This Week in Family Medicine — Oct 18, 2026
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The week's practice-changing Family Medicine research, summarized for clinicians.
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Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.
In adults with type 2 diabetes not using insulin, continuous glucose monitoring in primary care lowered A1c about 0.9 points more than routine care over 26 weeks, without severe hypoglycaemia.
New England Journal of Medicine · 2026 · PubMed
This week’s papers
- 01
Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.
In adults with type 2 diabetes not using insulin, continuous glucose monitoring in primary care lowered A1c about 0.9 points more than routine care over 26 weeks, without severe hypoglycaemia.
Oser TK, Martens T, Ruedy KJ, et al. · New England Journal of Medicine · 2026
From the briefingThe headline paper comes from the New England Journal of Medicine, where Oser and colleagues randomized 283 adults with type 2 diabetes who were not using insulin, across 22 primary care practices in the United States, to continuous glucose monitoring or routine care for 26 weeks [1]. These were patients with fairly high starting values, an average glycated hemoglobin close to 9 percent. Haemoglobin A1c in the monitoring group fell by about nine tenths of a percentage point more than in the routine care group, landing at around 7.2 percent, and time spent in the target glucose range rose by roughly 21 percentage points. Time in hypoglycaemia was actually slightly lower with monitoring, and no severe hypoglycaemia events were reported. The caveats are worth stating: the trial ran for six months, it was open label by necessity, and it was funded by the sensor manufacturer, so durability and cost-effectiveness remain open questions. Still, it is a randomized trial set squarely in primary care, and it strengthens the case that monitoring is not just for insulin users.
If you only have time for one paper this week, make it the continuous glucose monitoring trial from the New England Journal of Medicine [1]. It is a randomized trial run in primary care practices, and it reopens the question of whether monitoring belongs in the routine management of type 2 diabetes well before insulin enters the picture.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Implementing the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable chronic obstructive pulmonary disease in primary care.
Canadian COPD guidance matches inhaler therapy to symptoms and exacerbation risk, recommending single-inhaler triple therapy for high-symptom, high-risk patients partly to reduce mortality.
D'Urzo AD, Jackson LD, Bourbeau J, et al. · Canadian Family Physician · 2026
From the briefingFrom Canadian Family Physician, D'Urzo and colleagues summarize the 2023 Canadian Thoracic Society guideline on stable COPD pharmacotherapy [2]. The framework rests on treatable traits: symptom burden, health status, and exacerbation risk. A single long-acting bronchodilator is recommended for patients with low symptom burden, dual bronchodilation for patients with moderate to high symptoms but low exacerbation risk, and single-inhaler triple therapy for patients with high symptoms and high exacerbation risk, with mortality reduction cited as part of the rationale. This is a synopsis rather than new data, aimed at closing the gap between guidelines and everyday prescribing.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
How Would You Screen This 26-Year-Old Woman for Cervical Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
Updated cervical cancer recommendations favour primary HPV testing and allow self-collected samples, a shift experts debate applying across ages and in underscreened or higher-risk patients.
Smith CC, Chelmow D, Freund KM, et al. · Annals of Internal Medicine · 2026
From the briefingAnnals of Internal Medicine published a Grand Rounds discussion led by Smith, in which a primary care physician and an obstetrician-gynaecologist debate how to screen a 26-year-old woman for cervical cancer [3]. The backdrop is a shift away from cytology-based screening toward primary HPV testing, now preferred by the American Cancer Society and the Women's Preventive Services Initiative and included in a draft update from the United States Preventive Services Task Force, with self-collected specimens as an option. The discussion notes that half of all cervical cancers occur in women who are underscreened or never screened, which is where self-collection may matter most. It is expert opinion rather than trial evidence, but a useful map of a field in transition.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Increasing prescribing of acetylsalicylic acid in pregnancy: Program evaluation in Saskatchewan.
Nearly half of singleton pregnancies qualified for preeclampsia aspirin prophylaxis, yet prescribing rose only from 7 to 35 percent of at-risk patients after one educational session.
