Jennifer Barrett

Nurse practitioners’ (NPs) and physician assistants’ (PAs) impact on diabetes management is comparable to management by physicians, according to a study published in the

Several previous studies have indicated that patient outcomes when managed by NPs and PAs were similar with those managed by physicians. The latest findings continue to underscore that patients can benefit highly from the care of NPs and PAs, and increasing their involvement in patient management could help meet the demand for primary care providers in the United States.

The researchers examined whether patients in the Veterans Health Administration managed by either primary care NPs, PAs, or physicians had similar hemoglobin A1c levels at comparable times. The study included 19,238 veterans with newly diagnosed diabetes in 2008, continuous primary care from 2008 to 2012, and more than 75% of primary care visits with NPs, PAs, or physicians. Annual hemoglobin A1c levels were documented through 2012 and all patients had 4 years of consistent primary care follow-up.

Of those included in the study, 2,821 were managed by NPs, 1,367 were managed by PAs, and 15,050 were managed by physicians. Patients managed by NPs and PAs had 14.5% and 15% of primary care visits with physicians, respectively.

A total of 15,841 patients were prescribed glucose-lowering medications. Of these, 96% had at least 1 oral medication, 37% had at least 2 oral medications, and 17% were prescribed insulin. According to the results, median hemoglobin A1c at initiation of the first and second oral drug was significantly lower in patients of NPs (7% and 7.5%, respectively) compared with that of physicians (7.1% and 7.7%). However, NPs and physicians started patients on insulin at similar hemoglobin A1c levels (9.5% and 9.7%).

The findings indicate no difference in hemoglobin A1c levels at diagnosis, initiation of medication, or after first 4 years of follow-up. NPs started patients on insulin at slightly lower hemoglobin A1c levels than physicians, but these differences were not statistically significant.

Overall, the researchers concluded that expanding the roles of NPs and PAs in patient management could significantly benefit patients in health care, both within and outside the Veterans Affairs system.

Yang Y, Long Q, Jackson SL, et al. Nurse practitioners, physician assistants, and physicians are comparable in managing the first five years of diabetes.

. 2018. 131:3:276-283. Doi: https://doi.org/10.1016/j.amjmed.2017.08.026

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Nurse practitionersâ€™ and physician assistantsâ€™ impact on diabetes management is comparable to management by physicians, according to a newly published study.


Nurse Practitioners, Physician Assistants Deliver Diabetes Care Comparable with Physicians

Although it is already established that migraines are associated with increased risk of stroke and heart attacks, the associations with other cardiovascular diseases and risks are less well known. According to a recent study published in

, migraines may be an important risk factor for other cardiovascular diseases as well.

In the study, the researchers examined the risks of myocardial infarction, ischemic and hemorrhagic stroke, peripheral artery disease, venous thromboembolism, atrial fibrillation, and heart failure in patients with first time diagnosis of migraine and compared with the general population.

The researchers identified patients based on recorded inpatient, outpatient, and emergency department diagnoses in the Danish National Patient Registry, excluding patients with a migraine diagnosis before 1995 or with previous cardiovascular disease.

Overall, the migraine cohort included 51,032 individuals and the matched general population cohort included 510,320. Of the migraine group, 2451 patients had 1 cardiovascular event and 575 patients had more than 1 cardiovascular event. The researchers concluded that, along with being associated with myocardial infarction and stroke, migraine also increased risks of venous thromboembolism and atrial fibrillation.

Additionally, the risk of cardiovascular disease was highest during the first year after diagnosis, with an eightfold increased risk of ischemic and hemorrhagic stroke and a twofold increased risk of myocardial infarction, venous thromboembolism, and atrial fibrillation. Over the long term, migraine remained associated with these cardiovascular diseases. The researchers did not find any association between migraine and heart failure or peripheral artery disease.

The associations were stronger in patients who had migraines with aura than in those who did not have aura, and in women than in men.

Although overall absolute risks were low, the findings indicate that migraine should be considered a risk factor for most cardiovascular diseases, according to the researchers. They noted that current migraine guidelines do not recommend use of anticlotting medications such as aspirin for treatment, but health care providers should consider whether patients at higher risk of heart disease would benefit from anticoagulant treatment.

