This Week in General Medicine — Oct 19, 2026
Generated Oct 19, 2026 · 10:30
The week's practice-changing General Medicine research, summarized for clinicians.
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Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.
In primary care adults with type 2 diabetes not using insulin, continuous glucose monitoring lowered glycated hemoglobin by about 0.9 points more than routine care over 26 weeks.
New England Journal of Medicine · 2026 · PubMed
This week’s papers
- 01
Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury.
In critically ill adults with acute kidney injury, initial intermittent hemodialysis failed noninferiority versus continuous therapy and was linked to higher 90-day mortality, about 63 versus 54 percent.
Gaudry S et al. · New England Journal of Medicine · 2026
From the briefingThe most consequential is a French multicenter trial by Gaudry and colleagues in the New England Journal of Medicine, which compared intermittent hemodialysis with continuous renal-replacement therapy as the first modality for critically ill adults with acute kidney injury [1]. It was designed as a noninferiority trial, but it was stopped early because interim analyses kept showing higher mortality with intermittent dialysis. Among about 535 analyzed patients, death by day 90 occurred in roughly 63 percent of the intermittent group versus about 54 percent of the continuous group, close to a ten point gap, and intermittent dialysis failed to show noninferiority on the composite kidney outcome. Hypotension was common and similar in both arms. Because the trial stopped early and was open label, the size of the mortality difference may be overstated, but it challenges the long-held view that the two modalities are interchangeable.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Intraoperative Dobutamine Plus Norepinephrine to Prevent Postoperative Acute Kidney Injury in Septic Shock: A Randomized Clinical Trial.
Adding intraoperative dobutamine to norepinephrine during surgical source control for septic shock reduced new or worsening acute kidney injury from about 35 to 23 percent, with more tachycardia.
Chu L et al. · JAMA · 2026
From the briefingStaying with the kidney, Chu and colleagues in JAMA randomized about 580 patients with septic shock undergoing surgical source control at 39 Chinese hospitals to intraoperative dobutamine, up to 5 micrograms per kilogram per minute, added to norepinephrine, versus norepinephrine alone [2]. New or worsening acute kidney injury within a week fell from about 35 percent to about 23 percent, roughly a one third relative reduction, with fewer stage 2 and stage 3 injuries. Most secondary outcomes did not differ, tachycardia was more common with dobutamine, and the trial was open label and confined to a surgical population, so it offers the first randomized support for a guideline recommendation that had rested on very low-certainty evidence, rather than settling the question for septic shock broadly.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Effect of Vasopressin Initiation Threshold on Septic Shock Mortality: The VASSPR Cluster Crossover Randomized Strategy Trial.
Among nearly 4,000 septic shock patients, a hospital strategy starting vasopressin at a lower norepinephrine-equivalent threshold did not reduce 28-day mortality compared with a higher threshold.
Peltan ID et al. · JAMA · 2026
From the briefingPeltan and colleagues, also in JAMA, ran a pragmatic cluster crossover trial at 13 hospitals in Idaho and Utah, involving nearly 4,000 patients with septic shock, comparing hospital strategies that started vasopressin when other vasopressors reached 0.1 versus 0.4 micrograms per kilogram per minute of norepinephrine equivalent [3]. The strategies did separate in practice, with more patients receiving vasopressin, and receiving it earlier, under the lower threshold, yet 28-day mortality was essentially the same at about 32 versus 33 percent, and kidney replacement therapy-free days were identical. The trial suggests that the timing of vasopressin within this range does not move survival.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Isoflurane-Based Inhaled Sedation in Mechanically Ventilated Adults With Acute Hypoxemic Respiratory Failure: The SAVE-ICU Randomized Clinical Trial.
Isoflurane-based inhaled sedation did not lower hospital mortality versus intravenous sedation in ventilated adults with hypoxemic respiratory failure and was associated with fewer delirium- and coma-free days.
Jerath A et al. · JAMA · 2026
From the briefingAnd in the SAVE-ICU trial in JAMA, Jerath and colleagues randomized about 780 ventilated adults with acute hypoxemic respiratory failure across 14 Canadian units to isoflurane-based inhaled sedation or usual intravenous sedation [4]. Hospital mortality was similar, about 43 percent versus 44 percent. If anything the secondary signals leaned against isoflurane, with more use of rescue therapies for hypoxemia and fewer delirium- and coma-free days, and roughly half of patients in the inhaled arm also needed intravenous sedation on any given day. Taken together, this cluster suggests that the choice of initial dialysis modality may matter considerably for survival, while vasopressin threshold and inhaled sedation do not appear to.
