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News From The Annals Of Internal Medicine: 2 July 2013

1. Proves Effective for

Salsalate, a prodrug form of salicylate, may be an effective treatment for patients with type 2 diabetes but its efficacy and safety have not been tested using currently accepted regulatory practices. Researchers randomly assigned 286 adult patients with established type 2 diabetes and inadequate glycemic control to take either placebo (n=140) or salsalate, 3.5 g/d (n=146) along with current therapies for 48 weeks. Of those patients, 283 were analyzed for changes in hemoglobin A1C level, anti-inflammatory effects, and adverse events. The researchers found that salsalate reduced both A1C and fasting blood glucose levels at all study time points (4, 8, 12, 16, 24, 36, and 48 weeks) and blood tests results revealed that salsalate reduced inflammation in the body. Patients taking salsalate had a six-times greater risk of hypoglycemia than those taking placebo. Increases in body weight and total and low-density lipoprotein cholesterol levels were seen, as was evidence of reduced kidney function that was reversed after salsalate was stopped. Further study of salsalate’s effects on cardiac and renal outcomes is warranted.

2. White Men More Likely than Black Men to Have Advanced Colorectal Neoplasia Found at Screening

A study of 1,172 average-risk white and 1,681 black persons undergoing screening colonoscopy found that black men were significantly less likely than white men to have advanced colorectal neoplasia (ACN) at screening. Studies have shown that black persons are more likely to be diagnosed with CRC and die from it than white persons. Researchers compared the prevalence and distribution of ACN among black and white patients to determine the extent to which genetic or biological factors versus disparities in screening rates explain this disparity. ACN was defined as a tubular adenoma 10 mm or more in size, any adenoma with villous features or high-grade dysplasia, any dysplastic serrated lesion, or invasive cancer. Researchers looked for racial differences in the overall prevalence of ACN after adjustment for other epidemiologic risk factors. They also examined racial differences in the distribution of proximal ACN versus distal ACN among those found to have ACN. The researchers found that ACN was significantly higher among white persons than black persons (6.8% vs. 5.0%). Analyses that controlled for multiple risk factors showed that black men were 41 percent less likely than white men to have ACN but such analyses were inconclusive for women. White patients were more likely to present with distal ACN, while prevalence of proximal ACN was similar for the two groups. The researchers conclude that disparities in access to screening and exposure to modifiable risk factors – not genetic or biological factors – may be largely responsible for higher incidence of CRC among black men.

3. New Tick-borne Illness Observed in Patients Thought to Have Human Granulocytic Anaplasmosis

Borrelia miyamotoi infection, a newly-recognized tick-borne illness, has been observed in patients thought to have human granulocytic anaplasmosis (). There are 11 recognized tick-borne illnesses in the northeastern United States and all can present as undifferentiated flu-like illness. In areas where deer ticks are common and Lyme disease, babesiosis, and are prevalent, patients presenting with sudden fever, myalgia, leucopenia, and elevated aminotransferase levels are presumptively diagnosed with . Researchers identified two such patients from the northeastern United States who were hospitalized for presumptive and treated with doxycycline. A lack of response to doxycycline after more than 24 hours led to further analysis. B. miyamotoi infection was identified in these patients who previously would have been reported to the Department of Public Health as possible HGA cases.


American College of Physicians