Diabetes Tech Use On the Rise But A1c Reductions Still Lag

 Use of diabetes technology has dramatically increased and glycemic control has improved among people with type 1 diabetes (T1D) in the US over the past 15 years, but at the same time, overall achievement of an A1c level < 7% remains low and socioeconomic and racial disparities have widened.

These findings came from an analysis of national electronic health records of nearly 200,000 children and adults with T1D by Michael Fang, PhD, of the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues. The study was published online on August 11, 2025, in JAMA Network Open.

Use of continuous glucose monitors (CGMs) increased substantially from 2009-2011 to 2021-2023, from less than 5% in both children and adults to more than 80% and over half, respectively. While A1c levels did drop over the 15 years, just 1 in 5 children and slightly over a quarter of adults achieved a level < 7%. The average A1c level stayed above 8%, with ethnic minorities and low-income patients seeing the smallest gains.

“Additional opportunities for individualized patient and clinician education can help optimize the use of technologies. In our analyses, the increase in CGM and insulin pump use substantially outpaced gains in glycemic control,” Fang and colleagues wrote.

In an accompanying editorial, Diana Soliman, MD, of the Division of Endocrinology at the University of Miami Miller School of Medicine in Miami, and colleagues wrote, “As technological innovation continues to accelerate, it is encouraging to see signs of progress in glycemic management. Ensuring that these advances benefit all individuals with T1D must remain a priority.”

Asked to comment, Anne L. Peters, MD, professor of clinical medicine and director of Clinical Diabetes Programs at the Keck School of Medicine of USC, Los Angeles, told Medscape Medical News that a key component is having staff to help with prior authorization paperwork and certified diabetes care and education specialists (CDCES) to help train patients and troubleshoot. “These health disparities are real but fixable. However, it takes staff to make it happen.”

Tech Use Up But A1c Level Hasn’t Dropped Much

Fang and colleagues used the OptumLabs Data Warehouse to identify 186,590 eligible individuals with T1D, of whom 26,853 were younger than 18 years. Three quarters were White, 12% were Black, and 7% were Hispanic individuals. Few previous studies of T1D have included such representative population-based data, the authors noted.

From 2009-2011 to 2021-2023, among youths, the use of CGMs rose from 4% to 82%, insulin pumps from 16% to 50%, and the combination from 1% to 47% (P for trend < .001 for all). Such use in 2021-2023 was higher among White youths and those with commercial insurance.

During the same period, among adults, the use of CGM rose from 5% to 57%, insulin pumps from 11% to 29%, and the combination from 1% to 22% (P for trend < .001 for all). Throughout, adults who were White, younger, and commercially insured were more likely to use CGMs.

Overall, mean A1c levels dropped from 8.9% to 8.3% in youths and from 8.2% to 8.0% in adults from 2009-2011 to 2021-2023.

Among youths, the prevalence of achieving glycemic control, defined as an A1c level < 7%, rose from about 7% in 2009-2011 and 2014-2017 to 19% in 2021-2023 (P for trend < .001). Glycemic control improved for all youth subgroups except for Black youths. Differences by race, ethnicity, and insurance type increased after 2018-2020.

During 2021-2023, 21% of White youths vs 17% of Hispanic and 12% of Black youths achieved glycemic control. Those with commercial health insurance also had higher rates of glycemic control than those with Medicaid insurance (22% vs 13%).

For adults with T1D, glycemic control rose from 21% in 2009-2011 to 28% in 2021-2023 (P for trend < .001). Again, the prevalence of achieving glycemic control was higher among those who were White (30% vs 20% of Hispanic and 21% of Black patients in 2021-2023) and those who had commercial insurance (30% vs 19% of those who had Medicaid insurance).

Implications for Clinical Practice

These findings have important implications for clinical practice and policy, Soliman and colleagues said. “Barriers to diabetes technology access, including financial costs, lack of clinician prescription, and inadequate clinical communication, continue to disproportionately affect medically underserved populations. While the increase in diabetes technology may be attributed to expanded insurance coverage, incorporation into guidelines, and improved technology, there remains a crucial need to extend this technology more widely.”

