Qaseem A, Cross JT, Harrod CS
… +4 more, Owens DK, Balk EM, Crandall CJ, Clinical Guidelines Committee of the American College of Physicians
Ann Intern Med
· 2026 Jun · PMID 42296496
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DESCRIPTION: The American College of Physicians (ACP) developed this clinical guideline for internal medicine physicians and other clinicians caring in outpatient settings for adults with overweight or obesity. METHODS:...DESCRIPTION: The American College of Physicians (ACP) developed this clinical guideline for internal medicine physicians and other clinicians caring in outpatient settings for adults with overweight or obesity. METHODS: This guideline is based on systematic reviews of pharmacologic treatments in adults with overweight or obesity and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RECOMMENDATION 1: ACP suggests initiating one of the following pharmacologic treatments with lifestyle modifications for weight management in nonpregnant adults with obesity (body mass index ≥30 kg/m) in outpatient settings (conditional recommendation): First-line treatments are semaglutide (moderate-certainty evidence) and tirzepatide (moderate-certainty evidence); second-line treatment is phentermine-topiramate (low-certainty evidence); third-line treatment is liraglutide (low-certainty evidence); fourth-line treatment is naltrexone-bupropion (low-certainty evidence). When initiating a recommended medication for weight management or switching to another recommended medication because of an inadequate response, clinicians and patients should discuss benefits, harms, costs, access and availability, clinical comorbidities, weight loss goals, life expectancy, values and preferences, and contraindications and warnings (for example, the requirement for monthly pregnancy tests with use of phentermine-topiramate, the contraindication to phentermine-topiramate in those with cardiovascular disease, and suicidal ideation with naltrexone-bupropion). RECOMMENDATION 2: ACP suggests initiating one of the following pharmacologic treatments with lifestyle modifications for weight management in nonpregnant adults with overweight (body mass index ≥27 to 30 kg/m) and type 2 diabetes, dyslipidemia, hypertension, obstructive sleep apnea, or cardiovascular disease (conditional recommendation): First-line treatments are semaglutide (moderate-certainty evidence) and tirzepatide (moderate-certainty evidence); second-line treatment is liraglutide (low-certainty evidence). When initiating a recommended medication for weight management or switching to another recommended medication because of an inadequate response, clinicians and patients should discuss benefits, harms, costs, access and availability, clinical comorbidities, weight loss goals, life expectancy, values and preferences, and contraindications and warnings (for example, use in pregnancy).
Ann Intern Med
· 2026 Jun · PMID 42258829
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Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and a major cause of disability, manifesting with symptoms including fatigue, weakness, exercise intolerance, worsening heart failure, impaired co...Iron deficiency anemia (IDA) is the most common cause of anemia worldwide and a major cause of disability, manifesting with symptoms including fatigue, weakness, exercise intolerance, worsening heart failure, impaired concentration, irritability, and depression. Women of reproductive age are disproportionately affected due to menstrual blood loss and gynecologic disorders. Iron deficiency anemia is diagnosed in patients who have both iron deficiency (ID), noted by low ferritin level and/or transferrin saturation, and anemia. Notably, iron deficiency (ID) can also occur in the absence of anemia, and overreliance on hemoglobin thresholds may risk missing the diagnosis in menstruating women due to flawed sex-specific reference ranges. Work-up for ID and IDA should focus on identifying the underlying cause of anemia, and may include a gynecologic work-up, bidirectional endoscopy, testing for infection and celiac disease, as well as administering a trial of iron. Iron deficiency can be treated with either oral or intravenous iron. Although several guidelines address the diagnosis or management of ID and IDA, they differ in their recommendations based on the population studied, the clinical context, and the quality of the underlying evidence. Here, 2 hematologists and coauthors of the 2025 Iron Consortium Guideline published in discuss areas of guideline uncertainty relating to the diagnosis, evaluation, and treatment of patients with IDA and for Ms. B, a young woman diagnosed with ID.
