2 Minute Medicine Rewind May 12, 2025

Real-Time AI-Assisted Insulin Titration System for Glucose Control in Patients With Type 2 Diabetes

1. Use of an artificial intelligence (AI)-based insulin clinical decision support system in insulin titration for adults with type 2 diabetes mellitus (T2DM) was non-inferior compared to standard therapy with senior endocrinology physicians.

Evidence Rating Level: 1 (Excellent)

While many adults with T2DM eventually require insulin therapy for long-term management of their disease, less than one-third receiving insulin will reach their management goals. Several attempts have been made to develop digital technologies to address this problem. One such approach is an AI-based insulin clinical decision support system (iNCDSS) which has previously been shown to outperform other models. This multicentre, single-blind randomized clinical trial therefore sought to investigate the safety and efficacy of iNCDSS in the management of adult patients with T2DM receiving insulin therapy in endocrinology wards. 149 participants (mean[SD] age, 64.2[12.0]; 43.6% female) from 3 medical centres in China were included in the trial and randomized to the iNCDSS group or to the physician group. The primary outcome of this study was the proportion of time in the target glucose range (TIR; 70-180 mg/dL) as measured by continuous glucose monitoring (CGM). The iNCDSS group was found to be noninferior to the physician group based on TIR (mean[SD], 76.4[16.4]% versus 73.6[16.8]% respectively; difference, 2.7%; 95% CI, −2.7% to 8.0%; P = .33). Additionally, there were no statistically significant differences in number of adverse events or rates of hyperglycemic and hypoglycemic episodes between the iNCDSS and physician groups. Overall, this study found that the use of iNCDSS in insulin titration for adults with T2DM is safe, effective and non-inferior compared to standard therapy with senior endocrinology physicians. 

 

Casting vs Surgical Treatment of Children With Medial Epicondyle Fractures

1. Casting only was non-inferior compared to surgical treatment in the management of children with medial epicondyle fractures.

Evidence Rating Level: 1 (Excellent)

Medial humeral epicondyle fractures are among the most common types of elbow fractures occurring in children. However, there remains an unclear consensus surrounding the management of displaced medial epicondyle fractures. This non-inferiority randomized clinical trial therefore sought to investigate clinical outcomes with cast immobilization only versus surgical intervention in the management of displaced pediatric medial epicondyle fractures. 72 patients (mean[SD] age, 12.1[2.1] years; 59.7% female) from 4 university hospitals in Finland were randomized to either operative or nonoperative management. The primary outcome was the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score at 12 months, with a score of 0 denoting no disability and 100 denoting extreme disability. Secondary outcomes included active elbow range of motion, grip strength and others. At 12 months, the QDASH score in the surgery group was 1.73 (95% CI, 0.65-2.81) compared to 2.71 (95% CI, 0.52-4.90) in the casting group, representing a model-based mean difference of −0.98 (95% CI, −2.95 to 0.98) which met noninferiority criteria. At 3 and 6 months, there was a statistically significant difference in active elbow range of motion favouring the surgery group (mean, 135.2° [median, 140.0°; IQR, 130.0°-145.0°] vs 125.0° [median, 125.0°; IQR, 116.0°-140.0°] and mean, 144.1° [median, 145.5°; IQR, 137.5°-145.5°] vs mean 135.3˚[median 137.0˚; IQR 130˚-145˚] at 3 and 6 months for the surgery and casting groups respectively). Overall, this study found that among children with displaced medial epicondyle fractures, management with casting was non-inferior to surgical intervention.

 

Risk of hypothyroidism in meat-eaters, fish-eaters, and vegetarians: a population-based prospective study

1. After controlling for BMI, vegetarians were at a higher risk of hypothyroidism compared to those consuming a high-meat diet. 