Addressing these challenges, they said, “requires coordinated efforts that combine reduced financial barriers with clinician training, shared decision-making, and culturally competent communication to promote equitable and effective use of technology.”

Peters has one practice in the relatively wealthy west side of Los Angeles and another in an underserved area in East Los Angeles. On the west side, she has a full-time staffer who exclusively handles prior authorizations for diabetes devices and a CDCES who trains patients and follows them weekly. The patients there all speak English and have high health literacy.

On the east side, there aren’t any educators and no classes on advanced technology. A prescription for an automated insulin delivery device can take months to get filled. Non-English speaking patients may have difficulty accessing manufacturer assistance and may lack smartphones compatible with their devices. Even when patients are able to start using the technology, they may not have the support they need to continue.

“The systems of care often lack what it takes to provide adequate care for under-resourced people with T1D. When we’ve had research funding to provide a CDCES, my patients in East LA do great. The training often takes longer than in those who are starting at a higher knowledge level, but technology is very useable by under-resourced people,” Peters said.

The study was funded by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. Fang had no other disclosures. Soliman had no disclosures. Peters reported recording videos for Medscape Medical News, being on the advisory board for Vertex, and having stock options for Omada Health.

https://www.medscape.com/viewarticle/diabetes-tech-use-rise-a1c-reductions-still-lag-2025a1000lc9

'In Utero Treatment for Brain Birth Defect Feasible, Promising'

 

• In utero embolization of fetuses with vein of Galen malformation (VOGM) was feasible, according to early results from a single-center intervention study.
• The three survivors out of seven participants who underwent fetal embolization were 8, 18, and 24 months of age as of April 10, and all were without neurodevelopmental delay.
• Risk of pre-term delivery warrants further study, researchers noted.

In utero embolization of high-risk vein of Galen malformation (VOGM) was feasible for fetuses, early results from a single-center intervention study showed.

Five of the seven attempts at this procedure successfully blocked off these abnormal, direct connections between veins and arteries in the brain that lead to very high venous blood pressureopens in a new tab or window, with three treated fetuses surviving past the neonatal period to meet milestones at 6 months of age, reported Darren Orbach, MD, PhD, of Boston Children's Hospital, and colleagues in JAMAopens in a new tab or window.

The three survivors -- ages 8, 18, and 24 months as of April 10 -- showed no signs of the neurodevelopmental delay that usually accompanies the condition.

"While major advances have been made in the treatment of infants with VOGM in the past several decades, the overall mortality rate remains stubbornly high, and the likelihood of excellent neurodevelopmental outcome remains stubbornly low," Orbach told MedPage Today in an email.

Indeed, the patients in the study had a mean pretreatment falcine sinus diameteropens in a new tab or window of 10.3 mm, which would have been expected to confer "90% mortality and only 9% likelihood of reaching milestones at 6 months under conventional postnatal management," Orbach and colleagues noted.

"Since newborns with VOGM present within hours or days of birth with very aggressive pathophysiology, it became apparent to us that if an intervention before birth were feasible, that might be a very promising avenue for significant improvement in outcomes," Orbach explained.

"This fetal surgery is the first we are aware of that aims to change the brain blood flow in utero," he said. "Thus, though there were compelling theoretical grounds for optimism, both the safety of the surgical approach and the efficacy of the intervention were unknown when we launched the clinical trial. Fortunately, the first patient in the trial in whom we were able to successfully perform the fetal surgery had a fantastic clinical outcomeopens in a new tab or window. But of course, it is vital to replicate such results in other patients."

"We were therefore excited to see that the first group of our enrolled subjects showed a dramatic reduction in mortality and neurodevelopmental morbidity, as compared to standard postnatal management," he continued.

However, five patients (71.4%) had unplanned early deliveries due to circumstances related to fetal intervention. Three of these were pre-term, at a mean of 3.2 days post-intervention.

"Any potential reduction in mortality, brain injury, and neurodevelopmental delays must be weighed against an increased risk of unscheduled, preterm delivery," the group thus cautioned, although Orbach called it "gratifying that the improved outcomes for the enrolled subjects were clearly present, despite the risk of earlier delivery."

