Overweight patients prefer shopping for their doctor
OVERWEIGHT and obese patients are more likely to ‘doctor-shop’ than normal weight patients, US research shows.
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diabetes
The following articles have the tag diabetes
Diabetes risk rises with statin potency
PATIENTS taking high-potency statins have a higher risk of developing diabetes than those taking low-potency statins, a large Canadian epidemiological study shows.
Australian who developed cancer from diabetes drug to fight US pharmaceuticals
AN AUSTRALIAN patient who developed bladder cancer after taking type 2 diabetes medication pioglitazone (Actos, Eli Lilly) for almost two years has been added to legal action taking place in the US against two pharmaceutical companies.
Showing retinal images improves diabetes
SHOWING patients with type 2 diabetes non-proliferative diabetic retinopathy and suboptimal glycaemic control their retinal images improves HbA1c, an Australian pilot study shows.
GPs have less rapport with obese patients
GPs build less rapport with overweight and obese patients compared with normal weight patients, a US study suggests.
Practice nurses help with diabetes control
A HIGH level of involvement of practice nurses in the care of patients with diabetes improves glycaemic control without increasing costs, Australian data shows.
Stroke risk double in depressed
DEPRESSED middle-aged women in Australia have almost double the risk of stroke, a study suggests.
Obese patients may be missing out on weight loss advice
TIME pressure, the focus on chronic disease and a lack of support for GPs means patients may miss out on weight loss advice, research suggests.
High LDL-C may not predict MI in CKD
AN AUSTRALIAN expert has urged caution in interpreting research that indicates LDL cholesterol is not an accurate marker of myocardial infarction (MI) risk in patients with chronic kidney disease (CKD).
Rural patients not lacking diabetes care
THE health divide between metropolitan and rural areas makes no exception for patients with diabetes.
Weight Watchers beats DIY diets
WEIGHT Watchers works, with participants losing on average five times more weight than those on a DIY diet, according to research.
Obese patients may be missing out on weight loss advice
TIME pressure, the focus on chronic disease and a lack of support for GPs mean patients may miss out on weight loss advice, research suggests.
Sexual health and the heart
A MAN with erectile dysfunction presents an opportunity for cardiovascular review.
Cognitive decline as CVD risks rise
COGNITIVE function may decline in adults from as young as 35 years as heart disease risk factors increase, a study suggests.
Freeze on MBS rebate levels will threaten patient access: AMA, RACGP
DOCTORS have issued a final warning to government over a widely expected freeze on MBS rebate levels ahead of tonight’s federal budget.
New flu strain could increase pneumonia prevalence
A virulent flu strain this winter is expected to make more Australians susceptible to pneumonia, according to an expert.
Complementary complexities
COMPLEMENTARY medicine figures prominently in the healthcare regimen of many Australians.
Mediterranean diet could stave off dementia
AVOIDANCE of saturated fats, meat and dairy has been linked to a reduced risk of cognitive impairment and memory loss in the largest study of its kind to date.
Insulin requirement not affected by low carb diet in GDM
PUTTING pregnant women with gestational diabetes mellitus (GDM) on a low carbohydrate diet doesn’t reduce their chances of needing insulin during the pregnancy, new data shows.
Online help yields only low success rates
COMPUTER-based interventions to help patients manage type 2 diabetes have minimal effect on glycaemic control, a Cochrane review shows.
Diabetes much higher in migrant groups
THE prevalence of type 2 diabetes can be up to seven times higher in some migrant groups compared to Australian-born patients, data suggests.
GPs at the forefront of diabetes pilot
ABOUT 3.2 million Australians have diabetes or prediabetes, and with direct healthcare expenditure on the disease in the region of $907 million, controlling the ballooning costs of management is a key government priority.
An irritating, recurring itch
VULVAL pruritus is a common symptom resulting from infectious or noninfectious causes.
Mediterranean diet preserves cognitive function
A MEDITERRANEAN-style diet packed with fish, chicken and olive oil and low on fatty dairy products and meat may lower the risk of cognitive impairment later in life, a large US study says.
Early adulthood obesity predicts disease or death by middle-age
MEN who are obese in their early 20s are three times more likely to develop serious ill health by middle age, research suggests.
Good record keeping critical in appeal win
DOCTORS continue to have a responsibility to provide advice to patients about altering health-harming lifestyle habits, but we are not responsible if a patient fails to take our advice.
Weight and disease paradox
DON'T expect a simple solution to a complex problem like obesity.
Parental control for teen diabetes crucial
IN THE US today, one in three new cases of diabetes diagnosed in people younger than 18 years is type 2 disease.
Snapshot of Australia’s health
THE healthiest Australians live in western Brisbane, according to a new national snapshot.
Diabetes risk linked to mercury exposure
HIGH mercury levels in young adults are associated with an increased risk of diabetes, new US data suggests.
Bariatric surgery saves on drug costs
SAVINGS on pharmaceuticals are greatest for diabetes medications after bariatric surgery, Australian data shows.
Post-smoking weight gain not a CV risk
PEOPLE who gain a small amount of weight when they quit smoking nevertheless retain the benefit of reduced cardiovascular (CV) risk, a study shows.
Green thumb produces rare disease
ABOUT two years ago this man sustained a penetrating injury from a bougainvillea spike when re-potting plants.
Vagaries of disease detection revealed
GPs in the UK are required to keep registers of patients with chronic conditions. There are discrepancies between the numbers of patients in these registers and the prevalence of the diseases in the population.
Vibrating fork fights the battle of the bulge
AN ELECTRONIC fork that vibrates when you eat too fast has gone on sale in the US, with its French inventors claiming it can help combat obesity and digestive issues.
Blood glucose meter recall
A BLOOD glucose meter, used by some Australian patients with diabetes, cuts out at dangerously high blood glucose levels and is being recalled by the manufacturer.
‘Healthy’ but obese is a transient state
A THIRD of young people who are obese but ‘metabolically healthy’ will transition to a metabolically unhealthy state over time, Australian data shows.
Aussies fail to see obesity link with diabetes
AUSTRALIANS appear ignorant of the link between weight gain and type 2 diabetes and do not rate the condition high among their health concerns, a survey has found.
Diabetes dismissed as a major health concern: study
AUSTRALIANS appear ignorant of the link between weight gain and type 2 diabetes and do not rate the condition high among their health concerns, a survey has found.
Caution over study highlighting adverse effects of insulin
A DIABETES expert has urged caution over study results linking exogenous insulin therapy with increased risk of cancer and all-cause mortality.
Rural patients coping without specialists
PUTTING more specialists in rural and remote areas may not be the solution.
Could increasing testosterone prevent diabetes?
A WORLD-FIRST study to test whether boosting testosterone levels could help prevent type 2 diabetes in men will get underway in Australia this year.
Hypertension leading cause of death, disability worldwide
HIGH blood pressure contributes to more death and disability worldwide than any other risk factor, a global study shows.
Low rates of contraception with teratogenic drug use
GPs have been warned to advise women with diabetes who are of childbearing age about the risks of potentially teratogenic drugs, after a study revealed low rates of contraceptive use in patients at risk.
New tool for diabetes patients to help with HbA1c changes
NURSES are being encouraged to point patients with diabetes in the direction of a new tool that will help them understand changes in the way their HbA1c results are reported.
Fertility often ignored in chronic disease
Women with chronic non-communicable disease have concerns about their fertility that aren’t being addressed, according to an Australian study.
Increased stroke at younger age leads to greater ‘life time disability’
ISCHAEMIC stroke incidence has increased in younger age groups since the early 1990s, with almost a fifth of these patients now aged under 55, research suggests.
Study finds diabetes screening does not reduce mortality
THE benefits of screening for type 2 diabetes could be restricted to individuals with detectable disease, according to a general practice study.
Breast cancer risk higher in postmenopausal women with diabetes
POSTMENOPAUSAL women with type 2 diabetes are 27% more likely to get breast cancer than other women at the same stage of life, a meta-analysis has found.
GPs want more progress on addiction, dementia
BLOOD pressure, diabetes and cholesterol have all been nominated by MO’s GP readership as areas in which they and their colleagues have had the greatest impact on patient outcomes during MO’s 25 years of publication.
Statins' CV benefit outweighs diabetes risk
THE benefits of statin therapy outweigh the risk of diabetes even among those most likely to develop the disease, according to new findings that experts believe should reassure prescribers.
Spike in end-stage kidney disease fuelled by diabetes epidemic
Australia’s diabetes epidemic is driving a marked increase in end-stage kidney disease with more than a million people a year now being hospitalised for dialysis, a report shows.
Coming soon to iPhone: a glucose monitoring app
A blood glucose monitor that enables patients with diabetes to obtain a test strip reading through their iPhones is set for launch in Australia in September.
Bariatric surgery should not be last resort for diabetes: experts
BARIATRIC surgery should no longer be seen as a last resort in treatment of diabetes, as some procedures improve glycaemic control beyond that expected for weight loss, experts say.
Early insulin therapy won’t lower CV events: study
A LANDMARK trial of early insulin initiation in patients with or at risk of type 2 diabetes plus cardiovascular risk factors or disease has failed to demonstrate that it confers any benefit in reducing CV events or mortality.
Safety of short-term glargine use confirmed
The jury is now in on short-term use of insulin glargine – and the finding is that it does not cause cancer, experts say.
Doubt over RAAS use in teens
HIGH rates of renal complications and poor survival among teenagers with type 2 diabetes raises questions about the use of RAAS inhibitors in these patients, researchers say.
Exercise referral program a local hit
A SYDNEY GP division’s partnership with local doctors and fitness providers has been so successful it is set to expand.
