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MD-FM Thursday May 8, 2014

Two-year life extension for diabetics treated with insulin after myocardial infarction

 

SARAH:

MD-FM, the latest medical news from around the world… Here’s Peter Goodwin.

 

SEGMENT 1: Type 2 Diabetes: Insulin glycemic control after MI extends life

 

PETER:

Hello! And to begin with, patients with diabetes who had intensive insulin-based treatment after a myocardial infarction lived longer than those treated with conventional glucose-lowering therapy. That was after 20 years follow-up in the DIGAMI-1 trial, a landmark study of type-2 diabetes in Sweden, published in The Lancet Diabetes & Endocrinology. Here’s Sarah Maxwell:

 

SARAH:

Yes, over 600 patients admitted to hospital with a suspected acute MI in the previous 24-hours, were randomly assigned to: either an insulin-glucose infusion for at least 24 hours, followed by insulin injection four times a day for at least three months, or: standard glucose-lowering treatment for one year. Survival was improved on average by two point three years with the intensified insulin-based glycemic control and the benefit lasted for at least eight years…

 

RITSINGER:

It actually strengthens the assumption that if they institute it early after an acute myocardial infarction, the intensified glycemic control might indeed have a beneficial effect on mortality especially in patients with pronounced disgylcemia.

 

SARAH:

Lead study author Dr Viveca Ritsinger, from Karolinska University Hospital, in Stockholm. And she told us the challenge now will be choosing the best treatment for each patient:

 

RITSINGER:

Patients with low cardiovascular risks and no prior treatment with insulin, had actually the best prognosis. And patients with high cardiovascular risk and previous treatment with the insulin, had the worst prognosis.

 

SARAH:

Viveca Ritsinger, from Karolinska University Hospital, in Sweden.

 

SEGMENT 2: Low carb better than low fat diet for type 2 diabetes

 

PETER:

For patients with type-2 diabetes, a low-carbohydrate diet –but not a low-fat diet –reduced inflammation in a study reported by the journalAnnals of Medicine…

 

SARAH:

Yes, 61 patients with type-2 diabetes were randomly assigned to either a low-carb diet or a traditional low-fat diet, under the guidance of a dietician. Weight reductions were similar in both groups but glucose levels decreased more in the group who lowered their carbohydrate intake to 25% of total energy intake:

 

NYSTROM:

Nothing got better in the low fat group. Even though they did reduce the body weight by four kilos, nothing got better. They had no reduction in inflammation and no improvement in blood lipids and no improvement either in glucose levels.

 

SARAH:

That was study co-author Fredrik Nyström from Linköping University in Sweden. Over the two years, only patients in the low-carbohydrate group had lower levels of inflammatory markers in the blood, despite the fact that weight loss was similar in both groups:

 

NYSTROM:

It was not just olive oil and so on that they were recommended to consume, it was completely ok to eat butter and lard and bacon and so on. And they did increase the intake of saturated fatty acids. So even in the face of a larger consumption of saturated fatty acids, the inflammation got reduced on a high fat diet. I think that’s completely new actually.

 

SARAH:

And professor Nystrom has this recommendation for practitioners and patients:

 

NYSTROM:

If you want to reduce inflammation, you better choose fat rather than carbohydrates when you loose weight as a patient with type-2 diabetes. 

 

SARAH:

Fredrik Nyström from Sweden.

 

SEGMENT 3: Calcium supplements do not raise coronary risks in women

 

PETER:

There’s no increased risk of cardiovascular disease for women who take calcium supplementation, according to findings from a prospective cohort study, published in Osteoporosis International. This follows recent reports suggesting that calcium supplements could actually increase women’s coronary risk. The Nurses' Health Study –led by researchers at the Brigham and Women's Hospital in Boston –followed over 74,000 women for 24 years, and found no independent associations between supplemental calcium intake and risk of incident coronary heart disease and stroke.

