A 63-year-old woman with advanced cancer refuses chemotherapy, believing that prayer alone will heal her. Her oncologist struggles with the ethical dilemma—should he push for treatment, knowing it might extend her life, or respect her faith-based decision, even if it means a shorter prognosis? These are the tough realities many doctors face, where science meets belief, and the right course of action isn’t always clear.

For many patients, illness is not just a medical experience—it’s a deeply spiritual one. Research shows that up to 78% of patients with cancer consider spirituality important in their healthcare journey, and many make medical decisions based on religious beliefs. Some refuse blood transfusions, others fast despite health risks, and many look for divine intervention when medicine reaches its limits. Yet, despite this profound influence, modern medicine often treats spirituality as an afterthought, leaving a critical gap in holistic patient care.

Consider a young Muslim patient diagnosed with diabetes who insists on fasting during Ramadan, despite the dangers. His endocrinologist has two options: firmly advise against fasting or work with him to adjust his insulin schedule to minimize risks. Many physicians are trained to focus solely on medical facts, but real-world medicine isn’t always that simple. Sometimes, patient-centered care means meeting patients where they are—faith and all. Studies even show that when doctors acknowledge a patient’s religious beliefs, patients report greater satisfaction with their care. However, most physicians aren’t trained for these conversations, leading to missed opportunities for trust and collaboration.

And then there’s end-of-life care. A devout Christian man in the ICU insists that his doctors “do everything possible” to keep him alive, even as his organs fail and his suffering increases. His family clings to hope, praying for a miracle. The medical team knows that aggressive interventions may only prolong pain, but how do you tell a grieving family that their faith in divine healing won’t change the inevitable? Studies suggest that patients who receive spiritual support from their medical teams are more likely to opt for palliative care over aggressive interventions, leading to better quality of life in their final days. But when spiritual needs are ignored, patients and families may feel abandoned or misunderstood, adding emotional distress to an already difficult situation.

So, what’s the right approach? Should doctors engage with patients’ spirituality, or is that crossing a professional line? Have you faced a situation where religion shaped a medical decision in ways you didn’t expect?

Children with obesity have increased rates of dermatologic conditions, according to a study published online Feb. 10 in Pediatric Dermatology.

Samantha Epstein and Sonal D. Shah, M.D., from the Case Western University School of Medicine in Cleveland, conducted a retrospective cohort study involving children younger than 18 years with and without obesity and various dermatologic conditions and comorbidities.

The researchers observed an association between childhood obesity and increased rates of all dermatologic conditions and the associated comorbidities evaluated. The most commonly associated dermatologic condition was acanthosis nigricans (risk ratio, 62.16), while the least common was acne vulgaris (risk ratio, 2.50). The incidence of dermatologic conditions trended upward, with a greater increase seen in children with obesity compared with those without obesity. Notably, from 2016 to 2023, the incidence of hidradenitis suppurativa increased by 17.18 percent. Comorbidities seen in higher proportions among children with obesity included type 2 diabetes mellitus, hypertension, hyperlipidemia, asthma, obstructive sleep apnea (OSA), attention-deficit/hyperactivity disorder (ADHD), and major depressive disorder. Compared with children without obesity with one of these comorbidities, children with obesity with hypertension, ADHD, depression, or OSA had an increased risk for every skin condition apart from rosacea.

"While obese children are at increased risks for various skin conditions, children with obesity and additional comorbidities, such as diabetes, hypertension, ADHD, depression, OSA, or polycystic ovary syndrome, carry an even greater risk of certain dermatologic conditions," the authors write. "This supports the complex interplay between obesity and dermatologic health, particularly the proinflammatory effects of obesity."

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For individuals with type 2 diabetes (T2D), semaglutide is associated with a modestly increased risk for nonarteritic anterior ischemic optic neuropathy (NAION), according to a study published online Feb. 20 in JAMA Ophthalmology.

Cindy X. Cai, M.D., from the Johns Hopkins School of Medicine in Baltimore, and colleagues conducted a retrospective study across 14 databases to examine the potential association between semaglutide and NAION. Adults with T2D taking semaglutide, other glucagon-like peptide 1 receptor agonists (GLP-1 RAs; dulaglutide and exenatide), or non-GLP-1 RA medications (empagliflozin, sitagliptin, and glipizide) from Dec. 1, 2017, to Dec. 31, 2023, were included. Of 37.1 million individuals with T2D, there were 810,390 new semaglutide users.