Salmon C, Bordun-Slater KA, Bryce R, et al. · Canadian Family Physician · 2026
From the briefingThen, from Canadian Family Physician, Salmon and colleagues evaluated low-dose aspirin prophylaxis for preeclampsia at two family medicine clinics in Saskatchewan [4]. After a national guideline made a body mass index over 30 a stand-alone indication, just under half of patients with a singleton pregnancy whose risk could be assessed qualified for aspirin. Before a single lunch-and-learn session, only about one in fourteen of the at-risk patients received it; afterward, roughly a third of at-risk patients did. That is a real improvement, but the numbers are small, the design is a simple before and after comparison, and most at-risk patients still went without, even though well over 85 percent of patients presented before 16 weeks, the window for starting aspirin. The authors conclude that education helps but additional strategies are needed.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Comparative Effectiveness of Phenobarbital vs Diazepam for Alcohol Withdrawal Syndrome.
Among more than 24,000 hospitalized patients with alcohol withdrawal, phenobarbital and diazepam showed no difference in length of stay or mechanical ventilation, suggesting near therapeutic equivalence.
Bradley T, Feeney M, Law AC, et al. · JAMA Internal Medicine · 2026
From the briefingIn JAMA Internal Medicine, Bradley and colleagues used data from 754 hospitals in the United States to emulate a trial comparing phenobarbital with diazepam in more than 24,000 adults admitted with alcohol withdrawal [5]. Earlier comparisons pitted phenobarbital against lorazepam; this one matched it against a long-acting, self-tapering benzodiazepine. The result was essentially a tie: length of stay was about four days in both groups, and mechanical ventilation was used in roughly 3 percent of patients either way. The one difference was that self-directed discharge was a little more common with diazepam. The authors suggest near therapeutic equivalence. It is observational, so residual confounding is possible, but with this sample size it is reassuring for either approach in hospital settings.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
The Rise of Adulterated 7-Hydroxymitragynine Kratom Products Creates Challenges for Health Care and Policy.
Concentrated semisynthetic 7-hydroxymitragynine kratom products are potent opioid agonists carrying far greater risk than botanical kratom, and pending federal scheduling may push them into unregulated markets.
Stogner J · Journal of the American Board of Family Medicine · 2026
From the briefingTurning to the outpatient world, Stogner writes in the Journal of the American Board of Family Medicine about concentrated 7-hydroxymitragynine, or 7-OH, products now sold in retail outlets across the United States [6]. Traditional kratom leaf contains only trace amounts, but these semisynthetic isolates are potent mu-opioid agonists with morphine-like effects, sold as tablets and vapes. The DEA has issued a notice of intent to temporarily place 7-OH in Schedule I, while exempting plain botanical kratom. The commentary argues that patients should know these isolates carry much greater risk than leaf kratom, and flags that scheduling may disrupt how some patients manage opioid cravings or push products onto black markets. This is a policy commentary, not outcome data.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Psychedelic-assisted psychotherapy: Emerging paradigm.
Psychedelic-assisted psychotherapy shows potential benefit for selected conditions in phase 2 and 3 trials, but heterogeneity is high and it is not a first-line or primary care treatment.
Shane D, Akhtar S, Hapke E · Canadian Family Physician · 2026
From the briefingFinally, in Canadian Family Physician, Shane and colleagues review psychedelic-assisted psychotherapy [7]. Evidence comes mainly from phase 2 and 3 trials in specialized settings; meta-analyses suggest potential benefit for selected conditions, but heterogeneity is high and long-term comparative effectiveness is uncertain. The authors are clear that this is not a first-line or primary care-delivered treatment, though family physicians are increasingly fielding patient questions about it.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Adult Attention Deficit-Hyperactivity Disorder.
Adult ADHD affects about 2.5 percent of adults worldwide, often goes undiagnosed, and commonly coexists with psychiatric and cardiometabolic conditions, with treatment combining medication and psychosocial support.
Buitelaar JK, Newcorn JH · New England Journal of Medicine · 2026
From the briefingThe New England Journal of Medicine published a review of adult ADHD by Buitelaar and Newcorn [8], noting a worldwide adult prevalence of about 2.5 percent and frequent coexisting anxiety, mood, sleep, and substance use disorders, along with higher rates of obesity, cardiovascular disease, and diabetes. They emphasize that the condition often goes unrecognized, that standardized rating scales support assessment, and that treatment combines psychoeducation, stimulant or nonstimulant medication, and psychosocial support. Sleep links naturally to that.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
An innovative hybrid cognitive behavioral therapy for insomnia approach to insomnia treatment: a retrospective chart review study.
Hybrid telehealth cognitive behavioural therapy for insomnia improved self-reported sleep measures, and nearly two thirds of tapering patients stopped sleep medications, though evidence is an uncontrolled chart review.
