RESUMO
Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychosocial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.
Assuntos
Humanos , Masculino , Feminino , Adulto , Comportamento Aditivo , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estados Unidos , Medicina de Precisão , Tratamento de Substituição de Opiáceos , Analgésicos Opioides/efeitos adversosRESUMO
The rates of type 2 diabetes (T2D) in children and adolescents are rising globally, and this is closely linked to the obesity epidemic that is affecting millions of youth around the world. In this review, we examine the differences between type 1 diabetes and T2D, and highlight the mechanisms involved in T2D development including genetic, epigenetic and environmental factors. We also highlight the role of inflammation in causing insulin resistance, one of the main drivers of T2D genesis.