While commending the attempt to find a fetal treatment for a difficult disease state in which there are no good treatment options for some large malformation patients, Johanna Fifi, MD, of Mount Sinai Health System in New York City and immediate past president of the Society of NeuroInterventional Surgery, agreed that the risks are notable.

"The induction of premature labor is quite concerning, as postnatal treatment outcome is correlated with gestational age and size of the neonate," Fifi, who was not involved in the study, told MedPage Today in an email. "Therefore, any potential benefit must be weighed against this risk. In addition, fetal treatment risk after term must be compared to postnatal embolization risk."

Mean gestational age at the time of attempted fetal surgery was just shy of 37 weeks, Orbach and colleagues noted. Fetal MRI and echocardiography were performed before and after embolization.

Additional findings were that, among the five fetuses with successful embolization, combined cardiac output dropped 33.4% on average, addressing the risk of heart failure from the congenital condition.

Furthermore, four out of the five embolized fetuses showed no new parenchymal brain findings on postnatal MRI. The other "showed a small focus of hemorrhage in the right occipital lobe and growth of the subdural hematomas compared with the fetal scan." This child had severe high-output heart failure related to the vascular malformation immediately after birth, was not stable enough to undergo postnatal embolization, and died.

The three survivors who underwent successful fetal embolization did not show signs of parenchymal injury on follow-up MRI.

Maternal spinal anesthesia was used for the procedure, while fetuses received an intramuscular injection of fentanyl, vecuronium, and atropine after being positioned by external manipulation by the fetal surgeon.

Fetal embolization utilized ultrasound guidance with transuterine, transcranial needle access and microcatheterization of the falcine sinus and prosencephalic venous varix with detachable coils.

Of the two cases where the embolization procedure was not successful in utero, one died and the other survived with intracranial hemorrhage and seizures after multiple rounds of postnatal embolization.

Limitations included the study's small sample size and lack of a randomized control group, Orbach and colleagues noted. The follow-up period also was relatively short. And due to the geographic dispersion of participants, neurodevelopmental follow-up in partnership with local primary pediatricians was needed, "thus potentially introducing lack of uniformity."

Generalization to other centers is unknown, they added, and the "technical learning curve associated with the fetal procedure and the risk of procedure-related preterm delivery underscore the need for further technique refinement and broader multicenter validation."

While "we cannot firmly conclude yet that this procedure is safe and effective," Orbach said, "we have demonstrated feasibility, and we are excited to complete a clinical trial."

Disclosures

The study was supported by the Gerber Foundation, Haas Family Cerebrovascular Interventions Research Fund, and Sage Schermerhorn Chair in Image-Guided Therapy.

A co-author reported personal fees from UpToDate and grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development outside the submitted work.

Fifi did not report any relevant disclosures.

Primary Source

JAMA

Source Reference: Orbach DB, et al "In utero embolization for fetal vein of Galen malformation" JAMA 2025; DOI: 10.1001/jama.2025.12363.

https://www.medpagetoday.com/pediatrics/generalpediatrics/116940

Rural Emergency Rooms Are Increasingly Run Without Doctors: Kaiser

 There was no doctor on-site when a patient arrived in early June at the emergency room (ER) in the small hospital at the intersection of two dirt roads in this town of 400 residents.

There never is.

The three-bed emergency department in Dahl Memorial Hospital in Ekalaka, Montana -- a 2-hour drive from the closest hospital with more advanced services -- instead depends on physician assistants (PAs) and nurse practitioners (NPs).

Carla Dowdy, PA-C, the institution's chief medical officer, realized the patient needed treatment beyond what the ER could provide, even if it had had a doctor. So, she made a call for a medical plane to fly the patient to treatment at Montana's most advanced hospital. Dowdy also called out medications and doses needed to stabilize the patient as a paramedic and nurses administered the drugs, inserted IV lines, and measured vital signs.

Emergency medicine researchers and providers note that ERs, especially in rural areas, increasingly operate with few or no physicians amid a nationwide shortage of doctors.