Jones B, Smith-Mason CE, Medalie L, et al. · Family Practice · 2026
From the briefingIn Family Practice, Jones and colleagues reviewed charts from 155 patients treated through a hybrid model of cognitive behavioural therapy for insomnia, combining telehealth sessions with a sleep data portal [9]. Total sleep time, sleep onset, night waking, and sleep efficiency all improved significantly, and almost two thirds of patients in the medication tapering group stopped their sleep medications completely. There was no control group and outcomes were self-reported sleep logs, so this is early, uncontrolled evidence, but it describes a plausible referral route where in-person sleep specialists are scarce.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Delirium.
Delirium is common and preventable, with sedatives, anticholinergics, infection and older age raising risk, and no single drug or intervention proven to treat it once established.
Golden BP, Vasilevskis EE · Annals of Internal Medicine · 2026
From the briefingRounding out the theme, Annals of Internal Medicine published an In the Clinic review of delirium by Golden and Vasilevskis [10]. Older age, acute infection, and sedative or anticholinergic medications raise risk; delirium is described as preventable; and no single drug or intervention has proven effective as treatment, so care rests on multifaceted strategies addressing contributing factors. That point about sedatives and anticholinergics loops back to the insomnia paper, where getting patients off sleep medications was one of the main outcomes.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Family Medicine. This week we're covering 10 notable papers spanning chronic disease and prevention in primary care, substance use and withdrawal, and the brain and behaviour, from adult ADHD to insomnia and delirium. Let's dive in.
We start with chronic disease, where one trial and one guideline synopsis both ask how much more primary care can achieve with tools already on the market. The headline paper comes from the New England Journal of Medicine, where Oser and colleagues randomized 283 adults with type 2 diabetes who were not using insulin, across 22 primary care practices in the United States, to continuous glucose monitoring or routine care for 26 weeks [1]. These were patients with fairly high starting values, an average glycated hemoglobin close to 9 percent. Haemoglobin A1c in the monitoring group fell by about nine tenths of a percentage point more than in the routine care group, landing at around 7.2 percent, and time spent in the target glucose range rose by roughly 21 percentage points. Time in hypoglycaemia was actually slightly lower with monitoring, and no severe hypoglycaemia events were reported. The caveats are worth stating: the trial ran for six months, it was open label by necessity, and it was funded by the sensor manufacturer, so durability and cost-effectiveness remain open questions. Still, it is a randomized trial set squarely in primary care, and it strengthens the case that monitoring is not just for insulin users. From Canadian Family Physician, D'Urzo and colleagues summarize the 2023 Canadian Thoracic Society guideline on stable COPD pharmacotherapy [2]. The framework rests on treatable traits: symptom burden, health status, and exacerbation risk. A single long-acting bronchodilator is recommended for patients with low symptom burden, dual bronchodilation for patients with moderate to high symptoms but low exacerbation risk, and single-inhaler triple therapy for patients with high symptoms and high exacerbation risk, with mortality reduction cited as part of the rationale. This is a synopsis rather than new data, aimed at closing the gap between guidelines and everyday prescribing.
Prevention is our second theme, and two papers show both the promise and the friction of putting newer recommendations into practice. Annals of Internal Medicine published a Grand Rounds discussion led by Smith, in which a primary care physician and an obstetrician-gynaecologist debate how to screen a 26-year-old woman for cervical cancer [3]. The backdrop is a shift away from cytology-based screening toward primary HPV testing, now preferred by the American Cancer Society and the Women's Preventive Services Initiative and included in a draft update from the United States Preventive Services Task Force, with self-collected specimens as an option. The discussion notes that half of all cervical cancers occur in women who are underscreened or never screened, which is where self-collection may matter most. It is expert opinion rather than trial evidence, but a useful map of a field in transition. Then, from Canadian Family Physician, Salmon and colleagues evaluated low-dose aspirin prophylaxis for preeclampsia at two family medicine clinics in Saskatchewan [4]. After a national guideline made a body mass index over 30 a stand-alone indication, just under half of patients with a singleton pregnancy whose risk could be assessed qualified for aspirin. Before a single lunch-and-learn session, only about one in fourteen of the at-risk patients received it; afterward, roughly a third of at-risk patients did. That is a real improvement, but the numbers are small, the design is a simple before and after comparison, and most at-risk patients still went without, even though well over 85 percent of patients presented before 16 weeks, the window for starting aspirin. The authors conclude that education helps but additional strategies are needed.
