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July 7, 2009
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Volume 4
Issue 27
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DynaMed Systematic Literature Surveillance
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For the week ending July 3, 2009
This week, 396 articles were considered for inclusion in DynaMed and 142 met criteria for inclusion.
Based on the criteria of selecting “articles most likely to change clinical practice,” one article of significant interest is included in this weekly update.
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Insulin Therapy Associated with Dose-Dependent Increase in Risk for Cancer and Risk May be Higher for Insulin Glargine
A recent observational study evaluated the malignancy rates associated with human insulin and insulin analogues in 127,031 adults with diabetes receiving first-time insulin monotherapy. All participants were without known malignant disease at baseline; 75% were treated with human insulin and 19% with insulin glargine exclusively. Others received either insulin aspart or insulin lispro. In mean follow-up of 1.6 years, 5,009 patients developed malignancies, and there was a dose-dependent association with malignancy rate found for all insulin types (level 2 [mid-level] evidence). Insulin glargine was associated with a greater increase in cancer risk compared to human insulin in dose-adjusted analysis (Diabetologia 2009 Sep;52(9):1732).
The American Diabetes Association (ADA) has issued a statement advising patients NOT to stop taking insulin glargine (Insulin Glargine and Cancer 2009 Jun 26).
For more information, see the Insulin Management topic in DynaMed.
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DYNAMED EXTRA – FDA Panel Recommends Addition of Black Box Warning to Any Prescription Medication Containing Acetaminophen
Due to the risk of liver damage associated with high doses of acetaminophen, a US Food and Drug Administration (FDA) advisory panel has voted to recommend a black box warning for all prescription medications that combine acetaminophen with any other drug. These include the pain medications Vicodin, Percocet and Tylenol 3. A slim majority of panelists voted in favor of withdrawing prescription products containing acetaminophen from the market. The warning would not apply to over-the-counter drugs, but the panel did recommend a reduction in the maximum over-the-counter single adult dose from 1,000 mg to 650 mg, and to make the 500 mg pill available by prescription only. The FDA has not yet accepted these recommendations as official policy (Medpage Today 2009 Jun 30).
For more information, see the Acetaminophen and Acetaminophen poisoning topics in DynaMed.
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Medical Calculators Added To DynaMed
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DynaMed now includes more than 500 clinical calculators, decision rules and statistics calculators to give clinicians even more decision making tools to use at the point of care.
After logging in, click on Calculators in the upper right corner of the screen to access this new feature.
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Subscribe FREE to DynaMed Weekly Update
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DynaMed Weekly Update is a compilation of 1 to 5 articles that are of significant interest to clinicians. Articles are selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice. Updates are prepared by the DynaMed Editorial Team which includes 28 clinicians from multiple disciplines. Send comments to DynaMedEditor@epnet.com. To learn more about DynaMed, go to www.dynamicmedical.com.
Published by
Copyright © 2009 EBSCO Publishing. All rights reserved.
DynaMed® is a registered trademark of and published by DynaMed LLC. Original date of on-line publication December 15, 1995 with continuous daily updating. ISSN: 1554-1177. Subscriptions and queries can be addressed to DynaMed LLC, EBSCO Publishing, 10 Estes St., Ipswich, Massachusetts, USA 01938-0602, telephone (978) 356-6500, facsimile (978) 356-6565, e-mail Editor@DynamicMedical.com.
The opinions expressed herein are solely those of the authors and editors and may or may not represent the official position of cooperating or endorsing Medical Societies.
Development of DynaMed was supported in part by the National Science Foundation through a Small Business Innovative Research grant. (All other support comes from subscriptions. No advertisements are accepted.) 
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