The researchers found that among semaglutide users, the incidence rate of NAION was 14.5 per 100,000 person-years. Using the sensitive NAION definition, the hazard ratio for NAION among new users of semaglutide was not different compared with that of the non-GLP-1 RA medications empagliflozin, sitagliptin, and glipizide. Using the specific definition, the risk was higher for semaglutide users compared with patients taking empagliflozin (hazard ratio, 2.27). The risk for NAION was increased in a self-controlled case series analysis of semaglutide exposure (meta-analysis incidence rate ratio, 1.32).

"In the absence of a known mechanism for this association, we urge clinicians to weigh the concern for an increased risk of a rare but potentially blinding eye condition with the many therapeutic benefits of semaglutide," the authors write.

Several authors disclosed ties to industry.

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Diabetes mellitus type 1 (DM1) is associated with lower probability of incident cardiovascular events than type 2 (DM2), according to a study published online Feb. 12 in the Journal of the Society for Cardiovascular Angiography & Interventions.

Andrew M. Goldsweig, M.D., from Baystate Medical Center in Springfield, Massachusetts, and colleagues compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization among DM1 and DM2 patients (aged 46 to 75 years) receiving care at outpatient facilities with primary care and/or endocrinology, enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017 to 2022.

The study population included 5,823 and 156,204 DM1 and DM2 patients, respectively, with a total of 758,643 visits. The researchers found that DM1 patients were younger and had fewer comorbidities. There were 11,096 incident cardiovascular events, with a prevalence ratio of 0.63 for events associated with DM1 versus DM2. The prevalence ratio was 0.66 after adjustment for age. DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2 when analyzed by separate cardiovascular events. Across all 10-year age categories, overall cardiovascular event probability was lower in DM1 than DM2 in both female and male patients, before and during/after the COVID-19 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine.

"Although these findings represent good news for DM1 patients, further research is necessary specifically in DM1 patients to prevent and treat cardiovascular events," the authors write.

One author disclosed ties to the life science industry.

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For older adults with type 2 diabetes (T2D), use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with a modestly lower risk for depression compared with dipeptidyl peptidase-4 inhibitor (DPP-4i) use, according to a study published online Feb. 25 in the Annals of Internal Medicine.

Huilin Tang, Ph.D., from the University of Florida College of Pharmacy in Gainesville, and colleagues compared the risk for depression in older adults with T2D initiating treatment with GLP-1 RAs versus sodium-glucose cotransporter-2 inhibitors (SGLT-2is) or DPP-4is in a target trial emulation study using national Medicare administrative data from January 2014 to December 2020. Adults aged 66 years or older with T2D initiating treatment with a GLP-1 RA were propensity score-matched to those initiating treatment with an SGLT-2i (14,665 matched pairs) or a DPP-4i (13,711 matched pairs).

The researchers found that the rate difference of depression was 3.48 per 1,000 person-years between GLP-1 RA users and SGLT-2i users (hazard ratio, 1.07; 95 percent confidence interval, 0.98 to 1.18). The rate difference was −5.78 per 1,000 person-years for GLP-1 RA users versus DPP-4i users (hazard ratio, 0.90; 95 percent confidence interval, 0.82 to 0.98).

"These results, if confirmed in randomized controlled trials, could have important implications for the management of T2D, especially in older patients at risk for depression," the authors write.

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For patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disorder (COPD), sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with a reduced risk for moderate or severe COPD exacerbations compared with dipeptidyl peptidase 4 inhibitors (DPP-4is), according to a study published online Feb. 10 in JAMA Internal Medicine.

Avik Ray, M.D., from Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues conducted a comparative effectiveness study to assess the risk for moderate or severe COPD exacerbations among patients aged 40 years or older with T2D and active COPD who initiated treatment with SGLT-2is versus DPP-4is; GLP-1 RAs versus DPP-4is; and SGLT-2is versus GLP-1 RAs (27,991; 32,107; and 36,218 pairs, respectively).

The researchers found that the risk for moderate or severe COPD exacerbation was lower among those treated with SGLT-2is versus DPP-4is and among those treated with GLP-1 RAs versus DPP-4is (9.26 versus 11.4 per 100 person-years [hazard ratio, 0.81] and 9.89 versus 11.49 per 100 person-years [hazard ratio, 0.86], respectively), with minimal differences observed among those treated with SGLT-2is versus GLP-1 RAs. Across sensitivity and subgroup analyses, the results were consistent.

