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Journal digest – five must-read papers for January

Weight plan can help GPs ‘reverse diabetes’

Type 2 diabetes can be reversed following an intensive weight management programme, and remission is a ‘practical target for primary care practices’ a study has concluded.

The study found almost half of participants had achieved diabetes remission after a year on an intensive calorie-controlled programme, without increasing diabetes medication.

GP practices recruited 298 adults aged 20-65 years diagnosed with type 2 diabetes in the previous six years. Practices were randomly assigned to provide either the weight management programme via practice dietitians or nurses, or standard best practice GP care.

Almost a quarter of patients in the weight management group achieved weight loss of 15kg or more at 12 months, leading to diabetes remission in 90% of cases. Half of these maintained a 10kg loss, 75% of whom achieved remission.

Professor Michael Lean, study co-lead from the University of Glasgow, said: ‘Our results should pave the way for this type of intervention to be considered in the routine care of patients with type 2 diabetes who wish to attain remission.’

Lancet 2017; online 5 Dec

‘More check-ups’ for older asthma patients

Research presented at the British Thoracic Society winter meeting, concluded that over-55s with asthma are the most likely patient group to experience symptoms flare-ups and that this may have implications for how older patients are cared for and monitored.

Researchers examined the medical records of some 424,000 patients of all ages with all types of asthma and found over-55s were less likely to have mild disease than younger patients, and far more likely to experience symptom flare-ups despite taking their treatment.

Older patients were also more likely to have asthma alongside other conditions, with 23% of over-55s also having a diagnosis of COPD.

Dr Chloe Bloom, lead researcher and respiratory clinical academic at Imperial College London, said: ‘The results perhaps suggest we should increase our asthma care focus on the older age group. More research is needed to look at how this might impact on primary care treatment of people with asthma. This could include having more regular check-ups with their GP.’

BTS Winter Meeting, London, 8 Dec 2017

Shorten duration of analgesics, GPs told

Commonly used analgesic drugs significantly impair cardiometabolic health and increase obesity, and so should be used for shorter periods, a study has found.

In the largest study of its kind, researchers at the University of Newcastle found patients taking gabapentinoids and opiates had double the risk of obesity as well as increased rates of hypertension and poor sleep.

They looked at 133,000 patients and found those on opiates and cardiometabolic drugs had the worst cardiometabolic profile, and were 95% more likely to be obese, 82% more likely to have a ‘very high risk’ waist circumference and 63% more likely to have hypertension, compared with those on cardiometabolic drugs only.

The proportion of patients sleeping less than six hours or more than nine hours a night was higher in the analgesic groups, with those taking combinations of neuropathic pain medication and opiates showing the worst sleep.

Dr Sophie Cassidy, lead author and research associate at the university’s institute of cellular medicine, said: ‘We know opiates are dependency forming but these results add further weight to calls for these chronic pain medications to be prescribed for shorter periods.’

PLoS One 2017, online 6 Dec

COPD spirometry ‘can prevent misdiagnosis’

Misdiagnosis of COPD in primary care highlights the need for adequate access to quality assured spirometry, a study has concluded.

Research presented at the British Thoracic Society’s winter meeting, revealed that 10% of COPD patients had no evidence of airflow obstruction to support their diagnosis, yet most were still being prescribed inhaled drugs.

Half were receiving inhaled medications only recommended for a confirmed diagnosis of moderate or severe COPD.

The research was initiated after the National COPD Audit Programme in 2016 revealed that in a quarter of cases nationwide, spirometry values were not consistent with a patient’s diagnosis of COPD.

Dr Lynn Josephs, lead researcher and clinical research consultant fellow at the University of Southampton, said: ‘We would encourage GPs and respiratory nurses to identify any patients being treated for COPD whose spirometry does not confirm their diagnosis.

‘Patients without obstructive spirometry should be reassessed, in order to identify other causes for their breathlessness or cough.’

BTS Winter Meeting, London, 8 Dec 2017

BMI ‘affects response to RA treatment’

GPs should discuss the impact of weight on treatment outcomes with rheumatoid arthritis patients, a new study has recommended.

Rheumatoid arthritis patients who have healthy BMIs are more likely to achieve sustained disease remission than their overweight counterparts, the study found.

Researchers looked at data for 980 patients with an average age of 53 years and who had been diagnosed with early rheumatoid arthritis. About two-thirds were overweight or obese and most were treated with DMARDs.

They found overweight patients were on average 25% less likely to achieve sustained remission than patients with a healthy BMI. Obese and very obese patients were respectively 43% and 53% less likely to achieve remission compared with those with a healthy BMI.

The paper concluded: ‘Given the positive impact of weight reduction on quality of life, clinicians may want to discuss with patients our data showing a negative impact of adiposity on early RA outcomes.’

BMJ Open 2016, online 16 Sep


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