A recent studyopens in a new tab or window found that in 2022, at least 7.4% of emergency departments across the U.S. did not have an attending physician on-site 24/7. Like Dahl Memorial, more than 90% were in low-volume or critical access hospitals -- a federal designation for small, rural hospitals.

The results come from the 82% of hospitals that responded to a survey sent to all emergency departments in the country, except those operated by the federal government. The study is the first of its kind, so there isn't proof that such staffing arrangements are increasing, said Carlos Camargo Jr., MD, DrPH, the lead author and a professor of emergency medicine at Harvard Medical School in Boston. But Camargo and other experts suspect that ERs running without doctors being present are becoming more common.

Placing ERs in the hands of non-doctors isn't without controversy. Some doctors and their professional associations say physicians' extensive training leads to better care, and that some hospitals are just trying to save money by not employing them.

The American Medical Associationopens in a new tab or window, open to all medical students and physicians, and the American College of Emergency Physiciansopens in a new tab or window (ACEP) both support state and federal laws or regulations that would require ERs to staff a doctor around the clock. Indiana, Virginia, and South Carolina recently passed such legislation.

Rural ERs may see fewer patients, but they still treat serious cases, said Alison Haddock, MD, president of ACEP. "It's important that folks in those areas have equal access to high-quality emergency care to the greatest extent possible."

Other healthcare providers and organizations say advanced practice providers with the right experience and support are capable of overseeing ERs. And, they note, mandating that a physician be on-site could drive some rural hospitals to close because they can't afford or recruit enough -- or any -- doctors.

"In an environment, especially a rural environment, if you have an experienced PA who knows what they know, and knows the boundaries of their knowledge and when to involve consultants, it works well," said Paul Amiott, PA-C, EMT-P, a board member of the Society of Emergency Medicine PAs.

"I'm not practicing independently" despite working 12-hour night shifts without physicians on-site at critical access hospitals in three states, he said.

Amiott said he calls specialists for consultation often, and about once a month asks the physician covering the day shift at his hospital to come help him with more challenging cases such as emergency childbirth and complicated trauma. Amiott said this isn't unique to PAs -- ER doctors seek similar consultations and backup.

Varies by State

The proportion of ERs without an attending physician always on-site varies wildly by state. The 2022 survey found that 15 states -- including substantially rural ones, such as New Mexico, Nevada, and West Virginia -- had no such emergency departments.

But in the Dakotas, more than half of emergency departments were running without 24/7 attending physician staffing. In Montana it was 46%, the third-highest rate.

None of those three states have a program to train physicians as ER specialists. Neither does Wyoming or Idaho.

But Sanford Health, which bills itself as "the largest rural health system in the United States," is launching an emergency medicine residency in the region. The Sioux Falls, South Dakota-based program is intended to boost the ranks of rural emergency doctors in those states, the residency director said in a news releaseopens in a new tab or window.

Leon Adelman, MD, MBA, is an emergency medicine physician in Gillette, Wyoming, which, at around 33,800 residents, is the largest city in the state's northeast. Working in such a rural area has given him nuanced views on whether states should require 24/7 on-site physician coverage in ERs.

Adelman said he supports such laws only where it's feasible, like in Virginia. He said the state's emergency physicians' organization pushed for the law only after doing research that made the group confident that the requirement wouldn't shutter any rural hospitals.

Camargo said some doctors say that if lawmakers are going to require 24/7 on-site physician coverage in ERs, they need to pay to help hospitals implement it.

Adelman said that when instituting staffing requirements is not possible, states should create other regulations. For example, he said, lawmakers should make sure hospitals not hiring physicians aren't refraining just to save money.

He pointed to Vermont, where a reportopens in a new tab or window recommended that several of the state's hospitals cut physicians from their ERs. The report was part of a mandated process to improve the state's troubled healthcare systemopens in a new tab or window.

Adelman said states should also require PAs and NPs without on-site physician supervision to have extensive emergency experience and the ability to consult with remote physicians.