"These findings suggest that SGLT-2is and GLP-1 RAs may be preferable to DPP4is when deciding among glucose-lowering medications for patients with T2D and active COPD," the authors write. "However, given the observational nature of the study, there is potential for residual or unmeasured confounding, and findings from similar clinical studies and clinical trials will help corroborate these results."

Several authors disclosed ties to the pharmaceutical industry; one author disclosed being an expert witness in litigation against inhaler manufacturers.

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Patients with pregnancy-related hypertension (HTN) or diabetes are more likely to be screened for diabetes and dyslipidemia after delivery, but screening rates remain low for those with and without HTN and diabetes, according to a research letter published online Feb. 17 in Circulation.

Amy Y.X. Yu, M.D., from the University of Toronto, and colleagues conducted a population-based cohort study and compared postpartum screening for diabetes and dyslipidemia among patients with and without hypertensive disorders of pregnancy or gestational diabetes (GDM). A total of 1,265,015 pregnant patients younger than 50 years who were discharged alive after admission for a live birth, stillbirth, or intentional pregnancy termination after ≥20 completed weeks of gestation were identified.

The researchers found 165,660 patients (13.1 percent) had pregnancy-related hypertension or diabetes, which was the main exposure. Among exposed patients, 81.1 percent had pregnancy-related hypertension or diabetes during the index pregnancy, and the rest were exposed during a previous pregnancy. Compared with unexposed patients, exposed patients were more likely to be screened for diabetes and dyslipidemia within three years, but the difference was moderate and both groups had low screening rates (43.8 versus 33.0 percent; relative risk [RR], 1.33). Screening within one year was also low (17.3 percent exposed versus 11.1 percent unexposed; RR, 1.56). Screening was lower for dyslipidemia within three years than for diabetes (RRs, 1.32 versus 1.19). During the 17-year study period, screening practices remained relatively similar.

"Suboptimal vascular risk factor screening after pregnancy-related hypertension or diabetes is a missed opportunity for cardiovascular prevention," the authors write.

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The U.S. Food and Drug Administration has approved Merilog (insulin-aspart-szjj) as a biosimilar to Novolog (insulin aspart) for adults and pediatric patients with diabetes mellitus.

Merilog is a rapid-acting human insulin analog and the first rapid-acting insulin biosimilar product approved by the FDA. Administering Merilog subcutaneously five to 10 minutes before mealtime helps improve glycemic control in patients with diabetes. Both a 3-mL single-patient-use prefilled pen and a 10-mL multiple-dose vial are included in this approval.

Serious side effects reported with Merilog include hypoglycemia, severe allergic reactions, and low potassium levels in the blood. Common side effects include injection site reactions, itching, rash, skin thickening or pitting at the injection site, weight gain, and swelling of hands and feet.

"The FDA has now approved three biosimilar insulin products to treat diabetes," Peter Stein, M.D., director of the Office of New Drugs in the FDA Center for Drug Evaluation and Research, said in an agency press release. "Today’s approval highlights our continued efforts to improve the efficiency of the biosimilar approval process to help support a competitive marketplace and increase options for costly treatments, like insulin. Increasing access to safe, effective and high-quality medications at potentially lower cost remains a continued priority for the FDA."

Approval of Merilog was granted to Sanofi-Aventis.

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Federal funding for medical research has dropped by roughly $1 billion this year, raising alarm among universities, medical centers and lawmakers who warn the shortfall could slow progress in cancer, diabetes and heart disease research.

The National Institutes of Health's (NIH) grant review process was also disrupted when the Trump administration suddenly canceled scheduled funding meetings due to a temporary communications freeze.

Some of those meetings have since resumed, but experts warn that delays could impede new research projects.

The drop in funding comes amid administrative delays and policy changes under the Trump administration, including a controversial move to cut NIH payments for research facility and administrative costs.

A federal judge in Massachusetts temporarily blocked those cuts, pending upcoming hearings.

The NIH awarded about $2.5 billion in grants in the first six weeks of 2024, federal records show. This year, that number has plummeted to $1.4 billion -- hundreds of millions of dollars lower than the amount awarded in the same timeframe over the past six years.

“The president has completely stopped funding for research that discovers cures for diseases that devastate families across the country, like cancer and Alzheimer’s disease, all so he can give tax breaks to billionaires and big corporations,” U.S. Sen. Tammy Baldwin (D-Wis.), said in a statement.

