Journal of general internal medicine
-
Comparative Study
Symptom burden of adults with type 2 diabetes across the disease course: diabetes & aging study.
Reducing symptom burden is paramount at the end-of-life, but typically considered secondary to risk factor control in chronic disease, such as diabetes. Little is known about the symptom burden experienced by adults with type 2 diabetes and the need for symptom palliation. ⋯ In a diverse cohort of adults with type 2 diabetes, pain and non-pain symptoms were common among all patients, not only among those near the end of life. However, symptoms were more prevalent among patients with shorter survival. Older adults reported more physical symptoms, whereas younger adults reported more psychosocial symptoms. Diabetes care management should include not only good cardiometabolic control, but also symptom palliation across the disease course.
-
It is increasingly apparent that human health is reliant on our fellow travellers, the innumerable microorganisms that inhabit our bodies. This realization has led to the concept of the superorganism, which suggests that shared metabolic and signalling pathways are crucial for optimal existence of both host and commensal microflora. This commentary focuses on implications of this paradigm for personalized medicine and therapeutics. ⋯ Probiotics can potentially modulate the superorganism for therapeutic benefit. However, the probiotics industry will need to undergo a transformation, with increased focus on stringent manufacturing guidelines and high-quality clinical trials. Ultimately, we suggest that healthcare will move beyond its prevailing focus on human physiology, and embrace the superorganism as a paradigm to understand disease.
-
Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration.
Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented. ⋯ Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Impact of lifestyle intervention and metformin on health-related quality of life: the diabetes prevention program randomized trial.
Adults at high risk for diabetes may have reduced health-related quality of life (HRQoL). ⋯ Overweight/obese adults at high risk for diabetes show small improvement in most physical HRQoL and vitality scores through the weight loss and increased physical activity achieved with an ILS intervention.