Annals of Internal Medicine tip sheet for March 20, 2012, issue
Embargoed news for Annals of Internal Medicine
2012-03-20
(Press-News.org) 1. Dapagliflozin Effective Add-on for Patients with Inadequately Controlled Blood Glucose
Experts caution that long-term safety data is still lacking
Even on high doses of insulin, some patients with type 2 diabetes still have poorly controlled blood glucose levels. Increasing doses of insulin raises the risks for weight gain, hypoglycemia, fluid retention, and congestive heart failure, so physicians may choose to add additional medications rather than increase the insulin dose. Dapagliflozin, the first in the class of selective renal sodium glucose contransporter (SGLT) inhibitors, offers a novel, insulin-independent mechanism of action for diabetes treatment. Researchers sought to determine the safety and efficacy of adding dapagliflozin therapy in patients whose type 2 diabetes was inadequately controlled while taking high doses of insulin with or without oral diabetes medications. They randomly assigned 808 patients in 126 medical centers to receive either placebo or dapagliflozin once daily for 48 weeks. Halfway through the study, the dapagliflozin patients had better control of blood sugar and had lost weight compared to those on placebo. At the end of the trial, the dapagliflozin patients were on lower doses of insulin, but they also had more episodes of hypoglycemia. The author of an accompanying editorial cautions that the safety and efficacy of dapagliflozin is still under investigation, with safety being the primary issue. Long-term surveillance is necessary to exclude an association between dapagliflozin and cancer. In addition, gastrointestinal side effects and genitourinary symptoms and infections are still a concern.
2. Peer Mentoring Improves Glucose Control in African American Veterans
Diabetes is more common and more severe among African Americans. Patients with diabetes can manage their blood sugar through changes in their diet and exercise habits, but these changes can be difficult to maintain long-term. To determine if behavioral interventions can improve diabetes self-care, researchers randomly assigned 118 African American patients at a Veterans Affairs hospital to one of three groups: usual care; a peer mentoring group; and a financial incentives group. The usual care patients had no interventions. The peer mentoring group received at least one phone call a week from a peer who was trained to use motivational interview techniques and their own personal experiences to help the patient modify behaviors and work towards glucose-control goals. The financial incentives group was offered $100 at six months if they decreased their blood glucose level by one percentage point and $200 at six months if they decreased it by two percentage points. After six months, the patients in the peer mentoring group decreased their blood glucose levels by one percentage point compared to those in the usual care group. Patients in the financial incentives group had a statistically insignificant decrease in blood glucose levels. According to the researchers, talking to peers who have successfully managed their disease shows promise in helping patients improve glucose control.
3. Bleeding Hazard May Trump Potential Benefits of Antiplatelet Therapy for Patients with Chronic Kidney Disease
Approximately 10 to 15 percent of the adult population worldwide has chronic kidney disease, or CKD. People with early-stage CKD have a significantly higher risk for cardiovascular disease, and at end-stage disease, cardiovascular risk increases 30- to 50-fold. Antiplatelet agents are commonly used to prevent cardiovascular events. However, the bleeding risk of antiplatelet agents may be greater among persons with CKD because of impaired hemostasis. Researchers reviewed published randomized trials to summarize the effects of antiplatelet treatment on cardiovascular events, mortality, and bleeding in persons with CKD. The researchers found the evidence on the use of antiplatelets in patients with CKD is low quality. For CKD patients with acute coronary syndromes or those undergoing percutaneous coronary revascularization, antiplatelet agents have little or no effect on myocardial infarction, death, or coronary revascularization, but increase major and minor bleeding. The research also showed that use of antiplatelet agents in persons with CKD who have or are at risk for cardiovascular disease reduces fatal or nonfatal myocardial infarction by approximately 33 percent. However, with a lack of evidence surrounding effects on stroke and mortality, the researchers conclude that the bleeding risks of antiplatelet therapy may outweigh the benefits for patients with CKD.
INFORMATION: END
ELSE PRESS RELEASES FROM THIS DATE:
2012-03-20
Computer simulations have revealed a plausible explanation for a phenomenon that has puzzled astronomers: Rather than occupying orbits at regular distances from a star, giant gas planets similar to Jupiter and Saturn appear to prefer to occupy certain regions in mature solar systems while staying clear of others.
"Our results show that the final distribution of planets does not vary smoothly with distance from the star, but instead has clear 'deserts' – deficits of planets – and 'pile-ups' of planets at particular locations," said Ilaria Pascucci, an assistant professor ...
