Latest Internal Medicine research

Top 10 this week

Week of 1 November 2026

1. 1

   Impact of malnutrition and protein-enriched oral nutrition on early recovery after fragility fractures in older adults: the NuTra trial

   BMC geriatrics · Q1 journal · RCT · Evidence level 1 (High) · 17 October 2026

   In this single-center trial of 218 adults aged 70 and older with fragility fractures, 46% screened at nutritional risk; a protein-enriched diet did not reduce complications or improve mobility, hospital stay, or discharge destination versus a standard diet. Nutritional risk tracked with frailty and greater need for institutional care, while age-related comorbidity predicted discharge destination, leaving open whether longer-term nutritional support helps.

2. 2

   Cost-Effectiveness of a Culturally Adapted Diabetes Self-Management Education Program for Marshallese Adults With Type 2 Diabetes-a State-Transition Markov Analysis

   Diabetes, obesity & metabolism · Q1 journal · RCT · Evidence level 1 (High) · 17 September 2026

   Cost-effective culturally adapted DSME program for Marshallese adults

3. 3

   Hospitalization outcomes in adults with type 2 diabetes mellitus treated with once-weekly insulin efsitora versus once-daily basal insulins: A post hoc analysis of the QWINT-1 to -4 randomized trials

   Diabetes research and clinical practice · Q1 journal · RCT · Evidence level 1 (High) · 3 October 2026

   In a post hoc analysis pooling four trials, hospitalization rates were 9.2% with weekly efsitora and 7.1% with daily basal insulin, while median hospital stays were 5 days in both groups. Blood sugar and hypoglycemia measures were similar around hospitalization, but permanent treatment discontinuation, primarily due to adverse events, was higher with efsitora; the exploratory findings need cautious interpretation.

4. 4

   A 52-Week Efficacy and Safety Study of Teneligliptin, as an Add-On to Empagliflozin and Metformin in Patients With Type 2 Diabetes Mellitus: A Randomised, Double-Blind, Placebo-Controlled Phase 3 Trial (TERA305 Study)

   Diabetes, obesity & metabolism · Q1 journal · RCT · Evidence level 1 (High) · 5 October 2026

   In 214 adults with type 2 diabetes still above target on metformin and empagliflozin, adding teneligliptin lowered HbA1c by 0.67 percentage points more than placebo over 24 weeks. Glucose improvements continued through week 52, and safety outcomes were similar, but everyone received teneligliptin during the final 28 weeks, so longer-term benefit lacks a randomized comparison.

5. 5

   Clinical similarity, economic divergence: cost-effectiveness and population health implications of dietary, pharmacological, and exercise interventions in older adults with type 2 diabetes: a secondary analysis of a randomized controlled trial

   BMC geriatrics · Q1 journal · RCT · Evidence level 1 (High) · 25 July 2026

   In a 10-week trial analysis of 100 adults aged 65 and older with type 2 diabetes, diet and exercise cost less and produced more quality-adjusted life than empagliflozin, despite similar blood sugar improvements. Empagliflozin had the highest rate of combined improvement in blood sugar and frailty; whether lifestyle's short-term economic advantage holds over time is unknown.

6. 6

   Financial incentives and health coaching to improve glycemic outcomes among young adults with type 1 diabetes: A factorial randomized trial (SweetGoals)

   Diabetes research and clinical practice · Q1 journal · RCT · Evidence level 1 (High) · 11 August 2026

   Financial incentives and coaching lower A1c in young T1D

7. 7

   Safety, Acceptability and Efficacy of Noninvasive Transcutaneous-Autonomic Neuromodulation in Uncontrolled Hypertension

   Hypertension (Dallas, Tex. : 1979) · Q1 journal · RCT · Evidence level 1 (High) · 28 September 2026

   Among 63 adults with uncontrolled hypertension, daily transcutaneous nerve stimulation was safe and acceptable but did not significantly lower daytime systolic blood pressure compared with sham treatment after three months. An analysis suggested a greater response among participants whose starting systolic pressure exceeded 160 mm Hg, but that subgroup signal needs testing in a larger study.

