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Obstetrics and Gynecology - Office Gynecology
Cabergoline after second-trimester pregnancy loss or termination (June 2023)
Breast symptoms (engorgement, tenderness, milk leakage) after second-trimester pregnancy loss or termination are common, but pharmacotherapy to suppress engorgement and lactation is limited. In a randomized placebo-controlled trial of approximately 70 patients with pregnancy loss or termination at 18 to 26 weeks of gestation, cabergoline (1 mg orally within four hours of fetal expulsion/extraction) substantially reduced breast symptoms on days 2 through 14 of follow-up.2 Side effects were similar between groups, but the trial was not powered to detect small differences. When counseling patients about breast symptoms after second-trimester pregnancy loss or termination, UpToDate discusses the option of cabergoline as well as nonpharmacologic measures (eg, ice, compression with a tight sports bra, avoiding breast stimulation).
Endocrinology and Diabetes Mellitus - Diabetes Mellitus
More fully automated insulin delivery system for type 1 diabetes (June 2023)
For patients with type 1 diabetes (T1D), more fully automated insulin delivery (AID) systems promise enhanced glycemic management without the substantial time and training required for use of partially automated systems. In a 13-week unblinded trial in which 219 patients with T1D (aged 6 to 79 years, A1C 5.5 to 13.1 percent) were randomly assigned to more fully AID or standard care (any mode of insulin delivery coupled with continuous glucose monitoring), the AID system led to a greater reduction in A1C (mean adjusted difference in A1C -0.5 percent).3 Participants assigned to AID also had a higher percentage of time spent in the target glucose range without increased frequency of hypoglycemia. In the United States, this more automated system has regulatory approval for individuals with T1D aged >=6 years and may expand use of continuous insulin therapy.4
Adult Primary Care
Tonsillectomy for adults with recurrent tonsillitis (June 2023)
Tonsillectomy in adults with recurrent tonsillitis has not been extensively studied. In a trial conducted in the UK enrolling 453 adults with recurrent acute tonsillitis, those who received tonsillectomy had fewer days of sore throat during the subsequent 24 months than those in the conservative management group (median 23 versus 30 days).5 UpToDate uses a shared decision-making approach to tonsillectomy in adults, recognizing that some patients are likely to have positive outcomes, although data are limited.
Cardiovascular Medicine - Heart Failure
Remote pulmonary artery pressure monitoring in patients with heart failure (June 2023)
In patients with heart failure (HF), remote pulmonary artery (PA) pressure monitoring may lead to changes in medical therapy that prevent progressive volume overload and the need for hospitalization. In a recent trial that included nearly 350 patients with HF, patients assigned to remote PA pressure monitoring had a lower risk of HF hospitalization and a small increase in quality-of-life scores compared with those receiving standard care.1 However, similar to other trials of hemodynamic monitoring in patients with HF, methodologic issues (eg, inability to blind patients and clinicians to device placement) limit the generalizability of these findings to practice. In highly selected patients with HF, placement of a PA pressure monitor is an option for chronic disease management.
1. Brugts JJ, Radhoe SP, Clephas PRD, et al Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial. Lancet. 2023. [Context Link]
2. Henkel S, Johnson SA, Reeves MF, et al Cabergoline for Lactation Inhibition After Second-Trimester Abortion or Pregnancy Loss: A Randomized Controlled Trial. Obstet Gynecol. 2023;141:1115. [Context Link]
3. Russell SJ, Beck RW, et alBionic Pancreas Research Group Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. N Engl J Med. 2022;387(13):1161. [Context Link]
4. FDA approval of iLet Bionic Pancreas. Available at: https://www.fda.gov/news-events/press-announcements/fda-clears-new-insulin-pump- (Accessed on May 30, 2023). [Context Link]
5. https://www.sciencedirect.com/science/article/pii/S0140673623005196?via%3Dihub (Accessed on May 19, 2023). [Context Link]
Disclaimer: This content is provided for reference purposes only and represents a portion of the UpToDate topic. Readers should not rely on the content or any information cited here as being applicable to specific patient circumstances. All topics are updated as new evidence becomes available and our peer review process is complete.