A period of careful eating and regular exercise can stave off diabetes for a decade, a study suggests.

US researchers followed up nearly 3,000 overweight people who had taken part in a three year diabetes prevention programme.

The group had initially been divided into three – assigned either to a diet and exercise programme, the diabetes drug metformin or a placebo.

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The Lancet report notes it was the dieters who reaped the most benefit.

All three groups were given access to ongoing lifestyle coaching once the initial three year trial had ended.

That trial, carried out by the US-based Diabetes Prevention Program Research Group, had shown a diet aimed at achieving 7% weight loss, combined with half an hour of exercise five days a week, reduced the risk of developing Type 2 diabetes by 58% compared with the placebo group.

The group on metformin, a drug which has been used to treat the condition since the 1950s, saw their risk decline by nearly a third.

In the seven years after the trial ended, both the drug and placebo groups – now also eating more carefully and exercising – saw the rate of diabetes fall.

But the most significant drop was among those who had started out on a diet and exercise regime – their risk was over a third lower than the placebo group.

In an accompanying editorial, Dr Anoop Misra, a specialist in diabetes in New Delhi, described the prevention of the disease as “a long and winding road”.

‘No short cut’

Dr Misra said: “There seems to be no short cut, and a persistent and prolonged intensive lifestyle intervention seems to be the most effective way to travel on it.”

But he warned it could not be the only measure: “We need more effective drugs for those who cannot follow intensive lifestyle therapy because of infirmity.”

Type 2 diabetes usually appears in people over the age of 40, however increasing numbers of children are being diagnosed with the condition, some as young as seven.

Although obesity is a risk factor, not all people with type 2 diabetes are overweight.

Dr Iain Frame, head of research at Diabetes UK, said: “It is fascinating to read about the 10-year follow up studies and of the importance of lifestyle interventions, with or without metformin, in the prevention of Type 2 diabetes even after 10 years.

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“There is clearly no easy route to take to prevent Type 2 diabetes but indications are that with further research into the long-term benefits of good dietary advice, physical activity and, where necessary drug therapies, we may be a step closer into helping people at high risk of developing Type 2 diabetes modify their lifestyle choices that are sustainable in the longer term.”

Source: BBC NEWS

Popularity: 2% [?]

Physicians treating a woman with severe influenza A (H1N1) infection who was not responding to standard therapies stated that the patient’s condition improved after being treated with an unlicensed intravenous formulation of GlaxoSmithKline’s Relenza (zanamivir), according to a case study documented in The Lancet. The physicians wrote that “although this is a single case report and direct cause and effect cannot be confirmed, the improvement in clinical status following intravenous Relenza encourages prompt further investigation.”

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Prior to receiving intravenous Relenza, the condition of the patient, who had recently undergone chemotherapy for Hodgkin’s disease, had deteriorated to the point of requiring ventilation. The patient did not respond to treatment with Roche’s Tamiflu (oseltamivir) given orally twice daily, or the inhaled formulation of Relenza. However, after being administered the intravenous version of GlaxoSmithKline’s product in combination with high-dose corticosteroids, the patient’s condition improved within 48 hours and she recovered with no side effects, the doctors said.

Source: FirstWord

Popularity: 3% [?]

The combined use of proton pump inhibitors (PPIs) with sanofi-aventis and Bristol-Myers Squibb’s Plavix (clopidogrel), or with Eli Lilly and Daiichi Sankyo’s Effient (prasugrel), did not interfere with the clinical benefits of the antiplatelet agents in patients after an acute coronary syndrome (ACS), according to an analysis of study data to be published in The Lancet. Researchers noted that the results contrast with prior findings from other studies, and remarked that these latest data “do not support the need to avoid concomitant use of PPIs…in patients receiving clopidogrel or prasugrel.”

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The analysis was based on data from the randomised TRITON-TIMI 38 trial that enrolled over 13 600 patients who suffered a heart attack or unstable angina, and who were given either Plavix or Effient. The study authors evaluated the effects of PPIs in the trial, and they found that for patients who took these medications in combination with Plavix or Effient there was no increased risk of cardiovascular events, compared with patients who took Plavix or Effient alone.

A previous analysis of medical and pharmacy claims data by Medco indicated that among patients who had undergone a percutaneous coronary intervention, those who were being treated with Plavix plus a PPI had a 50-percent increase in the risk of having a major cardiovascular event, compared with those who took Plavix alone.