“Make no mistake, their efforts to rob Peter to pay Paul means crushing families’ hopes and dreams of having cures,” she added.

The NIH typically distributes roughly $36 billion in grants annually. The funding supports groundbreaking research in such areas as gene therapy, immune-based cancer treatments, cystic fibrosis and sickle cell disease.

Without full funding, experts warn that vital projects could be delayed or stopped altogether.

U.S. Sen. Patty Murray (D-Wash.) attempted to restore NIH funding to previously agreed-upon levels through a budget bill, but the effort failed on a party-line vote.

“Trump and Elon -- either through sheer ignorance or a genuine lack of caring -- are putting lifesaving research in America on life support,” Murray said in a statement, referring to billionaire Elon Musk and his reported influence on White House budget decisions.

Musk heads the Trump-created U.S. Department of Government Efficiency, or DOGE, which has slashed funding and staff in several federal departments and agencies.

What's more, the administration has also faced internal turmoil at the NIH, with two high-ranking officials suddenly resigning and the agency still lacking a permanent director.

Meanwhile, Trump's nominee to head the NIH, Stanford professor Dr. Jay Bhattacharya, is preparing for Senate confirmation hearings in the coming weeks.

The uncertainty at the NIH comes as Robert F. Kennedy Jr., the new secretary of health and human services (HHS), has suggested he wants to back off on infectious disease research and focus more on chronic conditions like diabetes and heart disease. NIH is part of Kennedy's department.

The New York Times reported that the proposed cuts in medical research have raised deep concerns among recipient institutions.

“If the federal government cuts its investment, we will have to scale back on research, and cutting-edge science will be cut short,” Dean Madden, the vice provost for research at Dartmouth’s medical school, said at a news conference Friday, according to The New York Times.

“You don’t know what discoveries won’t be made as a result, but they might include a cure for some childhood cancer or treatment for Alzheimer’s or dozens of other diseases that are afflicting patients across our country,” Madden added.

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SOURCES: The New York Times, media report, Feb. 14, 2025; U.S. Sen. Tammy Baldwin, statement, Feb. 14, 2025: U.S. Sen. Patty Murray, statement, Feb. 15, 2025

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Serum testosterone (T) recovery to normal levels is associated with a significant improvement in overall survival in patients with high-risk prostate cancer receiving radiotherapy and long-term androgen deprivation therapy (ADT), according to a study presented at the American Society of Clinical Oncology annual Genitourinary Cancers Symposium, held from Feb. 13 to 15 in San Francisco.

Abdenour Nabid, M.D., from Centre Hospitalier Universitaire de Sherbrooke in Quebec, Canada, and colleagues randomly assigned 630 patients with high-risk prostate cancer to pelvic radiotherapy plus 36 versus 18 months of ADT (310 and 320 patients, respectively). Serum T was collected at baseline and regularly thereafter. T recovery was defined as return of T to within the normal range value of each participating institution. T data were available for 515 patients who were retained for the analysis.

Overall, 6,587 T measurements were available during a period of 22 years (median follow-up, 17.4 years). The researchers found that 52.4 percent of patients recovered T to normal levels: 57.0 and 44.3 percent in the 18- and 36-month cohorts, respectively. Patients not recovering T to a normal level were older, had higher clinical stage, and had diabetes. The median time to T recovery was 3.6 years among patients regaining T to a normal level. The 10- and 15-year overall survival rates were 76 and 44 percent, respectively, among those recovering T versus 55 and 30 percent, respectively, for those not recovering T. When considering the global hazard ratio, a significantly lower risk for death favored patients recovering T (hazard ratio, 0.54).

"The increased death rate in patients not recovering T is likely due to causes unrelated to prostate cancer," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Many patients with overweight or obesity discontinue glucagon-like peptide-1 (GLP-1) receptor agonist therapy within one year, with higher discontinuation rates seen for those without type 2 diabetes, according to a study published online Jan. 31 in JAMA Network Open.

Patricia J. Rodriguez, Ph.D., M.P.H., from Truveta Inc. in Bellevue, Washington, and colleagues conducted a retrospective cohort study involving 125,474 adults with overweight or obesity who newly initiated treatment with a dual-labeled GLP-1 receptor agonist (liraglutide, semaglutide, or tirzepatide) between Jan. 1, 2018, and Dec. 31, 2023. Patients were followed for up to two years to assess discontinuation and for two additional years to examine reinitiation.

