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Immediate access to opioid agonist treatment (OAT) for patients presenting with opioid use disorder may provide greater health benefits at less cost than observed standard of care, according to a study published online Nov. 21 in the Annals of Internal Medicine. Emanuel Krebs, from St. Paul's Hospital in Vancouver, Canada, and colleagues sought to determine the cost-effectiveness of OAT versus observed standard of care for patients presenting with opioid use disorder. Population-level administrative databases capturing treatment and criminal justice records for California were linked (2006 to 2010). Immediate access to OAT for all treatment recipients was found by the researchers to cost less (by $78,257), with patients accumulating more quality-adjusted life-years (by 0.42) versus the observed standard of care. Imagining a hypothetical scenario where all Californians starting treatment of opioid use disorder in 2014 had immediate access to OAT, the team found that total lifetime savings for this cohort could be as high as $3.8 billion.

Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write.