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The author of the Medco study, Robert Epstein, explained that the overall health of the patients involved in the studies may have played a role in producing contrasting results. He suggested that the new analysis involved healthier patients who were not in a “real-world setting.” The lead investigator of the latest study, Michelle O’Donoghue, noted that PPIs are often given to more seriously ill patients, which might explain why they experience more adverse events. However, she said such differences were adjusted for in the research. The authors stated that a thorough clinical trial is needed to clearly understand how PPI use affects treatment with antiplatelet drugs.

Source: FirstWord

Popularity: 3% [?]

Results of a study published in The Lancet suggest that pregnant women infected with the influenza A (H1N1) virus might be at increased risk for complications, including higher rates of hospitalisation and death. Scientists from the US Centers for Disease Control and Prevention, who conducted the study, called for physicians to “promptly treat pregnant women” infected with the virus using antivirals, such as Roche’s Tamiflu (oseltamivir) and GlaxoSmithKline’s Relenza (zanamivir).

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The study looked at the impact of influenza A (H1N1) on pregnant women from April 15, when the outbreak began, to June 16. Of 45 US deaths from influenza A (H1N1) during this period, six were in pregnant women, which represented 13 percent of deaths at the time. The CDC said of the 34 cases of influenza A (H1N1) in pregnant women reported to the agency from April 15 to May 18, 11 women were hospitalised, which was a fourfold increase in the rate of hospitalisation compared to the general population.

All of the pregnant women who died from influenza A (H1N1) complications were healthy prior to infection and subsequently developed viral pneumonia. The CDC said they did not receive antivirals soon enough to benefit from their treatment. Recommendations suggest that antiviral treatment be started within 48 hours after symptoms begin, however Denise Jamieson of the CDC, who led the study, said “some clinicians hesitate treating pregnant women with antiviral medications because of concerns for the developing foetus, but this is the wrong approach.”

Jamieson remarked: “We do not have evidence that pregnant women have increased susceptibility or are more likely to acquire influenza. It’s just that when they have influenza they are at increased risk of having severe disease.”

Source: FirstWord

Popularity: 4% [?]

Results of a study published Monday in The Lancet suggest the schizophrenia drug clozapine is associated with a “substantially lower” mortality in patients who take the product, compared with those who take other antipsychotics, researchers noted. Study leader Jari Tiihonen commented: “In all western countries, clozapine is recommended for use only as a second-line drug. I would like to see it considered for first-line use.”

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The study examined death rates in Finland between 1996 and 2006 in the general population versus those of about 67000 patients with schizophrenia who were taking the six most frequently prescribed antipsychotic drugs. Results showed that compared to patients treated with perphenazine, those who took clozapine had a 26-percent reduction in mortality, representing the lowest risk in the analysis. In addition, data showed that the highest increase in risk was observed in patients who took AstraZeneca’s Seroquel (quetiapine), who had a 41-percent increase in mortality compared with those who took perphenazine.

Patients taking clozapine, which is sold by Novartis as Clozaril and is also available as a generic, require regular blood tests for agranulocytosis. The researchers said that the difference in mortality seen in the study between clozapine and the other antipsychotic drugs may be attributable to more intensive monitoring during treatment with clozapine, greater effectiveness of clozapine, lower safety of other drugs, or all of these factors.

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Professor Tim Kendall, deputy director of the Royal College of Psychiatrist’s research unit, who was not involved in the study, stated: “These findings should be interpreted with real caution. The evidence for first-line use is not there. Clozapine is associated with a much broader range of side effects.”

Source: FirstWord

Popularity: 3% [?]

GlaxoSmithKline announced that type 2 diabetes drug Avandia showed no increased cardiovascular risk compared with commonly prescribed treatments, according to long-term study results presented at the annual meeting of the American Diabetes Association. The findings were also published in The Lancet and in an editorial accompanying the study, the authors stated that “definitive conclusions about the relation between [Avandia] and cardiovascular disease remain elusive, owing to study limitations.”

In the randomised RECORD trial, 2220 patients with type 2 diabetes were treated with Avandia as an add-on to metformin or sulphonylurea, and 2227 patients were treated with a combination of metformin and sulphonylurea. GlaxoSmithKline said the findings indicated that “cardiovascular hospitalisation and cardiovascular death (which includes heart attack, congestive heart failure, and stroke) was not statistically different between the two groups after an average of 5.5 years of therapy.” In addition, the company noted that glycaemic control was significantly better in the Avandia group after the average 5.5 years of treatment.

