Knowledge, Attitude, and Practice of Metformin Extended-Release Tablets Among Clinicians in China: A Cross-Sectional Survey

Background: Metformin extended-release (XR) is a once-daily alternative conventional immediate-release (IR) tablet for adults with type 2 diabetes. Aim: This study aimed to investigate the knowledge, attitude, and practice of the use of metformin XR tablets among clinicians. Methods: We conducted a cross-sectional online survey among endocrinologists, general practitioners, and internists, who are taking routine care of adults with type 2 diabetes in health institutes at all levels in Sichuan Province, China. We designed an online questionnaire including the demographic information, knowledge, attitude, and practice about metformin XR tablets. Results: We included 158 clinicians, 67.7% of whom were females and 63.9% were from tertiary hospitals. The median age was 39.6 years (ranging between 22 and 62 years). Only 8.2% of the clinicians correctly answered the knowledge questions, 82.3% and 62.0% of the responders assumed that metformin XR had superior efficacy and tolerability to the metformin IR, respectively. Only 46.8% of the clinicians prescribed the metformin XR based on the patient's preference for once daily frequency. Conclusion: The knowledge, attitude, and practice of metformin XR among Chinese clinicians need improving. Clinicians need credible information to support their clinical decision-making regarding metformin XR.

Aspartate aminotransferase to alanine aminotransferase ratio and short-term prognosis of patients with type 2 diabetes hospitalized for heart failure

INTRODUCTION

We aimed to explore the prognostic value of the aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio in non-surgical patients with type 2 diabetes hospitalized for heart failure.

MATERIAL AND METHODS

Using a large electronic medical record-based cohort of diabetes in China (WECODe), we gathered data on non-surgical hospitalized patients with type 2 diabetes and heart failure from 2011 to 2019. Baseline AST/ALT ratio was calculated. The primary outcomes were all-cause death within 30 days after discharge, composite cardiac events, major acute kidney injury, and major systemic infection. A multivariable Cox proportional regression model was utilized to evaluate the association between the AST/ALT ratio and outcomes.

RESULTS

This retrospective cohort included 8,073 patients (39.4% women) with type 2 diabetes hospitalized for heart failure. The median age was 71 years. Higher AST/ALT ratio was associated with higher risks of poor endpoints (with per standard deviation increment in AST/ALT ratio, for death within 30 days after discharge: adjusted hazard ratio [HR] = 1.35, 95% confidence interval [CI], 1.21 to 1.50; for composite cardiac events: HR = 1.18, 95% CI: 1.06 to 1.31). Compared to patients in the lowest quartile for the AST/ALT ratio, those in the highest quartile have elevated risk of death within 30 days after discharge and major systemic infection (HRs [95% CIs] 1.61 [1.18 to 2.19] and 1.28 [1.06 to 1.56], respectively). Subgroup analyses and sensitivity analyses confirmed the robustness of the findings.

CONCLUSIONS

Type 2 diabetes patients hospitalized for heart failure with the AST/ALT ratio in the highest quartile face a poor short-term prognosis.

LEAP2: Next game-changer of pharmacotherapy for overweight and obesity?

The world is seeking effective and safe weight-lowering drugs for centuries. LEAP2, acting on ghrelin and growth hormone secretagogue receptor, according to a study by Hageman et al.1 in this issue of Cell Reports Medicine, found its way toward the next target of pharmacotherapy for obesity and related diseases.

Time-varying cost-effectiveness analysis of sodium-glucose cotransporter-2 inhibitors in Chinese patients with heart failure and reduced ejection fraction: A microsimulation of the real-world population

Objective

Sodium-glucose cotransporter-2 (SGLT2) inhibitors showed time-varying effects in heart failure and reduced ejection fraction (HFrEF), but corresponding cost-effectiveness in different timeframes remained poorly understood. This study estimated the time-varying cost-effectiveness of SGLT2 inhibitors in HFrEF from the perspective of the Chinese healthcare system.

Methods

Based on real-world individual patient data, a 2-year microsimulation model was constructed to evaluate the cost-effectiveness of adding SGLT2 inhibitors to standard therapy compared with standard therapy alone among patients with HFrEF. A published prediction model informed transition probabilities for all-cause death and hospitalization for heart failure. The time-varying effects of SGLT2 inhibitors, medical costs, and utility values were derived from the published literature. Scenario analyses in different timeframes were conducted to assess the trend of cost-effectiveness over time.

Results

Compared with standard therapy alone, SGLT2 inhibitors plus standard therapy were found cost-effective at a willingness-to-pay (WTP) threshold of $12,741 per quality-adjusted life year (QALY) gained in 2 years. The incremental cost-effectiveness ratio (ICER) decreased from $12,346.07/QALY at 0.5 years to $9,355.66/QALY at 2 years. One-direction sensitivity analysis demonstrated that the cost-effectiveness of SGLT2 inhibitors was most sensitive to the cost of SGLT2 inhibitors, the cost of hospitalization for heart failure, the cost of standard therapy for heart failure, and the baseline risks of all-cause death and hospitalization for heart failure. Probabilistic sensitivity analysis proved the robustness of the results.