The researchers found that compared with those with type 2 diabetes, patients without type 2 diabetes had a significantly higher one-year discontinuation rate (64.8 versus 46.5 percent). Significant associations were seen for higher weight loss and higher income with lower rates of discontinuation; a higher risk for discontinuation was seen in association with moderate or severe incident gastrointestinal adverse events (hazard ratios, 1.38 and 1.19 for those with and without type 2 diabetes, respectively). Of 41,792 patients who discontinued and had a discontinuation weight measurement available, one-year reinitiation was lower for those without versus with type 2 diabetes (36.3 versus 47.3 percent). Increased hazards of reinitiation were seen in association with weight regain of 1 percent from discontinuation (2.3 and 2.8 percent for those with and without type 2 diabetes, respectively).

"Greater weight loss and higher income (type 2 diabetes only) were associated with lower discontinuation, while weight regain since discontinuation was associated with higher reinitiation," the authors write.

Several authors disclosed ties to the health care industry.

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Overdiagnosis of thyroid cancer in the United States remains a persistent problem, according to a study published online Feb. 5 in The Lancet Diabetes & Endocrinology.

Michelle M. Chen, M.D., from Stanford University in Palo Alto, California, and colleagues examined whether U.S. thyroid cancer incidence has truly decreased or merely plateaued and to understand some of the underlying factors driving these trends. The analysis included 91,968 patients with thyroid cancer identified from the National Cancer Institute Surveillance, Epidemiology, and End Results database and the National Center for Health Statistics database (1975 to 2019).

The researchers found that the rise and subsequent plateau in the incidence of thyroid cancer have been primarily driven by time period effects, likely due to changing patterns in diagnostic pressure. The incidence of thyroid cancer by age increased during the study period and was driven predominantly by overdiagnosis. Although the incidence of thyroid cancer has plateaued, it remains at peak levels, suggesting that overdiagnosis remains a crucial unresolved public health issue.

"Further work is needed to help limit the current drivers of overdiagnosis and to implement novel solutions aimed at ... physicians, patients, and policy makers," the authors write.

Several authors disclosed ties to relevant organizations.

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The U.S. Food and Drug Administration is urging all patients with smartphone-compatible diabetes devices to check their phone configurations to ensure all safety alerts are being received.

The FDA notice concerns continuous glucose monitors, insulin pumps, and automated insulin dosing systems that rely on a smartphone to deliver critical safety alerts. The agency has received reports that patients are not receiving or hearing the alerts even though they thought the alerts had been configured for delivery.

In a safety communication, the FDA offers several suggestions for users of the devices, including turning off automatic operating system (OS) updates and not updating the smartphone's OS until confirming the diabetes device app is compatible with the new version; after updating the phone's OS or adding a new accessory, carefully monitoring the medical device app to make sure alerts are received and can be heard as expected; checking that the smartphone alerts are configured as expected at least once a month; and, if alerts are not being received as expected from the mobile medical app, calling the technical support number for the medical device for assistance.

"Modern medical devices, such as diabetes devices that connect to a smartphone, can provide users with the convenience and flexibility to configure alerts that are personalized to them. However, users should stay aware of alert settings and monitor these devices to ensure they continue to receive critical alerts as expected," Courtney Lias, director of the Office of In Vitro Diagnostic Products in the FDA Center for Devices and Radiological Health, said in an agency news release. "Even if configured correctly, certain hardware or software changes can interrupt the expected operation of these critical devices, which can lead to patient harm if undetected."

The FDA is working with diabetes-related medical device manufacturers to ensure smartphone alert configurations of devices are carefully evaluated before patient use and that any updates to recommended configurations are communicated quickly and clearly to users.

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A federal judge has temporarily blocked the National Institutes of Health (NIH) from making big cuts in medical research funding ordered by the Trump administration.

The proposed cost-cutting could have reduced support for hospitals, universities and labs across the country.

Monday's ruling by U.S. District Judge Angel Kelley puts on hold funding caps for indirect research costs such as lab security and administrative support. The administration's policy would slash funding for those expenses to 15% from the current 27% to 28% average, CBS News reported.

The NIH estimates the change would save $4 billion a year, but critics warned it would disrupt critical research on common diseases such as cancer, heart disease and diabetes.