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.
In over 24,000 inpatients with alcohol withdrawal, starting phenobarbital or diazepam produced similar length of stay and mechanical ventilation rates, suggesting near therapeutic equivalence in observational data.
Bradley T et al. · JAMA Internal Medicine · 2026
From the briefingIn JAMA Internal Medicine, Bradley and colleagues used a target trial emulation in the Premier database, covering more than 24,000 inpatients with alcohol withdrawal at 754 hospitals in the United States, to compare starting phenobarbital versus diazepam on the day of admission [5]. Earlier comparisons had mostly pitted phenobarbital against lorazepam; this one chose a pharmacologically closer comparator. Length of stay was about four days in both groups and mechanical ventilation was around three percent in both, with no meaningful differences in secondary outcomes, apart from more self-directed discharges with diazepam. The authors read this as near therapeutic equivalence between phenobarbital and long-acting benzodiazepines, though residual confounding is always possible in this design.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Benzodiazepine Use Early in Pregnancy and Risk for Congenital Malformations.
Across more than four million insured pregnancies, first-trimester benzodiazepine exposure was not associated with increased major congenital malformations, though coexposure with other psychoactive drugs gave inconsistent results.
Fung K et al. · Annals of Internal Medicine · 2026
From the briefingA related reassurance comes from Annals of Internal Medicine, where Fung and colleagues pooled Medicaid and commercial insurance data on more than four million pregnancies to examine first-trimester benzodiazepine exposure [6]. The absolute risk of any major malformation was about four to five percent whether or not the pregnancy was exposed, with essentially no difference in relative risk, no consistent organ-specific signal, and no dose-response relationship. Results with coexposure to other psychoactive drugs were inconsistent and the authors flag those for further study, and the analysis was limited to malformations detected at birth.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Delirium.
Delirium is common and largely preventable, and because no single medication or intervention treats it, care rests on multifaceted strategies targeting predisposing and precipitating factors.
Golden BP et al. · Annals of Internal Medicine · 2026
From the briefingAlso in Annals, Golden and Vasilevskis provide a clinical review of delirium [7], emphasizing that advanced age, acute infection, sedatives and anticholinergics raise risk, that delirium is largely preventable by addressing predisposing and precipitating factors, and that no single drug or intervention has been shown to treat it, which supports multicomponent approaches as the standard of care.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.
In primary care adults with type 2 diabetes not using insulin, continuous glucose monitoring lowered glycated hemoglobin by about 0.9 points more than routine care over 26 weeks.
Oser TK et al. · New England Journal of Medicine · 2026
From the briefingIn the New England Journal of Medicine, Oser and colleagues randomized about 280 adults with type 2 diabetes not using insulin, across 22 primary care practices in the United States, to continuous glucose monitoring or routine care for 26 weeks [8]. Glycated hemoglobin fell from just under 9 percent to about 7.2 percent with monitoring, compared with about 8 percent in the control group, an adjusted difference of nearly one percentage point. Time in the target glucose range was about 21 points higher, hypoglycemia time was slightly lower, and there was no severe hypoglycemia. This is a single, industry-funded, unblinded trial lasting six months, with participants whose baseline control was quite poor, so durability and benefit in better-controlled patients remain open, but it fills a real evidence gap for the non-insulin population.
If you only have time for one paper this week, make it the continuous glucose monitoring trial by Oser and colleagues in the New England Journal of Medicine [8]. It provides the first randomized evidence from real primary care practices that monitoring improves control in type 2 diabetes without insulin, a population that makes up a large share of general medicine panels and where the role of the technology had been uncertain.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
How Would You Screen This 26-Year-Old Woman for Cervical Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.
Experts debate applying updated cervical screening guidance that favors primary HPV testing and permits self-collection, noting half of cervical cancers arise in underscreened or never-screened women.