Behavioural modification most effective in diabetes prevention
FUNDING intensive behaviour modification programs would be far more effective at reducing the toll of diabetes than instituting a junk food tax, Australian researchers say.
Targeting behaviour better than a junk food tax
FUNDING intensive behaviour modification programs would be far more effective at reducing the toll of diabetes than instituting a junk food tax, Australian researchers say.
Reassurance that contact lenses safe for patients with diabetes
MANY patients with diabetes can safely wear contact lenses despite being more susceptible to infections, according to a review.
Health damage from youth diabetes hard to reverse
THE largest study yet to investigate how to treat type 2 diabetes in teenagers found nearly half of them failed to maintain glycaemic control and one in five experienced serious complications.
$30m diabetes pilot under way across Australia
The Gillard government’s $30 million diabetes pilot has begun in earnest, with participating practices embarking on a patient recruitment drive.
Demands for over-40s to be diabetes tested
ALL Australians over the age of 40 would be funded to undergo annual diabetes testing, according to a broad-reaching new policy document from Diabetes Australia (DA).
Register will track bariatric surgery data
THE long-term impact of bariatric surgery on diabetes and other obesity-related comorbidities will be tracked using a new registry.
Autism link to maternal obesity
OBESE mothers are more likely to have children with developmental disorders including autism, a study shows.
Chronic disease risk factors rife among Aussies
MOST Australians have at least one preventable risk factor in their lifestyle that could lead to chronic disease, according to a new report.
5kg gain after quitting raises risk of type 2
AN INCREASED risk of type 2 diabetes associated with quitting smoking is confined to patients who gain at least 5kg when they give up tobacco, a study suggests.
Diabetes in Gen Y set to skyrocket
ONE in three members of generation Y is set to develop type 2 diabetes during their lifetime, according to new modelling.
Statin relabelling sparks ‘hysterical overreaction’
CHANGES to labelling requirements on statins in the United States have prompted “an hysterical overreaction” in the lay media, according to Sydney lipids expert Professor Leon Simons.
Increased diabetes risk for women on statins
POSTMENOPAUSAL women prescribed statins to lower their cholesterol have a higher risk of developing new-onset diabetes mellitus than women not taking statins, US research shows.
New national ‘holistic’ diabetes scheme unveiled
THE $1200-a-patient fixed payment to practices is all but gone, most MBS rebates will remain, and practices will be paid to hire new staff to manage red tape, under a new version of the national diabetes scheme about to be trialled.
Pig cells soon to treat Parkinson’s
TRANSPLANTING porcine organs into humans remains a distant hope, but using pig cells to treat conditions like Parkinson’s disease is only a couple of years away, experts say. Although rejection of pig organs in non-human primates has been limited by genetically modifying pig donors to protect the transplanted tissues, the best organ survival times, around 200 days for a heart, are still low, international transplantation experts wrote in a Lancet review of xenotransplantation. “The results of preclinical transplantation of pig cells – for example, islets, neuronal cells, hepatocytes or corneas – ...
Rare diabetes type may be over-treated
SOME patients with diabetes may be over-treated because doctors are unaware that they have an uncommon form of the disease attributable to a single genetic cause, an expert says. Monogenetic diabetes was caused by a single mutation to one of several genes and affected 2–5% of patients with diabetes, according to Dr Andrew Cotterill, director of paediatric endocrinology at the Mater Children’s Hospital, Brisbane. It was important to identify these patients because family members would be affected, the patient can often stop taking insulin, and follow-up need only be annual, Dr Cotterill told the Australian Diabetes Society ...
Conflicting advice on eggs in diabetes diet
PEOPLE with type 2 diabetes should ignore current Australian advice on egg consumption with the latest evidence suggesting an egg a day increases mortality, the Australian Diabetes Society conference was told. Dr Alan Barclay, head of research at the Australian Diabetes Council, presented data from a literature review of eight studies on egg consumption to the society’s annual scientific meeting in Perth last week. Three large studies showed daily egg consumption increased the risk of cardiovascular disease in people with existing diabetes, and a small study showed eating an egg a day increased all-cause mortality in people ...
AusDiab to study impact of environment on health
THE ONGOING AusDiab study will for the first time assess the health impact of environmental factors such as access to green space and proximity to fast food outlets. Some 8300 participants will take part in the third round of the study, funded by the NHMRC, to measure blood pressure, cholesterol and blood glucose, and assess diet and other lifestyle factors. Researchers led by Professor Paul Zimmet from the Baker IDI, Melbourne, will for the first time use geocoding to determine each participant’s access to lifestyle-enhancing amenities by assessing the built environment near their residential address. The ...
Replacing carbs with nuts in diabetes
EATING nuts as a replacement for carbohydrates might improve glycaemic control and lower lipids in patients with type 2 diabetes, a study shows. Canadian researchers found snacking on nuts as part of a balanced diet decreased HbA 1c levels, and significantly decreased LDL cholesterol. A total of 117 patients, mean age 62 years, were randomised to eat either 75 g of mixed nuts a day, muffins or half portions of each as part of a 2000 kcal diet for three months. Only eating the full nut dose had a significant effect, reducing HbA 1c levels by 0.21%. No ...
Doubts over tight glucose control
INTENSIVE glucose control should be the goal in people with early type 2 diabetes, an expert says, despite the fourth and largest meta-analysis showing it produces no reduction in mortality. In a meta-analysis of 13 studies in more than 30,000 patients, French researchers showed intensive glucose lowering did not lower all-cause or cardiovascular mortality compared with standard treatment. The rate of non-fatal myocardial infarctions was 15% lower with intensive treatment, but not after excluding low quality trials. Intensive treatment had an effect on only one microvascular outcome, lowering microalbuminuria by 10% compared with standard treatment. ...
Call to probe sex toys link to infertility and diabetes
GERMANY'S Green party has called on the German government to probe the level of potentially dangerous chemicals in plastic sex toys that studies suggest cause infertility and diabetes in women. Filing the formal request in parliament this week, Greens MP Volker Beck said consumers needed to be protected when it came to sexual health. “Feigned embarrassment or false taboos should not prevent information getting out and checks being done," the MP said. The party wants Chancellor Angela Merkel's government to investigate legal limits on the levels of certain chemicals in dildos, vibrators and other sex aids ...
Gender sways obesity advice to patients
OBESE male patients who visit male doctors are more likely to receive weight-related counselling than obese female patients seeing female doctors, a study has found. US researchers believe male doctors may be able to successfully tap into a deep-seated belief that physical fitness is linked to masculinity. Data from clinical encounters between 5667 obese adult patients and their doctors was analysed to look at the association between patient-doctor gender concordance and diet/nutrition, exercise and weight reduction. Obese men in concordant pairs had 58% higher odds of receiving diet/nutrition counselling ...
Glitazone cuts conversion to type 2 at a cost
PIOGLITAZONE can reduce conversion to type 2 diabetes but at a cost of weight gain and oedema, a trial has shown. US researchers studied the effects of 30 mg pioglitazone per day compared with placebo in 600 patients with impaired glucose tolerance and baseline mean BMI of 34.5. Pioglitazone reduced the risk of converting from impaired glucose tolerance to type 2 diabetes by 72% over 2.4 years (48% pioglitazone vs 28% placebo), the manufacturer-supported study found. Treatment of 18 participants for a year prevented one case of diabetes. However, weight gain in the pioglitazone group was ...
UK expert backs pay-for-performance models
A LEADING UK healthcare expert has endorsed the Gillard Government’s decision to pilot its pay-for-performance (PFP) diabetes care scheme, saying the controversial funding model is a potentially important element in the future of primary care. Dr Stephen Campbell, senior research fellow at the University of Manchester’s National Primary Care Research and Development Centre, told MO that a similar scheme introduced in the UK had proven the concept could work. Even better results could have been achieved if the scheme had been piloted before implementation, he added. Dr Campbell was due to deliver a public lecture on the ...
Diabetes for life
A recent child suicide has highlighted the difficulties faced by kids with chronic conditions like diabetes. Kate Woods asks, are we focusing too much on the physical targets at the expense of the children’s mental wellbeing?
Setback for pay-for-performance scheme
THE Gillard Government’s hopes for a future pay-for-performance diabetes scheme have been dealt another blow, with a UK study suggesting the change would encourage GP “gaming” and worsen health disparities. A study of 4000 patients with diabetes registered with 23 London practices found that pay-for-performance – which is already fully operational in the UK – encouraged crowded or “more deprived” clinics to exclude older and longer-term patients from reporting benchmarks. Excluded patients were less likely to achieve treatment targets, according to the study authors, who warned that “permitting physicians to exclude patients from pay-per-performance programs may worsen ...
Free medicines to tackle Brazilian poverty
THE Brazilian Government is set to provide free medicines to treat hypertension and diabetes in a bid to end poverty, BBC News reports. The drugs will be distributed through a nationwide Popular Pharmacies network of 15,000 budget chemists and will be available to all patients with a doctor’s prescription. Newly elected president Dilma Rosseff indicated the new measure was part of a campaign to end poverty in Brazil. In 2009, hyper-tension and diabetes were responsible for 34% of deaths in Brazil. The country has been widely praised for providing free antiretroviral drugs to patients ...
Setback for pay-for-performance scheme
THE Gillard Government’s hopes for a future pay-for-performance diabetes scheme have been dealt another blow, with a UK study suggesting the change would encourage GP “gaming” and worsen health disparities. A study of 4000 patients with diabetes registered with 23 London practices found that pay-for-performance – which is already fully operational in the UK – encouraged crowded or “more deprived” clinics to exclude older and longer-term patients from reporting benchmarks. Excluded patients were less likely to achieve treatment targets, according to the study authors, who warned that “permitting physicians to exclude patients from pay-per-performance programs may worsen ...