“The findings essentially are that, in overall cardiovascular terms, the drug is safe,” noted lead investigator Philip Home. “There’s no decreased risk, and that includes the heart failure element,” Home indicated, adding that “if anything, deaths were reduced with [Avandia] compared to those in the control group. It doesn’t reach statistical significance, but it’s on the right side of benefit.” Nonetheless, study researchers also stated that the data were “inconclusive about any possible effect on myocardial infarction,” and that results from the trial demonstrated that “the addition of rosiglitazone…is confirmed to increase the risk of heart failure.”

Bernard Zinman, co-author of the editorial appearing in The Lancet alongside the RECORD study, said that “it’s good there isn’t a strong negative signal but it doesn’t tell us it’s safe.” Zinman also indicated that the study “doesn’t tell us anything” about the drug’s propensity for causing heart attacks. Meanwhile, Cleveland Clinic cardiologist Steven Nissen described the trial as “seriously flawed.” He stated that not enough patients remained in the study to determine conclusively that the drug does not pose a higher risk for heart attacks and other cardiovascular problems.

GlaxoSmithKline spokesperson Mary Anne Rhyne commented that most patients who stopped taking Avandia did so near the trial’s end, which allowed researchers to make conclusions. The company released figures showing that 61 percent of patients in the Avandia arm and 51 percent patients in the control group remained on their medicines at the end of the study. Rhyne said that the numbers were not unusual for a trial where patients were followed for more than five years.

Nissen further remarked that the trial was made “worthless” by the fact that patients in the Avandia arm took 10 percent more cholesterol-lowering drugs. However, Home replied that the use of the lipid-lowering drugs could only have had a minor impact on the data.

In further reaction to the news, the chief scientific and medical officer of the American Diabetes Association, Richard Kahn, indicated that the association will evaluate the data and consider reversing its recommendation against using GlaxoSmithKline’s thiazolidinedione drug. The ADA’s recommendation came after the release of Nissen’s meta-analysis in 2007, which showed that Avandia increased the risk of heart attack by 43 percent and the risk of cardiovascular death by 64 percent, when compared with placebo or other treatment regimens.

Source: FirstWord

Popularity: 2% [?]

Study findings published in The Lancet on Tuesday showed that Merck & Co.’s Gardasil was effective in women aged 24 to 45 years who had no history of genital warts or cervical disease. “As the potential for HPV infection and disease exists in women in their third, fourth, and fifth decades of life, these women could benefit from prophylactic HPV vaccination,” the researchers wrote.

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As part of the study, women were randomised to receive either Gardasil or placebo. After two years, four of the 1910 women who received at least one dose of Merck’s vaccine went on to develop an infection or cervical disease related to HPV strains 6, 11, 16, 18, which represented efficacy of 91 percent, the study data found. Among the 1907 participants who received at least one dose of placebo, 41 women developed an infection or cervical disease.

Researcher Nubia Muñoz and colleagues noted that “most women who were HPV positive were positive to only one HPV type, meaning that the quadrivalent HPV vaccine could still potentially benefit these women via protection against vaccine HPV types with which they are not infected with.”

Gardasil is currently approved in the US for girls and women aged 9 to 26 years.

Source: FirstWord

Popularity: 2% [?]

The number of under-fives in Europe with type 1 diabetes is set to double between 2005 and 2020, say experts.

The researchers, from Ireland and Hungary, warn cases in older children will also rise substantially.

Writing in The Lancet, they say genetics alone cannot account for the rapid rise, and suggest lifestyle factors are likely to play a role.

The study is based on 29,311 cases of type 1 diabetes recorded in 20 European countries between 1989 and 2003.

Type 1 diabetes is caused by insulin deficiency, and must be treated with regular injections of the hormone.

In the general population it accounts for only 10% of total diabetes cases, but is much more common than the type 2 version in children.

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The researchers, from Queen’s University, Belfast, and Pecs University, Hungary, found the overall incidence of type 1 diabetes rose by 3.9% per year.

However, among the under-fives it was 5.4% per year, and in the five to nine age group it was 4.3% per year.

They calculated that, on present trends, 24,400 new cases will be diagnosed in children under 15 in 2020, including 7,142 cases in the under-fives.

The total number of cases of type 1 diabetes among European children under 15 is predicted to rise from 93,584 in 2005 to 159,767 in 2020 – a 70% increase.

Among the under-fives, the total number of cases is predicted to double, from 9,955 in 2005 to 20,113 in 2020.

In the UK, where type 1 diabetes appears to be more common than elsewhere in Europe, the predicted rises are bigger still.

