New findings on continuous blood glucose monitoring
Filed under: Type 1, Childhood, Adult Onset, Research
The results of this study on continuous blood glucose monitoring (CBGM) were surprising to researchers, and I can see why. In this study, CBGM's effect on long-term blood glucose control was insignificant.
Researchers evaluated the benefits of two different CBGM devices in a study of over 400 insulin-taking type 1 or type 2 diabetics. 102 were randomly assigned to MiniMed's Continuous Glucose Monitoring System (R) (CGMS) and 100 patients were hooked up to Animas' Biographer. Approximately 200 remaining patients comprised a standard control group or an "attention" control group. The "attention" group was devised to compare against the increased contact with healthcare officials realized by patients on CBGM devices. Makes sense.
A little info for you, MiniMed's CGMS is connected via a wire under the skin, takes blood sugar recordings every 5 minutes and can be worn up to 72 hours. The Biographer works differently, extracting fluid electro-osmotically from the skin for 12 to 15 hours, offering blood sugar readings every 10 minutes. The only 'Biographer' product I could find was Animas' GlucoWatch (R) Biographer, which is literally worn on the wrist.
Patients entering the study had mean A1C levels from 7.0% to 15.5%. All four groups declined in mean A1C, especially during the study's first few months. But 18 months later, the differences in A1Cs were not significantly different from the mean baseline A1Cs nor from other groups.
By no means should anyone write off CBGM from this study. Simon Heller, professor of clinical diabetes and director of research and development with the Sheffield Teaching Hospitals Foundation (England) stated clinicians are still working out how to use the information offered by CBGM, so the lack of significant CBGM benefit in this study is to be expected. Dr. Heller stated CBGM devices should primarily be used as research tools and not marketed to patients. Future research needs to examine how patients and doctors can best use data generated by CBGM to positively impact treatment.
An aside, some experts are saying the average blood glucose level per individual is a better insight into diabetes control than A1C levels. The sharp fluctuations in blood sugars cause many diabetes complications. Don't miss this post by Allie Beatty.
[RESEARCH] Case-control study of self reported genitourinary infections and risk of gastroschisis: findings from the national birth defects prevention study, 1997-2003
Objective To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis.
Design Case-control study with self reported infections from a computer assisted telephone interview.
Setting National birth defects prevention study, a multisite, population based study including 10 surveillance systems for birth defects in the United States.
Participants Mothers of 505 offspring with gastroschisis and 4924 healthy liveborn infants as controls.
Main outcome measure Adjusted odds ratios for gastroschisis with 95% confidence intervals.
Results About 16% (n=81) of case mothers and 9% (n=425) of control mothers reported a genitourinary infection in the relevant time period; 4% (n=21) and 2% (n=98) reported a sexually transmitted infection and 13% (n=67) and 7% (n=338) reported a urinary tract infection, respectively. Case mothers aged <25 years reported higher rates of urinary tract infection alone and in combination with a sexually transmitted infection compared with control mothers. In women who reported both types of infection, there was a greater risk of gastroschisis in offspring (adjusted odds ratio 4.0, 95% confidence interval 1.4 to 11.6).
Conclusion There is a significant association between self reported urinary tract infection plus sexually transmitted infection just before conception and in early pregnancy and gastroschisis.
Drinking diet soda can still kill you
Filed under: Diet
When someone's trying to lose weight, one of the first steps they usually take is switching from full-sugar soda to the diet kind. But that might not be enough, one study shows -- cutting out all soda is the healthiest choice.According to findings from extensive research done in the US, drinking even one diet soda a day can greatly increase your chances of developing metabolic syndrome, which can lead to a heart attack and diabetes. What's more, compared to those who drank less than one soda a day, those who drank one or more were at a 30% greater risk becoming obese and had a 25% greater chance of developing high cholesterol. Yikes!
The healthiest soda is no soda -- drink water instead!
[RESEARCH] Sexual abstinence only programmes to prevent HIV infection in high income countries: systematic review
Objective To assess the effects of sexual abstinence only programmes for HIV prevention among participants in high income countries.
Design Systematic review.
Data sources 30 electronic databases without linguistic or geographical restrictions to February 2007, contacts with experts, hand searching, and cross referencing.
