8 Comments
Jun 3Liked by William H Bestermann Jr MD

One of your best pieces of writing, Bill. Well done. You must be very proud of your son. I did not serve in the active military, but I did serve in the National Health Services Corps, which is a uniformed branch of the armed services almost nobody knows about now. The NHSC paid three years of my in-state medical school tuition, and my obligation was to then serve three years duty as a doctor serving the needs of people in areas that lacked medical care. I did my duty, and came away feeling strongly that all young people ought to spend 1-3 years in community service of some kind, and that in return they would be rewarded not just with paid tuition for college or professional school, but with a rich set of experiences that can only come from aiding and assisting people in poorer communities around the country. We’ve almost entirely lost any sense of duty to country, to community, to our fellow men and women. Loss of that sense has contributed the degradation of our culture and our leadership.

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That comment makes my writing worthwhile and I agree with you completely. I did my training in uniform much as you did, but I was in the Navy. I did 7 years of military service and it was one of my best professional experiences. Sadly, a sense of duty seems much less common today. It is always great to hear from you

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Jun 4Liked by William H Bestermann Jr MD

Totally agree. As a daughter of a WWII veteran I learned so much from him (he and my mom had me late in life) and he signed up and was off to war at age 17. We have lost leadership these days. We have political hacks it seems with no patient advocacy. I respect our military but have lost respect for elected officials. Everyday there is news about how bad our healthcare system is. I truly wish things would change for the better. We have so many citizens that can't even access any care or have insurance. Our "healthcare" is sick and ill.

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There is an opportunity to begin to fix the system and our allies should be self-insured employers.

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Jun 4Liked by William H Bestermann Jr MD

We must never lose hope and we must fearlessly forge forward for the wellbeing of all and our country!

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That's the spirit!

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https://www.ahajournals.org/do/10.1161/podcast.20240531.705195/full/

the first paper is about type 2 diabetes and the prevalence and management of type 2 diabetes have changed dramatically in recent years. Over 20 well-powered cardiovascular and kidney outcome trials in patients with type 2 diabetes involving more than 200,000 patients provide rigorous clinical evidence supporting broader utilization of sodium glucose co-transporters to inhibitors, SGLT2 inhibitors and glucose like peptide one receptor agonist GOP one receptor agonist. And professional guidelines recommend using these agents for patients with elevated CV or kidney risk. Despite these data and recommendations, utilizations of these therapies remain low. The diabetes remote intervention to improve use of evidence-based medications that drive program systematically identified patients with type 2 diabetes at elevated cardiovascular and or kidney risk, who were longitudinally managed in a large healthcare system and then facilitated prescription of these medication classes through remote physician overseen, non-licensed navigator and clinical pharmacist driven management.

So to assess whether a patient's acceptance of medical therapy recommendations was affected by the timing of education. These investigators led by co-corresponding authors, Dr. Alexander Blood and Benjamin Scirica from Brigham and Women's Hospital in Boston, randomly assigned patients to a strategy of education in conjunction with medical therapy management simultaneously. So that's the simultaneous group. Versus a strategy of an initial two-month period of education prior to medical therapy management. So that's the education first group. And the primary outcome was the proportion of patients with prescriptions for either STLT-II inhibitors, GLP-I receptor agonist by six months.

Dr. Greg Hundley:

Wow, Peder. So a randomized remote implementation trial of STLT-II inhibitors or GLP-I agonists by a multidisciplinary team involving patients with type 2 diabetes. So, Peder, what did they find?

Dr. Peder Myhre:

Exactly, Greg. So in total, 200 patients were randomized and according to the protocol, none of these patients were prescribed either STLT-II inhibitors, or GLP-I receptor agonist therapy despite having an indication. So after six months of the intervention, 69.8% of patients in the simultaneous arm received a new prescription versus 56% of patients in the education first arm. And that was significant. And the median time to first prescription was 24 versus 85 days between these two groups. And that was also significant. And patients in both groups demonstrated benefits of weight loss and HbA1c reduction.

So Greg, to sum this up, contrary to the study hypothesis, the education first strategy of providing an initial enhanced standard of care with both patient and clinician notification, coaching and video education prior to medication management was not as effective in impacting the eventual uptake of therapy by six months from enrollment. However, the authors suggest that a remote team-based care delivery should be considered to close care quality gaps, implement new therapies, and improve care across populations.

Dr. Greg Hundley:

Wow, Peder, that's a surprising result here. I would've thought that the education first group really may have been helpful, but appears here not so much.

Dr. Peder Myhre:

That's what the authors thought as well.

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Bill, I agree completely with Dr Kibbe. I took accepted a scholarship in Med School and spent a few years as a PCP in the Navy. Best years of my life.

You must be so proud of your son, I sure am. Thank him for his service. Self-sacrifice for the common good? Where did that go? Great post as always.

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