Some doctors have pointed to a caseopens in a new tab or window in which a 19-year-old woman died after being misdiagnosed by an NP who was certified in family medicine but not emergency care, and was working alone at an Oklahoma ER. Few NPs have emergency certification, an analysis foundopens in a new tab or window.

The Society of Emergency Medicine PAs outlines the training and experienceopens in a new tab or window PAs should have before practicing in rural areas or without on-site doctors.

Haddock said emergency physicians have seen cases of hospitals hiring inexperienced advanced practice providers. She said ACEP is asking the federal government to require critical access and rural emergency hospitals to have physicians on-site or on call day and night.

Haddock said ACEP would not want such a requirement to close any hospital, and noted that the organization has various efforts to keep rural hospitals staffed and funded.

Dahl Memorial Hospital has strict hiring requirements and robust oversight, said Dowdy, who previously worked for 14 years in high-volume, urban ERs.

She said ER staffers can call physicians when they have questions and that a doctor who lives on the other side of Montana reviews all their patient treatment notes. The ER is working on getting virtual reality glasses that will let remote physicians help by seeing what the providers in Ekalaka see, Dowdy said.

She said patient numbers in the Ekalaka ER vary but average one or two a day, which isn't enough for staff to maintain their knowledge and skills. To supplement those real-life cases, providers visit simulation labs, do monthly mock scenarios, and review advanced skills, such as using an ultrasound to help guide breathing tubes into patient airways.

Dowdy said Dahl Memorial hasn't had a physician in at least 30 years, but CEO Darrell Messersmith said he would hire one if a doctor lived in the area. Messersmith said there is a benefit to having advanced practice providers with connections to the region and who stay at the hospital for several years. Other rural hospitals, he noted, may have physicians either as permanent staff who leave after a few years or contract workers who fly in for a few weeks at a time.

People eating at Ekalaka's sole breakfast spot and attending appointments at the hospital's clinic all told KFF Health News that they've been happy with the care they have received from Dowdy and her co-workers.

Ben Bruski had to visit the ER after a cow on his family ranch kicked a gate, smashing it against his hand. And he knows other people who have been treated for more serious problems.

"We've got to have this facility here because this facility saves a lot of lives," Bruski said.

KFF Health Newsopens in a new tab or window is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF 

https://www.medpagetoday.com/emergencymedicine/emergencymedicine/116953

'Shooter Attacked CDC Headquarters to Protest COVID Vaccines'

 The man who fired more than 180 shots

opens in a new tab or window with a long gun at the headquarters of the CDC broke into a locked safe to get his father's weapons and wanted to send a message against COVID-19 vaccines, authorities said Tuesday.

Documents found in a search of the home where Patrick Joseph White had lived with his parents "expressed the shooter's discontent with the COVID-19 vaccinations," Georgia Bureau of Investigation (GBI) Director Chris Hosey said.

White, 30, had written about wanting to make "the public aware of his discontent with the vaccine," Hosey added.

White also had recently verbalized thoughts of suicideopens in a new tab or window, which led to law enforcement being contacted several weeks before the shooting, Hosey said. He died at the scene Friday of a self-inflicted gunshot wound after killing DeKalb County Police Officer David Rose.

The shooting reflects the dangers public health leaders have been experiencing around the country since anti-vaccine vitriol took root during the pandemic. Such rhetoric has been amplified as President Donald Trump's Health Secretary, Robert F. Kennedy Jr., repeatedly makes false and misleading statements about the safety of immunizations.

Calling for 'Rational, Evidence-Based Discourse'

"We know that misinformation can be dangerous. Not only to health, but to those that trust us and those we want to trust," Susan Monarez, PhD, told CDC employees in an 'all-hands' meeting Tuesday, her first since the attack capped her first full week on campus as the CDC's director.

"We need to rebuild the trust together," Monarez said, according to a transcript obtained by the AP. "The trust is what binds us. In moments like this, we must meet the challenges with rational, evidence-based discourse spoken with compassion and understanding. That is how we will lead."