Adelborg K, Szepligeti SK, Holland-Bill L, et al. Migraine and risk of cardiovascular disease: Danish population based matched cohort study.

Although it is already established that migraines are associated with increased risk of stroke and heart attacks, the associations with other cardiovascular diseases and risks are less well known. 

Study: Migraines May Be Linked to More Cardiovascular Risks

In today's CDC media briefing on the latest influenza activity data, CDC officials indicated that flu-associated hospitalization rates are on pace to hit record highs compared with past severe seasons.

CDC Acting Director Anne Schuchat, MD, RADM, USPHS, and Dan Jernigan, MD, MPH, CAPT, USPHS, director of the Influenza Division of the National Center for Immunization and Respiratory Diseases, provided an update on the current status of the 2017-2018 flu season. The update cited data reporting that overall influenza activity has increased over the past week, while hospitalizations and deaths continue to climb.

Influenza-related hospitalizations are at the highest that the CDC has tracked since 2010, Dr. Schuchat noted in the briefing. Overall, hospitalizations have reached a cumulative rate of 51.4 laboratory-confirmed flu-associated hospitalizations per 100,000 population.

If hospitalization trends continue, these rates will surpass hospitalizations in the 2014-2015 season, according to the briefing.

“So far this year, the cumulative rate of hospitalizations is the highest since we’ve been tracking in this way, which goes back to 2010,” Dr. Schuchat said in the briefing. “In terms of the 2009-2010 pandemic year, it was very high for influenza activity but it wasn’t our peak for hospitalizations.”

Additionally, recent reports in the past week have indicated that activity in the western United States may be easing up, with Oregon as the one state reporting less activity. “However, we are by no means out of the woods,” she warned. Despite the possibility of relief in the west, US flu activity in the east has increased while southern states are continuing to see the same levels of high activity.

For this week, reported influenza-like illnesses have increased again, reaching 7.1% compared with the 6.6% reported in last week's briefing.

Only 2 seasons reported higher rates, Dr. Jernigan said, including the 2009 pandemic, which peaked at 7.7%.

The average flu season is typically 16 weeks, but can range from 11 to 20 weeks, suggesting that there may still be many more weeks left in the season.

An additional 16 influenza-related pediatric deaths have been reported this week, reaching a cumulative total of 53 children.

Adult mortality also increased from 9.1% to 9.7%.

Despite reports of decreased effectiveness for the H3N2 virus, the CDC continues to recommend the flu vaccine, as other flu viruses are circulating this season as well.

2017-2018 Influenza Season Week 4 ending January 27, 2018. Weekly US Surveillance Report. CDC’s website.

https://www.cdc.gov/flu/weekly/index.htm#S6

In today's CDC media briefing on the latest influenza activity data, CDC officials indicated that flu-associated hospitalization rates are on pace to hit record highs compared with past severe seasons. 

CDC: Flu Hospitalizations, Deaths on the Rise as Activity Increases

A new measure announced by the Drug Enforcement Administration (DEA) will expand access to opioid addiction treatment by allowing nurse practitioners (NPs) and physician assistants (PAs) in underserved areas to prescribe and dispense buprenorphine.

According to a press release, the action will expand access to medication for opioid addiction to residents in rural areas with limited access to physicians. As published today in

, NPs and PAs can now become DATA-Waived qualifying practitioners, which gives them authority to prescribe and dispense buprenorphine from their offices.

According to the Comprehensive Addiction and Recovery Act, which was passed in 2016, NPs and PAs who completed required training and sought to prescribe buprenorphine to up to 30 patients were able to apply for authority to prescribe the medication.

Prior to the CARA, most of the DATA-Waived physicians served urban areas, leaving rural parts of the United States underserved. After the CARA’s enactment, the DEA began the process of transitioning mid-level practitioners into DATA-Waived status.

The DEA cited a report published by the National Rural Health Association, in which 90% of DATA-Waived physicians practice in urban counties, with 53% of rural counties lacking any prescribing physician. According to the press release, many rural patients must travel long distances to access outpatient buprenorphine treatment.

DEA announces step to increase opioid addiction treatment [news release]. DEA’s website.