Intended for healthcare professionals

Opinion

The use of continuous glucose monitoring devices in non-diabetic adults … and other research

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q859 (Published 18 April 2024) Cite this as: BMJ 2024;385:q859
  1. Tom Nolan, clinical editor; sessional GP, Surrey
  1. The BMJ, London

Tom Nolan reviews this week’s research

Fasting glucose levels from continuous glucose monitoring

The market for continuous glucose monitoring (CGM) devices now goes well beyond just being used for people with diabetes. They’re advertised as a means of getting a “deeper understanding” of your body and getting to the “root cause” of health problems. Dubious claims aside, a study in Nature Medicine highlights the need for clarity on how to interpret fasting glucose levels in people with no prior diagnosis of diabetes who are using CGM devices. Of the 5328 people in the study using CGM whose first fasting glucose level was normal, 40% had fasting glucose levels in the prediabetic range in subsequent measurements, and 3% had subsequent measurements in the diabetes range. Should this be welcomed as an advance in diagnostic accuracy, or is it a new frontier in overdiagnosis?

Nat Med doi:10.1038/s41591-024-02908-9

β blockers after myocardial infarction

The evidence for β blocker use after myocardial infarction (MI) is largely based on older studies, before the age of percutaneous coronary intervention. An open label, randomised trial provides some much needed data from current practice in people at lower risk of death or another MI. The study compared β blockers with no β blockers in people with MI and preserved left ventricular ejection fraction who had undergone revascularisation. After 3.5 years, the rates of death or subsequent MI were 7.9% of the 2508 patients in the β blocker group and 8.3% in the 2512 control patients (hazard ratio 0.96, 95% CI 0.79 to 1.16). But don’t cross off β blockers from your protocols yet. The study was underpowered due to unexpectedly low rates of the primary endpoint. Several further studies on this question are ongoing.

N Engl J Med doi:10.1056/NEJMoa2401479

Removing aspirin after PCI

International guidelines recommend aspirin plus ticagrelor in patients who have had percutaneous coronary intervention (PCI) to treat acute coronary syndromes. You often see the relief from patients when, after a year, they can finally reduce their treatment to just one antiplatelet drug, in the hope that they’ll stop bruising at the faintest touch.

A new randomised control trial asked if taking ticagrelor alone from one month to 12 months after PCI may be as effective as taking it with aspirin, and reduce the risk of adverse events. A total of 3400 people in China, Italy, Pakistan, and the UK were randomised to receive either ticagrelor plus aspirin or ticagrelor plus placebo from four weeks after PCI to 12 months. The rates of bleeding events in the ticagrelor plus placebo group were lower, affecting 2.1% of participants, compared with 4.6% in the dual antiplatelet group (hazard ratio 0.45, 95% CI 0.30 to 0.66). Meanwhile, there was no difference in major adverse cardiovascular or cerebrovascular events between the two groups (3.6% and 3.7% respectively).

Lancet doi:10.1016/S0140-6736(24)00473-2

Mixed results for glioblastoma treatment

Glioblastoma has one of the worst prognoses of any cancer, with most patients dying within a year of diagnosis. There’s a glimmer of hope for an effective treatment from a phase 1 study in which three patients with glioblastoma were given chimeric antigen receptor (CAR) T cell therapy, which involves genetically modifying the patient’s own T cells to enable them to target and kill cancer cells. CAR T therapy has transformed treatment of acute lymphoblastic leukaemia and diffuse large B cell lymphoma, but benefits against solid cancers are proving harder to come by. In this study, researchers added extra modifications to get T cells to express T-cell-engaging antibody molecule (TEAM-E) as well as CAR, and patients required a surgical procedure to enable treatment to be delivered into the ventricular system through an injection port. All three patients in the study showed a rapid radiological response to treatment, but two soon relapsed. Further research aims to find ways to induce a prolonged response to the treatment.

N Engl J Med doi:10.1056/NEJMoa2314390

Is there a D Mannose here?

One of the many recurring gags in The Simpsons is Bart’s prank calls to Moe’s tavern “Is Mr Freely there? First initials IP.” Others include Mike Rotch, Drew P Weiner, Tess T Culls, Ivana Tinkle, Lee Keebum, Yuri Nator, and D Mannose. OK, not the last one, but the monosaccharide is so widely used nowadays for urinary tract infections (UTIs) that one or two of the drinkers at Moe’s tavern might get the joke.

A randomised control trial compared D-mannose with placebo in women with recurrent UTIs in the UK. Taking the food supplement for six months had no significant effect on the need to contact primary care with symptoms of a UTI (51% versus 56% in the placebo group). The authors conclude that D-mannose should not be recommended in this group of patients. Calls to your local pharmacy asking if they have a D Mannose there are therefore not required.

JAMA Intern Med doi:10.1001/jamainternmed.2024.0264

Footnotes

  • Competing interests: None declared

  • Provenance and peer review: Not commissioned; not peer reviewed