Even with insurance, many diabetics

Brief description: https://www.acpjournals.org/doi/10.7326/M23-0540
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An analysis of medical crowdfunding campaigns reveals the types of costs that diabetes patients struggle to pay. The data shows that even uninsured diabetics use GoFundMe to cover medical expenses beyond insulin, such as uncovered co-pays, outpatient care and active dogs. The findings were published in Annals of internal medicine.

More than 40% of diabetes patients in the United States have trouble paying their medical bills. Among patients with health-related financial problems, 56% delayed or delayed care. Crowdfunding like GoFundMe is being used by these patients to cover medical expenses. Studying crowdfunding campaigns can shed light on the costs that contribute to their financial stress.

Researchers from Duke University School of Medicine, Washington School of Medicine, and Stanford University School of Medicine studied a random sample of 313 active U.S. medical crowdfunding campaigns that posted on GoFundMe from 2010 to 2020. Real-world testimonials describing patient situations were evaluated to identify the types of costs patients were willing to cover. The researchers found that when the median fundraising goal was $10,000, 14% of campaigns reached their fundraising goal. The data show that many aspects of diabetes care beyond insulin are considered cost-effective, including life-saving care such as hospitalization and meals. Even people with insurance often spend more money due to lack of coverage for certain expenses or disproportionate co-pays. The researchers also found that 35% of people with type 1 diabetes had started a fundraising campaign for diabetic dogs, which cost about $15,000 and were not covered by insurance, as their effectiveness varied significantly. Clinicians who know a patient is interested in buying a dog can direct them to proven management strategies, such as continuous glucose monitoring, the researchers said. Policymakers should consider these patient needs and costs when developing policies to help make diabetes care more affordable.

Media Contacts: For a PDF of the ban, please contact Angela Collom at [email protected]. To speak with corresponding author Caroline Sloan, MD, please email [email protected].
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2. Initiation of CFTR modulator therapy in a mother with cystic fibrosis associated with severe complications in the fetus
Draft: https://www.acpjournals.org/doi/10.7326/L23-0112
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A woman with cystic fibrosis treated with elexacaftor-tezacaftor-ivacaftor (ETI) during pregnancy with cystic fibrosis transmembrane conductance regulator (CFTR) delivered a healthy baby. The case report was published in edr34

CF is a life-shortening, autosomal recessive disease that affects approximately 150,000 people worldwide. Most cases in populations of Northern European ancestry are due to an allelic pathogenic variant (F508del) in the CFTR gene. Therefore, professional societies recommend screening for CF at preconception or early in pregnancy.

Stanford University School of Medicine researchers report using ETI in pregnant CF carriers to prevent intrauterine effects of CF on the fetus. The mother’s two other children are affected by CF, have the F508del mutation, and both had meconium ileus in utero and required intestinal surgery after birth. Amniocentesis showed that the current fetus was positive for the F508del mutation. The mother was treated with ETI and 7 weeks after treatment, ultrasound showed both meconium ileus and resolution of the distal microcolon. At 39 weeks’ gestation, the patient gave birth to a healthy female infant with normal stools while tolerating breast milk. Like her brothers and sisters, she did not need colon surgery. The researchers were encouraged that initiation of CFTR modulation therapy in the mother was associated with less severe complications in the fetus. Their findings suggest that further studies of this therapy in larger patient cohorts are warranted.

Media Contacts: For a PDF of the ban, please contact Angela Collom at [email protected]. To speak with corresponding author Yair J. Blumenfeld, MD, please contact Erin Digitale at [email protected].
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3. Does this patient need antibiotics? Draw a picture? Physicians discuss diagnosis and treatment options for patients with diverticulitis.
‘Beyond the Guideline’ Features Based on Medical Grand Rounds at Beth Israel Deacon Medical Center
Brief description: https://www.acpjournals.org/doi/10.7326/M23-0669
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In a New Annals ‘Beyond the Guidelines’ feature, two gastroenterologists with experience in acute diverticulitis discuss CT scans for diagnosis, antibiotics for treatment, colonoscopy to diagnose underlying malignancy, and elective surgery to prevent recurrent disease in a patient with diverticulitis. All ‘Beyond the Guidelines’ features are based in the Department of Medicine at Beth Israel Deacon Medical Center (BIDMC) in Boston and include print, video and educational components. Annals of internal medicine.

Acute diverticulitis is a common condition that occurs frequently in some patients and generally presents with left-sided abdominal pain accompanied by low-grade fever and other gastrointestinal symptoms. Complications can include constipation, fistula formation, perforation, and bowel obstruction, which is why proper diagnosis and treatment are important.

In recently published clinical practice guidelines, the American College of Physicians (ACP) recommends the use of a CT scan of the abdomen in cases of diagnostic uncertainty; Initial management of uncomplicated cases in an outpatient setting without antibiotics; Referral for colonoscopy after the first episode if not performed recently; and discussion of elective surgery to prevent recurrent disease in patients with recurrent complicated diverticulitis or uncomplicated disease. However, not every patient falls exactly within the guideline parameters.

BIDMC Grand Grounds panelists, Judy W. Nye, MD, Assistant Professor of Medicine, Department of Gastroenterology at Harvard Medical School, and Anthony J. Lembo, MD, research director of the Digestive Diseases and Surgery Institute at the Cleveland Clinic, said a 62-year-old woman with recurrent uncomplicated diverticulitis was initially diagnosed with a CT scan. In their review, both Dr. Nee and Lembo agree with the ACP guidelines, as they do not recommend antibiotics for patients with simple uncomplicated diverticulitis or repeat colonoscopy for patients with uncomplicated diverticulitis undergoing routine colorectal cancer screening. Dr. Ni said that a CT scan for the patient’s initial diagnosis of acute diverticulitis was necessary to rule out alternative causes of abdominal pain, and that the patient has recurrent symptoms and may be warranted now. However, antibiotics and colonoscopy do not appear to be necessary because the patient’s diverticulitis is uncomplicated and current on colonoscopy. Dr. Lembo agrees that a colonoscopy is not necessary, but antibiotics may be prescribed unless symptoms are mild. Dr. Nee recommends that the patient be discussed with elective surgery because the benefits of this procedure may outweigh the risks. Dr. Lembo does not recommend elective surgery at this time, but does recommend that the patient express a desire for surgery and have further discussion with a colorectal surgeon.

A complete list of ‘Beyond the Guide’ topics is available at www.annals.org/grandrounds.

Media Contacts: For a PDF of the ban, please contact Angela Collom at [email protected]. To interview a panelist, please contact Kendra McKinnon at [email protected].

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