Latest Research
Selenium for Mild Grave’s Disease Ophthalmopathy?
May 26, 2011 at 1:43 pm
Severe ophthalmopathy (orbitopathy) in Graves disease is usually treated with corticosteroids, while mild levels of the condition are often left untreated even though it can be annoying for patients.
A small study published in the NEJM supports the use of selenium supplements in patients with mild disease with an improvement in related quality of life and several ophthalmological endpoints as assessed by blinded ophthalmologists.
The benefits were found to persist at 12 months and no adverse effects were recorded.
Marcocci C, et al. N Engl j med 2011; 364: 1920
Metformin and Vitamin B12 Deficiency
June 21, 2010 at 10:45 am
A Dutch study has confirmed the finding that long term metformin can interfere with vitamin B12 absorption and therefore increase the risk of vitamin B12 deficiency. The effect of metformin lowering B12 levels increased with the duration of therapy.
B12 deficiency can result in anaemia, cognitive changes and neuropathy, so the authors recommend routine monitoring of B12 levels in patients on metformin.
deJager et al. BMJ 2010 May 20; 340:c2181
Diabetes and Cancer Link
June 21, 2010 at 10:39 am
The American Diabetes Association and the American Cancer Society have published a consensus report on the association between diabetes and some types of cancer. The risk is highest for liver, pancreatic and endometrial cancers with about a 2-fold risk or higher.
They suggest possible mechanisms for the link including hyperinsulinaemia, hyperglycaemia, inflammation and shared risk factors including obesity, ageing and diet.
They conclude that while cancer risk should not determine treatment in an average patient (less risk with metformin, possible higher risk with insulin), it may be a consideration in a higher-risk patient.
Giovannuci E, et al. CA Cancer J Clin 2010
An Unusual Complication of Intensive Diabetic Glycaemic Control
May 25, 2010 at 8:25 am
Researchers have described an unusual severe painful neuropathy that occurred in 16 patients during intensive treatment of poorly controlled diabetes. Average HbA1C was around 14% before and 7% after intensive therapy. The pain was in a stocking-glove distribution in most of the patients. Autonomic symptoms were common and retinopathy worsened during the first 6 months of sustained glycaemic control.
The pain subsided in most patients after 1-2 years of combination drug therapies. The pathophysiology and incidence of this condition are not clear.
Gibbons CH, Freeman R. Ann Neurol 2010 Apr; 67: 534
Increased Mortality Risk Persists Long After Hip Fracture
March 25, 2010 at 9:16 am
A meta-analysis involving 24 studies has found relative hazards of death 3 and 3.5 times among women and men respectively, 15 years after hip fracture.
It also found the highest mortality risk occurred within the first 3 months with a 5 to 8 fold relative hazard of death compared with controls, and at all ages studies, men showed higher mortality rates than women.
Haentjens P, et al. Annals Int Med 2010; 152(6): 380-390
http://www.annals.org/content/152/6/380.abstract
Tighter Glucose Control Associated with Increased Deaths
February 17, 2010 at 11:31 am
More evidence against too-tight glycaemic control in type 2 diabetes has come to light with a study published in the Lancet involving 48,000 patients with diabetes whose treatments had been intensified.
During the 5 year follow up, a U-shaped curve with respect to all-cause mortality and glycated haemoglobin was found – patients in the lowest decile of HbA1C (median level 6.4%) and the highest (10.6%) had significantly higher mortality than those in the reference decile (7.5%).
It is postulated that the increased frequency of hypoglycaemic episodes may be implicated in the increased death rate in the tightest control group.
Currie CJ, et al. Lancet 2010 doi: 10.1016/S0140 – 6736(09)61969 – 3
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/abstract
Short Term Increase In Diabetes After Smoking Cessation
February 17, 2010 at 11:27 am
While smoking cessation has many positive health effects, researchers have found there is an increased risk for developing type 2 diabetes during the first several years after quitting.
This 9 year study, which followed nearly 11,000 adults, found that compared with adults who never smoked, those who continued smoking had a roughly 30% increased risk for diabetes, while those who quit smoking by year 3 had almost a 75% increased risk.
It is proposed that weight gain and systemic inflammation maybe 2 of the mechanisms by which this increased risk is mediated.
So we should think of countermeasures such as aggressive weight control and lifestyle counselling in all of our patients who cease smoking.
Yeh HC, et al. Ann Int Med 2010; 152(1): 10-17
http://www.annals.org/content/152/1/10.abstract
Gastric Banding in Obese Teenagers
February 17, 2010 at 11:24 am
More news on the topic of weight reduction in teenagers, with an Australian study showing laparoscopic adjustable gastric banding was superior to lifestyle intervention in obese teens.
At 2 years, significantly more teens in the banding group had lost at least half of their excess weight compared to the lifestyle group, with the banding leading to resolution of the metabolic syndrome and improved quality of life.
However, nearly one third of patients required revisional surgery despite the significant experience of the researchers.
O’Brien P, et al. JAMA 2010; 303(6): 519-526
http://jama.ama-assn.org/cgi/content/full/303/6/519?home
Weight Loss in Adolescents
February 17, 2010 at 11:22 am
We all know how difficult it can be to get adolescents to lose weight. Some studies have suggested that obese children eat more rapidly than their non-obese counterparts.
A tool called a Mandometer has been found to aid weight loss in this group.
It is a feedback device that graphs how quickly a person is eating relative to a target rate and alerts the person to slow down or eat faster. It also allows self- reporting of satiety levels at regular intervals.
A recent study showed a Mandometer group had significant reduction in BMI compared to a standard-care group and this benefit continued for 6 months after the intervention, suggesting their eating habits had been retrained.
Ford AL. MBJ 2010; 340: b5388
http://www.bmj.com/cgi/content/abstract/340/jan05_1/b5388
Tighter Glucose Control Associated with Increased Deaths
January 29, 2010 at 10:41 am
More evidence against too-tight glycaemic control in type 2 diabetes has come to light with a study published in the Lancet involving 48,000 patients with diabetes whose treatments had been intensified.
During the 5 year follow up, a U-shaped curve with respect to all-cause mortality and glycated haemoglobin was found – patients in the lowest decile of HbA1C (median level 6.4%) and the highest (10.6%) had significantly higher mortality than those in the reference decile (7.5%).
It is postulated that the increased frequency of hypoglycaemic episodes may be implicated in the increased death rate in the tightest control group.
Currie CJ, et al. Lancet 2010 doi: 10.1016/S0140 – 6736(09)61969 – 3
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61969-3/abstract