Targeting HbA1c
Just how low should HbA1c go? Kate Woods looks at the argument surrounding glycaemic control.
Top 10 - A year living on the edge
It’s been a tumultuous year on the political scene. MO counts down the major events of 2010.
Botched circumcision leads to suspension
A MELBOURNE GP has been suspended for three months after botching a circumcision that left a young patient requiring months of reconstructive surgery. In a decision handed down by the Victorian Civil and Administrative Tribunal last month, Dr Mohammed Mateenul Jabbar was reprimanded for unprofessional conduct after he inappropriately performed the procedure on a 26-month-old child at his private clinical rooms. The tribunal found Dr Jabbar failed to take into account the patient’s complete medical history, specifically his type 1 diabetes, and the increased risk of complications from this. It was found that during the procedure, ...
Supplements may curb diabetes
VITAMIN C and calcium supplements may offer some protection against the onset of diabetes, according to a large prospective study. US researchers asked more than 200,000 participants about their supplemental vitamin and mineral use, and reviewed diabetes prevalence among the cohort four years later. Those who used vitamin C supplements had a 9% lower risk of developing diabetes compared to non-users, the researchers found at follow-up, while those who used calcium supplements had a 15% lower risk. The data, which was adjusted for confounders, including general health status, also showed that using multivitamins was not associated ...
‘Patchy’ diabetic foot care needs improvement
COMPREHENSIVE “foot protection programs” should be routinely adopted for patients with type 2 diabetes to reduce their risk of amputations, experts say. Education about foot hygiene and appropriate footwear should form the mainstay of such programs, backed up by regular podiatry reviews, say new national guidelines for foot complications in type 2 diabetes. Practices should also keep in regular touch with podiatrists and ensure patients know who to call if their feet deteriorate. With diabetic foot care in Australia still “very patchy”, guidelines chair Associate Professor Jonathan Shaw urged more practices to adopt comprehensive programs and ...
‘Patchy’ diabetic foot care needs improvement
COMPREHENSIVE “foot protection programs” should be routinely adopted for patients with type 2 diabetes to reduce their risk of amputations, experts say. Education about foot hygiene and appropriate footwear should form the mainstay of such programs, backed up by regular podiatry reviews, say new national guidelines for foot complications in type 2 diabetes. Practices should also keep in regular touch with podiatrists and ensure patients know who to call if their feet deteriorate. With diabetic foot care in Australia still “very patchy”, guidelines chair Associate Professor Jonathan Shaw urged more practices to adopt comprehensive programs and ...
Early data linking pioglitazone with cancer under investigation
US regulators are investigating a possible link between pioglitazone and bladder cancer, based on early data supplied by the drug’s manufacturer. No link has been proven yet, and the FDA says patients should continue taking the drug. An observational study has flagged a possible link in patients with the longest exposure to the drug and highest cumulative doses, the US Food and Drug Administration (FDA) said. Eli Lily, distributors of pioglitazone in Australia, were unable to comment on the FDA’s announcement at time of going to press. The announcement comes at a troubled time for ...
Breastfeeding can prevent maternal diabetes
MOTHERS who breastfeed their babies are also reducing their own risk of developing diabetes, US research suggests. Just a month of breastfeeding was enough to almost halve rates of diabetes compared to mothers who never breastfed. And even among mothers who did breastfeed, those doing so exclusively had a lower diabetes risk than non-exclusive feeders. The mechanisms are unclear but lactation is thought to reduce visceral fat, improve glucose metabolism and affect hormone levels and sensitivity. Animal studies have found that lactation can increase sensitivity to insulin. “Our study provides another good reason to encourage ...
Magnesium may prevent diabetes
MAGNESIUM could be an important yet under-recognised factor in the development of diabetes, a new study suggests. Twenty-year follow-up of 4500 healthy US young adults (18-30 years) revealed those with the lowest magnesium intake were almost twice as likely to develop diabetes. Conversely, high magnesium intake – by diet or supplementation – appeared to reduce systemic inflammation and boost insulin sensitivity. The findings built on a recent trial showing magnesium supplementation improved insulin sensitivity in non-diabetics, prompting the authors to call for research on whether supplementation can stave off diabetes. Associate Professor Stephen Twigg, president of ...
UK patients back nurse prescribing
PATIENTS are happy to accept nurse prescribing in the management of chronic conditions, a new UK study has revealed, with many claiming there are distinct advantages. Researchers from the division of health and social care at the University of Surrey focused on the experiences of the patients of seven nurse prescribers working within National Health Service primary care settings. All the patients had diabetes and their condition was being managed in part by nurse prescribers. Patients reported that seeing a nurse prescriber meant they saw a doctor less often, and that as appointments with nurse prescribers ...
Magnesium may prevent diabetes
MAGNESIUM could be an important yet under-recognised factor in the development of diabetes, a new study suggests. Twenty-year follow-up of 4500 healthy US young adults (18-30 years) revealed those with the lowest magnesium intake were almost twice as likely to develop diabetes. Conversely, high magnesium intake – by diet or supplementation – appeared to reduce systemic inflammation and boost insulin sensitivity. The findings built on a recent trial showing magnesium supplementation improved insulin sensitivity in non-diabetics, prompting the authors to call for research on whether supplementation can stave off diabetes. Associate Professor Stephen Twigg, president of ...
Election health promises hang in the balance
GPs appear no closer to knowing what direction health system reform will take with both major parties still courting the support of independents they will require to form government. Labor’s sweeping health reforms, including the future of 23 new GP super clinics and its controversial $436 million patient enrolment and pay-for-performance diabetes scheme, now hang in the balance. Similarly, the Coalition’s promises to scrap the super clinics initiative and increase rebates for long consultations, after-hours work and practice nurses also remain in doubt. RACGP president Dr Chris Mitchell said while it was difficult to know what ...
AMA faces off with Government in new health reform rebellion
AMA Victoria has upped its pressure on the Government ahead of the coming election, encouraging GPs in marginal electorates to discuss potentially negative impacts of health reform with their patients. GPs in marginal Victorian electorates will this week receive brochures to display, distribute to and discuss with their patients. The campaign, Beware faceless medicine , warns patients their right to choose their GP may be hampered by government reforms such as the controversial diabetes scheme. “It is a neat administrative arrangement but it potentially denies patients the right to see the doctor of their choice,” ...
New concerns over replacement diabetes drugs
NO SOONER have second-line diabetes drugs begun jostling to fill the rosiglitazone void, than experts have issued a safety warning about one of the contenders. With DPP-4 inhibitor use predicted to rise, researchers have called for further investigation into a spate of apparently serious allergic reactions to sitagliptin. Thirty-seven of the 48 reported cases (77%) were hospitalised, and four required ventilator support or intensive care treatment. In 75% of cases, the reaction resolved after withdrawal of the drug. Professor Don Chisholm, head of the diabetes and obesity research program at Sydney’s Garvan Institute of Medical Research, ...
HbA1c test for diabetes diagnosis imminent
AUSTRALIAN GPs will be diagnosing diabetes using HbA1c within the next 12 months, experts believe, despite concerns that the test is not as accurate as current glucose testing. With the international community poised to back HbA1c as the test of choice, opinion leaders expect Australia to follow suit and introduce a Medicare rebate for HbA1c as a diagnostic test. There remains considerable debate among experts about the merits of diagnosing with HbA1c, and it remains unclear how the move will affect the prevalence of diabetes in Australia. However, the extra convenience for patients and doctors of ...
Trial suffers setback as tide turns against rosiglitazone
REGULATORS have halted further enrolment into a major ongoing trial of the controversial diabetes drug rosiglitazone. The TIDE trial – a head-to-head comparison of rosiglitazone and pioglitazone – was due to enrol 16,000 patients from 15 countries and finish in 2015. However, the US Food and Drug Administration has placed TIDE on “partial clinical hold” until further notice. Patients already enrolled can continue to participate. Australian experts have been divided on the trial, with some saying it is unethical in light of rosiglitazone’s safety concerns and calling for it to be stopped entirely (MO online, 25 ...
Trial suffers setback as tide turns against rosiglitazone
REGULATORS have halted further enrolment into a major ongoing trial of the controversial diabetes drug rosiglitazone. The TIDE trial – a head-to-head comparison of rosiglitazone and pioglitazone – was due to enrol 16,000 patients from 15 countries and finish in 2015. However, the US Food and Drug Administration has placed TIDE on “partial clinical hold” until further notice. Patients already enrolled can continue to participate. Australian experts have been divided on the trial, with some saying it is unethical in light of rosiglitazone’s safety concerns and calling for it to be stopped entirely (MO online, 25 ...
Air quality linked to multi-system diseases
AIR pollution not only affects the heart and lungs, it is also contributing to the diabetes epidemic and may even be a trigger for suicide. Experts have long warned that smog contributes to the risk of respiratory and cardiovascular diseases, but new research suggests the effects on health are more widespread. A US study found diabetes prevalence was consistently higher in heavily polluted areas, with every 10 µg increase in particulate matter 2.5 (PM2.5) levels linked to a 1% increase in prevalence. Even where pollution fell within recommended limits, diabetes prevalence was up to 20 times ...
AMA enlists patient support to stand up for GPs
THE AMA has come out fighting on general practice issues, launching a campaign in the lead-up to the federal election amid concerns over the profession’s future under planned sweeping health reforms. As part of the campaign, Family Medicine is running out of time, the association has called on all parties to develop policies which “support and preserve” the vital role of GPs. And, in a rare move, it is now seeking to enlist the support of patients. A patient petition demanding that the Government cut red tape, ensure patients have the right to choose their ...