8. 8

   Effectiveness of digital health education interventions for chronic disease self-management in community-dwelling older adults: an umbrella review and evidence classification

   Frontiers in public health · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 12 October 2026

   An umbrella review of 199 randomized trials found no high-credibility evidence that digital health education improves chronic disease self-management for adults 60 and older living in the community. Nearly two-thirds of 44 outcomes were not significant, and prediction intervals crossed no effect throughout. This does not show the programs are ineffective; limited trials, short follow-up and varied methods leave the question open.

9. 9

   Opioid-free analgesia for acute renal colic: a randomized, double-blind, head-to-head comparison of intravenous ibuprofen, dexketoprofen trometamol and paracetamol in the emergency department

   Internal and emergency medicine · Q1 journal · RCT · Evidence level 1 (High) · 30 October 2026

   In a randomized trial of 251 adults, adjusted pain scores at 30 minutes were 9.5 points lower on a 100-point scale with dexketoprofen than with paracetamol. About two-thirds to three-quarters in each group achieved at least 50% pain reduction, with no significant difference between treatments; the single-centre findings leave the practical importance of the score difference uncertain.

10. 10

    Effects of Lanthanum Carbonate on Whole-Body Phosphorus and Calcium Balance in Adults With Chronic Kidney Disease and Normophosphatemia

    Kidney medicine · Q1 journal · RCT · Evidence level 1 (High) · 12 August 2026

    After 12 weeks, adults with stage 3b-4 chronic kidney disease taking lanthanum had lower whole-body phosphorus balance than those taking placebo, averaging -131 versus +320 mg/day; calcium balance was also lower. The small study measured balance during a controlled diet, not clinical outcomes, so whether these changes benefit patients remains unknown.

Paper of the day, last two weeks

• Association Between Weight Loss on Incretin-Based Therapy and Cardiovascular Outcomes and Mortality: A Systematic Review and Meta-Regression

  Diabetes, obesity & metabolism · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 3 November 2026

  Systematic review assesses cardiovascular outcomes of incretin therapy

• Preparing for responsive management versus renal dialysis in older people living with kidney failure and frailty or multimorbidity in the UK (Prepare for Kidney Care): a two-arm, superiority, parallel-group, open-label, pragmatic, phase 3, individually randomised controlled trial

  Lancet (London, England) · Q1 journal · RCT · Evidence level 1 (High) · 4 November 2026

  Pragmatic RCT comparing conservative vs dialysis in frail elderly

• Closed-Loop Insulin Delivery in Inpatient Care: A Systematic Review and Meta-Analysis of Clinical and Implementation Outcomes

  Diabetes, obesity & metabolism · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 3 November 2026

  Across 13 inpatient studies, closed-loop insulin delivery increased time in range by about 22 percentage points and lowered average glucose; nine studies contributed to the pooled analysis. No serious device-related adverse events were reported, but effects on hospital stay and comparative safety remain uncertain, and staff training, technical support, and workflow integration may limit wider use.

• Antecedent Kidney Function and Cardiovascular Mortality in Over 300 000 Patients With Incident Heart Failure With Preserved Ejection Fraction

  Circulation. Heart failure · Q1 journal · Cohort · Evidence level 3 (Low) · 2 November 2026

  In a cohort of 236,910 US veterans with newly diagnosed heart failure with preserved ejection fraction, 49% had an estimated kidney filtration rate below 60 before heart failure began. Lower kidney function was linked to progressively more cardiovascular deaths and heart failure hospitalizations; the observational study identifies a higher-risk group but does not show that kidney dysfunction causes those outcomes.

• Patient- and Facility-Level Factors Associated With Long-Term Care Facility-Acquired Pneumonia and Mortality in Korea

  Journal of the American Medical Directors Association · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 22 September 2026

  In a national cohort of 311,344 long-term care residents, 4.9% developed pneumonia, and 55% of those residents died in the facility compared with 13.9% without pneumonia. The observational study also linked patient and facility characteristics to pneumonia and mortality, but cannot establish cause and effect; its findings point to the need to address prevention and resource gaps.

• Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023

  The Lancet regional health. Western Pacific · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 22 October 2026

  In surveillance of 76,211 bloodstream infection isolates from 72 hospitals, several resistance patterns declined from 2014 to 2023: ESBL-producing E. coli fell from 61.5% to 47.4%, and MRSA from 39.0% to 26.2%. Carbapenem-resistant Klebsiella pneumoniae more than doubled to 14.9%, while resistance varied by location; stewardship gains have not removed the need for targeted infection control.