 

 

SEGMENT 4:  Fruits and vegetables reduce stroke risk

 

PETER:

Eating more fruits and vegetables could reduce your risk of having a stroke. That’s the finding of a meta-analysis that looked at 20 studies published over the last 19 years, reported in the American Heart Association's journal Stroke


SARAH:

Yes, 20 prospective cohort studies, looking at nearly 800,000 men and women and 17,000 stroke events, found that the risk of stroke decreased by 32% with every 200g of fruit eaten daily, and by 11% with every 200g of vegetables per day…

 

PETER:

More good news for the veggie rich diet, but did the researchers adjust for any other possible influential factors here?

 

SARAH:

Yes, they adjusted for: smoking, alcohol, blood pressure, cholesterol, physical activity, body mass index and other dietary variables. They also showed, that age didn’t make a difference. Whether the men and women were older or younger than 55 years of age, there was still a benefit…

 

PETER:

Sounds, great. So, was this a blanket benefit with all fruit and veg or were some more protective than others?

 

SARAH:

Well, it’s hard to be critical of a diet packed with fresh produce regardless of which ones it is, but it seems that: citrus fruits, apples/pears, and leafy vegetables especially might contribute to the protection.

 

 

SEGMENT 5: Drugs better for reducing alcohol abuse

 

PETER:

For adults with alcohol use disorders (AUD’s) a review and meta-analysis of more than 120 studies found that treatment with oral naltrexone or acamprosate showed the strongest evidence for decreasing alcohol consumption…

 

SARAH:

Yes, that’s the finding of data, published in JAMA, that suggests all patients with AUD’s should be offered medication as one of several evidence based treatment options. Study author Daniel Jonas told MDFM the potential benefits are far reaching:

 

JONAS:

The health implications of preventing someone from returning to drinking or of really reducing their alcohol consumption are substantial for things like: mortality, motor vehicle accidents, liver cirrhosis, a number of different types of cancer, cognitive dysfunction, and the list goes on and on but treating these things can just have a really large impact.

 

SARAH:

Daniel Jonas from the University of North Carolina, who said these data show the treatment options for these patients are already on the table...

 

JONAS:

It’s only like a third of people with an alcohol used disorder get any kind of treatment at all. Under 10% get a medication. So there’s a big opportunity to intervene more than we are for people with alcohol use disorders and our study shows there are several medications that can be beneficial and that can help.

 

SARAH:

Daniel Jonas, associate professor of medicine at the University of North Carolina at Chapel Hill.

 

PETER:

But some patients with AUDs might have been put-off in the past from taking their meds because some drugs work by making you quite ill if you drink…

 

SARAH:

That’s right and, in fact, the aversive medication disulfiram was not found to be effective in this particular review. Katherine Bradley, who wrote an accompanying editorial, explained to MD-FM that naltrexone and acamprosate work by a different mechanism:

 

BRADLEY:

They specifically target the underlying biology of the addiction rather than making people sick. And they make people less likely to drink or less likely to drink heavily if they do drink. So by targeting the underlying biology of the addiction, they decrease drinking without the using an aversive.

 

SARAH:

Katherine Bradley, senior investigator at Group Health Research Institute, in Seattle.

 

IN BRIEF 1: Inflammation linked to progression in hand osteoarthritis

 

PETER:

Finally, in brief: patients with hand osteoarthritis inflammatory features seen on ultrasound were found to be independently associated with radiographic progression of structural damage, in a study with 56 patients, followed up for over two years, reported in the Annals of Rheumatic Diseases. And persistent inflammatory features showed stronger associations with progression than fluctuating ones.

The authors say this confirms that inflammation plays a part in causing structural damage in these patients.   

 

IN BRIEF 2: Naturally early menopause raises heart failure risk

 

PETER:

Women who happen to go through the menopause early –between the age of 40 and 45 –are at an increased risk of heart failure. And current or past smoking raise the CV risks even higher. That’s the finding of the first large-scale and long-term study linking early menopause and heart disease –reported in the journal Menopause. Researchers looked at more than 22,000 postmenopausal women in the Swedish National Patient Register and found there was a 40% higher risk of heart failure among those who went through the menopause naturally at an early age, than those who experienced ‘the change’ at the usual age –between 50 and 54. For every one-year increase in age at time of menopause, heart failure rate was lowered by 2%.

 

PETER:

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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