By Beth Gilbert HealthDay Reporter
The annual meeting of the American College of Physicians (Internal Medicine Meeting) was held from April 18 to 20 in Boston and was attended by internists, adult medicine specialists, subspecialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults, with presentations focusing primarily on updates in neurology, oncology, infectious diseases, endocrinology, and cardiology.
During one workshop, Gregg D. Simonson, Ph.D., of the International Diabetes Center at HealthPartners Park Nicollet in St. Louis Park, Minnesota, discussed how continuous glucose monitors (CGMs) lead to improved diabetes management and provided internal medicine physicians with the knowledge, skills, and confidence to incorporate CGMs into their practice.
Simonson noted that interpreting and acting on the CGM data and reports is critical for success. As such, the International Diabetes Center HealthPartners Institute created the Ambulatory Glucose Profile report to organize critical CGM metrics and data into a clinically useful single-page report. This allows an individual with diabetes and their care team to quickly determine what actions (i.e., lifestyle and medication changes) might be needed to improve their diabetes management.
During the workshop, all attendees were provided the opportunity to apply a CGM sensor and wear it for 10 to 14 days so they could learn firsthand the usefulness of this technology. Practical CGM tips were provided, including management of skin irritation and techniques to improve sensor adhesion. The attendees were also given detailed information on documentation, billing, and coding for CGMs.
“Workshop attendees received the International Diabetes Center HealthPartners Institute’s Clinician CGM Guided Management (CCGM) of Patients with T2DM on Insulin booklet and instruction on how to use the information and guidelines it contains to effectively manage individuals treated with basal, basal-bolus, or premixed insulin regimens,” Simonson said. “To reinforce key points of the workshop, all participants were provided a CGM Case Study Workbook to complete while working in small groups. Facilitated discussion provided an opportunity to share best practices and ask questions of the faculty.”
During another presentation, John M. Inadomi, M.D., of the Spencer Fox Eccles School of Medicine at the University of Utah in Salt Lake City, provided an update in gastroenterology, including insight on proton pump inhibitors (PPIs), metabolic dysfunction-associated steatotic liver disease (MASLD), and colorectal cancer screening.
Inadomi discussed the multitude of adverse effects that have been attributed to PPIs, including kidney disease, cardiovascular events, bone fractures, and infections, but said clinicians should not stop PPIs for fear of adverse effects. Rather, they should decide on the basis of whether their patient has an appropriate indication for long-term PPI use.
Inadomi also noted that MASLD can now be categorized into metabolic syndrome or nonmetabolic syndrome. Metabolic syndrome steatotic liver disease is further categorized as MASLD (no or little alcohol use), MetALD (moderate alcohol use: two to three drinks per day for women or three to four drinks per day for men), or alcoholic liver disease (more than three drinks for women and more than four for men). According to Inadomi, a variety of lifestyle changes (weight loss, healthy diet, exercise, cholesterol reduction, and controlling diabetes) are effective to reduce steatosis, and now pharmacologic therapy (glucagon-like peptide-1 receptor agonists) has shown efficacy in reducing liver steatosis.
“Colorectal cancer screening adherence is still far below the national goal of 80 percent in all populations. Most guidelines recommend initiating screening in average-risk adults at age 45 years (with the exception of the ACP guideline that continues to recommend starting at age 50 years),” Inadomi said. “Average-risk screening should be performed with existing tests (FIT [fecal immunochemical test], FIT/DNA, colonoscopy), and the future of blood-based biomarker screening depends on whether it is possible to increase their sensitivity for advanced polyps, and dramatically reduce their costs.”
Kristine E. Ensrud, M.D., M.P.H., of the University of Minnesota in Minneapolis, discussed what primary care clinicians should know about osteoporosis drug treatment.
Ensrud noted that the goal of osteoporosis drug treatment is to reduce the risk for clinical or symptomatic fractures. Bisphosphonates, including alendronate, risedronate, and zoledronate, are the first-line pharmacologic treatments for postmenopausal osteoporosis. Treatment with these antiresorptive agents reduces the risk for vertebral and nonvertebral fractures, including hip fracture. Denosumab is an alternative antiresorptive agent for initiation of osteoporosis drug treatment. The bisphosphonate ibandronate and the selective estrogen receptor modulator raloxifene are U.S. Food and Drug Administration-approved for the treatment of postmenopausal osteoporosis; however, according to Ensrud, they are rarely prescribed because while these medications reduce the risk for vertebral fractures, they have no effect on the risk for nonvertebral fractures, including hip fracture.
“To minimize the risk of long-term potential harms such as atypical femoral fractures, discontinuation of bisphosphonates should be considered in patients with a BMD (bone mineral density) T score of −2.5 or above after three to five years of oral bisphosphonate treatment or two to three years of intravenous bisphosphonate treatment,” Ensrud said. “Treatment with medications with anabolic effects (teriparatide, abaloparatide, romosozumab) should be considered in patients adherent to therapy with bisphosphonates or denosumab who experience treatment failure defined as multiple or disabling fracture on therapy. In addition, treatment-naive patients at very high risk of fracture (i.e., BMD T score −3.5 or less, recent disabling fracture and BMD T score −2.5 or less, or multiple prior fractures) are potential candidates for anabolic agents. Primary care clinicians should consider referring these types of patients to a subspecialist with expertise in the management of metabolic bone disease.”
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