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Objectives:The primary objective of the study was to assess the mean change in hemoglobin A1c (HbA1c) when acarbose was added to insulin and non-insulin regimens in patients with type 2 diabetes mellitus (T2DM). Secondary objectives were to evaluate the discontinuation rate of acarbose, and to assess the number of patients who were placed on insulin despite the addition of acarbose.Methods:A retrospective chart review was conducted on veterans with T2DM initiated on acarbose between October 1, 2013 and December 31, 2013. To be included, patients must have had a refill history indicating at least 3 months of acarbose use and HbA1c readings within 6 months prior to initiation and after at least 3 months of use. Excluded patients were those with type 1 diabetes mellitus, serum creatinine ≥2 mg/dL at acarbose initiation, or a diagnosis based on ICD-9 codes for an existing gastrointestinal condition or liver cirrhosis. The two-tailed, paired t-test was used for analysis of the primary objective and descriptive statistics were used for all other outcomes.Results:Of the 146 patients screened, 102 patients were included in the study. Exclusions were primarily due to patients not being on acarbose for at least 3 months (n=43). The average HbA1c before and after acarbose initiation was 9.08% (SD=1.74) and 8.43% (SD=1.74) respectively, with an average HbA1c reduction of 0.65% (n=102, p=0.0005). Forty patients (39.2%) discontinued acarbose after at least 3 months of use. Of the 73 patients not on insulin at the time of acarbose initiation, 19 (26%) were started on insulin therapy despite addition of acarbose.Conclusion:Acarbose can be considered in patients who may reach their HbA1c goal with minimal HbA1c reduction. However, adverse effects are a limitation to use. Potential risks and benefits should be assessed and discussed with the patient prior to prescribing acarbose.

Background The emergence of antimicrobial resistance in uropathogens has generated interest in the use of nitrofurantoin in controversial populations, such as in males and in those with renal dysfunction. The purpose of this study is to compare the efficacy and safety of nitrofurantoin for the treatment of cystitis in males and females with variable degrees of renal dysfunction. Methods A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting. The primary outcome was clinical cure compared between males and females and across various renal function groups (CrCl > 60 mL/min, 30-60 mL/min, and < 30 mL/min) following nitrofurantoin treatment. The secondary outcome was adverse events. Results A total of 446 patients were included with 278 females and 168 males. Overall clinical cure rate was 86.5% [95% CI 83.0, 89.4%] (n=386). Clinical cure rate did not vary between genders (OR 0.6 [95% CI 0.35, 1.04], p=0.085) or between patients who have a CrCl > 60 mL/min compared to those with CrCl 30-60 mL/min (OR 1.01 [95% CI 0.40, 2.44], p=1). The one patient with a CrCl < 30 mL/min was not included in the analysis. A history of benign prostatic hyperplasia (BPH) (OR 0.5 [95% CI 0.26, 0.99], p=0.045) or cirrhosis (OR 0.21 [95% CI 0.06, 0.82], p=0.025) was associated with decreased odds of clinical cure. Adverse events occurred in 2% (n=9) of patients. Conclusions There was no statistically significant difference in clinical cure with nitrofurantoin between genders and various renal functions.

Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason ™ " (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOAn 87-year-old hospitalized man has lost 7% of his body weight in the past year. His family and the inpatient nutritionist ask about a prescription appetite stimulant.