Conclusion

Adding SGLT2 inhibitors to standard therapy was found to be cost-effective in Chinese patients with HFrEF. Longer treatment appeared to be more economically favorable, but further explorations are warranted.

Fine needle aspiration cytology of a granular cell tumor arising in the thyroid gland: a case report and review of literature

Granular cell tumor (GCT) is an uncommon tumor of soft tissue, and rarely occurs in thyroid. In this article, we report the FNAC results and pathological analysis of a 14-year-old female who presented with a painless mass in the right lobe of thyroid gland. A resection of the right lobe and isthmus of thyroid were applied after cells with abundant strong eosinophilic cytoplasma, indistinct border and inconspicuous nucleolus were found in the FNAC of the mass. Postoperative pathology and immunohistology helped diagnosis the lesion as thyroid GCT. Differential diagnosis from five diseases and cell types were performed and a review of all eleven papers reporting thyroid GCT was provided.

Glycated Haemoglobin A1c Variability Score Elicits Kidney Function Decline in Chinese People Living with Type 2 Diabetes

Our aim was to investigate the association of glycated haemoglobin A1c (HbA1c) variability score (HVS) with estimated glomerular filtration rate (eGFR) slope in Chinese adults living with type 2 diabetes. This cohort study included adults with type 2 diabetes attending outpatient clinics between 2011 and 2019 from a large electronic medical record-based database of diabetes in China (WECODe). We estimated the individual-level visit-to-visit HbA1c variability using HVS, a proportion of changes in HbA1c of ≥0.5% (5.5 mmol/mol). We estimated the odds of people experiencing a rapid eGFR annual decline using a logistic regression and differences across HVS categories in the mean eGFR slope using a mixed-effect model. The analysis involved 2397 individuals and a median follow-up of 4.7 years. Compared with people with HVS ≤ 20%, those with HVS of 60% to 80% had 11% higher odds of experiencing rapid eGFR annual decline, with an extra eGFR decline of 0.93 mL/min/1.73 m2 per year on average; those with HVS > 80% showed 26% higher odds of experiencing a rapid eGFR annual decline, with an extra decline of 1.83 mL/min/1.73 m2 per year on average. Chinese adults with type 2 diabetes and HVS > 60% could experience a more rapid eGFR decline.

Approaches to Reach Trustworthy Patient Education: A Narrative Review

BACKGROUND

Patient education is a cornerstone of modern healthcare. Health literacy improves health-related quality of life and health outcomes of patients, enhanced by effective patient education. Inadequate competency of patient education in healthcare providers triggered this review to summarize common approaches and recent advancements.

METHODS

This narrative review summarizes common approaches and recent advancements in patient education with their relations to health literacy, their strengths, limitations, and practical issues.

RESULTS

This review highlighted the multifaceted approaches to patient education, emphasizing the importance of tailoring methods to meet the diverse needs of patients. By integrating various strategies, including intrapersonal, interpersonal, and societal/community-level interventions, healthcare providers can create a more comprehensive educational experience that addresses the complexities of patient needs, meanwhile improving the health literacy of patients. With the rise of digital media and artificial intelligence, there is an increasing need for innovative educational resources that can effectively reach and engage patients. Ongoing research and collaboration among healthcare professionals and policymakers will be essential to refine educational strategies and adapt to emerging challenges. It is essential to remain vigilant about potential conflicts of interest that may compromise the integrity of educational content.

CONCLUSION

Effective patient education empowers individuals and their contributions to a healthier society by fostering informed decision-making and encouraging proactive health management.

Is antibiotic prophylaxis generally safe and effective in surgical and nonsurgical scenarios? Evidence from an umbrella review of randomized controlled trials

BACKGROUND

The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of evidence.

MATERIALS AND METHODS

The authors performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence.

RESULTS

Seventy-five meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For nonsurgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in nonemergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation.

CONCLUSIONS

Antibiotic prophylaxis in surgical and nonsurgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.

Professional medical education approaches: mobilizing evidence for clinicians

Rapidly proliferating high-quality evidence supports daily decision-making in clinical practice. Continuing professional medical education links this evidence to practicing clinicians who are strongly motivated to improve the quality of their care by using the latest information. Approaches to professional education vary, and their effects depend on specific scenarios. This narrative review summarizes the main approaches for professional medical education that facilitate the mobilization of evidence for clinicians. It includes traditional learning (passive and active dissemination of educational materials, lectures, and mass media dissemination), constructivist learning (engaging in local consensus processes and education outreach visits, interfacing with local opinion leaders, conducting patient-mediated interventions, employing audit and feedback processes, and utilizing clinical decision-supporting systems), and blended learning approaches (the integration of in-person or online passive learning with active and creative learning by the learners). An optimized selection from these approaches is challenging but critical to clinicians and healthcare systems.