Patients with Type 1 Diabetes Prefer Inhaled Insulin

Internal Medicine World Report, August 2007, Volume 0, Issue 0

Patients with type 1 diabetes who use inhaled insulin rather than subcutaneous insulin are more satisfied with their treatment and have a better quality of life (QOL). The finding is based on a study of 327 adults and adolescents with type 1 diabetes who were randomized to treatment with inhaled or subcutaneous insulin for 24 weeks. Overall treatment satisfaction scores increased 13.2 units in the inhaled insulin group and only 1.7 units in the subcutaneous insulin group ( <.001). All 12 treatment satisfaction subscales favored inhaled insulin ( <.01), regardless of age or gender. QOL scores for mental health, symptoms, health status, cognitive functioning, and barriers to adherence during treatment were significantly higher with inhaled insulin than subcutaneous insulin ( <.05 for all). Testa MA, et al. Satisfaction and quality of life with premeal inhaled versus injected insulin in adolescents and adults with type 1 diabetes. Diabetes Care. 2007;30:1399-1405.

Type 1 and 2 Diabetes Increasing Among Young Americans

The incidence of type 1 diabetes is highest in non-Hispanic white youth in the United States. This finding emerged from a multiethnic, population-based study of 2435 persons aged <20 years with newly diagnosed diabetes. The overall incidence of diabetes was 24.3 per 100,000 person-years. The highest rate of type 1 diabetes was in non-Hispanic whites, more often in teens (aged 10-14: 32.9 per 100,000 person-years) than in younger patients (aged 5-9: 28.1 per 100,000 person-years; or 0-4 years: 18.6 per 100,000 person-years). Type 2 diabetes rates are also increasing, but in minority group members aged 15 to 19 years (see Chart Room). Dabelea D, et al. Incidence of diabetes in youth in the United States. JAMA. 2007; 297:2716-2724.

Sun Exposure Protects Against Lymphoma

Recreational sun exposure is associated with a reduced risk of malignant lymphoma. The finding emerged from a population-based, case-control study of 710 patients (aged 18-80 years) with malignant lymphoma and matched controls who provided information on lifetime vacations in sunny climates, outdoor leisure activities, and the use of sun beds and sun lamps. Spending vacations at sunny locations and frequent use of sun beds or sun lamps correlated with a decreased risk of lymphoma. However, participation in outdoor leisure activities increased risk of T-cell non-Hodgkin lymphoma and follicular lymphoma. Cumulative time working outside was associated with a lower risk of follicular lymphoma, but a slightly higher risk of Hodgkin lymphoma. Weihkopf T, et al. Sun exposure and malignant lymphoma: A population-based case-control study in Germany. Int J Cancer. 2007;120:2445-2451.

Adding Low-Dose Rosiglitazone Benefits Type 2 Diabetics







While the controversy with rosiglitazone (Avandia) is still raging, new data show that a low dose of this drug is effective adjunctive therapy in patients with type 2 diabetes who have poor glycemic control with insulin monotherapy. A group of 630 patients with type 2 diabetes that was inadequately controlled with insulin monotherapy were randomized to receive rosiglitazone or placebo in addition to insulin for 24 weeks. Compared with insulin monotherapy, combination therapy with 2 or 4 mg/day of rosiglitazone significantly decreased mean levels of glycosylated hemoglobin ( = .02 and P <.001, respectively, per dose), C-reactive protein ( = .003 and <.001), and fibrinogen ( = .002 and = .004). Combination therapy with 4 mg/day of rosiglitazone significantly decreased matrix metalloproteinase 9 levels relative to baseline ( = .007) and to placebo (P <.001). Adverse events were similar in both groups and were mild to moderate in intensity. Hollander P, et al. Low-dose rosiglitazone in patients with insulin-requiring type 2 diabetes. Arch Intern Med. 2007;167:1284-1290.

AAA Screening Cost-Effective, Saves Lives

A 7-year population-based trial investigated the benefits and cost-effectiveness of screening older adults for abdominal aortic aneurysm (AAA). The study randomized 67,770 men (aged 65-74 years) to ultrasonography screening for AAA or to no screening. A total of 1334 AAAs were identified among the 27,000 men who underwent screening. During 7 years of follow-up, 1401 deaths occurred, 301 of which were AAA related. The hazard ratio was 0.53 for AAA-related mortality in the group of men who had the screening. The rupture rate in men with normal screening test results at baseline screening was low (0.54 per 10,000 person-years) at study end. Cost-effectiveness was estimated at $19,500 per life-year gained, based on AAA mortality, and $7600 per life-year gained, based on all-cause death. Kim LG, et al. A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med. 2007;146:699-706.