Smith CC et al. · Annals of Internal Medicine · 2026
From the briefingAlso in Annals of Internal Medicine, a Beth Israel Deaconess grand rounds discussion led by Smith works through screening a 26-year-old woman for cervical cancer [9]. The discussants note that roughly half of cervical cancers occur in women who are underscreened or never screened, and they weigh updated recommendations from the American Cancer Society, the Women's Preventive Services Initiative, and a draft from the Preventive Services Task Force that favor primary HPV testing and allow self-collected samples, while debating how to apply them across ages and in higher-risk patients.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Adult Attention Deficit-Hyperactivity Disorder.
Adult ADHD affects about 2.5 percent of adults, is often undiagnosed, and co-occurs with psychiatric and somatic conditions such as cardiovascular disease and diabetes seen in general practice.
Buitelaar JK et al. · New England Journal of Medicine · 2026
From the briefingFinally, Buitelaar and Newcorn review adult ADHD in the New England Journal of Medicine [10], estimating that about 2.5 percent of adults worldwide are affected, that many remain undiagnosed, and that the condition travels with anxiety, mood and substance use disorders as well as obesity, cardiovascular disease and diabetes, which places it squarely within internal medicine. Treatment centers on psychoeducation and stimulant or nonstimulant medication, usually combined with psychosocial support.
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 General Medicine. This week we're covering 10 notable papers spanning critical care for sepsis and acute kidney injury, the hospital management of sedatives and withdrawal, and primary care questions from diabetes technology to cervical screening and adult ADHD. Let's dive in.
We start in the intensive care unit, where four trials tested common decisions in the sickest patients, and the results point in different directions. The most consequential is a French multicenter trial by Gaudry and colleagues in the New England Journal of Medicine, which compared intermittent hemodialysis with continuous renal-replacement therapy as the first modality for critically ill adults with acute kidney injury [1]. It was designed as a noninferiority trial, but it was stopped early because interim analyses kept showing higher mortality with intermittent dialysis. Among about 535 analyzed patients, death by day 90 occurred in roughly 63 percent of the intermittent group versus about 54 percent of the continuous group, close to a ten point gap, and intermittent dialysis failed to show noninferiority on the composite kidney outcome. Hypotension was common and similar in both arms. Because the trial stopped early and was open label, the size of the mortality difference may be overstated, but it challenges the long-held view that the two modalities are interchangeable. Staying with the kidney, Chu and colleagues in JAMA randomized about 580 patients with septic shock undergoing surgical source control at 39 Chinese hospitals to intraoperative dobutamine, up to 5 micrograms per kilogram per minute, added to norepinephrine, versus norepinephrine alone [2]. New or worsening acute kidney injury within a week fell from about 35 percent to about 23 percent, roughly a one third relative reduction, with fewer stage 2 and stage 3 injuries. Most secondary outcomes did not differ, tachycardia was more common with dobutamine, and the trial was open label and confined to a surgical population, so it offers the first randomized support for a guideline recommendation that had rested on very low-certainty evidence, rather than settling the question for septic shock broadly.
Two other critical care trials were clearly neutral. Peltan and colleagues, also in JAMA, ran a pragmatic cluster crossover trial at 13 hospitals in Idaho and Utah, involving nearly 4,000 patients with septic shock, comparing hospital strategies that started vasopressin when other vasopressors reached 0.1 versus 0.4 micrograms per kilogram per minute of norepinephrine equivalent [3]. The strategies did separate in practice, with more patients receiving vasopressin, and receiving it earlier, under the lower threshold, yet 28-day mortality was essentially the same at about 32 versus 33 percent, and kidney replacement therapy-free days were identical. The trial suggests that the timing of vasopressin within this range does not move survival. And in the SAVE-ICU trial in JAMA, Jerath and colleagues randomized about 780 ventilated adults with acute hypoxemic respiratory failure across 14 Canadian units to isoflurane-based inhaled sedation or usual intravenous sedation [4]. Hospital mortality was similar, about 43 percent versus 44 percent. If anything the secondary signals leaned against isoflurane, with more use of rescue therapies for hypoxemia and fewer delirium- and coma-free days, and roughly half of patients in the inhaled arm also needed intravenous sedation on any given day. Taken together, this cluster suggests that the choice of initial dialysis modality may matter considerably for survival, while vasopressin threshold and inhaled sedation do not appear to.
