By Jennifer Kearney-Strouse
Three authors discussed articles just published in Annals of Internal Medicine in a first-of-its-kind plenary session led by Christine Laine, MD, MPH, FACP, the journal's Editor-in-Chief, on Friday at Internal Medicine Meeting 2024.
The talks focused first on a randomized trial of isocaloric feeding in adults with diabetes that compared time-restricted eating (TRE) and basic calorie control for weight loss.
Lead author Nisa Maruthur, MD, MHS, FACP, of Johns Hopkins in Baltimore, reported that 41 patients were randomly assigned to TRE with a 10-hour eating window and 80% of calories consumed before 1 p.m., or to a usual eating pattern with a window of 16 hours or less and at least 50% of calories consumed after 5 p.m., each for 12 weeks. Nutrient content and calories were the same in both groups.
The researchers found that TRE did not decrease weight or improve glucose homeostasis versus a usual eating pattern. "We feel that clinicians can counsel their patients that [time-restricted eating] may help them to lose weight but likely because of the decrease in caloric intake," Dr. Maruthur said.
Next up was a study that assessed the use of next-generation antibiotics against resistant gram-negative infections in U.S. hospitals. The FDA has approved seven next-generation gram-negative antibiotics between 2014 and 2019, but the study found that clinicians still commonly use older, generic antibiotics to treat these infections, reported senior author and ACP Member Sameer Kadri, MD, MS, from the National Institutes of Health (NIH) in Bethesda, Md.
The solutions include better drugs and better tests, according to Dr. Kadri. "Agents are needed with innovative mechanisms targeting pathogens without good treatment options, and we need to expand access to antibiotic susceptibility testing for these new agents as soon as they come out," he said. "That might help, to some extent, bridge the unmet patient need in future antibiotics."
The final talk of the plenary unveiled ACP’s new clinical guideline on pharmacological treatments in adults with type 2 diabetes. ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle modifications for patients with inadequate glycemic control, according to Carolyn Crandall, MD, MACP, of the David Geffen School of Medicine at the University of California, Los Angeles, an author of the guideline.
SGLT-2 inhibitors should be used to reduce the risk for all-cause mortality, major adverse cardiovascular events (MACE), progression of chronic kidney disease (CKD), and hospitalization due to congestive heart failure (CHF), while GLP-1 agonists offer reduced risk for all-cause mortality, MACE, and stroke, she noted.
These recommendations were developed based on comparisons of potential combinations of therapies. "The comparative evidence between all the evaluated pharmacological classes suggests that the most favorable net benefit is derived from an add-on SGLT-2 inhibitor or GLP-1 agonist," said Dr. Crandall, who is Chair of ACP's Clinical Guidelines Committee. "The only newer pharmacological treatments for type 2 diabetes that reduce all-cause mortality compared to placebo or usual care are actually the SGLT-2 inhibitors and GLP-1 agonists, hence our recommendations."
The new guideline recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor as second-line therapy to reduce morbidity and all-cause mortality in adults with type 2 diabetes and inadequate glycemic control, Dr. Crandall said. "Why? Well, because add-on DPP-4 inhibitors compared to usual care results in no difference in all-cause mortality, MACE, MI, stroke, CHF hospitalization, CKD progression, or severe hypoglycemia."
After the three presenters' talks and a Q&A session, Dr. Laine encouraged attendees to share their thoughts via Annals' website. "Go to Annals.org—you can read all these articles in full detail, and comment on them by clicking the comment link next to the article," she said. ■