Frequent Brain Stimulation Reduces Alzheimer's Risk

An active mind can lower the risk of developing Alzheimer's disease (AD), according to a study of >700 older adults who underwent annual clinical evaluations for up to 5 years. During follow-up, 90 people developed AD. More frequent participation in cognitive activities was associated with a 42% decreased risk of developing AD. Compared with cognitively active persons, those regarded as cognitively inactive were 2.6 times more likely to develop AD. In 102 persons who died and had brain autopsy, there was no association between neuropathology and levels of cognitive activity before or during the study. Wilson RS, et al. The relation of cognitive activity to risk of developing Alzheimer's disease. Neurology. Online before print. 2007 Jun 27.

Sex Steroids Do Not Affect Mortality in Men




Concerns that age-related declines in endogenous sex steroid levels increase a man's risk of death appear to be unfounded, according to a population-based study of 1709 men (aged 40-70 years) who were followed for a mean of 15.3 years. In multivariate analysis, ischemic heart disease mortality was significantly associated with lower dihydrotestosterone levels ( = .04) and higher free testosterone levels ( = .02). The relative risk of death from ischemic heart disease was 0.80 for every 1-standard deviation decrease in free testosterone level. Respiratory mortality was also significantly associated with free testosterone level ( = .002). However, there were no robust associations when sex steroids were directly measured. And, after multivariate adjustment, there was no association between mortality risk and total testosterone or sex hormone-binding globulin level. Araujo AB, et al. Sex steroids and all-cause and cause-specific mortality in men. Arch Intern Med. 2007;167:1252-1260.

Antipsychotics Linked to Mortality Risk in the Elderly

The use of conventional and atypical antipsychotics increases the risk of death in older adults with dementia, according to a retrospective study of 27,259 patients (aged ≥66 years) with dementia who were treated with atypical antipsychotics, a matched group of similar patients treated with conventional antipsychotics, and an untreated control group. Compared with those who did not take antipsychotics, new users of atypical antipsychotics had a 31% higher risk for death at 30 days if they lived in the community and a 55% higher risk for death if they were in a long-term care facility. This increased mortality risk appeared to persist for 180 days, although the results may have been affected by unequal rates of censoring over time. Compared with users of atypical antipsychotics, users of conventional antipsychotics had a higher risk of mortality at 30, 60, 120, and 180 days. Gill SS, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med. 2007;146:775-786.

High Calcium Intake May Predispose to Prostate Cancer

A diet rich in calcium and dairy products may increase a man's risk for prostate cancer. Dietary intake of calcium and dairy products was examined in 29,133 male smokers aged 50 to 69 years. A total of 1267 cases of prostate cancer were documented during 17 years of follow-up. Compared with calcium intake <1000 mg/day (the lowest quintile), calcium intake ≥2000 mg/ day (the highest quintile) increased risk of prostate cancer by 63%. And compared with the lowest quintile of total dairy intake (381 g/d), the highest quintile (1220 g/d) was associated with a 26% increased risk of prostate cancer. However, the correlation between total dairy intake and prostate cancer risk was not significant after adjusting for calcium intake. Mitrou PN, et al. A prospective study of dietary calcium, dairy products and prostate cancer risk (Finland). Int J Cancer. 2007; 120:2466-2473.

Vitamin D/Calcium May Prevent, Improve Diabetes

A review of several trials that investigated glucose control shows a relatively consistent association between low daily intake of calcium (219-600 mg/d vs a high intake of 661-1200 mg/d) or dairy products (<1.5 servings/d vs 3-4 servings/d), low 25-hydroxyvitamin D status (10-23 ng/mL vs 25-38 ng/mL), and type 2 diabetes in adults. The highest intakes of calcium were associated with a 64% lower incidence of diabetes and a 29% lower incidence of metabolic syndrome. When intakes of calcium and vitamin D were combined, the inverse associations were still observed, with the highest-versus-lowest combined intake translating into an 18% lower incidence of diabetes. Pittas AG, et al. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92:2017-2029.

SSRIs May Reduce Hip BMD in Older Women

The use of selective serotonin reuptake inhibitors (SSRIs), but not tricyclic antidepressants (TCAs), increases the rate of hip bone loss in older women. Hip bone mineral density (BMD) was measured at baseline and after a mean of 4.9 years in 2722 community-dwelling older women (mean age, 78.5 years). After 4.9 years of follow-up, mean yearly decreases in total hip BMD were 0.47% in women who did not take antidepressants, 0.82% (P <.001) in women who used SSRIs, and 0.47% (P = .99) in women who used TCAs. The associations between antidepressant use and hip BMD loss did not change when participants who scored at least 6 on the Geriatric Depression Scale (the cutoff use to define depression) were excluded from the analysis. Diem SJ, et al. Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167:1240-124.

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