American College of Physicians, April 3-5

The annual meeting of the American College of Physicians (Internal Medicine Meeting) was held from April 3 to 5 in New Orleans and was attended by internal medicine physicians, adult medicine specialists, subspecialists, medical students, and allied health professionals. The conference highlighted recent advances in the prevention, detection, and treatment of illnesses in adults, with presentations focusing primarily on updates in neurology, oncology, infectious diseases, endocrinology, and cardiology.As part of the SURPASS-SWITCH trial, Liana K. Billings, M.D., of Endeavor Health (NorthShore Hospitals) in Evanston, Illinois, and colleagues found that switching to tirzepatide leads to greater glycated hemoglobin (HbA1c) reduction and weight loss than simply increasing the dose of dulaglutide, without additional safety concerns.The authors aimed to evaluate if switching adults with inadequately controlled type 2 diabetes from submaximal dulaglutide to tirzepatide offered additional efficacy compared with dulaglutide dose escalation. Enrolled in the study were 282 adults with type 2 diabetes and an HbA1c ≥7.0 to ≤9.5 percent who were on a stable dose of dulaglutide weekly (0.75 or 1.5 mg) for at least six months and zero to three oral antihyperglycemic medications for at least three months. Patients were randomly assigned to either an escalation of dulaglutide to the maximum tolerated dose/4.5 mg once weekly or a switch to tirzepatide and increasing to the maximum tolerated dose/15 mg once weekly for 40 weeks.After 40 weeks, the researchers found that HbA1c reduction was −0.67 percent with dulaglutide and −1.44 percent with tirzepatide, while the final mean HbA1c was 7.1 percent in the dulaglutide arm and 6.2 percent in the tirzepatide arm. Weight loss was 3.6 kg in the dulaglutide arm versus 10.5 kg in the tirzepatide arm. The most common side effects were gastrointestinal, including nausea and diarrhea, in both groups."This study highlights the importance of considering alternative therapies rather than maximizing the dose of a current medication when patients are not meeting their treatment goals," Billings said. "We now provide evidence to support the decision to switch to tirzepatide if a patient with type 2 diabetes has uncontrolled blood glucose on submaximal doses of dulaglutide."The study was funded by Eli Lilly, the manufacturer of tirzepatide.AbstractIn another study, Zehavi Horowitz-Kugler, M.D., of K Health in New York City, and colleagues demonstrated the potential efficacy of artificial intelligence (AI) to better diagnose and manage common acute symptoms and improve clinical decision-making in primary care settings.The authors evaluated the utility of an AI system in a virtual primary care clinic. The sample included 461 visits for certain acute symptoms (respiratory, urinary, vaginal, eye, and dental). Expert adjudicators reviewed both AI recommendations and the physician's actual decision in each case and rated them on a 4-point scale (optimal, reasonable, inadequate, or potentially harmful).The researchers noted that AI conducted a detailed intake and provided a comprehensive diagnosis and management plan, doing so responsibly and only when sufficiently confident. The adjudicators found AI to be more often optimal and less often potentially harmful than physicians. AI excelled at identifying key information both from the intake and the patient's electronic health record and was more consistently adherent to guidelines. The physicians outperformed AI in certain cases, specifically when physical findings were essential."Overall, AI and the physicians were rated equally (e.g., both optimal or both inadequate) in 68 percent of the cases. In 21 percent of the cases, AI was rated better, and in 11 percent, the physicians were rated better," Horowitz-Kugler said. "AI has three major advantages: (a) it was trained on millions of real primary care cases and not textbooks/vignettes; (b) it mirrors the full patient-physician interaction; and (c) it will only provide recommendations if it has high confidence."The study was funded by K Health.AbstractACP: Guidance Provided for Use of Cannabis in Chronic Noncancer Pain ManagementMONDAY, April 7, 2025 (HealthDay News) -- In a best practice guideline issued by the American College of Physicians and published online April 4 in the Annals of Internal Medicine, advice is presented for clinicians regarding the benefits and harms of cannabis or cannabinoids for the management of chronic noncancer pain. The guideline was published to coincide with the Internal Medicine Meeting, the annual meeting of the American College of Physicians, held from April 3 to 5 in New Orleans.Read Full TextACP: AI Recommendations More Often Better Quality for Virtual Care VisitsMONDAY, April 7, 2025 (HealthDay News) -- Artificial intelligence recommendations are more often rated as better quality than final recommendations of physicians for virtual care visits made by patients with respiratory, urinary, vaginal, eye, or dental symptoms, according to a study published online April 4 in the Annals of Internal Medicine to coincide with the Internal Medicine Meeting, the annual meeting of the American College of Physicians, held from April 3 to 5 in New Orleans.Read Full TextACP: Switching From Dulaglutide to Tirzepatide Improves HbA1c Reduction in T2DMFRIDAY, April 4, 2025 (HealthDay News) -- For patients with inadequately controlled type 2 diabetes receiving dulaglutide, switching to tirzepatide is associated with additional hemoglobin A1c reduction and weight loss compared with escalating treatment with dulaglutide, according to a study published online April 4 in the Annals of Internal Medicine to coincide with the Internal Medicine Meeting, the annual meeting of the American College of Physicians, held from April 3 to 5 in New Orleans.Read Full Text.Sign up for our weekly HealthDay newsletter