The decision will temporarily halt funding cuts in 22 states that sued to block them. Those states include California, New York, North Carolina and Massachusetts, which are among the top NIH grant recipients.

A hearing on the challenge is scheduled for Feb. 21.

"Make no mistake," the Association of American Medical Colleges said in a statement. "This announcement will mean less research. Lights in labs nationwide will literally go out. Researchers and staff will lose their jobs."

Lawmakers from both parties have long opposed efforts to cut NIH’s indirect cost funding.

Those "facilities and administration" costs are hard to attribute on paper as direct research costs, funding recipients told CBS News, but are needed for the studies to continue.

U.S. Sen. Susan Collins, R-Maine, who opposes the cuts, said Robert F. Kennedy Jr., Trump’s nominee for health secretary, may undo them.

"He has promised that as soon as he is confirmed, he will re-examine this initiative that was implemented prior to his confirmation," Collins said in a statement. She told CBS News that she had called Kennedy to register her "strong opposition" to the cuts. The Senate is expected to vote on his nomination this week.

The idea of cutting indirect cost funding is not new.

During Trump's first term, he proposed capping these expenses at 10%, but Congress blocked the plan.

The NIH justified the cutback as similar to rates paid for administrative overhead costs by other nonprofit foundations that fund medical research, CBS News reported.

"The United States should have the best medical research in the world. It is accordingly vital to ensure that as many funds as possible go towards direct scientific research costs rather than administrative overhead," an NIH memo stated.

The Children's Hospital Association, which represents more than 200 hospitals nationwide, called on lawmakers Monday "to prevent unilateral changes in the established processes" for determining the indirect rates. The group noted that such changes are barred by "current law and longstanding Congressional intent."

"Reducing the indirect cost rate will threaten the ability of children's hospitals to provide future groundbreaking cures for children," the association said in a statement.

Meanwhile, current and former health officials said the change would upend an established system for managing research grants.

"We fight like hell trying to keep the rates down," said a former federal health official who worked for years with a team that audited indirect costs on NIH's behalf, according to CBS News.

Before grants are awarded, research institutions must submit detailed proposals explaining how they plan to use the funds.

The largest share of indirect costs typically goes toward maintaining labs and equipment -- not administrative expenses, officials said, as reported by CBS News. Federal research dollars cannot be used for unrelated building expenses.

Auditors regularly inspect facilities and interview researchers to ensure grant money is being used appropriately.

"We do not give away the farm. Whoever said that has never gone out on a site visit with us," a former official said, according to CBS News.

By imposing a flat cap on indirect costs, the Trump administration’s proposal ignores the work already done by health authorities to come up with current funding rates, critics said.

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The Hennepin Healthcare Research Institute has more on why medical research is important.

SOURCE: CBS News, media report, Feb. 10, 2025

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Age differences are seen in the efficacy of treatments for type 2 diabetes, according to a study published online Feb. 3 in the Journal of the American Medical Association.

Peter Hanlon, Ph.D., from the University of Glasgow in the United Kingdom, and colleagues reviewed the literature to examine whether age or sex is associated with differences in the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors. Individual participant data were obtained for 103 trials: 103 reported hemoglobin A1c (HbA1c), and six reported major adverse cardiovascular events (MACEs).

The researchers found that compared with placebo, SGLT2 inhibitor use was associated with less HbA1c lowering with increasing age for monotherapy, dual therapy, and triple therapy (absolute reductions, 0.24, 0.17, and 0.25 percent, respectively, per 30-year increment in age). GLP-1 receptor agonist use was associated with greater HbA1c lowering with increasing age for monotherapy and dual therapy (absolute reductions, –0.18 and –0.24 percent) but not for triple therapy. Slightly better HbA1c lowering was seen in association with DPP4 inhibitor use in older people for dual therapy (absolute reduction, –0.09 percent) but not for monotherapy or triple therapy. The relative reduction in MACEs with SGLT2 use was greater in older versus younger participants, while the relative reduction with GLP-1 receptor agonist use was less in older versus younger participants. Sex was not associated with differences in efficacy for any of the diabetes treatments studied.

"For hemoglobin A1c, use of SGLT2 inhibitors showed modestly reduced efficacy with increasing age," the authors write. "In contrast, the reduction in major adverse cardiovascular events with SGLT2 inhibitors was greater in older people compared with younger people."

Several authors disclosed ties to the pharmaceutical industry.

