Over half the patients with Type 2 diabetes have their HbA1c measured too frequently — i.e., at least three times a year. Why is that a bad thing? Dr. Rozalina McCoy, the lead author of a paper in The BMJ explains.

Using claims data, her group followed over 30,000 patients with stable HbA1c levels and found that only 40% had measurements taken within guideline-suggested limits — twice a year.

Links:

[Running time: 13 minutes]

The 2008 and 2012 recommendations from the USPSTF regarding PSA-based prostate screening have been accompanied by drops in both the screening and detection rates of prostate cancer, two studies in JAMA find.

Our guest, Dr. David Penson, wrote an editorial accompanying those studies. It attempts to put these new findings into perspective and to help the patients and physicians caught in the middle of a continuing debate on the wisdom of screening.

Physician’s First Watch coverage of the JAMA studies and editorial (free)

The Lancet Infectious Diseases has just published a worrying account from China about a dangerous antibiotic resistance factor carried on plasmids. The factor, called MCR-1, confers resistance to colistin — a last line of defense against multi-resistant Gram-negative bacilli.

The co-author of a helpful commentary in that journal, Dr. David L. Paterson of the University of Queensland in Brisbane, is our guest.

Lancet Infectious Diseases article (free abstract)

Lancet Infectious Diseases commentary (free abstract)

Physician’s First Watch coverage (free)

The SPRINT study, suggesting that we aim for a systolic BP target of 120 mm Hg in high-risk hypertensive patients, has been published with much fanfare.

Dr. Paul Whelton — one of the SPRINT investigators — is our guest. He warns against setting 120 as a performance measure, observing that roughly half the patients in the aggressively treated group had levels above that.

Links:

NEJM article (free)

The ACCORD trial found dangers in too-strict control of blood pressure and glucose in diabetes. Our guest has just published a study in JAMA Internal Medicine measuring the scope of the problem. Using Veterans Affairs data, his group found that “deintensification” of therapy after targets were met or exceeded was disappointingly rare.

JAMA Internal Medicine study (free abstract)

Physician’s First Watch summary (free)

We interview John Baron about his recent New England Journal of Medicine study testing the ability of calcium or vitamin D (or both) to prevent recurrences of colorectal adenomas in a population who had lesions found during colonoscopy. On follow-up after three to five years, the effects of daily calcium and/or vitamin D supplements were the same as for placebo — that is, there was no significant reduction in risk.

The results were surprising, since the same author found a protective effect for calcium in a 1999 publication in NEJM. (In that study, vitamin D wasn’t tested.)

LINKS:

New England Journal of Medicine study (free abstract)

Physician’s First Watch coverage (free)

Two analyses in the BMJ show little or no benefit from loading up older patients with calcium — indeed, the bad side effects of doing so (kidney stones and cardiovascular problems, to name two) outweigh the benefits.

Our conversation with Dr. Mark Bolland should offer reassurance to clinicians and their patients that a normal diet will provide enough of the stuff for good health.

BMJ studies (free)

Physician’s First Watch coverage (free)

[Running time: 18 minutes]

A group of physicians, economists, and medical students gathered on Medstro to talk about Medicare’s solution to the decades-old “doc fix” problem — it’s how you get paid for caring for Medicare patients.

The chat was occasioned by an essay in the New England Journal of Medicine by Meredith Rosenthal, an economist and a close observer of Medicare policy and reimbursement in general. She joins the discussion and helps sort things out. You’ll want to listen, but we warn you: it’s contentious!

[Running time: 29 minutes]

NEJM essay (free)

Pulmonary embolism is a vexing problem in primary care: Does this patient have it? Can I send them home with reassurance? Should I refer them for further testing?

A Dutch group has evaluated the tests most likely to be available in the primary care setting — the various flavors of the Wells rules and the Geneva scores — against a panel of some 600 patients with suspected PE and known outcomes after referral and three months’ follow-up. They come down in favor of the Wells rule and simple D-dimer testing, but an editorialist in the BMJ offers a note of dissent.

Our interview with one of the study authors, Dr. Geert-Jan Geersing, sorts this all out.

[Running time: 13 minutes]

BMJ study (free)

BMJ editorial (subscription required)