White's parents have fully cooperated with the investigation of their son, who had no known criminal history, Hosey said at the Tuesday news briefing. With a search warrant at the family's home in the Atlanta suburb of Kennesaw, authorities recovered written documents and electronic devices that are being analyzed. Investigators also recovered five firearms, including a gun of his father's that he used in the attack, Hosey said.

White did not have a key to the gun safe, Hosey said: "He broke into it."

CDC security guards stopped White from driving into the campus on Friday before he parked near a pharmacy across the street and opened fire from a sidewalk. The bullets pierced "blast-resistant" windows across the campus, pinning employees down during the barrage. More than 500 shell casings were recovered, the GBI said.

CDC Security Guards Turned Him Away

In the aftermath, CDC officials are assessing campus security and encouraging staff to alert authorities to any new threats, including those based on misinformation regarding the CDC and its vaccine work.

"We've not seen an uptick, although any rhetoric that suggests or leads to violence is something we take very seriously," said FBI Special Agent Paul Brown, who leads the agency's Atlanta division.

Jeff Williams, who oversees safety at the CDC, told employees there is "no information suggesting additional threats currently."

"This is a targeted attack on the CDC related to COVID-19," Williams said. "All indications are that this was an isolated event involving one individual."

The fact that CDC's security stopped him from entering the campus "prevented what I can only imagine to be a lot of casualties," Williams said.

"Nearly 100 children at the childcare center were reunited with their parents at the end of the night," he said. "The protections we have in place did an excellent job."

RFK Jr.'s Responses to the Attack

Kennedy toured the CDC campus on Monday, accompanied by Monarezopens in a new tab or window. "No one should face violence while working to protect the health of others," Kennedy said in a statement Saturday, without addressing the potential impact of anti-vaccine rhetoric.

Kennedy refused to directly answer when asked during an interview with Scripps News on Monday what message he had for CDC employees who are worried about the culture of misinformation and skepticism around vaccines.

Although law enforcement officials have made clear the shooter was targeting the public health agency over the COVID-19 vaccine, Kennedy said in the interview that not enough was known about his motives. He described political violence as "wrong," but went on to criticize the agency's response to the COVID-19 pandemic.

"The government was overreaching in its efforts to persuade the public to get vaccinated and they were saying things that are not always true," Kennedy said.

Some unionized CDC employees called for more protections, and some who recently left amid widespread layoffs squarely blamed Kennedyopens in a new tab or window.

Years of false rhetoric about vaccines and public health was bound to "take a toll on people's mental health," and "leads to violence," said Tim Young, a CDC employee who retired in April.

https://www.medpagetoday.com/publichealthpolicy/washington-watch/116957

'Clear' Vapes May Have Even Worse Health Effects

 

• "Clear" e-cigarettes had disproportionately greater cardiovascular effects than other types of vapes when smoking conditions were controlled.
• "Clear" e-cigarettes contained synthetic coolants, menthol, and other flavorings despite their marketing.
• Acute increases in blood pressure may be related to the synthetic coolants reducing tobacco or nicotine harshness and facilitating deeper inhalation.

E-cigarettes marketed as "clear" may get around flavor bans, but they appear to have a greater health impact than other types of vapes, according to findings from an observational cohort study.

Among participants in the Cardiovascular Injury due to Tobacco Products 2.0 study, smokers of "clear" e-cigarettes had modestly but significantly greater increases in blood pressure, heart rate, and mean arterial pressure (MAP) compared with non-users and peers using menthol and other flavored vapes.

Compared with non-users, the "clear" vapers had acute increases approaching 10 mm Hg in systolic and diastolic blood pressure and MAP, and increases of 10 beats per minute in heart rate, reported Naomi Hamburg, MD, MS, of Boston University, and colleagues in the Journal of the American Heart Associationopens in a new tab or window.

"Given prior evidence linking the hemodynamic effects of e-cigarette use to nicotine, it is possible that the presence of synthetic coolants in 'clear' e-cigarettes facilitated inhalation, in turn leading to higher puff volume and thus exposure to e-liquid aerosol and nicotine," the authors wrote.

"The potential that 'clear' e-cigarettes induced more pronounced hemodynamic effects necessitates further study of the health impact of these products and synthetic cooling agents," they concluded.