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Clinical decision support (CDS) aimed at reducing overuse of care in seniors does not yield durable changes in terms of prostate-specific antigen (PSA) screening in older men, but is durable for reducing urinary overtesting, according to a research letter published online Feb. 11 in the Annals of Internal Medicine.

Lucia C. Petito, Ph.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined whether the effectiveness of a behavioral intervention to reduce overtesting and overtreatment of older adults in three areas persisted in the 12 months after intervention discontinuation. The pragmatic, cluster randomized controlled trial was conducted at 60 primary care practices in Chicago, which enrolled 371 clinicians to receive intervention (CDS delivered through the electronic health record) or control for 18 months.

The researchers found that the intervention group, but not the control group, had an increase in the annual rate of PSA testing per 100 patients during the postintervention year. Per 100 eligible patients, the annual rate of urinalysis or urine culture was lower in the intervention versus the control group at the end of the postintervention period; neither rate changed meaningfully during the following year. At the beginning of the postintervention period, the annual rate of diabetes overtreatment per 100 eligible patients was slightly lower in the intervention group, but rates were indistinguishable between the intervention and control groups at the end of the postintervention period.

"These findings suggest that to maintain benefits, CDS interventions aimed at reducing low-value care should generally be left in place or be provided on a less frequent schedule to reduce alert fatigue," the authors write.

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For individuals with type 1 diabetes, intraindividual body weight variability, or body weight cycling, is associated with an increased risk for renal events, according to a study published online Feb. 4 in the Journal of Clinical Endocrinology & Metabolism.

Marion Camoin, M.D., from the Assistance Publique–Hôpitaux de Paris, and colleagues conducted a retrospective analysis of data from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) studies to examine the association between body weight cycling and risk for renal events among patients with type 1 diabetes. Four indices of intraindividual body weight variability were calculated for 1,432 participants of the DCCT/EDIC studies; variability independent of the mean (VIM) was the main index. During follow-up (21 ± four years), six criteria of progression of chronic kidney disease (CKD) were studied.

The researchers found that a high VIM was significantly associated with the incidence of a 40 percent decline in estimated glomerular filtration rate (eGFR) from baseline values, doubling of baseline serum creatinine, CKD stage 3, and a decline in eGFR >3 mL/min/m2 per year after adjustment for CKD risk factors at baseline and follow-up and use of nephroprotective drugs. There was also an association seen for VIM with incidence of moderately and severely increased albuminuria, but after adjustment for follow-up covariates, the associations were no longer significant. For the other indices of body weight cycling, similar results were observed.

"Strategies aimed at weight reduction in people with type 1 diabetes should focus on promoting long-term weight maintenance, as weight stability may have a positive impact on health outcomes," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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The absolute risk for thyroid cancer is low among patients receiving glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, but risk is elevated in the first year of treatment, according to a study published online Jan. 23 in JAMA Otolaryngology-Head & Neck Surgery.

Juan P. Brito, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues estimated the risk for incident thyroid cancer among adults with type 2 diabetes being treated with GLP-1 RAs versus other common glucose-lowering medications. The analysis included 41,112 patients starting treatment with GLP-1 RAs; 76,093 starting a dipeptidyl peptidase-4 inhibitor (DPP4i); 43,499 starting a sodium-glucose cotransporter 2 inhibitor (SGLT2i); and 191,209 starting sulfonylurea therapy.

The researchers found that the numbers of patients diagnosed with thyroid cancer were 0.17 percent in the GLP-1 RA group, 0.23 percent in the DPP4i group, 0.17 percent in the SGLT2i group, and 0.20 percent in the sulfonylurea group. GLP-1 RA initiation was not significantly associated with an increased overall risk for thyroid cancer versus the other diabetes drugs in the modified intention-to-treat analysis (hazard ratio [HR], 1.24; 95 percent confidence interval [CI], 0.88 to 1.76). In the first year after GLP-1 RA initiation, thyroid cancer risk was elevated (HR, 1.85; 95 percent CI, 1.11 to 3.08) and was amplified in the overall as-treated analysis that restricted patients from analysis when therapy was discontinued or another medication was added (HR, 2.07; 95 percent CI, 1.10 to 3.95).

"These findings indicate that GLP-1 RA initiation was associated with new diagnosis of thyroid cancer only in the short term, likely due to increased vigilance and case detection rather than de novo pathogenesis," the authors write.

Several authors disclosed ties to relevant organizations.

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