Review methods Two reviewers independently applied inclusion criteria and extracted data, resolving disagreements by consensus and referral to a third reviewer. Randomised and quasirandomised controlled trials of abstinence only programmes in any high income country were included. Programmes aimed to prevent HIV only or both pregnancy and HIV. Trials evaluated biological outcomes (incidence of HIV, sexually transmitted infection, pregnancy) or behavioural outcomes (incidence or frequency of unprotected vaginal, anal, or oral sex; incidence or frequency of any vaginal, anal, or oral sex; number of partners; condom use; sexual initiation).
Results The search identified 13 trials enrolling about 15 940 US youths. All outcomes were self reported. Compared with various controls, no programme affected incidence of unprotected vaginal sex, number of partners, condom use, or sexual initiation. One trial observed adverse effects at short term follow-up (sexually transmitted infections, frequency of sex) and long term follow-up (sexually transmitted infections, pregnancy) compared with usual care, but findings were offset by trials with non-significant results. Another trial observed a protective effect on incidence of vaginal sex compared with usual care, but this was limited to short term follow-up and countered by trials with non-significant findings. Heterogeneity prevented meta-analysis.
Conclusion Programmes that exclusively encourage abstinence from sex do not seem to affect the risk of HIV infection in high income countries, as measured by self reported biological and behavioural outcomes.
Too much exercise can be bad for you too!
Filed under: Research, Exercise
Exercise is an important part of a healthy lifestyle. But in individuals with heart troubles, too much exercise can be a bad thing too -- it can speed up heart failure ... in rats, at least. These findings are in direct opposition to what researchers thought they would find -- that the more they exercised, the healthier rats are. But don't use these findings as an excuse to skip the gym for the next few decades -- it's still thought that a reasonable amount of exercise is better than a sedentary lifestyle. Excessive exercise might be a problem, but a daily walk will not kill you.
[RESEARCH] Mortality in patients with and without colectomy admitted to hospital for ulcerative colitis and Crohn's disease: record linkage studies
Objective To compare mortality outcomes in the three years after elective colectomy, no colectomy, and emergency colectomy among people admitted to hospital for inflammatory bowel disease, to inform whether the threshold for elective colectomy in clinical practice is appropriate.
Design Record linkage studies.
Setting Oxford region (1968-99) and England (1998-2003).
Participants 23 464 people with hospital stay for more than three days for inflammatory bowel disease, including 5480 who had colectomy.
Main outcome measures Case fatality, relative survival, and standardised mortality ratios.
Results In the Oxford region, three year mortality was lower after elective colectomy than after either no colectomy or emergency colectomy, although this was not significant. For England, mortality three years after elective colectomy for ulcerative colitis (3.7%) and Crohn's disease (3.3%) was significantly lower than that after either admission without colectomy (13.6% and 10.1%; both P<0.001) or emergency colectomy (13.2% and 9.9%; P<0.001 for colitis and P<0.01 for Crohn's disease). Three or more months after elective colectomy, mortality was similar to that in the general population. Adjustment for comorbidity did not affect the findings.
Conclusions In England, the clinical threshold for elective colectomy in people with inflammatory bowel disease may be too high. Further research is now required to establish the threshold criteria and optimal timing of elective surgery for people with poorly controlled inflammatory bowel disease.
Mapping Diabetes
Filed under: Type 2, Adult Onset, Diet, Lifestyle, Research, Daily News
Scientists have mapped the genes responsible for causing type 2 diabetes. This new research is giving hope to new tests that can predict an individuals risk for developing the disease and future treatments.
The study compared the genetic make-up of 700 people with type 2 diabetes and a family history of the condition, with 700 diabetes-free people. Four points on the gene map linked to a person's diabetes risk and were confirmed with another group of 5,000 type 2 diabetics. The findings of this research could explain up to 70% of the genetics related to developing diabetes. A particular zinc transporter, known as SLC30A8, which regulates insulin secretion, was shown to have a mutation. Researchers feel they may be able to treat some cases of diabetes by correcting this mutation.
These findings will allow for the creation of a genetic test to predict people's risk of developing type 2 diabetes, as well as better treatments for the presiding cause of their diabetes. Nary a day passes that I am not motivated for the future of all diabetics. This is the type of research that strengthens my faith in the coming of a cure. Identify the nature of the problem and nip it in the bud.
[RESEARCH] Patients' attitudes to the summary care record and HealthSpace: qualitative study
Objective To document the views of patients and the public towards the summary care record (SCR, a centrally stored medical record drawn from the general practice record) and HealthSpace (a personal health organiser accessible through the internet from which people can view their SCR), with a particular focus on those with low health literacy, potentially stigmatising conditions, or difficulties accessing health care.
Design 103 semistructured individual interviews and seven focus groups.