Vitamin D link to death in type 2 diabetes patients
EVIDENCE is growing to suggest that severe vitamin D deficiency significantly increases the risk of death in patients with type 2 diabetes. Fifteen-year follow-up of a group of Danish patients found that those with plasma vitamin D levels below 13.9 nmol/L – the lowest 10% percentile – faced double the risk of all-cause and cardiovascular mortality. The increased risk persisted even after adjustment for diabetes duration, HbA1c, kidney function and cardiovascular risk factors. Researchers followed up 289 hospital outpatients – 196 of whom died over the study period. Although causality remains unproven, they said the ...
Rosiglitazone remains but experts debate withdrawal
US regulators have thrown a lifeline to diabetes drug rosiglitazone as experts continue to debate whether the drug should be withdrawn. Members of a US Food and Drug Administration (FDA) advisory committee last week voted to keep the drug on the market. Twelve of the 33 members recommended withdrawal; 10 voted to restrict sales and accentuate label warnings; seven voted for tighter warnings only; three voted for no changes; and one abstained. Several recent studies have linked rosiglitazone to increased risks of adverse cardiovascular outcomes and mortality, although other findings have conflicted. At most, 20,000 ...
Roxon defends diabetes scheme after survey backlash
HEALTH Minister Nicola Roxon has been forced to defend the Government’s controversial block funded diabetes management scheme, with GPs overwhelmingly rejecting the scheme according to a new poll. A national online survey of 487 GPs conducted by the AMA found that just 4% of respondents planned to adopt the blended block funding and pay-for-performance model for diabetes management set to come into force from 2012. Sixty-four per cent of GPs said they would not sign up to the voluntary model while 32% remained unsure about the benefits of the new system over existing fee-for-service arrangements. The ...
Lower BP no benefit in diabetes and CAD
LOWER blood pressure targets for patients with diabetes and coronary artery disease (CAD) may not achieve their aim of improving cardiovascular outcomes. A US secondary analysis of 6400 patients with diabetes and CAD has challenged 2008 Australian Heart Foundation guidelines recommending BP targets of less than 130/80 mmHg in patients with diabetes and/or coronary heart disease. There was little difference in the rate of cardiovascular events between those maintaining systolic BP under 130 mmHg and those with “usual” control (130/80 mmHg to 145/85 mmHg). And when extended follow-up data was included, those in the tighter controlled ...
Lower BP no benefit in diabetes and CAD
LOWER blood pressure targets for patients with diabetes and coronary artery disease (CAD) may not achieve their aim of improving cardiovascular outcomes. A US secondary analysis of 6400 patients with diabetes and CAD has challenged 2008 Australian Heart Foundation guidelines recommending BP targets of less than 130/80 mmHg in patients with diabetes and/or coronary heart disease. There was little difference in the rate of cardiovascular events between those maintaining systolic BP under 130 mmHg and those with “usual” control (130/80 mmHg to 145/85 mmHg). And when extended follow-up data was included, those in the tighter controlled ...
Election speculation casts cloud over future of health reforms
WITH speculation rife that Prime Minister Julia Gillard will call a snap federal election, questions still hang over key planks of the Federal Government’s health reforms. While the landmark Council of Australian Governments deal struck early this year will see new monies flow to health services around the country, a sudden election could see key pieces of health reform legislation delayed. The National Health and Hospitals Network Bill – which includes provisions for the controversial diabetes scheme – remains before the House of Representatives. While it is expected to pass through the Lower House, an easy passage ...
Rosiglitazone debate continues
THERE is no longer any clinical justification for prescribing rosiglitazone and ongoing trials of the drug should stop immediately, a leading expert believes, following the release of new evidence. Professor Duncan Topliss, former chair of the TGA’s Adverse Drug Reactions Advisory Committee, said, based on current evidence, rosiglitazone would never have been registered. His comments follow publication of new observational data from the US Food and Drug Administration linking the drug to an increased risk of heart failure, stroke and all-cause mortality compared with pioglitazone. An updated meta-analysis also showed an increased risk for myocardial infarction ...
Drugs battling diabetes but ‘losing the war’
THE limitations of drug treatments as a panacea for type 2 diabetes must be recognised if the global burden of the disease is to be reduced, The Lancet says. In a special issue last week, the journal reported that since 2000 the number of people with diabetes had more than doubled to 285 million globally. “The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportions is a public health humiliation,” an editorial said. It called for “imaginative” responses involving physical activity and attention to diet rather than focusing on medical intervention alone. ...
Drugs battling diabetes but ‘losing the war’
THE limitations of drug treatments as a panacea for type 2 diabetes must be recognised if the global burden of the disease is to be reduced, The Lancet says. In a special issue last week, the journal reported that since 2000 the number of people with diabetes had more than doubled to 285 million globally. “The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportions is a public health humiliation,” an editorial said. It called for “imaginative” responses involving physical activity and attention to diet rather than focusing on medical intervention alone. ...
Glargine cancer link debated
THE jury is still out on the safety of insulin glargine after recent reports again raised the possibility it was linked to an increased risk of cancer. An Italian retrospective case-control study found a higher incidence of cancer among patients taking high-dose insulin glargine compared to other insulins and analogues. But Professor Duncan Topliss, director of diabetes and endocrinology at Alfred Health, said the findings were far from definitive, given the convoluted nature of the analysis. Despite the authors’ best attempts to adjust for confounders, the picture remained clouded by the high numbers of comorbidities in ...
Fasting during Ramadan raises risk for patients with diabetes
WITH the Muslim holy month of Ramadan due to begin in August, clinicians should be proactive in dispensing advice to patients with diabetes who wish to fast, British experts say. They have developed an advice chart to aid clinicians in managing Muslim patients with diabetes during Ramadan, when Muslims are required to fast during daylight hours. They advise first assessing the patient’s level of risk, with those at high risk (e.g. with severe and recurrent episodes of hypoglycaemia and unawareness or with poor glycaemic control) advised not to fast. Patients judged at moderate risk (well-controlled patients ...
Obesity a govt policy failure
EMPHASIS on encouraging people to eat less and exercise more has allowed government and industry to avoid responsibility for the obesity epidemic, an Australian expert believes. Professor Martin Silink, head of paediatric endocrinology at the University of Sydney, said the focus on personal responsibility meant governments, the food and advertising industries, and society in general, were inadvertently absolved from “accepting their part in the policy failure that has allowed an obesogenic environment to flourish”. “The danger of reducing the complex problem of obesity into a simple statement is that it holds back the development of rational ...
Glargine cancer link debated
THE jury is still out on the safety of insulin glargine after recent reports again raised the possibility it was linked to an increased risk of cancer. An Italian retrospective case-control study found a higher incidence of cancer among patients taking high-dose insulin glargine compared to other insulins and analogues. But Professor Duncan Topliss, director of diabetes and endocrinology at Alfred Health, said the findings were far from definitive, given the convoluted nature of the analysis. Despite the authors’ best attempts to adjust for confounders, the picture remained clouded by the high numbers of comorbidities in ...
Delay of rosiglitazone study puts heat on FDA
CONTROVERSY over the continued use of rosiglitazone has flared again, following allegations that the US Food and Drug Administration (FDA) is sitting on a new study into the drug’s side-effects. The draft manuscript, posted online by the US Pharmalot blog, purports to show that rosiglitazone increased the risk of stroke, heart failure and death compared with pioglitazone, concluding it should be taken off the market. Lead author Dr David Graham, an FDA epidemiologist, emailed the FDA commissioner late in May to inform her the study was ready for publication but was being delayed by his supervisor. ...
Diabetes impacts mind as early as middle age
THE impact of diabetes on cognitive decline is measurable even in middle-age, a study suggests. In a prospective cohort study, men and women drawn from the general Dutch population underwent cognitive function measurements twice in 10 years. The researchers found that patients with diabetes showed significantly greater declines in memory function, cognitive flexibility and global cognitive function than those without diabetes. Comorbidities such as hypertension, hypercholesterolaemia and central obesity only partly explained the association, the researchers said. Australian epidemiologistand psychologist Professor Kaarin Anstey said while it was well-established that diabetes was a risk factor for ...
Western Australia steadfast on GST takeover resistance
AS the deadline for the Federal Government’s health reforms looms, Western Australia is remaining firm on its refusal to sign up to the controversial plan. With new health funding arrangements set to commence from 1 July, WA remains the only state not to have signed up to the agreement, which would see the Government assume control of 30% of the states’ GST revenue. The revenue would be placed in a pool of funding used to finance health and hospital services. The deal would provide funding for increased GP training numbers, additional money for aged care as well ...
Govt targets HbA1c as marker of success
THE Federal Health Department has given the clearest signal yet that HbA1c levels will used as a benchmark to monitor improvement of patient care and outcomes under its controversial new diabetes funding scheme. The news has led to renewed calls from diabetes and primary care experts for caution in using the measure. There is also ongoing concern that such an indicator would be clinically inappropriate and difficult to implement given the limitations of existing national data. Previous concerns about have also been raised over GPs’ inability to control patient behaviour. Responding to questioning during recent Senate ...
Diabetes discussions vital for GPs and dietitians
BETTER and more timely communication and data sharing between dietitians and GPs is needed to improve the overall management of diabetes, according to new research. The study, based on questionnaires completed by 356 dietitians assessing Medicare’s existing Chronic Disease Management (CDM) program, also found that the limit on the number of services funded under the scheme was a major barrier to better care. Study author Dr Robyn Cant (PhD), research fellow at the Monash University school of nursing and midwifery, found the limited weekly hours worked by private practising dietitians and a reliance on paper-based communication with ...
