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Life expectancy for type-1-diabetics has improved substantially

 MD-FM Thursday September 26, 2013 




GENERIQUE

Carillon

 

Sarah:

MD FM, Medical News from around the world with Peter Goodwin.

 

P1

 

PETER:

Hello, and with me is Sarah Maxwell. To begin with, news from the European Association for the Study of Diabetes meeting that took place in Barcelona this week:  a Scottish study found that people with type-1 diabetes now have substantially improved life expectancies, narrowing the gap with the general population

 

SARAH:

The study showed that compared to the general population, life expectancy differences for people with type-1 diabetes aged between 20 to 24, are now 11 years for men and 14 years for women. Much less than the overall difference of 27 years reported in the 1970s. Helen Colhoun, presented these data in Barcelona and said we can still do better

 

Colhoun-1:We can improve the pretty poor state of glycemic control, we can also consider using other treatment modalities as well, for example we are currently doing a large trial on metformin in type-1-diabetes to see what its impact is on cardiovascular outcomes. Smoking rates in type-1-populations are about the same as in the background population, we really really need to get those smoking rates way down. ”

 

SARAH:

That was Professor Helen Colhoun, from the University of Dundee in the UK, whose team analyzed data on nearly 25,000 people with diabetes in Scotland. They’re now studying life expectancy in different subgroups of patients with type-1-disease

 

Colhoun-2: “These are average life expectancy differences figures that I’m presenting today but we know for sure that among people with type 1 diabetes, some people are at much greater risk of complications and earlier death than others and we do need further research to understand why, beyond known risk factor levels, some people seem much more susceptible. ”


SARAH:

Helen Colhoun, from Scotland.

 

P2

 

PETER:  

And a drug formerly used to treat psoriasis has shown encouraging phase-II results in type-1 diabetes. That’s according to results, published in The Lancet Diabetes and Endocrinology, that showed Alefacept preserved the body’s ability to produce its own insulin. It works by targeting specific types of T-cells that attack the pancreas in type-1 diabetes, while preserving other immune cells.

VIRGULE MUSICALE



P3

 

PETER:

When a patient presents to the emergency department with severe headache, study data published in JAMA show that a new tool, that’s been called the OTTAWA sub-arachnoid haemorrhage rule, was more effective than standard practice for excluding a diagnosis of subarachnoid haemorrhage

 

SARAH:

Yes but only for patients fulfilling specific criteria: Those with an acute headache peaking within one hour and no neurologic deficit. The OTTAWA rule relies on specific features of subarachnoid haemorrhage to determine which patients need a CT scan and lumbar puncture

 

PETER:

Hmm, this sounds encouraging but how effective was it?

 

SARAH:

Well, in this trial all cases of subarachnoid haemorrhage were detected when the rule was applied, which is good since about five to 10% of cases are usually missed in practice. But the specificity was only 15 per cent, meaning many patients still had a CT scan and lumbar puncture when they didn’t have subarachnoid hemorrhage. David Newman-Toker wrote an editorial on the study in JAMA

 

Newman-Toker: “I think the rule has shown that it is probably very sensitive and probably better than current practice, but they need to be careful when applying the rule to patients who are at extremely high risk, like patients with a family history or a history of diseases that could increase the risk of subarachnoid hemorrhage to a point where this rule wouldn’t quite rule out all the risks even if the rule suggests otherwise. The main concern is if people apply it over-broadly to all patients with headache and think that what they’re getting is ruling out all the dangerous possible diseases that cause headaches.”

 

SARAH:

That was Dr. David Newman-Toker, from Johns Hopkins University School of Medicine in Baltimore.



VIRGULE MUSICALE

 

P4

 

PETER:

For women needing adjuvant radiotherapy for invasive early breast cancer, shorter radiation treatments and lower doses overall are at least as effective as, and, as safe as the historical standard dose prescribed in many countries according to data reported in The Lancet Oncology

 

SARAH:

Yes, that’s from 10-year follow-up results of a randomized UK START trial, looking at nearly 5000 women which confirmed that, three weeks of increased-dose radiation is just as effective as the traditional five weeks of treatment, that’s typically used. But the important thing is, it also led to fewer adverse events. Senior study author, John Yarnold

 

Yarnold-1: “A three-week schedule of radiotherapy is also, importantly, gentler on the healthy tissues. So there was a 20 percent lower rate and severity of side effects from radiotherapy. And clearly that is easier for patients, it’s cheaper for them and for their health services.”

 

SARAH:

That was professor John Yarnold, from London, who added that this so called “hypo-fractionated radiation” approach has now become the standard care in the UK

 

Yarnold-2: “Some other countries have gone in the same way, for example they are discussed in the French guidelines, they are discussed in the American guidelines. Canada has tested its own schedule for at least the last 5 years. Holland is switching towards the Canadian schedule… Now that we’ve got the 10-year data I think the momentum around the world will increase.”

 

SARAH:

John Yarnold, from The Institute of Cancer Research in the UK.



VIRGULE MUSICALE

 

P5

 

PETER:

For active-duty soldiers with post-traumatic stress disorder, the drug prazosin was very good at reducing trauma-related nightmares, and was also very well tolerated, according to a study published in the American Journal of Psychiatry..

 

SARAH:

Yes, over 15 weeks soldiers were randomized to placebo or prazosin, a drug that’s been used for decades to treat hypertension and benign prostatic hypertrophy. Lead study author, Murray Raskind, gave MDFM the details:

 

Raskind-1: “Both the frequency and the intensity and the quality of dreams changed. Normal dreaming, which often had not been perceived, came back as the trauma nightmares went away.”

 

SARAH:

That was Dr. Murray Raskind, from Seattle, Washington who added that current FDA-approved drugs for PTSD are not very effective for trauma-related nightmares

 

Raskind-2: “These symptoms at night have been very resistant to any sort of pharmacologic or psychotherapeutic treatment… SSRI antidepressants, sedative hypnotic drugs, exposure based psychotherapies, you name it, it hasn’t worked for these nightmares and distressed awakenings. And active duty soldiers often self-medicate with alcohol just to get a little bit of sleep.”



SARAH:

So, what are Dr. Raskind’s main conclusions on prazosin:

 

Raskind-3: “It’s not a cure, usually if prazosin is stopped, even after taking it for a decade, the nightmares and the sleep disruption will re-occur. That said, it’s possible, and this has not yet been studied, that if you institute prazosin very soon after a trauma, you may be able to prevent the development of this propensity for nightmares and sleep disruption.”

 

SARAH:

Dr. Murray Raskind, from University of Washington Medical Center in Seattle.



BREVE 1 Sur fond musical  

 

PETER:

Finally, in brief:

 

For babies at risk of neonatal hypoglycaemia, such as those whose mothers had diabetes, or who were born preterm or with low birthweight, using dextrose gel was more effective than feeding alone for normalising glucose. That’s according to a study, published in The Lancet, that suggests that because dextrose gel is inexpensive and simple to administer, it should be considered for first-line management of hypoglycaemic babies with hypoglycaemia during the first 48 hours after birth.



And…..

 

BREVE 2

 

For adults who’re overweight and obese and have knee osteoarthritis, combining intensive diet and exercise led to less knee pain and better function after 18 months than either diet or exercise alone. The data, published in JAMA, suggest that this combined approach helped patients achieve better long-term weight loss, of more than 10 per cent, and could have both anti-inflammatory and biomechanical benefits.

 

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week. So until then from me Peter Goodwin, goodbye!

 

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