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October 21, 2019

Anchor lead: Is home always the best place to die? Elizabeth Tracey reports

While most people say they would prefer to die at home, many still end up in the hospital at the end of life. Now a new analysis suggests that pressure to have a loved one at home may not be the best for all concerned. Tom Smith, director of palliative care at Johns Hopkins, offers his opinion.

Smith: There are some families that just don’t have a home. I think we often fail to realize how sick people are and some of the burdens we’re putting on families to do this. That said, you don’t often meet families who’ve taken care of somebody at home and said, oh, that was the worst experience of my life. That’s relatively uncommon compared to yeah, it was a real pain in the tush but we kept Grandpa at home where he’d spent his last 65 years and he was able to die with his dog at the foot of his bed.  :32

Smith says frank conversation about wishes and abilities helps. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When is palliative care most effective?
Elizabeth Tracey reports

October 18, 2019 Getting palliative care- a team approach aimed at improving symptoms of chronic disease – didn’t extend life in a large VA study if it was given within 30 days of someone’s death, but did if it was given before that. Tom Smith, director of palliative care at Johns Hopkins, explains.

Smith: They looked at people who got palliative care from 31
days before they died up to 364 days before they died. Those people lived weeks
to months longer than those who didn’t get palliative care. That’s consistent
with the national guidelines from the American Society for Clinical Oncology
which suggest every person with advanced cancer should be seen concurrently by
a palliative care multidisciplinary team within eight weeks of diagnosis and
the National Comprehensive Cancer Center Network guidelines basically say the
same thing.  :31

Smith notes that such an approach involving palliative care
early is known as collaborative care and it really seems to help quality of
life for people with chronic illnesses. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Metformin works to reduce heart risk in
people with diabetes and kidney disease, Elizabeth Tracey reports

October 17, 2019 Metformin is the first medication many people with type 2 diabetes are given, and now a new study shows that even in people with both diabetes and chronic kidney disease the drug is able to reduce the risk for cardiovascular events. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: People who have chronic kidney disease, the
majority have diabetes, and in people with diabetes who have uncontrolled blood
sugars kidney disease is one of the complications we worry most about.
Cardiovascular disease is the complication that is probably associated with the
greatest morbidity and mortality in people with diabetes and so both those
complications, cardiovascular disease and kidney disease, are very important.
And so to have specific medications that have benefit on reducing
cardiovascular events, is tremendously important.  :30

Kalyani notes that the FDA now requires manufacturers of
drugs for diabetes to demonstrate their impact on cardiovascular events as well
as the ability to lower blood sugar. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A diabetes medicine that used to be injected
can now be taken by mouth, Elizabeth Tracey reports

October 16, 2019 It’s a pretty safe bet that most people don’t want to have to use injectable medications. Now people with diabetes who need the class of medicines known as GLP1s, previously requiring injection, have an oral version available. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: The Food and Drug Administration approved the first
oral GLP1 treatment for type 2 diabetes. This is big news for people with type
2 diabetes. Up until this point every medication in this class was an
injectable medication. Now to have an oral medication that has similar effects
but does not need to be injected can really expand the scope of patients who
may be willing to take this class of medications but perhaps weren’t so excited
about taking injections before.  :31

Kalyani says the manufacturer has announced that the oral
and injectable forms of the drug will be priced similarly, and that’s also good
news. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the issues in using drugs for
diabetes in other conditions? Elizabeth Tracey reports

October 15, 2019 Perhaps you’ve heard of the diabetes drug metformin being used for weight loss, or the diabetes drug dapagliflozin in heart failure. Such uses are called off label, and while they may be helpful, Rita Kalyani, a diabetes expert at Johns Hopkins, is concerned.

Kalyani: How do these glucose lowering medications, approved
for diabetes, affect glucose levels in those without diabetes? I wonder about
that group without diabetes and how low their sugars are really going. When we
talk about translating this into clinical practice whether its dapagliflozin or
metformin or any other diabetes drug that’s being used outside treatment for
glucose lowering I think we need to still be cognizant of the glucose lowering
effect and have ways that that can be monitored if they’re being used for
purposes besides diabetes.  :33

Kalyani would welcome studies that identify best ways to
monitor blood sugar in those without diabetes when diabetes drugs are used. At
Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a drug used in diabetes help people with
heart failure? Elizabeth Tracey reports

October 14, 2019 Dapagliflozin is a drug used to manage diabetes, and now it’s been shown to benefit people with heart failure. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: What the investigators wanted to do in the DAPA-HF
study is examine whether dapagliflozin reduced progression of heart failure in
those who already had it. This was a hallmark study because it was probably the
first study looking at a population of with and without type 2 diabetes but
using a diabetes medication. What they found was that there’s a tremendous
benefit in lowering the progression of heart failure in those who already had
it, and that this benefit was the same in those with and without diabetes.  :32

Kalyani says this is good news for the more than 26 million people
worldwide who currently have heart failure, a number that is growing so rapidly
global health authorities call it a pandemic. At Johns Hopkins, I’m Elizabeth
Tracey.

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In the eleventh podcast, we welcome a new guest from the Journal of Emergency Nursing, Cheryl Wraa, MSN, RN, FAEN. First, Cheryl describes the types of manuscripts a potential author can submit. We review the process of identifying and selecting the journal best suited for the proposed manuscript.