Public Release: 

Guideline recommends diet and exercise interventions to prevent diabetes

News from Annals of Internal Medicine, July 14, 2015

American College of Physicians

1. Community Preventive Services Task Force recommends diet and exercise interventions to prevent diabetes

Evidence shows combined diet and exercise promotion programs are effective and cost-effective for preventing type 2 diabetes in at-risk patients
Free content

Clinical guideline: http://www.annals.org/article.aspx?doi=10.7326/M15-1029
Evidence review: http://www.annals.org/article.aspx?doi=10.7326/M15-0452
Economic evidence review: http://www.annals.org/article.aspx?doi=10.7326/M15-0469
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-1563
URLs go live when the embargo lifts

The Community Preventive Services Task Force (Task Force) recommends the use of combined diet and physical activity promotion programs to provide counsel and support to patients at increased risk for type 2 diabetes. A systematic review of 53 studies describing 66 programs found strong evidence that such programs are effective for reducing new onset diabetes. A separate review of economic evidence (28 studies) found these interventions to be cost-effective. The recommendation statement and evidence reviews are published in Annals of Internal Medicine.

Combined diet and physical activity promotion programs encourage persons who are at increased risk for diabetes to improve their diet and increase their physical activity. Guideline authors suggest that interventions include: trained providers in a clinical or community setting who work directly with patients for at least three months; some combination of counseling, coaching, or extended support; and multiple sessions related to diet and physical activity, delivered in person or by some other method. Additional elements may also be included. The research shows that higher intensity programs lead to greater weight loss and greater reduction in new onset diabetes.

The Task Force is an independent nonfederal, unpaid group of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and policies to improve health.

Notes: For an embargoed PDF, please contact Angela Collom or Cara Graeff. To reach someone from the Task Force, please contact Jamila Jones at the CDC Community Guide Branch at akq3@cdc.gov or 404-498-6401.


2. Surgery may extend life for patients with advanced, active ulcerative colitis

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-0960
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-1190
URLs go live when embargo lifts

Elective colectomy is associated with significantly longer survival than nonsurgical treatment for older patients with advanced, active ulcerative colitis (UC), according to a study published in Annals of Internal Medicine.

UC is a type of inflammatory bowel disease with inflammation confined to the colon. Current medical therapies often fail to induce remission in all patients and relapse rates are high even when remission is achieved. Elective colectomy can cure UC symptoms, but quality of life is altered after surgery. As such, the choice between long-term immunosuppressant therapy or total colectomy is a difficult one to make.

Researchers reviewed Medicare records for 830 patients with UC pursuing elective colectomy and 7,541 matched patients with UC pursuing medical therapy to determine if surgery improved survival. The researchers found that the 5-year mortality rate was about 30 percent lower for patients treated with surgery.

According to the author of an accompanying editorial, Dr. David B. Sachar from The Mount Sinai Medical Center in New York, NY, the goal of therapy should be "not saving colons, but saving lives." Dr. Sachar suggests that gastroenterologists look at this study and reevaluate what constitutes success in treating a patient.

Notes: For an embargoed PDF, please contact Angela Collom or Cara Graeff. To speak with the lead author, please contact Lee-Ann Donegan at Leeann.Donegan@uphs.upenn.edu or 267-240-2448.


3. '3 Wishes Project' helps to create meaning, memories, and closure at death

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0502
Editorial: http://www.annals.org/article.aspx?doi=10.7326/M15-1351
URLs are live when the embargo lifts

Eliciting and honoring last wishes helps to humanize dying in the intensive care unit (ICU), according to research being published in Annals of Internal Medicine.

The process of dying places enormous stress on patients and those caring for them. Researchers developed the 3 Wishes Project to try to bring peace to the final days of critically ill patients and to ease the grieving process for their loved ones. Consecutive patients, families, and clinicians at one 21-bed medical-surgery ICU were invited to propose three wishes aimed at honoring the patient or family when death was imminent. Wishes were classified into five categories: humanizing the environment; personal tributes; family reconnections; rituals and observances; and paying it forward (e.g., organ donation or charitable giving). Investigators interviewed families and clinicians to assess the program's effects. Overall, 97.5 percent of the wishes were implemented at a cost ranging from $0 to $200 per patient. End-of-life care was rated high by family members and postmortem interviews with 160 family members and clinicians provided overwhelmingly positive feedback.

According to the authors, the 3 Wishes Program encouraged the verbalization and realization of unmet spiritual needs, whether secular or faith-based. The authors say their findings underscore the drive that we all have to search for meaning, memories, and closure in anticipation of death.

Notes: For an embargoed PDF, please contact Angela Collom or Cara Graeff. To speak with the lead author, please contact Veronica McGuire at vmcguir@mcmaster.ca or 905-525-9140 ext. 22169.

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Also in this Issue:
Walking the Tightrope of Academia-Industry Relationships
Annals Editors discuss their policy on publishing articles written by authors with ties to industry
Editorial
M15-1500
http://www.annals.org/article.aspx?doi=10.7326/M15-1500

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