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The 116 participants in the study were di- agnosed with delayed melatonin secretion in dim light, an indicator of abnormal circa- dian timing related to sleep. They were randomly assigned to take 0.5 mg of fast- release melatonin or a placebo 1 hour be- fore bedtime for at least 5 consecutive nights per week for 4 weeks. All patients were scheduled to try to fall asleep at their de- sired, rather than habitual, bedtime.

Relative to baseline and compared with placebo, sleep onset occurred 34 minutes earlier in the melatonin group. The melato- nin group also had improved sleep quality and fewer sleep-related impairments.

The authors cautioned that melatonin may be less effective for sleep disorders that are not caused by a circadian delay.

No Benefit for Women From Sigmoidoscopy Screening Offering sigmoidoscopy screening to adults reduced colorectal cancer incidence and mortality in men, but had little or no effect in women, researchersreportedin the Annals of Internal Medicine.

Investigators randomly assigned 98 678 study participants aged 50 to 64 years who lived in Norway to a single screening with flexible sigmoidoscopy, with or without ad- ditional fecal blood testing, or to no screen- ing. Participants with positive screening re- sults were offered colonoscopy. After 17 years of follow-up, colorectal cancer inci- dence decreased by 34% and mortality de- clined 37% among men in the sigmoidos- copy group compared with men who weren’t screened. Little or no reduction in colorectal cancer risk or mortality occurred among women screened with sigmoidos- copy compared with those not screened.

An accompanyingeditorialsuggested that the findings might support revising the5- or 10-year intervals in current recommen- dations to help prevent potential harm from screening. However, theeditorial’s authors said the study also raises the question of whether screening recommendations should be sex-specific. Automated Device Improves Glucose Control in Hospitalized Patients Recentresearchhas shown that a closed- loop insulin delivery system—also known as an artificial pancreas—controls glucose more effectively than standard subcutaneous in- sulin therapy during hospitalization.

The investigators randomly assigned 136 adults with type 2 diabetes who needed in- sulin to receive it with the automated sys- tem or via standard subcutaneous therapy for 15 days or until they were discharged.

Glucose control was significantly better among patients who received insulin with the automated system than among those re- ceiving standard subcutaneous therapy.

In addition, the groups didn’t differ signifi- cantly in duration of hypoglycemia or in the amount of insulin delivered. No patient in either group had an episode of severe hy- poglycemia or clinically significant hypergly- cemia with ketonemia. Patients in the closed-loop group also said they were very satisfied with results from the system.

Behavior Therapy May Help Prevent Teen Suicide A form of behavioral therapy that helps pa- tients control their emotions and tolerate distress may prevent adolescents who are at high risk of suicide from harming them- selves or attempting suicide again.

In aJAMA Psychiatrystudy, 173 youths who had attempted suicide were ran- domly assigned to participate in either dia- lectical behavior therapy (DBT) or in indi- vidual and group therapy. Both groups had weekly individual and group psychotherapy as needed.

At 6 months, 9.7% of youths in the DBT group said they had attempted suicide com- pared with 21.5% who had individual and group therapy. In addition, 46.5% of those in the DBT group and 27.6% in the other therapy group hadn’t attempted suicide ortried to harm themselves. During a 6-month follow-up period after treatment ended, self- harm rates declined in both groups; DBT had a more pronounced clinical effect but the dif- ference wasn’t statistically significant. Be- cause study participants were predomi- nantly female, the investigators said the findings may not generalize to males. Drug Improves Glucose Levels and Drives Weight Loss Treatment with a balanced glucagon-like peptide 1 and glucagon receptor dual ago- nist, MEDIO382, significantly improved gly- cemic control, bodyweight, and liver fat in patients with type 2 diabetes who were over- weight or obese, according to aLancetstudy.

The 61 patients were randomly assigned to once-daily injections of MEDIO382 or to placebo in the multiple-ascending dose por- tion of the study, and 51 patients were ran- domly assigned to the study drug or to pla- cebo in the phase 2a portion.

From baseline to day 41, clinically assessed postprandial glucose de- creased significantly with MEDI0382 (–32.78%) compared with placebo (–10.16%). In the intention-to-treat popula- tion, the MEDI0382 group lost 8.5 pounds compared with a 3.7-pound weight loss in the placebo group. The phase 2b trial is ongoing.− Anita Slomski, MA Note: Source references are available online through hyperlinks embedded in the article text.

Melatonin improved sleep in patients with circadian disruption. Clinical Trials Update Molecule Data Source: PubChem ID 896 News & Analysis jama.com(Reprinted)JAMAAugust 28, 2018 Volume 320, Number 8749 © 2018 American Medical Association. All rights reserved.Downloaded From: https://jamanetwork.com/ by a Arizona State University User on 06/03/2020