Our third theme is substance use, where three papers deal with drugs whose landscape is changing quickly. In JAMA Internal Medicine, Bradley and colleagues used data from 754 hospitals in the United States to emulate a trial comparing phenobarbital with diazepam in more than 24,000 adults admitted with alcohol withdrawal [5]. Earlier comparisons pitted phenobarbital against lorazepam; this one matched it against a long-acting, self-tapering benzodiazepine. The result was essentially a tie: length of stay was about four days in both groups, and mechanical ventilation was used in roughly 3 percent of patients either way. The one difference was that self-directed discharge was a little more common with diazepam. The authors suggest near therapeutic equivalence. It is observational, so residual confounding is possible, but with this sample size it is reassuring for either approach in hospital settings. Turning to the outpatient world, Stogner writes in the Journal of the American Board of Family Medicine about concentrated 7-hydroxymitragynine, or 7-OH, products now sold in retail outlets across the United States [6]. Traditional kratom leaf contains only trace amounts, but these semisynthetic isolates are potent mu-opioid agonists with morphine-like effects, sold as tablets and vapes. The DEA has issued a notice of intent to temporarily place 7-OH in Schedule I, while exempting plain botanical kratom. The commentary argues that patients should know these isolates carry much greater risk than leaf kratom, and flags that scheduling may disrupt how some patients manage opioid cravings or push products onto black markets. This is a policy commentary, not outcome data. Finally, in Canadian Family Physician, Shane and colleagues review psychedelic-assisted psychotherapy [7]. Evidence comes mainly from phase 2 and 3 trials in specialized settings; meta-analyses suggest potential benefit for selected conditions, but heterogeneity is high and long-term comparative effectiveness is uncertain. The authors are clear that this is not a first-line or primary care-delivered treatment, though family physicians are increasingly fielding patient questions about it.
Our last theme covers the brain and behaviour, with two clinical reviews and one practical service evaluation. The New England Journal of Medicine published a review of adult ADHD by Buitelaar and Newcorn [8], noting a worldwide adult prevalence of about 2.5 percent and frequent coexisting anxiety, mood, sleep, and substance use disorders, along with higher rates of obesity, cardiovascular disease, and diabetes. They emphasize that the condition often goes unrecognized, that standardized rating scales support assessment, and that treatment combines psychoeducation, stimulant or nonstimulant medication, and psychosocial support. Sleep links naturally to that. In Family Practice, Jones and colleagues reviewed charts from 155 patients treated through a hybrid model of cognitive behavioural therapy for insomnia, combining telehealth sessions with a sleep data portal [9]. Total sleep time, sleep onset, night waking, and sleep efficiency all improved significantly, and almost two thirds of patients in the medication tapering group stopped their sleep medications completely. There was no control group and outcomes were self-reported sleep logs, so this is early, uncontrolled evidence, but it describes a plausible referral route where in-person sleep specialists are scarce. Rounding out the theme, Annals of Internal Medicine published an In the Clinic review of delirium by Golden and Vasilevskis [10]. Older age, acute infection, and sedative or anticholinergic medications raise risk; delirium is described as preventable; and no single drug or intervention has proven effective as treatment, so care rests on multifaceted strategies addressing contributing factors. That point about sedatives and anticholinergics loops back to the insomnia paper, where getting patients off sleep medications was one of the main outcomes.
If you only have time for one paper this week, make it the continuous glucose monitoring trial from the New England Journal of Medicine [1]. It is a randomized trial run in primary care practices, and it reopens the question of whether monitoring belongs in the routine management of type 2 diabetes well before insulin enters the picture.
Here is what this week's evidence adds up to in Family Medicine. First, continuous glucose monitoring lowered A1c by close to a full percentage point in adults with type 2 diabetes not using insulin, without added hypoglycaemia, though the trial was six months long, industry funded, and silent on cost. Second, prevention guidelines are moving faster than practice: primary HPV testing and self-collection are becoming preferred in cervical screening, and aspirin prophylaxis for preeclampsia reached only about a third of eligible patients even after education, in a small pre-post study. Third, a very large observational analysis found phenobarbital and diazepam roughly equivalent for hospitalized alcohol withdrawal, while concentrated 7-OH kratom products represent an emerging opioid risk described so far only in commentary. Fourth, hybrid virtual insomnia therapy shows promise for improving sleep and tapering hypnotics, but the evidence is an uncontrolled chart review, and controlled data are still needed.
That's your roundup for This Week in Family Medicine. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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