30-Second Takeaway
- Use mailed FIT outreach and navigation to meaningfully increase colorectal cancer screening, especially in low-uptake practices.
- Expect lower insulin spending and small A1c improvements from the Medicare $35 insulin cap, with slightly more hypoglycemia.
- For older adults needing second-line glucose-lowering therapy, prefer GLP-1 RAs or SGLT2 inhibitors over sulfonylureas when feasible.
Week ending April 11, 2026
System-level levers to improve cardiometabolic care in primary care panels
Patient navigation and mailed FIT most effectively increase CRC screening
This network meta-analysis of 76 RCTs compared eight interventions to improve colorectal cancer screening uptake against usual care. Patient navigation produced the largest increase (RR 1.58, 95% CI 1.23-2.02), followed by mailed FIT outreach (RR 1.36, 95% CI 1.07-1.74). Mailed FIT outperformed colonoscopy outreach (RR 1.35, 95% CI 1.11-1.63), and navigation beat reminder-only interventions (RR 1.48, 95% CI 1.14-1.94). In settings with baseline uptake <30%, mailed FIT yielded especially large gains (RR 3.12, 95% CI 1.70-5.71). Educational multimedia showed emerging benefit in higher-uptake and recent studies, offering a potentially scalable adjunct where digital capacity exists.
Medicare’s $35 insulin cap reduced costs and slightly improved glycemia
This interrupted time-series cohort of 4.8 million Medicare Part D beneficiaries assessed effects of the $35 monthly insulin cap. Mean quarterly insulin out-of-pocket spending declined by about $48 in 2021 and another $59 in 2023 versus baseline. Insulin use increased modestly, and mean HbA1c decreased by 0.06 percentage points after full rollout in 2023 among patients with EMR data. Rates of severe hypoglycemia requiring emergency or hospital care rose slightly after implementation. Overall, the cap improved affordability and access, with small population-level glycemic gains and a need for closer hypoglycemia monitoring.
Automated insulin delivery improved glycemia and hypoglycemia in insulin-treated type 2 diabetes
This systematic review and meta-analysis included nine studies (1,530 participants) using automated insulin delivery in insulin-treated type 2 diabetes. Automated systems increased time-in-range by 16.06 percentage points and reduced time-above-range by 15.90 percentage points. HbA1c decreased by 1.27 percentage points and mean glucose fell by 21.34 mg/dL, without weight or BMI changes. Time-below-range declined modestly, indicating improved hypoglycemia safety alongside tighter control. Evidence is limited by heterogeneous designs and only three RCTs, but supports considering automated insulin delivery for selected patients requiring intensive insulin.
GLP-1 RAs and SGLT2 inhibitors show safer profiles than sulfonylureas in older adults
This multinational cohort of 1.8 million adults aged ≥65 compared four second-line antihyperglycemic classes across 18 safety outcomes. GLP-1 receptor agonists and SGLT2 inhibitors were associated with significantly lower risks of hypoglycemia and hyperkalemia than sulfonylureas. GLP-1 receptor agonists also had lower risk of peripheral edema than DPP-4 inhibitors. SGLT2 inhibitors carried higher diabetic ketoacidosis risk than GLP-1 receptor agonists and sulfonylureas. These findings support preferring GLP-1 RAs or SGLT2 inhibitors over sulfonylureas in older adults, with DKA vigilance for SGLT2 inhibitors.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.