2012-03-20
SEATTLE – Pancreas cancer tumors spread quickly and are notoriously resistant to treatment, making them among the deadliest of malignancies. Their resistance to chemotherapy stems in part from a unique biological barrier the tumor builds around itself. Now scientists at Fred Hutchinson Cancer Research Center have found a way to break through that defense, and their research represents a potential breakthrough in the treatment of pancreas cancer.
In a paper to be published in the March 20 issue of Cancer Cell, senior author Sunil Hingorani, M.D., Ph.D., an associate member ...
2012-03-20
Putting the brakes on an abundant growth-promoting protein causes breast tumors to regress, according to a study published on March 19th in the Journal of Experimental Medicine.
Triple-negative breast tumors lack all of the known growth receptors that serve as treatment targets in other types of breast cancer, making this the most clinically challenging subtype of the disease. Patients with these tumors tend to relapse earlier and have shorter disease-free survival.
Andrei Goga and colleagues now show that triple-negative breast tumors express elevated levels of the ...
2012-03-20
People whose blood pressure drops rapidly when they move from lying down to standing, known as orthostatic hypotension, may have a higher risk of developing heart failure, according to research published in Hypertension, an American Heart Association journal.
The link between orthostatic hypotension and heart failure was stronger in people 45-55 years old compared to those 56-64, researchers said. High blood pressure, which was present in over half of people who developed heart failure, may be partially responsible for the association.
Over an average 17.5 years of follow-up, ...
2012-03-20
EDITOR'S PICK
A clearer understanding of glaucoma | Back to top
Glaucoma is one of the leading causes of vision loss and blindness worldwide. In glaucoma patients, the optic nerve, which relays information from the eye to the brain, is damaged, though the molecular cause of nerve damage is unclear. Dr. Simon John, from Tufts University in Boston, and colleagues specifically wanted to understand the earliest events that lead to optic nerve damage in glaucoma. Using a mouse model of the disease, the researchers showed that inflammatory immune cells called monocytes cross ...
2012-03-20
Physical violence, sexual abuse and other forms of childhood and adult trauma are major factors fueling the epidemic of HIV/AIDS among American women. Scientists have known for years that traumatized women are at greater risk of becoming infected.
Now, two new studies from the University of California, San Francisco (UCSF) and Harvard Medical School demonstrate that a high rate of trauma among women already infected with HIV also plays a role in the epidemic.
Described in back-to-back papers in the journal AIDS and Behavior, the new work demonstrates that women with ...
2012-03-20
Glaucoma is one of the leading causes of vision loss and blindness worldwide. In glaucoma patients, the optic nerve, which relays information from the eye to the brain, is damaged, though the molecular cause of nerve damage is unclear. Dr. Simon John, from Tufts University in Boston, and colleagues specifically wanted to understand the earliest events that lead to optic nerve damage in glaucoma. Using a mouse model of the disease, the researchers showed that inflammatory immune cells called monocytes cross blood vessels and invade the optic nerve. Remarkably, mice treated ...
2012-03-20
CHICAGO – The minimally invasive hernia repair procedure known as total extraperitoneal inguinal hernioplasty (TEP) was associated with higher patient satisfaction, less chronic pain and less impairment of inguinal (groin) sensation compared to the open surgical Lichtenstein repair, according to a study published in the March issue of Archives of Surgery, one of the JAMA/Archives journals.
Chronic pain and hypoesthesia (reduced sensitivity) are increasingly measured after inguinal hernia repair but few randomized clinical trials have compared TEP with Lichtenstein repair, ...
2012-03-20
CHICAGO – An antioxidant combination of vitamin E, vitamin C and α-lipoic acid (E/C/ALA) was not associated with changes in some cerebrospinal fluid biomarkers related to Alzheimer disease in a randomized controlled trial, according to a study published Online First by Archives of Neurology, one of the JAMA/Archives journals.
Oxidative damage in the brain is associated with aging and is widespread in Alzheimer disease (AD) patients. Some observational studies have suggested that an antioxidant-rich diet may reduce the risk of AD, but antioxidant randomized clinical ...
2012-03-20
CHICAGO – Patients with obstructive sleep apnea who undergo surgery for their condition should be closely monitored after their procedures are performed but may not need to be in an intensive care unit, according to a report published Online First by Archives of Otolaryngology – Head & Neck Surgery, one of the JAMA/Archives journals.
Surgical procedures in patients with sleep apnea (a sleep disorder characterized by pauses in breathing) have traditionally been considered dangerous and potentially life threatening if not monitored with caution because these patients are ...
LAST 30 PRESS RELEASES:
[Press-News.org] Annals of Internal Medicine tip sheet for March 20, 2012, issue
Embargoed news for Annals of Internal Medicine
