- N Engl J Med 2022; 387:692-703
Some insurance companies mandate a form of step therapy, which involves initial use of an inexpensive drug, bevacizumab, to treat diabetic macular edema. This trial compared two treatments: step therapy and use of a more expensive drug.
- N Engl J Med 2022; 387:751-752
Step therapy is a treatment approach often required by health insurers to control costs. It involves treating first with a lower-cost medication and, only if that proves ineffective, switching to another, more costly medication. Although step therapy is commonly applied in treating hypertension, diabetes, cancer, and other conditions, concerns regarding...
- N Engl J Med 2022; 387:587-598
Pregnant women were assigned to be evaluated with lower or higher glycemic criteria for the diagnosis of gestational diabetes. Lower criteria did not reduce the risk of a large-for-gestational-age infant.
- N Engl J Med 2022; 387:652-654
In the first decade of this millennium, convincing data showing that screening for and treatment of gestational diabetes mellitus improve both maternal and fetal outcomes1,2 ended debates within the obstetrical community about the usefulness of screening for gestational diabetes. Essentially all U.S. professional societies now recommend universal biochemical...
- N Engl J Med 2022; 387:433-443
This trial compared once-weekly dulaglutide, a GLP-1 receptor agonist, with placebo for glycemic control in youths with type 2 diabetes who may have been receiving metformin or basal insulin. Dulaglutide was superior at 26 weeks.
- N Engl J Med 2022; 387:e5
A 78-year-old man with type 2 diabetes presented with hemiballism of the left arm and leg (shown in a video). Evaluation revealed hyperglycemia and an area of increased density in the right basal ganglia on imaging.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:1155-1164
Management of type 1 diabetes mellitus in children involves close family support and glucose monitoring. Improved means of insulin administration include newer pumps or smart pens that receive data from continuous glucose monitoring and can assist in calculation of insulin doses.
- N Engl J Med 2022; 386:781-787
A 68-year-old man with metastatic melanoma was evaluated in the oncology clinic because of fatigue and weight loss. Hypothyroidism had been noted 4 months earlier; increased thirst and nocturia had developed 2 weeks earlier. The blood glucose level was 505 mg per deciliter (reference range, 70 to 110). Management decisions...
- N Engl J Med 2022; 386:503-505
Hispanic Americans’ health profile doesn’t adhere to the paradigm in which minority ethnic or poverty status determines poor health outcomes. But the U.S. health enterprise has not used this information to recalibrate or rethink our models of health and risk factors.
- N Engl J Med 2022; 386:405-408
Although public health practitioners and researchers focus primarily on improving health, economists view health as but one important component of what people may value. This insight is a key aspect of economics’ utility for informing public health policy.
- N Engl J Med 2022; 386:285-286
The year 2021 has been celebrated as the centennial of the discovery of insulin, a feat that prolonged the lives of millions of persons with type 1 diabetes but cured none of them. In the coming century, we can look forward to improved mechanical devices to mimic the actions of...
- N Engl J Med 2021; 385:2252-2263
In this double-blind trial, patients with stage 1 to 4 chronic kidney disease and type 2 diabetes were randomly assigned to receive finerenone or placebo. Finerenone treatment was superior with regard to the primary composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart...
- N Engl J Med 2021; 385:2092-2095
This interactive feature about a person with type 1 diabetes mellitus and impaired awareness of hypoglycemia offers a case vignette accompanied by two essays supporting the use of a continuous glucose monitor paired with an insulin pump or a continuous glucose monitor with alerts.
- N Engl J Med 2021; 385:1633-1636
Chronic-disease care in the United States doesn’t support optimal patient health and experience, especially for marginalized populations. Too often, care systems are based on tradition, self-interest, and revenue generation.
- N Engl J Med 2021; 385:e58
An 82-year-old man presented to the emergency department with fever and confusion. Computed tomography of the abdomen showed gas in the liver, and a diagnosis of emphysematous hepatitis was made after cultures grew extended-spectrum beta-lactamase Klebsiella pneumoniae.
- N Engl J Med 2021; 385:896-907
This trial compared weekly injections of efpeglenatide, an exendin-based glucagon-like peptide-1 receptor agonist, at a dose of 4 or 6 mg with placebo in participants with known type 2 diabetes and either a history of cardiovascular disease or current kidney disease plus at least one other cardiovascular risk factor. The...