A study asks when to start mammography, people with type 2 diabetes may benefit from continuous glucose monitoring, and deaths from COPD are increasing worldwide.
Welcome to This Week in Managed Care, I’m Laura Joszt.
For decades, healthcare groups have debated when women should have their first mammogram and how often they should receive them.
A new study used modeling to find out which of the recommendations from three major leading groups offered the best protection, since the different guidelines call for women to start screening at age 40, 45, or 50, with different intervals as women get older.
The analysis found that guidelines calling for women to start annual screenings at age 40 prevented the most deaths.
Said senior author Elizabeth Kagan Arleo, MD: “Our findings are important and novel because this is the first time the 3 most widely discussed recommendations for screening mammography have been compared head to head. Our research would be put to good use if, because of our findings, women chose to start annual screening mammography starting at age 40.”
CGM Study Results
Patients with type 2 diabetes on intensive insulin therapy could see benefits from continuous glucose monitoring (CGM) based on results from a new study.
Patients using CGM had a larger drop in A1C than those in a control group, as well as significantly more time in range. The type 2 patients liked using CGM more than researchers expected, and only 1 of the 77 patients stopped using the system before the end of the six-month study.
The findings, published this week in Annals of Internal Medicine, involve the first clinical trial to test a Dexcom G4 in patients with type 2 diabetes against a control group receiving usual care.
David Price, MD, of Dexcom said CGM is viewed differently by patients who already need multiple daily insulin injections. “These patients are on multiple medications a day—to offer an approach without adding another medication is perceived as beneficial.”
New Statement on Diabetes and Hypertension
The American Diabetes Association has offered a new position statement on treating patients who have diabetes and hypertension. The statement is the first update on the topic since 2003 and reflects several important studies, including the ACCORD trial.
The statement calls for the following:
Teat patients with blood pressure between 140/90 mmHg and 160/100 mmHg with a single agent
Treat patients with blood pressure above 160/100 mmHg with 2 agents
Follow the ADA algorithm for guidance on selecting agents, for treating patients who fail to meet targets, and for steps if patients have adverse effects
The full statement appears in the September issue of Diabetes Care.
COPD Death Rates
The death rate from chronic obstructive pulmonary disease (COPD) is rising worldwide, according to a study by Lancet Respiratory Medicine. The study looked at data from 310 diseases and injuries from 195 countries, and found that 3.2 million people died of COPD worldwide in 2015. This meant COPD deaths had climbed 11.6% since 1990, while COPD prevalence jumped 44% during that same period.
Asthma was the most common chronic respiratory disease in 2015, affecting 358 million people, or twice as many as COPD. But COPD caused eight times as many deaths. Researchers said neither disease gets the attention it deserves.
“COPD and asthma are important contributors to the burden of non-communicable disease. Although much of the burden is either preventable or treatable with affordable interventions, these diseases have received less attention than other prominent non-communicable diseases, like cardiovascular disease, cancer, or diabetes.”
Finally, a study in the current issue of The American Journal of Managed Care finds there’s potential for savings with a payment model called hospital-in-home.
A study by the Veterans’ Administration in Hawaii found that treatment with this model cost 38 percent less than similar care for patients in hospitals, where VA patients on the islands must often receive care.
The authors predict the hospital-in-home model may become more popular as Medicare requires more care to be offered through alternative payment models.