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Evidence-Based Medicine This department uses the best available scientiﬁc ﬁndings to offer practice guidance on a wide range of conditions seen in primary care.The author, Alan Ehrlich, MD, is a deputy editor for DynaMed, Ipswich, Mass., and assistant clinical professor in Family Medicine, University of Massachusetts Medical School, in Worcester. DynaMed (www.ebscohost.com/dynamed/) is a database that provides evidence-based infor- mation on more than 3,000 clinical topics and is updated daily through systematic surveillance covering more than 500 journals.The most important evidence identiﬁed is summarized here. STATINS SLIGHTLY INCREASE levels compared with placebo (-2.2 µmol/L vs. RISK OF DIABETES +2.6 µmol/L, P <0.001), it was associated with an A recent systematic review assessed the relation- increase in the composite outcome of myocardial ship between statin use and diabetes with data infarction, stroke, revascularization, and all-cause on 91,140 patients from 13 randomized trials. mortality (23.5% vs. 14.4%, P=0.04, NNH 11). Over mean follow-up of four years, statin use The trial was inadequately powered to show dif- was associated with a small increase in new-onset ferences in individual cardiovascular outcomes. diabetes (4.89% vs. 4.5%, odds ratio 1.09, 95% Treatment with B vitamins also had a detrimental CI 1.02-1.17). The number needed to harm effect on kidney function, signiﬁcantly reducing (NNH) was 255 patients treated with statins for the mean glomerular ﬁltration rate (16.5 mL/ four years to result in one additional diabetes minute/1.73 m2 vs. 10.7 mL/minute/1.73 m2, case. Diabetes risk with statins was highest in P=0.02). Due to these adverse outcomes, the trials with older patients. Because the risk of authors recommend that B vitamins not be used diabetes is low in comparison to the beneﬁcial to lower homocysteine levels ( JAMA. 2010;303: effects of statins on cardiovascular events, the B vitamin 1603-1609). authors do not recommend changing statin treat- formulations ment in patients with or at risk of cardiovascular LACTOBACILLUS GG MAY disease (Lancet. 2010;375:735-742). with B12 and DECREASE RISK OF high doses of NOSOCOMIAL RESPIRATORY TREATMENT WITH HIGH-DOSE folate and B6 AND GI INFECTIONS IN FOLIC ACID, VITAMIN B6, HOSPITALIZED CHILDREN AND VITAMIN B12 MAY INCREASE have been used Level 2: Mid-level evidence ADVERSE OUTCOMES IN to reduce Children can be at high risk of infections during PATIENTS WITH DIABETIC homocysteine hospital stays, and measures commonly used to NEPHROPATHY levels. prevent nosocomial infections (e.g., hand hygiene) Level 2: Mid-level evidence are not completely effective. A randomized Nephropathy is a common complication of dia- trial with 742 children evaluated the efﬁcacy betes and has been associated with high plasma of Lactobacillus GG for preventing hospital- homocysteine levels. Because B vitamin formu- acquired infections (Pediatrics. 2010;125
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