Sameer Kassem

Background: Obesity is associated with substantial cardiometabolic and psychosocial morbidity. Although randomized controlled trials demonstrate the efficacy of anti‐obesity therapies, outcomes in real‐world practice may be attenuated due to limited access, tolerability, adherence and insufficient long‐term support. Purpose: This narrative review aimed to synthesize real‐world evidence on adherence, tolerability, access and patient satisfaction across lifestyle programmes, pharmacotherapy, metabolic bariatric surgery (MBS) and endoscopic procedures, with emphasis on incretin‐based medications. Methods: PubMed/MEDLINE search was conducted through July 2026. Studies reporting real‐world treatment effectiveness, adherence, persistence, discontinuation, tolerability, access or patient satisfaction in adults or adolescents with overweight or obesity were included. Randomized trials and reviews were used to contextualize real‐world findings. Findings: Intensive lifestyle interventions generally achieve approximately 5% weight loss, but attrition and weight regain after programme completion are common. Incretin‐based therapies, including semaglutide and tirzepatide, produce substantial weight loss in trials but real‐world effectiveness is relatively smaller because of non‐initiation, incomplete dose escalation, gastrointestinal adverse effects, treatment interruptions, and financial or insurance barriers. Older medications demonstrate poor persistence, largely related to neurologic, psychiatric or gastrointestinal intolerance, despite lower costs for some agents. MBS provides the greatest and most durable weight loss but remains substantially underused, with racial, socioeconomic and insurance disparities. Endoscopic sleeve gastroplasty offers moderate, durable weight loss with low serious adverse event rates, whereas intragastric balloons are more limited by intolerance, reintervention and weight regain after removal. Conclusions: Real‐world effectiveness is determined not only by biological efficacy but also by treatment tolerability, adherence, access and sustained support. Proactive adverse effect management, individualized behavioural support, streamlined referral pathways and policies that improve affordability and equitable access are essential to narrowing the trial‐to‐practice gap.

Purpose: Integrative complementary medicine (ICM) combines complementary therapies with conventional supportive and palliative care to address quality of life (QoL). Diabetes mellitus (DM) is prevalent among patients with cancer and has been associated with worse health-related QoL. We examined the impact of an ICM program on QoL-related concerns among patients being treated for cancer, with vs. without DM. Methods: This prospective, controlled and pragmatic study examined a 6-week ICM program, comparing DM to non-DM patients using the ESAS (Edmonton Symptom Assessment Scale) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) tools. The threshold for statistical significance was established at a P -value of less than 0.05. Results: Of 671 patients, 135 (20%) had DM, with similar baseline QoL-related concerns (pain, fatigue, gastrointestinal and emotional concerns) in both groups. DM patients (vs. non-DM) responded significantly less on drowsiness on ESAS ( P = 0.047); and emotional functioning on EORTC ( P = 0.017). Compared to baseline, the non-DM group showed significant improvement in fatigue and sleep quality (on ESAS and EORTC; P < 0.001), while the DM group did not show any improvement for these concerns. Conclusion: Patients with cancer and DM showed a less significant response to ICM treatments when compared to non-DM patients, emphasizing the need for identifying this sub-population of patients while creating specialized ICM programs tailored to their needs. Future research should focus on exploring the impact of ICM programs on patients with both DM and cancer. Trial registration ClinicalTrials.gov NCT01860365, 2013-05-21.