Clinical e-Audit boosts HbA1c targets
ELECTRONIC clinical audits offer a paperwork-free way to improve indicators in patients with type 2 diabetes and help them achieve their therapeutic targets. As results from the first review of the program show, patients whose GPs completed the National Prescribing Service (NPS) e-Audit had improvements in glycaemic control, blood pressure and lipid levels. Moreover, most GPs who used the tool felt it was relevant and high quality, according to Karin Gurman of the NPS, who presented the results at the recent National Medicines Symposium in Melbourne. “The diabetes e-Audit is safe in terms of [data] transfer ...
Diabetes ups risk of pancreatic, liver cancer
PATIENTS who are hospitalised with type 2 diabetes face an increased risk of developing cancer, a large Swedish study suggests. The link was present for 23 cancers but was most pronounced for pancreatic, with hospitalised patients more than six times as likely to develop this cancer compared to the general population. Liver cancer was the second most common among the study population, with patients facing a fourfold increased risk. The research investigated the outcomes of 125,126 people hospitalised for diabetes between 1964 and 2007 – about half of all Swedish patients with diabetes. Patients with ...
Study backs depression link to insulin resistance
NEW Australian research has shed light on the well known, but poorly understood link between diabetes and depression. A recent study of more than 1700 healthy adults found that those with depression had significantly higher mean insulin resistance, even after adjustment for dietary and behavioural factors. Insulin resistance was increased by 17% in men and 11% in women with depressive disorder. However, the association was reduced after adjusting for waist circumference, suggesting a key role for abdominal fat as a shared underlying factor. “A causal association between depression and insulin resistance that is primarily mediated by increases ...
The down side of diabetes
How much of a role does depression play in diabetes? Kate Woods looks at which entity comes first and how it affects treatment.
Diabetes scheme won’t aid team care
THE Rudd Government’s diabetes management scheme will not address key barriers to more effective team care for patients with chronic conditions. The latest criticism follows the release of a recent qualitative study of 26 urban general practices that found a lack of trust and communication between GPs and allied health professionals, plus existing paper-based referral systems and patient records, was stymieing improved team care. Researchers at the University of NSW found existing team care arrangements provided little incentive for GPs to shift from “working independently as a primary healthcare service provider to part of a team in ...
High-normal glucose after 2hr GTT a risk for CVD
PEOPLE whose fasting plasma glucose (FPG) falls in the upper range of normal may still be at increased risk of cardiovascular death and should be monitored closely. Experts are calling for a renewed focus on postprandial glucose testing to establish risk in this population. This follows recent European data that found participants with a high-normal FPG (5.6mmol/L to 6.1 mmol/L), whose glucose remained elevated (<7.8mmol/L) after two-hour oral glucose tolerance testing, were at increased risk of cardiovascular death compared to those whose glucose quickly returned to baseline. Women in this group faced a 40% increased mortality ...
AMA alternative to diabetes scheme gets RACGP backing
THE AMA’s recently-released alternative to the Rudd Government’s unpopular diabetes plan has won over the RACGP but at least one senior academic is unconvinced of its merits. The alternative model comes a month after the Government unveiled its $436 million diabetes scheme, which will introduce voluntary patient enrolment and pay for performance into general practice. Under the AMA model, existing GP Management Plans would be simplified, allowing patients to access five allied health visits and selected home aids, including safety and mobility equipment, without the need for additional Team Care Arrangements. For patients with chronic and ...
Europe launches Bid to Prevent Type 2 Diabetes
A consortium of diabetes experts from 20 countries has launched the first ever Europe-wide strategy for the prevention of type 2 diabetes. The IMAGE project, funded with €1.2 million ($1.8 million) from the European Union, aims to unify the continent’s fragmented diabetes prevention strategies. The guidelines were released recently at the 6th World Congress on Prevention of Diabetes and its Complications in Dresden, Germany. The guidelines outline how to identify people at risk of type 2 diabetes and how to support changes in their diet and physical activity. Their release comes amid predictions that one in ...
Behind the diabetes scheme
The Federal Government’s controversial diabetes scheme appears to raise more questions than it answers. Andy Kollmorgen reports.
Diabetes groups fear blanket HbA1c targets
A lack of consultation has left experts concerned about the anticipated move towards pay-for-performance targets under the Federal Government’s new diabetes care plans. Key diabetes groups said they were caught unawares by the announcement and were yet to provide input on which clinical measures would be used. Some were worried that practices would be paid according to one-size-fits-all HbA1c targets, and have urged the Government to ensure the system reflects the challenges of treating different patient groups. Associate Professor Shane Hamblin, director of diabetes at Melbourne’s Western Health group, said universal targets were problematic and the ...
GP income threatened by new diabetes scheme
GPs will need to look closely at their practice contracts to ensure their personal earnings don’t take a hit under the Government’s new diabetes scheme. The $436 million scheme will see practices awarded block-funding for each patient they enrol, plus an average bonus payment of $10,800 per year based partly on their performance in keeping patients healthy. Block funding will consist of annual payments of $1200 per enrolled patient, which will be split $950 for general practices and $250 for allied care. It remains unclear, however, whether the $250 for ...
Maternal diabetes history is cardioprotective in women
WOMEN with type 2 diabetes and a maternal family history of the disease have a significantly lower risk of cardiovascular disease than those with no familial history, an Australian study shows. The latest instalment from the Fremantle Diabetes study found a familial history of diabetes conferred a 37% reduced risk of death from all causes and cardiac death, and a 68% reduced risk of incident MI in women with type 2 diabetes. Maternal family history had no effect on male patients and paternal history of diabetes was not associated with any clinical differences. A total of ...
Doubt cast over combined lipid therapies in diabetes
TREATING lipid abnormalities with a combination of a statin and a fibrate does not reduce the risk of cardiovascular events in all patients with type 2 diabetes, research shows. However, the findings do identify a subgroup of patients who benefit from the therapy, an Australian expert says. Around 5500 participants in the ACCORD trial receiving open-label simvastatin were routinely assigned to receive masked fenofibrate or placebo. After a mean 4.7 year follow-up, there was little difference in the primary outcome – first occurrence of non-fatal MI or stroke, or death from cardiovascular causes – between the ...
New gestational diabetes plan divides expert opinion
A BID to lower the thresholds for gestational diabetes mellitus (GDM) could open a “Pandora’s box” by doubling the number of women needing treatment, Australian experts have warned. If adopted, the new criteria would see almost one in five pregnant women diagnosed with GDM, according to Professor Robert Moses, director of diabetes services with the South Eastern Sydney and Illawarra Area Health Service. Intervention rates would likely rise, more babies would be born by caesarean, and healthcare costs would inevitably increase, he said. A new consensus statement from the International Association of Diabetes and Pregnancy Study ...
GP nurses help to drive care plan rise
A RISE in the number of diabetes and asthma care plans completed for patients has been linked to the efforts of practice nurses. The latest Productivity Commission report found patients with diabetes who received an annual cycle of care plan increased from 17% in 2004/5 to 19.8% in 2008/9. Written asthma care plans also went up from 17% in 2001 to 21% in 2007/8 and the proportion of children aged 0-14 years with asthma that had a plan rose from 24.7% in 2001 to 47.8% in 2007/8. Referring to the report, Professor Mark Harris, professor of ...
TGA to review rosiglitazone safety
THE TGA is set to re-examine the safety of rosiglitazone, following a US senate report that has raised new fears about the drug’s cardiovascular risk. The report, released on Saturday, marked the conclusion of a two-year inquiry by the US Committee on Finance, which included a review of internal documents from the drug’s manufacturer GlaxoSmithKline (GSK). Senators accused GSK of downplaying findings that rosiglitazone might increase cardiovascular risk and failing to sufficiently warn patients and regulators. A spokeswoman said the TGA was reviewing the report and awaiting a response ...
Diabetes risk tool reliable for GPs
AN Australian assessment tool has been found to be highly effective in predicting a patient’s diabetes risk, leading experts to call for its use to be more widely adopted in general practice. A revised, ‘patient-friendly’ version of the AUSDRISK tool has been developed by the Baker IDI Heart and Diabetes Institute as part of the Council of Australian Governments (COAG) diabetes reduction initiative. Its developers, who include leading endocrinologists and epidemiologists, said the tool was more valid for the Australian population than existing tools derived from overseas models. It was based on data derived from the AusDiab ...
Weak incentives limit uptake of insulin pumps
PRESSURE is mounting on the Federal Government to overhaul its failing insulin pump subsidy program, which continues to be hampered by low uptake. Just 41 children with type 1 diabetes have received the subsidised pumps – less than a quarter of the 174 that were expected when the $5.5 million program began in November 2008. With the maximum available subsidy capped at $2500 and pumps costing up to $8000, the technology remains unaffordable for many patients without private health insurance, critics say. Paediatrician Dr Peter Goss of Gippsland, Victoria, is Australia’s largest single user of the scheme, ...
Experts agree on uniform criteria for metabolic syndrome
A UNIVERSAL definition for metabolic syndrome has been developed by international experts in an effort to end widespread confusion over diagnostic criteria. The clinical utility of the metabolic syndrome has been controversial but a high-profile group of experts, including Professor Paul Zimmet, of the Baker IDI Heart and Diabetes Institute, reaffirmed its importance in a commentary in The Lancet . The article follows an agreement in October by six major international bodies – including the International Diabetes Federation, International Atherosclerosis Society and the American Heart Association - to unify the cut-points for blood pressure, waist circumference, ...
Drop in diabetic retinopathy and blindness due to better care
RATES of diabetic retinopathy and blindness have fallen since the 1980s thanks to improvements in the care of diabetes, an Australian-led study shows. Earlier identification and initiation of treatment could be driving the decline, the researchers believe. In a systematic review and meta-analysis, they report that the incidence of proliferative diabetic retinopathy (PDR) and severe visual loss (SVL) has dropped substantially. The incidence of PDR before 1985 was 19.5% at four-year follow-up, compared to 2.6% after 1985. Four-year rates of SVL were 9.7% before 1985 and 3.2% after 1985. Similar trends were seen with five-year ...
