2 Minute Medicine Rewind October 6, 2025

Glycaemic control and influencing factors among patients with post-chronic pancreatitis diabetes mellitus in China: a retrospective cross-sectional study

1. Smoking and prior acute pancreatitis attacks independently predict poor glycaemic control in patients with post-chronic pancreatitis diabetes (PPDM-C).

2. Early intervention and smoking cessation should be prioritized to improve metabolic outcomes in this population.

Evidence Rating Level: 2 (Good) 

Among patients with chronic pancreatitis, the prevalence of PPDM-C is extremely high, necessitating a more comprehensive understanding of this disorder. This retrospective cross-sectional study examined 302 patients with PPDM-C to identify predictors of poor glycemic control. Using data from 2018–2023, the authors defined poor glycemic status as HbA1c >7% and stratified patients based on whether they received diabetes treatment. Multivariate logistic regression and receiver operating characteristic analyses revealed that smoking and a history of acute pancreatitis (AP) attacks were independent risk factors for poor glycemic control in both treated and untreated groups. The association between smoking and poor control was dose-dependent, with heavy smokers showing up to a tenfold increased risk. Overall, 58% of participants had poor glycemic status, and untreated patients fared worse than those on therapy. Structural pancreatic damage and alcohol use were not independently linked to glycemic outcomes. These findings highlight the need for early detection, aggressive risk factor modification, and tailored glycemic management in this high-risk population.

 

Acute Surgery vs Conservative Treatment for Traumatic Acute Subdural Hematoma

1. Across 18 U.S. centers, preference for surgical or conservative management for acute subdural hematoma (ASDH) varied widely but did not affect six-month functional outcomes.

Evidence Rating Level: 2 (Good) 

ASDH is common in patients with TBI, but there remains limited evidence to support the decision between surgery or conservative management in treating patients with ASDH. This multicenter comparative effectiveness evaluated whether acute surgical evacuation offers better outcomes than initial conservative management for traumatic ASDH. Using data from the TRACK-TBI cohort (2014–2018) across 18 U.S. Level 1 trauma centers, 711 patients with nonpenetrating TBI and CT-confirmed ASDH were included (21% underwent acute surgery, 79% initial conservative care). Researchers compared outcomes between centers favoring surgery versus those favoring conservative management, applying an instrumental-variable approach adjusted for patient mix and prognostic factors. Despite large practice variation (acute surgery rates 0–86%), six-month functional outcomes on the Glasgow Outcome Scale-Extended were similar between the two strategies (adjusted OR 1.05, 95% CI 0.88–1.26). Mortality, quality of life, and other secondary outcomes also did not differ significantly. The findings suggest that when neurosurgeons face clinical equipoise, namely in circumstances where emergent surgery is not clinically indicated, initial conservative treatment is a reasonable option without compromising long-term outcomes.

 

Traumatic Brain Injury and Risk of Amyotrophic Lateral Sclerosis

1. Traumatic brain injury (TBI) was associated with a transiently increased amyotrophic lateral sclerosis (ALS) risk confined to the two years following injury.

2. The findings likely indicate reverse causality rather than a causal link between TBI and ALS.

Evidence Rating Level: 2 (Good) 

This large retrospective cohort study investigated whether TBI increases the risk of ALS using UK-wide electronic health records from over 340,000 adults between 2005 and 2020. The study included 85,690 individuals with TBI and 257,070 matched controls (matched by age, sex, and socioeconomic area). ALS incidence was compared using Cox proportional hazards regression. Over a median follow-up of 5.7 years, 150 ALS cases were recorded (7.05 per 100,000 person-years). Individuals with prior TBI had a higher ALS risk (HR 2.61; 95% CI, 1.88–3.63), but this association was limited to the first two years post-injury (HR 6.18; 95% CI, 3.47–11.00) and disappeared thereafter. No significant differences were found in age at ALS diagnosis or death between groups. The authors suggest that this time-limited risk likely reflects reverse causality. Namely, early, subclinical ALS may predispose individuals to falls or injuries leading to TBI, rather than TBI causing ALS. The study’s strengths include its large, population-based design and comprehensive linkage of national datasets, though limitations include potential under-recording of mild TBI and lack of data on confounding factors.

 

Investigating the long-term impact of a programme of mindfulness combined with exercise delivered online (MOVE) on individuals living with chronic pain-an exploratory one-year follow-up of a feasibility randomised control trial

1. The online program combining mindfulness-based stress reduction and exercise, as well as the online self-management guide, both led to modest long-term improvements in pain, function, and psychological well-being, with no significant differences between the two.

Evidence Rating Level: 1 (Excellent)

This exploratory one-year follow-up of the mindfulness combined with exercise delivered online (MOVE) feasibility randomized controlled trial investigated the long-term impact of an online program combining Mindfulness-Based Stress Reduction (MBSR) and exercise for individuals with chronic pain. 96 participants were randomized to either the MOVE intervention or an online self-management (SM) guide. The study assessed 14 patient-reported outcome measures (PROMs) at baseline, post-intervention, 3 months, and one year. At one-year follow-up, 48 participants completed assessments. Results showed small, non-significant between-group differences, with slight advantages for the MOVE group in depression (PHQ-9) and mental health-related quality of life (SF-36 MCS), while nine measures favored the SM group. Within-group trends indicated modest improvements in pain, function, and psychological measures across both groups. Notably, 63% of the MOVE group versus 44% of the SM group reported subjective improvement on the Patient Global Impression of Change scale. The study concludes that both online formats are feasible and acceptable, though a fully powered RCT is needed to determine the true efficacy of combined MBSR and exercise interventions in chronic pain management.

 

Effect of short-term exercise with different programs on prevention of sarcopenia in postmenopausal women: A Quasi-Randomized Controlled Trial

1. High intensity Interval Training Nordic Walking (HIIT-NW) significantly improves lower limb strength and lean mass, making it a favorable option for normal-weight postmenopausal women.

2. Conventional Strength Training is particularly effective for improving upper body strength and reducing body fat, offering added benefits for overweight individuals.

Evidence Rating Level: 1 (Excellent)

This quasi-randomized controlled trial evaluated the effects of two 12-week exercise programs, High-Intensity Interval Training Nordic Walking (HIIT-NW) and conventional Strength Training (ST), on sarcopenia prevention in 71 postmenopausal women aged 60-79 without sarcopenia. Participants were assigned to HIIT-NW, ST, or a control group, with body composition, physical function, and blood markers assessed pre- and post-intervention. Results demonstrated that both exercise interventions significantly improved key parameters compared to the control group. The HIIT-NW group showed significant increases in limb lean mass and the skeletal muscle index, with pronounced benefits in lower body strength, including knee flexor strength and Timed Up and Go performance. The ST group exhibited significant improvements in upper body strength, including left-hand grip strength and arm curl performance, alongside reductions in body fat mass and BMI. Therefore, this study concludes that both HIIT-NW and ST are effective for preventing sarcopenia, with HIIT-NW being particularly beneficial for enhancing lower limb strength in normal-weight women, while ST may be more suitable for overweight women due to its additional benefits for body composition.

Image: PD

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