Research explores advancement of DEI in med schools, older adults’ addiction to highly processed foods and more

With an abundance of medical journals, research and studies, it can be a challenge keeping up to date with the latest information. Because keeping abreast of current medical news is an important part of a career in medicine, we have combed through the latest information to find four recent studies that DOs will find significant and relevant to the work they do. See below for summaries and links to original research.

“U.S. Medical School Admissions Leaders’ Experiences With Barriers to and Advancements in Diversity, Equity and Inclusion,” JAMA Network, Feb. 24, 2023

This study set out to determine how U.S. medical school leaders are working to advance diversity, equity and inclusion in response to decades-long calls to increase racial and ethnic diversity.

Researchers conducted a qualitative study by interviewing 39 deans and directors of admissions from 37 allopathic medical schools across the United States. These interviews were conducted both online and in-person from Oct. 16, 2019 to March 27, 2020. The interviews were analyzed between October 2019 and March 2021.

Participants were asked to describe embedded processes and structures of institutional racism that impeded efforts to increase diversity in admissions. They were also asked to discuss their strategies to overcome these challenges.

Among those interviewed, years of admissions experience ranged from one year to 40 years. The majority of participants (56.4%) identified as women, and 61.5% of participants identified as White. Other populations recorded include 25.6% Black or African American, 10.3% Asian American and 5.1% Hispanic or Latinx.

Overall, participants broadly characterized diversity, with limited attention to racial injustice. Participants listed lack of leadership commitment; pressure from faculty and administrators to overemphasize academic scores and school rankings; and political and social influences (i.e., donors or alumni) as barriers to advancing racial and ethnic diversity in their schools. Additional barriers that may inadvertently lower expectations and accountability include accreditation requirements, holistic review initiatives and local policy-motivated reforms.

Participants named the following strategies to overcome challenges: narrative change and revision of school leadership structure, admissions goals, practices and committee membership.

Researchers concluded that medical school admissions leaders face multiple challenges within the current organizational and power structures of academic medical programs. Researchers believe that comprehensive institutional and process level reforms will need to be established in order to dismantle admissions systems that perpetuate institutional racism. Leadership is encouraged to pursue both internal and external opportunities to improve equal opportunities. Without these significant improvements, it will not be possible to increase the racial and ethnic diversity of the physician workforce.

“Addiction to Highly Processed Food Among Older Adults,” University of Michigan, Jan./Feb. 2023

In this study, conducted by the University of Michigan, the addiction to highly processed foods is studied in older adults. As noted in the study, highly processed foods can be addictive to some individuals, just like cigarettes and alcohol. Symptoms noted include the feeling of a loss of control over consumption, intense cravings and even withdrawal, during which an individual experiences irritability, difficulty concentrating or headaches. In 2022, the University of Michigan National Poll on Healthy Aging surveyed a group of national participants, ages 50-80, to measure symptoms of addiction to highly processed foods. Additionally, the study explored how these symptoms related to the participants’ physical and mental health, as well as feelings of social isolation.

Based on collected data, 13% of adults ages 50-80 met the criteria for addiction to highly processed foods within the past year, meaning they displayed two or more symptoms out of 11, in addition to significant impairment or distress. However, nearly half of the respondents (44%) indicated at least one symptom of addiction to highly processed foods. The most common symptom reported was intense cravings.

Women were over twice as likely as men to meet criteria for addiction to highly processed foods (18% vs. 8%). Adults between the ages of 50 to 64 were also more likely to meet the criteria as compared to adults between the ages of 65 to 80 (17% vs. 8%). Overall, respondents who self-reported fair or poor physical health were more likely to exhibit signs of addiction to highly processed foods.

The study recommends that individuals be screened at routine health care visits for addiction to highly processed foods using a tool such as the Yale Food Addiction Scale, which may help to identify older adult patients who could benefit from additional resources to address higher levels of physical and mental health care needs.

“The initiation of new glucose lowering therapies may act to reduce physical activity levels: pooled analysis from three randomized trials,” American Diabetes Association, Aug. 2022

The objective of this study was to determine the effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1RA) on physical activity. To determine this, researchers pooled data from three randomized trials that investigated the effect of empagliflozin (SGLT2i) and liraglutide (GLP-1RA) in comparison to sitagliptin (dipeptidyl peptidase 4 inhibitor) and dietary therapies on accelerometer-assessed physical activity.

The results showed that liraglutide, empagliflozin and sitagliptin led to a lower level of total daily physical activity after six months. Additionally, moderate-to-vigorous intensity physical activity was also reduced. Dietary interventions did not lead to any changes or increases in physical activity. Researchers concluded that the initiation of all glucose-lowering therapies was associated with reduced physical activity, and further investigation is recommended. Please see the original study for detailed graphics and charts exhibiting the findings.

“Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicenter, double-blind, randomized crossover trial,” The Lancet, Aug. 27, 2022

OPTION-DM was a multicenter, randomized, double-blind, crossover trial in patients with DPNP who had mean daily pain of 4 or higher, on a scale of 1-10. The participants were from 13 different United Kingdom centers and were randomly assigned a predetermined randomized schedule to receive one of six ordered sequences of the following three treatment pathways: amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline and duloxetine supplemented with pregabalin. Each treatment lasted 16 weeks. Monotherapy was given for six weeks and supplemented with the combination medication if there was suboptimal pain relief.

This study took place between Nov. 14, 2017, and July 29, 2019. During this time, 252 patients were screened, 140 patients were randomly assigned and 130 patients started a treatment pathway. Over half (84) of the participants completed at least two pathways. Each participant was analyzed for the primary outcome.

It was found that the seven day average NRS scores at week 16 had decreased from a mean of 6·6 (SD 1·5) at baseline to 3·3 (1·8) at week 16 in all three pathways. Additionally, mean NRS reduction in patients on combination therapy was greater than those who remained on monotherapy. Researchers were able to conclude, to the best of their knowledge, that OPTION-DM was the largest and longest ever, head-to-head, crossover neuropathic pain trial. They showed that all three treatment pathways and monotherapies had similar efficacy. Additionally, combination treatment was well tolerated and led to improved pain relief in patients with suboptimal pain control.