Our second theme is sedatives on the wards and beyond, with two large observational studies and a review. In JAMA Internal Medicine, Bradley and colleagues used a target trial emulation in the Premier database, covering more than 24,000 inpatients with alcohol withdrawal at 754 hospitals in the United States, to compare starting phenobarbital versus diazepam on the day of admission [5]. Earlier comparisons had mostly pitted phenobarbital against lorazepam; this one chose a pharmacologically closer comparator. Length of stay was about four days in both groups and mechanical ventilation was around three percent in both, with no meaningful differences in secondary outcomes, apart from more self-directed discharges with diazepam. The authors read this as near therapeutic equivalence between phenobarbital and long-acting benzodiazepines, though residual confounding is always possible in this design. A related reassurance comes from Annals of Internal Medicine, where Fung and colleagues pooled Medicaid and commercial insurance data on more than four million pregnancies to examine first-trimester benzodiazepine exposure [6]. The absolute risk of any major malformation was about four to five percent whether or not the pregnancy was exposed, with essentially no difference in relative risk, no consistent organ-specific signal, and no dose-response relationship. Results with coexposure to other psychoactive drugs were inconsistent and the authors flag those for further study, and the analysis was limited to malformations detected at birth. Also in Annals, Golden and Vasilevskis provide a clinical review of delirium [7], emphasizing that advanced age, acute infection, sedatives and anticholinergics raise risk, that delirium is largely preventable by addressing predisposing and precipitating factors, and that no single drug or intervention has been shown to treat it, which supports multicomponent approaches as the standard of care.
Our final theme is primary care, led by a trial that speaks directly to everyday diabetes management. In the New England Journal of Medicine, Oser and colleagues randomized about 280 adults with type 2 diabetes not using insulin, across 22 primary care practices in the United States, to continuous glucose monitoring or routine care for 26 weeks [8]. Glycated hemoglobin fell from just under 9 percent to about 7.2 percent with monitoring, compared with about 8 percent in the control group, an adjusted difference of nearly one percentage point. Time in the target glucose range was about 21 points higher, hypoglycemia time was slightly lower, and there was no severe hypoglycemia. This is a single, industry-funded, unblinded trial lasting six months, with participants whose baseline control was quite poor, so durability and benefit in better-controlled patients remain open, but it fills a real evidence gap for the non-insulin population. Also in Annals of Internal Medicine, a Beth Israel Deaconess grand rounds discussion led by Smith works through screening a 26-year-old woman for cervical cancer [9]. The discussants note that roughly half of cervical cancers occur in women who are underscreened or never screened, and they weigh updated recommendations from the American Cancer Society, the Women's Preventive Services Initiative, and a draft from the Preventive Services Task Force that favor primary HPV testing and allow self-collected samples, while debating how to apply them across ages and in higher-risk patients. Finally, Buitelaar and Newcorn review adult ADHD in the New England Journal of Medicine [10], estimating that about 2.5 percent of adults worldwide are affected, that many remain undiagnosed, and that the condition travels with anxiety, mood and substance use disorders as well as obesity, cardiovascular disease and diabetes, which places it squarely within internal medicine. Treatment centers on psychoeducation and stimulant or nonstimulant medication, usually combined with psychosocial support.
If you only have time for one paper this week, make it the continuous glucose monitoring trial by Oser and colleagues in the New England Journal of Medicine [8]. It provides the first randomized evidence from real primary care practices that monitoring improves control in type 2 diabetes without insulin, a population that makes up a large share of general medicine panels and where the role of the technology had been uncertain.
Here is what this week's evidence adds up to in General Medicine. First, randomized data now show glucose monitoring lowering glycated hemoglobin by close to a point in poorly controlled, non-insulin type 2 diabetes over six months; longer-term and cost questions are unanswered. Second, an early-stopped trial links intermittent hemodialysis as the first modality to higher mortality than continuous therapy in critically ill patients, a signal strong enough to reopen the question but still from a single open-label trial. Third, in septic shock, earlier vasopressin and inhaled isoflurane sedation did not improve survival, while intraoperative dobutamine reduced kidney injury in one surgical population. Fourth, large observational data suggest phenobarbital and diazepam perform similarly for inpatient alcohol withdrawal, and first-trimester benzodiazepine exposure was not associated with an overall rise in major malformations, although coexposure findings remain unsettled. And finally, cervical screening guidance is moving toward primary HPV testing with self-collection, with the final Task Force recommendation still pending.
That's your roundup for This Week in General 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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