Australian study backs aspirin in high-risk diabetes
EXPERTS have expressed concerns at reports that aspirin should not be used for primary prevention of cardiovascular disease in patients with diabetes. They say, rather than advising against aspirin use, more should be done to specify which patients would benefit from its use. The comments follow a new Australian study, which found substantial overall mortality reductions from low-dose aspirin, especially in men and those aged 65 years and older. Researchers followed 651 patients with type 2 diabetes, drawn from the Fremantle Diabetes Study, for a mean 11 years. They found that regular aspirin use led to ...
Risk of insulin resistance varies by cultural group
WHICH patients are more likely to develop insulin resistance may be determined by ethnicity, and the degree of adiposity may not be a good guide to risk. A Canadian study comparing 800 men and women from indigenous, Chinese, European and South Asian backgrounds has highlighted the impact of body composition on insulin resistance. Researchers found that at a given amount of body fat, men and women from the Indian subcontinent had less lean mass than Chinese and Europeans after adjustment for weight, height, physical activity and diet. Canadian Aboriginal people also had a high fat to ...
Diabetes patients miss out on essential meds post MI
PATIENTS with diabetes are at greater risk of dying following a myocardial infarction because systemic failures are leading them to be discharged without recommended medications. A nationwide study of 1744 patients with acute MI, attending 39 hospitals, found patients with diabetes were less likely to be discharged with evidence-based medications prescribed. After adjustment for baseline characteristics and therapeutic interventions, patients with diabetes had 79% higher mortality 12 months after MI than patients without diabetes. However, those who received early invasive management and were prescribed guideline-recommended medicines at discharge had a significantly reduced 12-month mortality risk. ...
Debate continues on insulin glargine safety
INTERNATIONAL experts are divided on the safety of insulin glargine, with studies still hinting at links to cancer incidence. Earlier this year four studies published in Diabetologia suggested long-acting insulin glargine (Lantus) might increase the risk of cancer ( MO , 10 July ), though this was played down by Australian experts. New research, presented to the recent European Association for the Study of Diabetes annual meeting in Vienna, indicated an increased risk among the most frequent insulin users, but that this risk might be attenuated by concurrent metformin use. The UK researchers ...
CVD prevention needed after high BP in pregnancy
WOMEN diagnosed with pre-eclampsia or gestational hypertension are at significantly increased risk of developing premature cardiovascular disease and should be targeted for preventive interventions, researchers say. In the largest prospective study of its kind, researchers have demonstrated continuing high cardiovascular risk for the estimated one in 10 women who have hypertensive disorders in pregnancy. The study of more than 15,000 women in Norway showed those with gestational hypertension or pre-eclampsia were likely to have higher BMI, blood pressure and unfavourable lipid profiles up to 16 years later. The researchers also showed repeated bouts of pre-eclampsia put ...
Experts divided over optimum HbA1c targets
EXPERTS around the world are continuing to debate whether HbA 1c targets should be set at 6.5% or 7% after studies published last year queried the benefits of intensive glucose lowering. Professor Earl Hirsch of the University of Washington, in Seattle, US, argued for HbA 1c targets of less than 6.5% for the majority of patients with diabetes. Professor Hirsch presented an analysis of data from the ACCORD study at the European Association for the Study of Diabetes 45th annual meeting in Vienna recently, showing every 1% average increase in HbA 1c was associated ...
Recent weight change linked to diabetes risk
BARIATRIC surgery dramatically reduces the risk of developing diabetes or needing diabetes medications in obese patients, new research shows. A prospective study by Swedish researchers, presented at the European Association for the Study of Diabetes 45th annual meeting in Vienna recently, found obese patients who underwent bariatric surgery had a 75% reduced incidence of diabetes compared to those who did not have surgery. The researchers analysed the impact of bariatric surgery in 2010 middle-aged obese patients with an average BMI of 41.8 kg/m2 recruited from 1987 to 2001, compared with 2037 matched nonsurgical controls. In the ...
Dopplers useful for detecting PVD in diabetes
MEASURING ankle-brachial index (ABI) by Doppler ultrasound is an effective screening tool for peripheral vascular disease (PVD) in patients with diabetes, Australian researchers said at the recent Australian Diabetes Society and Australian Diabetes Educators Association annual scientific meeting in Adelaide. Diabetes educators trained in ABI measurements using Doppler ultrasound screened 102 patients with diabetes, and concluded it was superior to physical examination alone in identifying PVD. An abnormal ABI, classified as below 1.0, was identified in 64% of patients. The researchers found neither age, nor duration of diabetes, appeared to be a predictor of an abnormal ...
Guidelines for individualised HbA1c targets to be released soon
LONG-AWAITED individualised HbA 1c target guidelines, developed by the Australian Diabetes Society (ADS), will soon be published in the MJA , according to one of the guidelines’ authors. The development of the guidelines was prompted by a rethink of aggressive HbA 1c lowering in the wake of three recent trials showing negligible benefits, and some serious adverse events, from intensive glycaemic lowering ( Medical Observer , 29 May ). Associate Professor Wah Cheung, co-director of the Centre for Diabetes and Endocrinology Research at Westmead Hospital, Sydney, told the recent annual scientific meeting of ...
Diabetes treatment on the right track
INTENSIVE therapy in patients with type I diabetes must be implemented early, researchers say, after a long-term study reported much lower frequencies of serious complications. The 30-year follow-up study concluded intensive therapy resulted in substantially lower rates of proliferative retinopathy, nephropathy and cardiovascular disease. Less than 1% of intensive therapy patients became blind, needed a kidney replacement or had an amputation because of diabetes. It proves, the researchers say, that prospects for patients with type 1 diabetes are far better now than in previous years because of the universal implementation of intensive therapy. ...
Moderate glucose control best with heart failure
THE risks associated with intensive HbA 1c reduction have again been highlighted, this time in a study of more than 5800 US veterans with diabetes and heart failure. Researchers found the lowest mortality rate over a two-year follow-up was among those with modest glucose control – HbA 1c levels between 7.1 and 7.8 (17% mortality). In comparison, mortality was 23% among those whose average HbA 1c was more than nine, and 25% among those with average levels 6.4 and under. The findings backed those of the ACCORD trial, which was stopped early due ...
Chronically ill hit hardest by swine flu
PEOPLE who are asthmatic or obese are at especially high risk of developing complications from swine flu, a leading virologist warns. Professor John Mackenzie, a pandemic adviser to the World Health Organization and professorial fellow in infectious and emerging diseases at Curtin University, WA, said most hospitalised cases worldwide involved people aged 20 to 40 years who had an underlying medical vulnerability. “Most of the serious cases are in people with asthma, the morbidly obese, and those with diabetes,” he said. Professor Mackenzie said others at risk were young to middle-aged people with COPD or underlying cardiac disease, and ...
In the mood for lifestyle advice
Appropriate treatment of mood disorders is vital to improve health and for prevention and treatment of lifestyle-related disease. LIFESTYLE-related disease is underpinned by physical inactivity and unhealthy weight gain. In women, this often manifests during the reproductive years as disturbances including obesity, menstrual disturbances, polycystic ovarian syndrome (PCOS) and gestational diabetes (GDM). It then progresses to pre-diabetes, diabetes and cardiovascular disease (CVD) as women age. Lifestyle-related diseases such as PCOS, type 2 diabetes mellitus (DM2) or CVD increase the risk of depression, while depression is a risk factor for lifestyle-related disease. 1 Anxiety is ...
Finding sleep solutions
The effect of sleep on disease risk is becoming clear. IT’S a common statement, often made to shock the uninitiated: “If you live to 80, you’ll spend 27 years of your life sleeping.” But that’s probably not true, particularly in this day and age. A more accurate ending to the statement might be: “You’ll spend 27 years of your life in bed .” Of course, being in bed, even without sleep, has nice connotations for some. However, for many people it’s not that simple; bedtime signifies tossing and turning, uncontrollable twitches, midnight worries, night tremors, ...
Carotid abnormalities seen in young obese
ADOLESCENTS with obesity or type 2 diabetes have dangerous abnormalities of their carotid arteries, leading to an increased risk of stroke and myocardial infarction. US researchers found evidence of increased thickness and stiffness in the carotid arteries of 136 obese youths (aged 10 to 24 years) and 128 youths of the same age with type 2 diabetes, compared with lean peers. The authors said the most important finding was that increased thickness of the common carotid artery and bulb could be found in patients of such age with uncomplicated obesity, demonstrating early changes in vascular structure in ...
Weight gain predictors identified
YOUNG women of healthy weight are actually putting on more than half a kilo a year, according to data from the Australian Longitudinal Study on Women’s Health. Women aged 18 to 23 years gained weight over the decade at a rate of 0.93% per year, equivalent to 605 g/year for a 65 kg woman. Lead researcher Professor Wendy Brown (PhD), from the University of Queensland, told the Heart Foundation Conference in Brisbane yesterday that predictors of high weight gain included gaining a partner, having a baby, and sitting for more than six hours a day. In ...
Psoriasis raises diabetes and HT risk
PSORIASIS is associated with a significantly increased risk of diabetes and hypertension, new research reveals. Analysis of the US Nurses’ Health Study has linked psoriasis with these conditions, underlining the importance of conceptualising psoriasis as a systemic disorder, researchers say. In the study of 78,000 nurses, followed for 14 years, those with psoriasis had more than double the risk of developing diabetes (63% compared to those without psoriasis) and a 17% increased risk of developing incident hypertension. The association was independent of smoking status, alcohol intake and BMI. Dr Stephen Shumack, honorary secretary of the Australasian College of Dermatologists, said evidence was ...