Brown JP, Huybrechts KF, Straub L
… +4 more, Patorno E, Seely EW, Bateman BT, Hernández-Díaz S
Ann Intern Med
· 2026 Jun · PMID 42258827
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BACKGROUND: Glucagon-like peptide-1 receptor agonist (GLP-1RA) use has increased among women of reproductive age, but limited data exist on safety in pregnancy. OBJECTIVE: To estimate the risk for nonlive birth, abnormal...BACKGROUND: Glucagon-like peptide-1 receptor agonist (GLP-1RA) use has increased among women of reproductive age, but limited data exist on safety in pregnancy. OBJECTIVE: To estimate the risk for nonlive birth, abnormal fetal growth, and major congenital malformation (MCM) with GLP-1RA dispensing in early pregnancy. DESIGN: In an observational cohort of pregnant women aged 16 to 55 years with a GLP-1RA dispensation in the 90 days before the last menstrual period (LMP), a target trial with 2 treatment strategies was emulated: continuation of dispensing into the first trimester (≥1 further dispensation), or noncontinuation. SETTING: Merative MarketScan U.S. insurance claims data (2011 to 2024). PARTICIPANTS: 3572 pregnancies (41.1% [ = 1467] among women with type 2 diabetes). MEASUREMENTS: Risk for nonlive birth was estimated using a weighted Kaplan-Meier estimator. Among live-birth pregnancies linked to infants, the weighted prevalence of MCM, small for gestational age (SGA), and large for gestational age (LGA) was estimated. RESULTS: The weighted risk for nonlive birth was 29.7% with continuation and 27.1% with noncontinuation (adjusted risk ratio, 1.09 [95% CI, 0.98 to 1.23]). Among 2529 live-birth pregnancies, 1443 (57.1%) received at least 1 GLP-1RA dispensation after LMP and 1499 (829 continuers) were linked to an infant. Weighted prevalence ratios for continuation versus noncontinuation were 1.29 (CI, 0.82 to 2.06) for SGA, 1.08 (CI, 0.84 to 1.40) for LGA, and 1.21 (CI, 0.83 to 1.82) for MCM. LIMITATION: Potential residual confounding by prior glycemic control. CONCLUSION: Risks for nonlive birth, SGA, LGA, and MCM were not definitively higher with continuation of GLP-1RAs into early pregnancy. However, estimates for MCM and SGA were imprecise and were compatible with both no increased risk and clinically relevant differences in risk. PRIMARY FUNDING SOURCE: National Institutes of Health.
Ikesu R, Mayeda ER, McGarry K
… +3 more, Nianogo RA, Ramirez CM, Tsugawa Y
Ann Intern Med
· 2026 Jun · PMID 42258826
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BACKGROUND: Because transitions in care settings can be confusing for persons with dementia (PWD), hospital admissions can negatively affect their physical and cognitive function. However, the effect of hospital admissio...BACKGROUND: Because transitions in care settings can be confusing for persons with dementia (PWD), hospital admissions can negatively affect their physical and cognitive function. However, the effect of hospital admissions on patient outcomes and health care spending remains largely unknown. OBJECTIVE: To estimate the effects of hospital admissions on health outcomes and health care spending among PWD. DESIGN: Quasi-experimental instrumental variable method, using emergency physicians' admission propensity as the instrument. SETTING: United States. PATIENTS: Medicare fee-for-service beneficiaries aged 66 years or older with dementia who visited an emergency department (ED) in 2017 to 2019. MEASUREMENTS: Death, inpatient days (excluding the index hospital admission), and health care spending (excluding the index ED visit and hospital admission) within 30 and 90 days of ED visits. RESULTS: Among 872 085 ED visits (62.9% women; mean age, 83.1 years) included in the analysis, 482 208 (55.3%) resulted in hospital admission. There was no evidence that hospital admission was associated with 30-day mortality rate (adjusted risk difference, -2.6 percentage points [pp] [95% CI, -5.2 to 0.1 pp]) or inpatient days (adjusted difference, 0.1 days [CI, -0.2 to 0.5 days]). Hospital admission was associated with higher 30-day health care spending (adjusted difference, $2547 [CI, $1390 to $3703]). Patterns were similar for 90-day outcomes. LIMITATION: Residual confounding. CONCLUSION: Among Medicare beneficiaries with dementia who visited an ED, there was no evidence that hospital admission was associated with mortality rates. Under conventional statistical criteria, an effect of hospital admissions between a 5.2-pp decrease and a 0.1-pp increase in 30-day mortality rates was highly compatible with the data. On the contrary, hospital admission was associated with higher health care spending. PRIMARY FUNDING SOURCE: None.
Ann Intern Med
· 2026 Jun · PMID 42258825
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Updated U.S. and international hypertension guidelines reflect new studies and analyses that support changes in hypertension management. The 2025 U.S. guideline for prevention, detection, evaluation, and management of hi...Updated U.S. and international hypertension guidelines reflect new studies and analyses that support changes in hypertension management. The 2025 U.S. guideline for prevention, detection, evaluation, and management of high blood pressure (BP) recommends lower BP targets, greater use of out-of-office BP for diagnosis and medication titration, and a different approach to severe hypertension presenting without acute or evolving cardiovascular disease symptoms or signs. New treatments for resistant hypertension are recommended. Trial evidence supports benefit from tighter BP control to prevent mild cognitive impairment and dementia, further emphasizing the importance of lower BP goals.
Field TS, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Jun · PMID 42224698
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Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Neurology: [Formula: see text].
Worsnop C, McDonald C, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Jun · PMID 42224697
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GIM/FP/GP: [Formula: see text] Allerg & Immunol: [Formula: see text] Pulmonology: [Formula: see text].GIM/FP/GP: [Formula: see text] Allerg & Immunol: [Formula: see text] Pulmonology: [Formula: see text].
Kirschner JM, Hunter BR, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Jun · PMID 42224695
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Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Critical Care: [Formula: see text] Pulmonology: [Formula: see text].Emergency Med: [Formula: see text] GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Critical Care: [Formula: see text] Pulmonology: [Formula: see text].
Tanner M, ACP Journal Club Editorial Team at McMaster University
Ann Intern Med
· 2026 Jun · PMID 42224694
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GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Endocrinology: [Formula: see text] Public Health: [Formula: see text].GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Endocrinology: [Formula: see text] Public Health: [Formula: see text].