News in Brief: Exenatide model of care for remote communities; GLP1-RA, SGLT2i use associated with lower COVID-19 mortality; Hospital doctors bullied to discharge patients early

Wednesday, 30 Jun 2021

Exenatide-LAR model of care for diabetes in remote communities 

A diabetes model of care that includes weekly exenatide-LAR injection combined with weekly nurse review shows great  potential for remote communities, according to a small study done in the Top End.

When used in two communities near Alice Springs it led to significant improvements in HbA1c in Indigenous Australians with type 2 diabetes that is often poorly controlled.

The intensive management protocol involves once-weekly supervised exenatide-LAR injection with weekly nurse review and adjustment of medication for 20  weeks with 13 people randomly assigned to the group, called the Community with exenatide-LAR.

Compared to the nine participants randomised to the Community without exenatide-LAR, an intervention involving weekly nurse review in addition to standard care over the same period, the weekly injections led to median difference in HbA1c change from baseline to final visit of −3.1%, 95% CI (−5.80%, −0.38%; p = 0.03).

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GLP1-RA, SGLT2i use associated with lower COVID-19 mortality compared with DPP4i

GLP1-RA and SGLT2i use is associated with lower COVID-19 mortality compared with DPP4i, new research suggests.

Using data from the US National COVID Cohort Collaborative investigators from Boston University School of Medicine analysed the records of over 12,440 patients with a prescription for the medicines  within 24 months of a positive SARS-CoV-2 PCR test.

Investigators say both GLP1-RA and SGLT2i use were associated with lower 60-day mortality compared with DPP4i use (OR 0.54 [95% CI 0.37–0.80] and 0.66 [0.50–0.86], respectively).

Use of both medications was also associated with decreased total mortality, emergency room visits, and hospitalisations though the team did note that DPP4i users were ‘older and generally sicker’.

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Hospital doctors bullied to discharge patients early

More than 60% of hospital doctors feel coerced to discharge patients before they are medically ready, according to a survey conducted by the SA Salaried Medical Officers Association.

Almost 40% of doctors said the pressure to discharge patients came from hospital executives and half said the early discharges negatively impacted on care, according to report In Daily.

The survey supports a “Time to Care” campaign by SASMOA which says that medical care is being compromised by lack of staff numbers to meet demand and lack of time to provide appropriate medical care for patients.

“Medical decisions should be made by doctors based on a medical assessment of patient need and not based on cutting costs,” the Association said.

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