Flavored tobacco products have been heavily criticized by public health groups, who reason that they are more appealing to teenagers and young people. Menthol flavoring, in particular, has been said to be especially popular among Black peopleopens in a new tab or window.

While there is no federal banopens in a new tab or window on flavored tobacco products, restrictions are in placeopens in a new tab or window in California, Maryland, Massachusetts, New Jersey, New York, Rhode Island, Utah, and Washington, D.C. Massachusetts, for one, bans the sale of all such products (with the exception of flavored e-cigs sold for on-site consumption at licensed smoking bars).

When explicitly flavored alternatives are not allowed, "clear" vapes may be viewed as especially enticing. Vapes have been found to be less harmful to health than traditional cigarettes, and have boosted smoking abstinenceopens in a new tab or window among adults intending to quit smoking.

Hamburg's team reported that they separately purchased 19 "clear" e-cigarettes online and sent them to Connecticut for chemical analysis. With gas chromatography coupled with mass spectroscopy, they found that all 19 contained synthetic cooling agents (e.g., WS-3, WS-23), 18 contained menthol, and 12 contained other flavorants.

"These 'clear' products contained the synthetic, odorless coolants WS-3 and WS-23, menthol, as well as other minty or fruity flavorings, which suggests a violation of the Massachusetts flavored tobacco product regulation," the authors wrote.

"It will be important across studies collecting both sales and epidemiology of e-cigarette use to develop consistent terminology to refer to the group of products labeled as 'clear.' Though manufacturers have not made consistent marketing claims, the 'clear' label could be perceived as an unflavored product," they added.

For this study, Hamburg and colleagues enrolled healthy adults ages 18-45 in Boston and Louisville, Kentucky, who had no established cardiovascular risk factors or cardiovascular disease. Participants were separated into groups of "clear" vape users (n=23), other vape users (n=111), and non-users (n=73).

Average ages were 21, 22, and 26, respectively, and baseline systolic blood pressure was 112, 115, and 110 mm Hg. The participants reported vaping a mean 27 out of the last 30 days.

Each participant was instructed to undergo a 10-minute session in a specialized smoking chamber, during which they were to take one puff of their own vape lasting 3-4 seconds every 30 seconds, or as tolerated. The non-users mimicked smoking using a straw inhaling air.

Acute changes in blood pressure and heart rate were logged immediately following these smoking conditions.

Hamburg's group acknowledged the small number of "clear" e-cigarette users as a limitation of the study.

"Our findings highlight the need for further controlled studies to understand the impact of synthetic cooling agents in e-liquids on the cardiovascular system," they wrote.

isclosures

The study was a project funded by the Yale Tobacco Center of Regulatory Science, the National Institute on Drug Abuse, and the Center for Tobacco Products of the FDA, with additional support from the National Heart, Lung, and Blood Institute and the American Heart Association.

Hamburg and colleagues had no relevant disclosures.

Primary Source

Journal of the American Heart Association

Source Reference: Minetti ET, et al "Cardiovascular health effects and synthetic cooling agents in e-cigarettes labeled as 'clear' marketed in Massachusetts after the tobacco product flavoring ban" J Am Heart Assoc 2025; DOI: 10.1161/JAHA.124.036106.

https://www.medpagetoday.com/primarycare/smoking/116958

'Relying on AI in Colonoscopies May Erode Clinicians' Skills'

 

• The adenoma detection rate (ADR) in more than 1,400 non-AI assisted colonoscopies dropped 6 percentage points, from 28.4% to 22.4%, after endoscopists routinely used the technology in their practice.
• AI-assisted colonoscopy was not significantly associated with a higher ADR when compared to the detection rates before the technology was introduced.
• The findings raise concerns about "deskilling" in non-AI colonoscopies performed by endoscopists who routinely use the technology.

Endoscopists who got used to using artificial intelligence (AI) during colonoscopies detected significantly fewer precancerous growths when the technology was taken away, a study from Poland found.

