Internal Medicine

CDSMP produces small persistent improvements in pain, mood, fatigue, and sleep at 6 months

This systematic review and meta‑analysis pooled studies of the Chronic Disease Self‑Management Program and found small but durable symptom improvements at 6 months. Mean differences were pain 0.53, depression (PHQ‑9) 1.47, fatigue 0.46, and sleep problems 0.57 on patient scales. Effects were observed across countries and various chronic conditions, with larger benefits in participants with multimorbidity. Implementation challenges noted include securing sustained funding and achieving recruitment and retention. 1

Non‑labeled sacubitril‑valsartan dosing is common and varies by region and clinician type

In the global IKNOW‑HF survey (1,829 respondents; 1,285 complete), 86.1% reported using non‑labeled sacubitril‑valsartan dosing. Non‑labeled use was more common among general cardiologists and in low‑ and lower‑middle‑income countries. Practicing in Asia and >10 years' experience independently predicted non‑labeled dosing in multivariable analysis. Presence of a cardiology pharmacist trended toward fewer non‑labeled prescriptions, suggesting a modifiable team factor. 2

Multilevel, multidomain interventions modestly lower HbA1c in Black adults with type 2 diabetes

This meta‑analysis of 46 RCTs (7,864 participants) found a weighted mean HbA1c reduction of ‑0.38% (95% CI ‑0.51 to ‑0.25). Multi‑domain interventions produced slightly larger reductions (WMD ‑0.43%), with moderate heterogeneity (I²≈50%). Risk of bias was low and evidence certainty high for these nonpharmacologic interventions in the studied population. No included trials targeted community/societal or built‑environment factors, a gap for addressing structural disparities. 3