Background: Misinterpretation of atrial fibrillation (AF) poses significant clinical risks. While the impact of computerized ECG interpretations (CIE) on clinical decision‐making is well‐documented, there is limited real‐world evidence on the diagnostic accuracy of emergency department (ED) clinicians in the absence of such tools. This study examines the frequency and clinical impact of AF misdiagnosis in an ED operating without CIE. Methods: ECGs of consecutive patients discharged with a diagnosis of AF over a five‐year period were reevaluated by two cardiologists, with an electrophysiologist serving as an arbitrator. Misdiagnosed cases underwent further clinical follow‐up. Results: Of 1828 ECGs initially identified as AF, 31 were excluded due to paced rhythms or indeterminate tracings, yielding a final cohort of 1797. Among these, 49 cases (2.7%) were misclassified, encompassing supraventricular tachycardia ( n = 30), sinus rhythm with premature atrial contractions, Mobitz type I block, or artifact ( n = 18), and multifocal atrial tachycardia ( n = 1). Patients with erroneous AF diagnoses were older (mean age 76.7 vs. 72.5 years, p = 0.032) and frequently received inappropriate therapies, including rate‐control agents ( n = 12), antiarrhythmics ( n = 8), and anticoagulants ( n = 24). Conclusions: AF misdiagnosis remains prevalent in the ED and can lead to unnecessary pharmacotherapy. The misdiagnosis rate appears comparable between CIE‐assisted and physician‐only interpretations.

BACKGROUND Glucagon-like peptide-1 receptor agonists (GLP-1RAs) play a key role in managing type 2 diabetes mellitus (T2DM). Transitioning between different GLP-1RA has been proposed as a treatment strategy. AIM To investigate switching patterns between GLP-1RA and their impact on glycemic control. METHODS A retrospective study involving patients with T2DM who initiated GLP-1RA therapy between 2009 and 2021 and transitioned to another GLP-1RA. Baseline glycated hemoglobin (HbA1c) was defined as the most recent measurement within 1 year prior to switching, and follow-up HbA1c was the first measurement recorded 4-15 months post-switch. RESULTS Among 70654 patients initiating GLP-1RA therapy, 18047 (25.5%) switched regimens. In the 13970 patients with available HbA1c, levels decreased from 8.5% ± 1.6% to 7.6% ± 1.4% (P < 0.001). HbA1c decreased in 78.3% (10943/13970) of these patients, with the most frequent improvement observed in those switching from daily to weekly GLP-1RA (81%, 5582/6890). CONCLUSION Switching between GLP-1RAs can serve as a practical alternative to treatment intensification for effectively managing T2DM.

Purpose of Review: We review the literature on the interconnections between diabetes and mental health disorders, such as depression and anxiety, highlighting recent findings and potential integrative medicine (IM) interventions for improving patient care in individuals with both comorbidities. Recent Findings: Underscore the bidirectional relationship between diabetes and depression, with each condition exacerbating the other with associated poorer clinical outcomes. Pathophysiological mechanisms like hypothalamic-pituitary-adrenal (HPA) axis dysregulation and chronic inflammation contribute significantly. IM approaches, including mind-body therapies, dietary modifications, and herbal medicine, show promise in enhancing both glycemic control and mental health well-being. Summary: IM offers a holistic, patient-centered approach potentially improving care for individuals with diabetes and mental health disorders. While evidence supports the efficacy of various integrative therapies, further rigorous research is needed to standardize these interventions and ensure their effective integration into conventional medical practice.

Background: Type 2 diabetes mellitus (T2DM) is common among patients with chronic obstructive pulmonary disease (COPD). We examined the association between glycemic control and clinical outcomes in patients with COPD exacerbation and T2DM. Methods: A retrospective study of patients with T2DM and COPD exacerbation comparing controlled (HbA1c < 7.5%) to uncontrolled (HbA1c ≥ 7.5%) glycemia prior to admission. The primary endpoint is defined as a composite of 6-month rehospitalization/mortality. Secondary endpoints included 6-month mortality and 6-month readmission. Results: Of 426 admissions, 179 (42%) had uncontrolled glycemia. The risk of rehospitalization/mortality was significantly increased in the uncontrolled group in univariate (HR1.6, 95%CI 1.11–2.3, p = 0.01) and multivariate (HR 1.82, 95%CI 1.24–2.67, p = 0.002) analyses. The risk of 6-month rehospitalization was increased in the uncontrolled group in both univariate (HR1.94, 95%CI 1.16–3.23, p = 0.011) and multivariate (HR1.98, 95%CI 1.19–3.27, p = 0.008) analyses. No difference was found between 6-month mortality risks. Conclusions: Optimal glycemic control may improve COPD management and reduce adverse outcomes.