In the observational study of more than 1,400 non-AI-assisted colonoscopies, the adenoma detection rate (ADR) dropped from 28.4% in the 3 months before AI was introduced into routine practice to 22.4% in the 3 months after (P=0.0089), reported Krzysztof Budzyn, MD, of the Medical University of Silesia in Katowice, Poland, and co-authors in The Lancet Gastroenterology & Hepatologyopens in a new tab or window.

The findings suggest that continuous exposure to AI may lead to "deskilling" when it is not being used, said co-author Marcin Romańczyk, MD, also of the Medical University of Silesia, likening it to drivers being over-reliant on GPS.

"Imagine that you want to travel anywhere, and you're unable to use Google Maps," Romańczyk, told MedPage Today. "We call it the Google Maps effect. We try to get somewhere, and it's impossible to use a regular map. It works very similarly."

While AI-assisted colonoscopy has been shown in randomized trials to boost ADR, the results of this study raise the possibility that the apparent benefit may partly reflect reduced performance without the technology.

Budzyn and colleagues noted that since AI implementation, the overall ADR rose from 22.4% to 25.3%, masking the decline in ADR for non-AI-assisted colonoscopy. AI-assisted colonoscopy was not significantly associated with higher ADR when compared to detection rates before its introduction (OR 0.80, 95% CI 0.63-1.02).

"We assume that continuous exposure to decision support systems such as AI might lead to the natural human tendency to over-rely on their recommendations, leading to clinicians becoming less motivated, less focused, and less responsible when making cognitive decisions without AI assistance," the authors wrote.

This could reflect weakened visual search habits, altered gaze patterns, dulling pattern recognition, and reduced diagnostic confidence, said Omer Ahmad, MBBS, PhD, of University College London, in an accompanying editorialopens in a new tab or window.

He called for performance-monitoring guidelines from professional societies, educational programs to raise awareness of deskilling, and incorporating non-AI sessions into routine practice to keep skills sharp.

However, Ahmad told MedPage Today there are no easy solutions. "I do not think there is a quick way to figure this out," he said. "We need high quality studies, perhaps crossover in design, to study both behavioral metrics and outcome measures in AI and non-AI assisted colonoscopies. This would offer insights into how skill erosion may occur."

The multicenter study evaluated 1,443 non-AI-assisted colonoscopies (out of 2,177 total colonoscopies) performed by 19 experienced endoscopists at four medical centers in Poland between September 2021 and March 2022. Of those, 795 were conducted before the introduction of regular AI use and 648 were performed after AI was implemented.

The study found ADR varied by gender and age, being higher in men (OR 1.78 vs women, 95% CI 1.38-2.30) and individuals 60 and older (OR 3.60 vs <60 years, 95% CI 2.74-4.72).

The authors acknowledged several limitations, including the study's observational design, which carries a risk of selection bias, and the possibility of unmeasured confounding factors. Only one AI system was used, which means results may not apply to other systems or to less experienced endoscopists, who could be more susceptible to skill loss than the clinicians evaluated in the study who had performed at least 2,000 colonoscopies each.

Disclosures

The study was funded by the European Commission, the Japan Society for the Promotion of Science, and the Italian Association for Cancer Research.

Budzyn and Romańczyk declared no competing interests. Other co-authors reported relationships with Alfasigma, Boston Scientific, Casen Recordati, Cybernet System, Erbe, Fujifilm, Mayoly, Medtronic, Microtech, Norgine, Odin, Oslo University Hospital, and Olympus Europe.

Ahmad reported receiving medical consultancy fees from Olympus, Odin Vision, Medtronic, and Norgine.

Primary Source

The Lancet Gastroenterology & Hepatology

Source Reference: Budzyn K, et al "Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study" Lancet Gastroenterol Hepatol 2025; DOI: 10.1016/S2468-1253(25)00133-5.

Secondary Source

The Lancet Gastroenterology & Hepatology

Source Reference: O Ahmad "Endoscopist deskilling: an unintended consequence of AI-assisted colonoscopy?" Lancet Gastroenterol Hepatol 2025; DOI: 10.1016/ S2468-1253(25)00164-5.

https://www.medpagetoday.com/gastroenterology/coloncancer/116968