delirium During Hospitalization with Sharon K. Inouye, MD, MPH

Lana Pine is the editor of HCPLive Rheumatology. She is an experienced editor and technical writer with a demonstrated history of working in the banking and publishing industries. In her free time, she enjoys cooking, yoga, listening to podcasts, and drawing. She can be reached via email at LPine@mjhlifesciences.com.

Most (94%) anti-nucleocapsid positivity was linked to a self-reported COVID-19 infection within the prior 3 months. 

Rheumatoid Arthritis

The HCPLive rheumatoid arthritis page is a comprehensive resource for clinical news and insights on arthritis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for RA, and more.

COVID-19

COVID-19 page, resources on the topics of medical news and expert insight into coronavirus can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COVID-19 research, treatment, and drug development.

Latest News

ACP's New Type 2 Diabetes Guidance Recommends SGLT2is, GLP-1 RAs as Second-Line to Metformin

ChatGPT Effectively Modifies Medical Notes to Patient-Friendly Formats

Sharon K. Inouye, MD, MPH: Why is Delirium During Hospitalization Not Taken Seriously?

Understanding Biologics for Patients With IBD

Infectious Diseases and Biologic Treatment Selection