Setting Three early adopter primary care trusts in England where the SCR and HealthSpace are being piloted. All were in areas of relative socioeconomic deprivation.
Participants Individual participants were recruited from general practice surgeries, walk-in centres, out of hours centres, and accident and emergency departments. Participants in focus groups were recruited through voluntary sector organisations; they comprised advocates of vulnerable groups and advocates of people who speak limited English; people with HIV; users of mental health services; young adults; elderly people; and participants of a drug rehabilitation programme.
Methods Participants were asked if they had received information about the SCR and HealthSpace and about their views on shared electronic records in different circumstances.
Results Most people were not aware of the SCR or HealthSpace and did not recall receiving information about it. They saw both benefits and drawbacks to having an SCR and described a process of weighing the former against the latter when making their personal choice. Key factors influencing this choice included the nature of any illness (especially whether it was likely to lead to emergency care needs); past and present experience of healthcare and government surveillance; the person’s level of engagement and health literacy; and their trust and confidence in the primary healthcare team and the wider NHS. Overall, people with stigmatising illness were more positive about the SCR than people who claimed to speak for "vulnerable groups." Misconceptions about the SCR were common, especially confusion about what data it contained and who would have access to it. Most people were not interested in recording their medical data or accessing their SCR via HealthSpace, but some saw the potential for this new technology to support self management and lay care for those with chronic illness.
Conclusion Despite an extensive information programme in early adopter sites, the public remains unclear about current policy on shared electronic records, though most people view these as a positive development. The "implied consent" model for creating and accessing a person’s SCR should be revisited, perhaps in favour of "consent to view" at the point of access.
[RESEARCH] Low dose aspirin and cognitive function in the women's health study cognitive cohort
Objective To determine whether low dose aspirin protects women aged 65 or more against cognitive decline.
Design Cohort study within both arms of the women's health study, a randomised, double blind, placebo controlled trial of low dose aspirin for the primary prevention of cardiovascular disease and cancer, 1992-5.
Setting Women's health study, 1998-2004.
Participants 6377 women aged 65 or more.
Interventions Low dose aspirin (100 mg on alternate days) or placebo for a mean of 9.6 years.
Main outcome measures Women had three cognitive assessments at two year intervals by telephone. The battery to assess cognition included five tests measuring general cognition, verbal memory, and category fluency. The primary prespecified outcome was a global score, averaging performance across all tests. The key secondary outcome was a verbal memory score, averaging performance on four measures of verbal memory.
Results At the initial assessment (mean 5.6 years after randomisation) cognitive performance in the aspirin group was similar to that of the placebo group (mean difference in global score -0.01, 95% confidence interval -0.04 to 0.02). Mean decline in the global score from the first to the final cognitive assessment was also similar in the aspirin compared with placebo groups (mean difference 0.01, -0.02 to 0.04). The risk of substantial decline (in the worst 10th centile of decline) was also comparable between the groups (relative risk 0.92, 0.77 to 1.10). Findings were similar for verbal memory; however, a 20% lower risk was observed for decline in category fluency with aspirin (relative risk 0.80, 0.67 to 0.97).
Conclusion Long term use of low dose aspirin does not provide overall benefits for cognition among generally healthy women aged 65 or more.
Heart disease data may not be gender-specific
Filed under: Research, Women Heart Health, Men Heart Health
We've all heard the expression: There are lies, damn lies, and statistics. I always do my best to remember these very words as I research articles for this blog. As I've pointed out several times, there seems to be a great deal of contradictory information circulating the research field, lending credibility to the aforesaid statement regarding statistics. Understandably, research methods, treatment models, and everything else in between can be the cause of the paucity of irrefutable evidence these days. But, there's simply no excuse for overlooking something as simple as dividing test results by gender. Now being quite honest, I'm not really all up in arms about the whole thing. The Mayo Clinic, however, seems a bit ticked.
According to their own study, the Mayo Clinic determined that it is very rare that researchers will produce a sex-based analysis of their findings. In a review of 64 cardiovascular clinic trials published from July 1 through December 31, 2004, only 153 of the publications provided sex-specific reporting. This is especially dangerous when dealing with diseases that tend to affect one sex more than the other, which is the case with heart disease. Being the number one threat to a woman's health, it is imperative that they know whether published data is skewed in any way by gender involvement.
The researchers from the Mayo Clinic suggest that when female patients are recommended a certain treatment or test, they should ask whether women were included in the research. And, if so (and if known), what percentage of the sample group did they represent.