New research, drugs may change care of common conditions

Developments in fields such as diabetic nephropathy and weight loss share a common theme: There is no magic bullet. The solution is to offer care tailored to the patient.

This issue looks at two common, related issues that internists encounter many times a day: diabetes and weight management. In the first category, this past year has seen some changes in the way experts believe diabetic nephropathy should be managed. Previously, aggressive treatment was almost always considered best, but recent data raise the possibility of more substantial variation by individual patient. In some cases, for example, proper targets for hemoglobin A1c level and blood pressure might be higher than previously thought. Our story reviews the latest research and offers a preview of upcoming revised guidelines.

In the second category, two new drugs approved by the FDA this year target the always tricky area of weight loss. But although these new pharmaceutical options may help some patients reach their weight loss goals, both carry risks and are far from being a “magic bullet.” Internists and patients will still need to work together closely to determine the best combination of diet, exercise and medication to achieve the desired result. Stacey Butterfield looks at strategies for discussing weight management with patients and examines the positives and negatives of the newly approved drugs in clinical practice.

Also in this issue, we take a look at skin and soft-tissue infections and the diagnostic challenges they often present for internists. Many of these conditions can be treated successfully in the office, but others require immediate referral to the hospital. The initial telephone contact with the patient can identify several “red flags” that can help tell the difference, experts say. And for patients who can be safely seen in the office, a careful history is key to determining the cause of the infection. Read more on what to look for during the physical exam, how to optimize treatment by decolonization, and why learning to drain abscesses yourself can help save time and resources.

Finally, this issue's Q&A delves into the details of a large medical home pilot in Colorado. The three-year Colorado Multipayer Patient-Centered Medical Home Pilot, which involved a collaboration among 16 primary care practices, had success in reducing emergency department use and hospital admissions but also encountered challenges in gathering cost data and in several other areas. More on this PCMH pilot, including its unique blended payment model, can be found here.

What challenges have you faced in transitioning to a medical home? Let us know by e-mail.


Jennifer Kearney-Strouse