Prevention of foot ulcers in diabetes
This Practice Nurse Clinical Update covers the prevention of foot ulceration and amputation in patients with diabetes. Earn CPD by completing a quiz on this Update Introduction THE risk of foot ulceration is greatly increased if patients with diabetes develop the long-term diabetes complications peripheral neuropathy and peripheral arterial disease (PAD). Around 25% of Australian adults with diabetes fall into this group. An estimated 3400 diabetes-related amputations occur each year in Australia, and most occur secondary to foot ulceration. It is predicted that the number of foot complications ( see ...
Global debate over diagnostic value of HbA1c
AUSTRALIA is likely to buck an international trend that will see HbA 1c measurement become the single diagnostic test for diabetes, until local data on the diagnostic value of the test becomes available. According to a report in the Journal of the American Medical Association , the International Diabetes Federation (IDF) and the leading diabetes bodies in Europe and the US are all likely to propose HbA 1c as the preferred diagnostic test when revised recommendations are published later in 2009. However, Associate Professor Stephen Twigg, president of the Australian Diabetes Society, said the ...
Study supports ARBs for diabetes prevention
NEW evidence has emerged linking the use of angiotensin II receptor blockers (ARBs) to a significant reduction in the incidence of new-onset diabetes. A study of 1024 Japanese patients with coronary artery disease and hypertension randomised to receive 4-12 mg per day of the ARB, candesartan, has found that, compared to 1025 patients using non-ARB therapy (including an ACE-inhibitor), they had a 63% reduced risk of diabetes. However, the finding was a secondary endpoint. For the primary endpoint, prevention of a first major adverse cardiovascular event, the two groups were statistically similar, although candesartan was better tolerated. ...
Antidepressants a diabetes risk?
LONG-TERM use of many antidepressant medications may be linked to an increased risk of type 2 diabetes, research has found. However, Australian experts say the effect could be a consequence of depression rather than treatment. Analysis of a cohort of 165,958 British general practice patients has revealed that those who used antidepressants for more than two years, in moderate to high daily doses, had an 84% increased risk of developing diabetes compared to non-users of antidepressants. The magnitude of risk was similar for long-term use of selective serotonin reuptake inhibitors and tricyclic antidepressants, the authors found. ...
World report - 6 March 2009
• UK VETO FOR ECSTASY DOWNGRADE THE UK government has rejected recommendations to downgrade ecstasy from a class A to a class B drug. The UK Advisory Council on the Misuse of Drugs advised that, based on a review of more than 4000 papers, methylenedioxymethamphetamine (MDMA) was no more dangerous than other amphetamines, which are listed as class B drugs. As a class A drug, ecstasy is ranked alongside heroin, crack cocaine, cocaine and LSD. Downgrading it to class B would have meant lighter sentences for supplying and possession. The council said that, while ecstasy ...
Safety fears over pay for performance
MAKING GP payments contingent on reaching specific clinical targets may result in poorer patient outcomes and even increased mortality risk, experts have warned. As the Federal Government considers introducing a pay-for-performance scheme in Australia, British experts have attacked their government’s performance-based diabetes management policy as lacking evidence and potentially harmful. Under the UK scheme, due to begin next month, GPs will be rewarded with a £3000 ($6640) payment if they lower HbA 1c levels to below 7% in half of their patients with type 2 diabetes. However, in a BMJ editorial, two British ...
A2 milk benefits rejected
SUGGESTIONS that A2 milk protects against autism in children, as well as against a range of other conditions including schizophrenia and diabetes, have been dismissed by Food Standards Australia New Zealand (FSANZ). Proponents of A2 milk, which is produced by certain breeds of cattle, such as Guernseys, say that its beta-casein proteins are protective against a range of diseases, especially for people with impaired digestive and immune systems. In contrast, there have been suggestions that A1 milk – the most common form available in Australia – is linked to a higher risk of autism, diabetes and heart ...
Treating normal BP beneficial in diabetes
GUIDELINES for treating patients with type 2 diabetes should recommend the use of antihypertensives, even for those with normal blood pressure, experts say. Findings from a retrospective analysis of the ADVANCE study showed active blood pressure lowering reduced the risk of renal disease even in those below current thresholds for treatment initiation. Researchers at the George Institute for International Health in Sydney and other international centres examined the effect of blood pressure lowering on renal outcomes in 11,140 patients with type 2 diabetes, treated with a fixed-dose combination of an ACE inhibitor (perindopril) and diuretic (indapamide) or ...
New push for lifestyle advice item
THE Australian General Practice Network (AGPN) is pushing for an MBS item number for practice nurses to provide lifestyle advice to patients at risk of chronic diseases, with diabetes prevention the main target. Currently, practice nurses are limited to assisting GPs with health assessments and chronic disease management services such as the Diabetes Cycle of Care, GP Management Plans and Team Care Arrangements. Under item 10997, practice nurses can monitor and support patients with chronic diseases by seeing them up to five times a year, but only after a diagnosis has been made. Julie Porritt, principal ...
‘Fake’ acupuncture could be as useful as the real thing
SHAM acupuncture techniques are just as effective as real acupuncture in preventing headaches and migraines, according to two separate Cochrane reviews. While reviewers concluded that acupuncture was an effective prophylaxis and treatment for both migraines and tension-type headaches, both reviews suggested that faked procedures, where needles are incorrectly inserted, are as effective. A review of 22 trials found consistent evidence that acupuncture proved beneficial in treating acute migraine. The reviewers said acupuncture should be a treatment option for willing patients as it was as effective as prophylactic drug treatment and had fewer adverse effects. ...
New aid could simplify insulin initiation for GPs
A NEW resource produced by Diabetes Australia – NSW aims to help GPs overcome barriers to initiating insulin in patients with diabetes. A DVD will show GPs how to initiate insulin, titrate the dose and follow up the patient over four short consultations. At Diabetes Australia’s recent Diabetes and Diabesity Update Day, Sydney GPs Dr David Lim and Dr John Barlow identified patient-generated obstacles, GP resistance and practice infrastructure issues as the three key barriers that stood in the way of insulin initiation. Dr Lim said that for many patients, insulin was regarded as a threat ...
New debate over glitazone safety
TREATMENT with the thiazolidinedione, rosiglitazone, results in more deaths from any cause than does treatment with pioglitazone, a study of elderly patients with diabetes has confirmed. However, an Australian expert said the latest findings did not provide further clarity on the safety of each agent. A cohort study of more than 28,000 US patients older than 65 years, with type 2 diabetes, found those using rosiglitazone had a 15% greater rate of all-cause mortality and a 13% greater incidence of hospitalisation than those using pioglitazone. The rosiglitazone group also had a 13% higher risk of congestive ...
Debate flares over aspirin role in diabetes
FURTHER doubt has been cast over the value of aspirin for the primary prevention of cardiovascular events among patients with type 2 diabetes. Last week, Japanese researchers presented data at the American Heart Association Scientific Sessions showing the antiplatelet therapy failed to reduce the risk of atherosclerotic events – including fatal and non-fatal cerebrovascular, coronary and peripheral vascular events. The study involved 2539 patients with type 2 diabetes aged 35-80 years, with no history of atherosclerosis, who were randomised to receive either low-dose aspirin (80-100 mg daily) or assigned to a non-aspirin control group. Median follow-up ...
Teens skip insulin for weight control
MANY younger patients with type 1 diabetes regularly omit their insulin injections in a dangerous attempt to control their weight, research shows. Unpublished data from a survey conducted by Diabetes Australia – Victoria and the Centre for Adolescent Health in Melbourne found one in three patients admitted skipping their insulin. And half of those who deliberately missed doses did so on a daily basis. Researchers questioned 243 patients – predominantly women with type 1 diabetes – and found those most likely to miss insulin as a weight-loss method were 18 or 19 years old. Dr Phil ...
Overseas advice to avoid rosiglitazone ‘premature’
AUSTRALIA is unlikely to follow the US and Europe in explicitly advising against the use of rosiglitazone (Avandia) for type 2 diabetes, experts say. New guidelines issued by the American Diabetes Association and the European Association for the Study of Diabetes said rosiglitazone should no longer be recommended for type 2 diabetes at any point during treatment. However, Associate Professor Jonathan Shaw, associate director of Melbourne’s Baker IDI Heart and Diabetes Institute, said the move was premature and it was unlikely NHMRC guidelines would change at present. “It’s still a moving field,” he said. Dr Gary ...
Urine albumin a marker of diabetes risk in men
MEASUREMENT of urinary albumin excretion (UAE) could be a valuable diagnostic tool for predicting the risk of type 2 diabetes in men, but not in women, experts say. A US epidemiological study of 4074 people without diabetes found elevated UAE in men was associated with a dose-dependent increased risk of developing diabetes over nine years. Men with slightly elevated UAE (between 9 and 12 mg/l) had an 81% increased risk of developing type 2 diabetes compared to those with normal levels. The risk was fourfold in those recording a UAE of greater than 200mg/l. The ...
Diabetes aspirin not for primary prevention
EVIDENCE has emerged to cast doubt on the efficacy of aspirin and antioxidants for primary prevention of cardiovascular events in patients with diabetes. A UK multicentre, randomised trial of 1276 adults older than 40 with type 1 and 2 diabetes found a similar rate of primary cardiovascular event occurred in patients receiving daily 100 mg aspirin compared to a control group. A similar rate of serious adverse events, including deaths, occurred in both groups. The findings did not provide any evidence to support its use as a primary preventer, the authors concluded. They added that “few data ...
