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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.

Aspirin therapy is associated with a reduced risk of hepatitis B virus-related hepatocellular carcinoma (HCC), according to a study scheduled for presentation at The Liver Meeting, held by the American Association for the Study of Liver Diseases from Oct. 20 to 24 in Washington, D.C. Teng-Yu Lee, M.D., Ph.D., from Taichung Veterans General Hospital in Taiwan, and colleagues used data from Taiwan's National Health Insurance Research Database from 1998 to 2012. Patients with non-hepatitis B infections were excluded, as were those with HCC before the follow-up index dates. A total of 1,553 patients who continuously received daily aspirin ≥90 days were randomly matched (1-to-4 ratio) with 6,212 patients who never received anti-platelet therapy based on baseline characteristics, the index date, and nucelos(t)ide analogue (NA) use during follow-up. The researchers found that the cumulative incidence of HCC in the treated group was significantly lower than that in the untreated group in five years (2.86 percent versus 5.59 percent). Aspirin therapy was independently associated with a reduced HCC risk (hazard ratio [HR], 0.63) in a multivariable regression analysis. An increased HCC risk was independently associated with older age (HR, 1.03 per year), male gender (HR, 2.65), cirrhosis (HR, 1.89), and diabetes mellitus (HR, 1.51). NA (HR, 0.57) and statin (HR, 0.57) use were associated with a decreased HCC risk.