• Recovery of worsening renal function after acute heart failure

  European journal of internal medicine · Q1 journal · Unclassified · Evidence level 5 (Expert Opinion) · 28 October 2026

  Among 331 patients whose kidney function worsened during a heart-failure hospitalization, 54% had recovered by 12 months. Those who recovered had about 77% lower adjusted mortality over the following five years than those with persistent kidney problems. This observational association does not prove recovery caused better survival, but it underscores the importance of following kidney function after discharge.

• Evaluation of the Association of N-Acetylcysteine and Mortality in Non-Acetaminophen-Induced Acute Liver Failure

  Journal of intensive care medicine · Q1 journal · Prospective cohort · Evidence level 2 (Moderate) · 29 October 2026

  In this retrospective study of 200 adults with non-acetaminophen acute liver failure, 21-day in-hospital mortality was 48.9% with IV N-acetylcysteine and 62.1% without it. The treatment was not linked to faster lab recovery or shorter hospital stays, and the observational design cannot establish that it caused the lower mortality; larger prospective studies are needed.

• Improving Patient Safety Through Medication Reconciliation at Care Transitions: A Mixed Methods Systematic Review

  Journal of general internal medicine · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 29 October 2026

  Across 70 studies, medication reconciliation was associated with 27% fewer 30-day all-cause readmissions than usual care, while also reducing discrepancies, adverse drug events and emergency visits. Pharmacist-led programs and reconciliation at hospital admission stood out, but the review does not establish which combination of protocol components works best across care settings.

• Anticoagulation and All-Cause Mortality in Adults Aged 80 Years and Older with Atrial Fibrillation: A Retrospective Cohort Study

  Journal of general internal medicine · Q1 journal · Retrospective cohort · Evidence level 3 (Low) · 27 October 2026

  In a retrospective cohort of 45,305 adults aged 80 and older with atrial fibrillation, continued anticoagulation was associated with lower 1-year mortality than no anticoagulation: 8.7% versus 17.7%. Gastrointestinal bleeding was more frequent with treatment, while brain bleeding rates were similar; mortality differences converged by 5 years. Because this was an observational study, it cannot establish that anticoagulation caused the lower mortality.

• Diagnostic accuracy of artificial intelligence (AI)-based models for acute myocardial infarction: a systematic review and meta-analysis

  Cardiovascular research · Q1 journal · SR of cohorts · Evidence level 2 (Moderate) · 23 October 2026

  Across 24 studies covering about 166,000 patients, AI algorithms showed high diagnostic accuracy for heart attacks, with similar results for ST-elevation and non-ST-elevation heart attacks. ECG-based models were less sensitive and troponin-based models less specific; the findings support AI as a possible addition to existing pathways, but direct comparisons and prospective testing are still needed.

• 2026 International Society of Hypertension Global Hypertension Practice Guidelines

  Journal of hypertension · Q1 journal · Guideline · Evidence level 1 (High) · 20 October 2026

  The 2026 International Society of Hypertension guidelines are presented with a 23-member review panel spanning 16 countries. The abstract provides no details on recommended blood pressure targets, treatments, or changes from prior guidance, so clinicians will need the full guideline to see what it advises and how it may affect practice.

• Sodium-Glucose Cotransporter-2 inhibitor use during or after acute kidney injury and the risk of major adverse kidney events and Mortality: A systematic review and Meta-Analysis

  Diabetes research and clinical practice · Q1 journal · SR/MA of RCTs · Evidence level 1 (High) · 23 October 2026

  Across seven studies, mostly observational, SGLT2 inhibitor use was associated with 35% lower all-cause mortality and lower odds of major adverse kidney events during or after acute kidney injury. The kidney-event finding varied across studies, and a randomized trial of 200 patients was inconclusive; very low-certainty evidence leaves open whether the apparent benefits are caused by treatment.

Evidence summaries in Internal Medicine

• SIADH
• Diabetic Nephropathy
• Skipping Breakfast and Cardiovascular/Metabolic Health
• Refeeding Syndrome
• Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
• Malaria
• HIV
• Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
• Tetanus
• Dengue Fever
• Pneumothorax
• Acute Pancreatitis
• DKA Claude
• Addison Disease
• Cholecystitis
• Diagnostic Test of Choice for Meningitis
• COPD Exacerbation
• Glycolysis