Evidence Rating Level: 2 (Good)

Several sources in the literature have reported that plant-based diets are associated with reduced risks of chronic health conditions such as type 2 diabetes and cardiovascular disease. However, consumption of exclusively plant-based diets may also leave an individual at risk of deficiency in essential nutrients such as iodine. This prospective cohort study therefore sought to investigate the risk of hypothyroidism across various dietary groups (including high meat-eaters, low meat-eaters, poultry-eaters, fish-eaters, vegetarians and vegans). 466,362 participants (mean age, 56.41; 52.7% female) across the United Kingdom were included. Prior to adjustment for BMI, none of the dietary groups were significantly associated with increased risk of hypothyroidism. Following adjustment for BMI, there was a significant association between a vegetarian diet and risk of hypothyroidism (HR = 1.23, 95% CI 1.07–1.42). After controlling for BMI, logistic regression analyses revealed increased odds among low meat-eaters with an odds ratio (OR) of 1.05 (95% CI 1.03–1.08), as well as for poultry-eaters (OR = 1.15, 95% CI 1.04–1.28) and pescetarians (OR = 1.10, 95% CI 1.01–1.19). Overall, this study found that following adjustment for BMI, vegetarians were at a higher risk of hypothyroidism compared to those consuming diets higher in meat.

 

Physical therapy vs. glucocorticoid injection in patients with meniscal tears and knee osteoarthritis: a multi-center, randomized, controlled trial

1. Patients with meniscus tears and knee osteoarthritis (KOA) who were randomized to physical therapy experienced improved pain and quality of life at 1 year of follow-up compared to those randomized to receive glucocorticoid injections. 

Evidence Rating Level: 1 (Excellent)

Severe tears of the meniscus may lead to KOA, wherein the most common management approach is symptomatic management until progression of KOA necessitates knee replacement. While both physical therapy and intra-articular glucocorticoid injections have been recommended for the treatment of KOA, there remains a lack of consensus on which management option is more efficacious in relieving pain and improving function. This randomized, single-blind, multi-centre randomized controlled trial therefore sought to investigate the treatment efficacy of physical therapy versus intra-articular glucocorticoid injection in patient suffering from meniscal tears and KOA. 140 patients were randomized to the glucocorticoid group (mean age, 58.11 years; 43% female) and 133 patients were randomized to the physical therapy group (mean age, 57.68 years; 41% female) from various medical centres across China. The primary outcome of the study was the total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 12 months, which measures knee pain, stiffness and physical function. At 12 months of follow-up, the physical therapy group had improvements in pain, stiffness and physical function as measured by the WOMAC score (76.85 ± 2.50 vs 99.55 ± 2.09 for the physical therapy and glucocorticoid groups respectively; mean difference = − 22.70; 95% confidence interval [95% CI] − 23.43 to − 21.96; p < 0.001). Overall, this study found that among patients with meniscus tears and knee osteoarthritis, those who received physical therapy showed improvements in pain and quality of life compared to glucocorticoids injections.

 

Crohn’s Disease Stricture Response to Treatment Assessed with Magnetic Resonance Imaging and Intestinal Ultrasound: STRIDENT Randomized Trial

1. Intestinal ultrasound (IUS) and magnetic resonance imaging (MRI) were effective imaging modalities for the assessment of the radiologic response of stricturing Crohn’s disease to treatment. 

Evidence Rating Level: 1 (Excellent)

In recent years, transmural healing has become a major treatment target in the management of Crohn’s disease. While such healing relies on imaging for assessment, there is a paucity of data examining the role of IUS in the monitoring of stricturing Crohn’s disease and time and cost remain significant barriers to access for MRI. This study, an analysis of secondary outcomes of the STRIDENT (Stricture Definition and Treatment) trial, therefore sought to investigate the role of MRI and IUS in monitoring the response of stricturing Crohn’s disease to treatment. 77 patients (median[IQR] age, 45[29-53] years) were included in the trial with all 77 receiving baseline IUS and MRI. Among baseline IUS scans, 59 were good quality with visible strictures. Among baseline MRIs, 72 had visible strictures. Stricture resolution on IUS occurred in 17/59 (29%) of patients, while stricture resolution on MRI occurred in 16/72 (22%) of patients. When comparing stricture resolution on IUS and MRI, there was a strong association (χ21(n = 59) = 41.19, Cramer’s V ϕ=0.84; P < .001). When comparing with endoscopy, there was a relatively strong association between stricture resolution on MRI and passable strictures visible on endoscopy (χ21(n = 64) = 10.54, Cramer’s V ϕ=0.41; P = .002). Overall, this study showed that MRI and IUS are effective imaging modalities in the assessment of the radiologic response of stricturing Crohn’s disease to treatment.  

Image: PD

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