Plastics pose a disease risk
FOOD Standards Australia New Zealand (FSANZ) will not be reviewing its current advice that the average daily absorption of bisphenol A (BPA) from food and drink packaging is safe. This is despite the latest research linking the chemical to an increased risk of diabetes and cardiovascular disease. A cross-sectional analysis of almost 1500 US adults found those with higher urinary BPA concentrations were 39% more likely to have either of these conditions compared to those with lower concentrations. Higher concentrations were also associated with abnormal liver enzyme levels. No positive association with other common diseases such as ...
Map tracks diabetes control nationwide
A NEW Australian ‘diabetes map’ reveals regions most in need of assistance to increase the number of patients meeting HBA 1c targets. The map, developed by the Mapping Glycaemic Control Across Australia Project, allows GPs and patients to access average HbA 1c levels at state, general practice division and postcode levels. Nationally, between 44% and 54% of patients were not achieving optimal diabetes control – a HbA 1c of 7% or lower. Murrumbidgee, NSW was the division with the highest proportion of patients (75%) achieving their target HBA 1c , while Southern Tasmania ...
Diabetes and depression
Diabetes doubles the risk of depression, but what are the key triggers? Kirrilly Burton reports. “RUN away from Allison, she’s got diabetes – you don’t want to catch it.” Over two decades later, Allison Milnes, now aged 34, vividly recalls this childish jibe yelled out during a game of chase and the intense feelings of isolation it evoked. Diagnosed with type 1 diabetes at eight, Allison is all too familiar with the stigma associated with a chronic illness such as type 1 diabetes, an autoimmune disease unrelated to diet and lifestyle. She’s also ...
Too early to call on once-weekly diabetes treatment
EXPERTS are warning a cautious approach is warranted before considering use of exenatide (Byetta) in patients with type 2 diabetes. The advice follows a US research finding that injecting exenatide once weekly (2 mg) resulted in significantly greater improvements in glycaemic control compared to the twice daily formulation (10 µg), without any increase in hypoglycaemia. However, Professor Duncan Topliss, director of the department of endocrinology and diabetes at The Alfred Hospital, Melbourne, said the 30-week duration of the study, funded by manufacturers Amylin and Eli Lilly, was not sufficient to eliminate a risk of serious adverse events. ...
Arsenic linked to type 2 diabetes
EVEN low levels of exposure to inorganic arsenic, such as from drinking water, may contribute to the risk of developing type 2 diabetes. A US cross-sectional study involving almost 800 adult participants found those with high urine arsenic levels were almost four times more likely to have type 2 diabetes than those with low arsenic levels. Participants with type 2 diabetes had a 26% higher level of total urine arsenic than those without the disease, after controlling for diabetes risk factors and intake of seafood – a known source of arsenic. The authors speculated arsenic could induce diabetes by non-specific mechanisms such ...
Diabetes drug alert: thousands need review
GPs have been urged to review patients taking rosiglitazone, following the sudden removal of key indications for prescribing the drug. Last year, studies linked rosiglitazone (Avandia/Avandamet) to an increased risk of heart failure, which led to bolstered product information warnings. Last week, manufacturer GlaxoSmithKline (GSK) announced the drug will no longer be indicated as triple therapy with metformin or a sulfonylurea or in combination with insulin. GSK said it would also be contraindicated in patients with heart failure and acute coronary syndrome. The drug is now not recommended for patients with known ischaemic heart disease. The ...
Antidiabetic therapy warning
A WARNING issued by the US Food and Drugs Administration (FDA) said there had been six recent reports of haemorrhagic or necrotising pancreatitis, including two deaths, among patients using the diabetes drug Byetta (exenatide). The FDA advised that treatment should cease if pancreatitis was suspected, and antidiabetic therapies other than Byetta should be considered in patients with a history of pancreatitis. Manufacturers Amylin and Eli Lilly said they were in discussion with the TGA about the FDA report. The proportion of cases reporting complications or fatal outcome was similar to that observed in patients with pancreatitis in ...
‘On country’ living reduces chronic disease
LIVING ‘on country’ reduces chronic disease among Aboriginal people, leading to less pressure on rural and remote GPs and the health system, according to senior lecturer and economist David Campbell. Working with the Desert Knowledge Cooperative Research Centre, Mr Campbell said Aboriginal people who were “actively engaged in looking after their country” showed reduced high blood pressure, diabetes and kidney disease. He said relying on medicines to treat chronic illness would fail unless doctors recognised the value of “complementary process”, such as looking after the landscape, hunting, fire management, and arts and crafts. “Healthier Aboriginal communities ...
Retinopathy a red flag for heart disease mortality
SIGNS of retinopathy detected using fundoscopy may be an early warning of an increased risk of death from coronary heart disease (CHD), even in non-diabetic patients, an Australian study has found. Researchers from the University of Sydney used retinal photography to assess the presence and severity of retinopathy among patients in the Blue Mountains Eye Study. They found the risk of death from CHD was 33% higher among non-diabetic patients who had retinopathic changes. Among the 2967 participants, the researchers found retinopathy was present in 28.6% of those with diabetes, and 9.7% without diabetes. The presence ...
World report - 8 August
• BRIT SANDWICHES SALT RICH PRE-PACKED sandwiches are loaded with salt and saturated fat, according to a UK study. Conducted by The Daily Mail and Channel 4, the study found Subway’s 12-inch Meatball Marinara contained 7.2 g of salt – the same salt content as 18 packs of chips. While Pret a Manger’s ‘Picnic cheddar, roast tomatoes and pickle bloomer’ sandwich contained 2.27 g of salt and 16.6 g of saturated fat, 80% more fat than in a Big Mac. The UK’s Foods Standards Agency recently called on the catering industry to revise ...
Diabetes prevention diet in doubt
THE benefit of promoting certain diets for the prevention of diabetes remains unclear, researchers say. A US study of 48,835 postmenopausal women concluded weight loss, rather than micronutrient composition, might affect risk of diabetes, after a low-fat dietary pattern showed no evidence of reducing diabetes risk after eight years. However, CSIRO endocrinologist Dr Peter Clifton said a younger population group would probably reveal more impact from such a diet. An editorial said: “Current nutritional recommendations for the primary prevention of [type 2 diabetes] are limited, with little that is truly evidence-based.” ...
Side-effect warning for enuresis therapy
PRESCRIBERS have been warned of potential side-effects from the use of desmopressin (Minirin, Octostim) for treatment of nocturnal enuresis and diabetes insipidus. The latest ADRAC bulletin said there had been 68 reports of adverse reactions to desmopressin, including 17 reports of convulsions (with or without reported hyponatraemia), and 10 further reports of hyponatraemia alone. The risk of hyponatraemia was greater when using intranasal preparations rather than oral forms, the bulletin warned. TGA indications restrict the intranasal preparation to use only when an oral formulation is not feasible. Australian Adverse Drug Reactions Bulletin 2008; 27(4).
Problem gambling now as common as type 2 diabetes
PROBLEM gambling is now a more widespread health problem than stroke or coronary heart disease and of comparable incidence to type 2 diabetes, experts say. They estimate that 1%-2% of Australians are affected by serious gambling problems. They have urged GPs to take a more active role in its diagnosis by screening for gambling problems in patients who smoke, suffer anxiety, depressive symptoms or have high alcohol or drug use. Simply asking one question – “Have you ever had an issue with your gambling?” – would help identify problem gamblers, they said. The head of Monash ...
Reduced lung function a red flag for diabetes
A REDUCTION in lung function precedes the onset of type 2 diabetes and accelerates throughout the course of the disease in adults, research suggests. A cross-sectional and prospective analysis of more than 1100 people with diabetes and 10,162 non-diabetic middle-aged adults found that both FVC and FEV 1 were significantly lower in those with diabetes (96% vs 103% P<.001 and 92% vs 96% P<.001 at baseline respectively). The differences remained significant after adjustment for a number of variables including demographic characteristics, adiposity, smoking, physical activity index and education. Professor Don Chisholm, head of clinical diabetes ...
Diabetes diagnostic criteria needs review
THE accepted fasting blood glucose threshold at which patients are at risk of microvascular disease has been cast into doubt by new Australian research. According to the authors, the findings could force a rethink on the accepted diagnostic criteria for diabetes. The existing World Health Organization-determined glucose cut-off of 7.0 mmol/L was previously thought to define the threshold separating those at risk, or not at risk, of microvascular disease. Now, using data from three recent studies – involving more than 11,000 people – researchers found there was “no evidence of a clear and consistent glycaemic threshold for the presence or incidence of ...
Granuloma annulare
Dr Adrian Lim discusses this frequently misdiagnosed condition. A 25-year-old man presents with a three-month history of a gradually expanding, asymptomatic, annular plaque over the first knuckle of his right hand. It had not responded to over-the-counter antifungal creams. He has no other abnormal skin findings on examination. What is your provisional diagnosis? The patient had a gradually expanding, asymptomatic, annular plaque over the first knuckle. PROVISIONAL DIAGNOSIS Granuloma annulare Granuloma annulare is a skin condition of unknown cause, usually affecting children and young ...
The vitiligo puzzle
Vitiligo is a common disease that affects about 1% of the population. Vitiligo is characterised by patches of depigmentation of the skin. It affects all races, although it is more visible in dark-skinned individuals. The exact cause of vitiligo is unknown. Melanocytes are absent in vitiliginous areas; however, the cause of melanocyte destruction is not understood. Autoimmune and neurogenic mechanisms have been postulated. At present, there is most evidence for an autoimmune process mediated by T-cells. Vitiligo has been classified into focal, segmental and generalised types, which are differentiated by extent of involvement and course. Generalised vitiligo is ...