Daily ReCAP April 25, 2017

Chronic: Galvus Plus Metformin Improves Blood Glucose Levels in Type 2 Diabetes Patients

The DPP-4 inhibitor vildagliptin (Galvus) used in conjunction with metformin improved blood glucose levels in patients with poorly controlled type 2 diabetes (T2D). In a study published in theJournal of Diabetes, investigators examined vildagliptin as an adjunct treatment in 345 adults with T2D whose HbA1c levels were greater than 55.7 mmol/mol. All the participants had been treated with metformin prior to the start of the study. The patients received vildagliptin plus metformin over a 180-day period, during which the investigators monitored their HbA1c levels and body weight. The results of the study showed that the HbA1c levels decreased by 0.9% on average, and more than half of the patients saw a decrease in levels by 0.7%. The investigators also observed statistically significant reductions in body mass, with 38% of participants losing at least 1 kg (2.2 lbs) in body weight. “This analysis of real-world data corroborates the results of previous [randomized controlled trials] indicating that add-on therapy with vildagliptin in uncontrolled patients on metformin is associated with a significant reduction in HbA1c, with no indication of weight gain or increased non-HDL blood lipids,” the authors wrote. “Future studies on long-term outcomes among vildagliptin users and time to insulin injection initiation are important to examine the safety and effectiveness of the medication.”

Acute: Campylobacter Surpasses Salmonella in 2016 Food Poisoning Cases

Preliminary findings from a new CDC report suggest that a germ mostly found in unpasteurized dairy products surpassed salmonella as the most reported cause of food poisoning cases in 2016. Campylobacter is a germ commonly found in raw milk, but it has also been see in contaminated poultry, water, and produce. It was the most common bug last year, followed by salmonella and shigella. There were no significant changes in new case rates for most kinds of food poisoning compared with the previous 3 years. In 2016, there were more than 24,000 reported illnesses, 5512 hospitalizations, and 98 deaths in 10 states due to infections. There has been a steady decline in illnesses from Salmonella typhimurium, which in part is because of tighter regulations and vaccinations of chicken flocks.

Preventive: Electronic Health Record Alerts Improve Influenza Vaccination Rates

Active choice intervention in the electronic health record (EHR) increased influenza vaccination rates, according to a study published in theJournal of Internal Medicine. Included in the study sample were 45,926 patients with a clinic visit during influenza season from September 2010 to March 2013, at 1 of 3 internal medicine practices at the University of Pennsylvania Health System. For the intervention, the EHR confirmed patient eligibility during the clinic visit when the physician accessed the patient’s chart. The physician and medical assistant were then prompted to actively choose to “accept” or “cancer” and order for a vaccine. The results of the study showed that more than 99.9% of vaccination orders placed during the study period led to patients’ receiving the vaccination. From year 2 preintervention to year 1 preintervention, the vaccination order rate in the control practices declined from 19.8% to 14.9%. During the same period, the vaccination order rate in the intervention group also declined from 21.2% to 14.5%. The results of the post-intervention year showed that the vaccination order rates increased to 28.2% in the control group and 36.3% in the intervention arm. Over time, the intervention arm has a significant increase in vaccination rates compared to the control group, which represented a 37.3% relative increase compared with the preintervention period. “Medical decision-making is often suboptimal,” lead author Mitesh S. Patel, MD, MBA, MS, toldMedical Economics. “Active choice is a method used to prompt one’s attention, provide information on the risks and benefits of options, and make it easy to submit a decision. Alerts in the electronic health record should be balanced to prevent overload and alert fatigue. The way choices are offered and information is framed in the electronic health record can have significant impact on how clinicians behave. Our study indicates that better testing can help to optimize the design of choices to improve the delivery of high-value health care.”