The researchers predict the total number of cases in the under-15s will rise by nearly 80% from 18,622 in 2005 to 33,289 in 2020.

And among the under-fives, they expect to see a 123% rise, from 1,975 in 2005 to 4,402 in 2020.

Lifestyle factors

The researchers say the increase in type 1 diabetes has been so rapid that it cannot be blamed on genetic factors alone.

They also point out that the highest increases have been seen in Eastern Europe, where lifestyle habits are changing more rapidly than in richer Western European nations.

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Researcher Dr Chris Patterson said: “The children of older mums are at slightly increased risk of type 1 diabetes as are children born by Caesarean section and children with rapid weight gain early in life, while breast-fed children are at slightly decreased risk.

“Infections and viruses may also play a role. But currently none of these risk factors can be said to be responsible for the increase, the cause of which remains largely unknown.”

The researchers warn that it is likely that hospitals will see more patients with severe diabetes complications presenting at a younger age.

These can include the potentially life-threatening condition ketoacidosis, in which the acidity of the blood is raised by the unregulated breakdown of fats and proteins by the liver.

Not only do young children with type 1 diabetes tend to be diagnosed late, and so have a higher risk of complications, they potentially face a lifetime of problems – bad news for them, and for the health care systems who must look after them.

Writing in the journal, the researchers said: “In the absence of any effective means to prevent type 1 diabetes, European countries need to ensure appropriate planning of services and that resources are in place to provide high-quality care for the increased numbers of children who will be diagnosed with diabetes in future years.”

Dr Iain Frame, director of research at the charity Diabetes UK, described the research as “worrying”.

“Many people live full and healthy lives, however, the longer the person has diabetes the higher the risk of complications such as heart disease, kidney failure and blindness.

“However, a lot more research is needed before we can come to any concrete conclusions about the causes of this rise in type 1 diabetes in younger children.”

Source: BBC NEWS

Popularity: 2% [?]

A cheap five-in-one pill can guard against heart attacks and stroke, research suggests.

The concept of a polypill for everyone over 55 to cut heart disease by up to 80% was mooted over five years ago, but slow progress has been made since.

Now a trial in India shows such a pill has the desired effects and is safe and well-tolerated by those who take it.

Although The Lancet study is proof of concept, experts still question the ethics of a pill for lifestyle issues.

Critics say the problems of high blood pressure and cholesterol should be tackled with diet and exercise rather than by popping a pill.

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The polypill used in the latest study combines five active pharmacological ingredients widely available separately – aspirin, a statin to lower cholesterol and three blood pressure-lowering drugs – as well as folic acid.

Does what it says on the tin

Trials on 2,053 healthy individuals free of cardiovascular disease, but with a risk factor such as high blood pressure or a long-term smoker, showed combining the drugs into one tablet delivered a similar effect to each drug separately.

Reductions were seen in both blood pressure and cholesterol without any major side effects.

The researchers believe that the combined action of all the components in their “Polycap” capsule made by Cadila Pharmaceuticals, could potentially halve strokes and heart attacks in average, middle-aged people.

On a global scale, this would save tens of millions of lives.

The study, led by Dr Salim Yusuf, from McMaster University in Ontario, Canada, took in people at 50 centres across India.

A spokeswoman for the British Heart Foundation said: “The results suggest that the polypill has the potential to reduce the incidence of cardiovascular disease.

“We now need further research to examine whether the polypill actually reduces mortality.”

A UK team led by Professor Simon Thom of Imperial College London is hoping to do just this.

They have been testing a four-in-one polypill called the Red Heart Pill, with the backing of the Wellcome Trust and the British Heart Foundation, which could cost as little as 15 euros per person per year.

Professor Thom said it would be at least five years before there was enough data to convince drug regulators to approve a polypill.

“Mounting evidence shows the polypill does exactly what it should, but no more, whereas exercise has wide reaching effects on health and wellbeing. So a polypill is an addition rather than a replacement for lifestyle interventions.”

Mike Rich of UK charity the Blood Pressure Association said: “This study further stimulates the debate over whether a ‘magic bullet’ is the answer to the prevention of heart disease and strokes.

“Eating healthily and taking regular exercise are proven ways to lower high blood pressure – and have many other health benefits too – and there is a danger that these lifestyle factors could be overlooked in favour of ‘popping a pill’.”

Joanne Murphy of The Stroke Association said: “By combining these medications in one pill, it will make it easier for people to take their medication. However, it is important that more research and investigation is done into this pill to ensure its safety.”

One GP, Dr Sarah Jarvis, said the pill should not be viewed as an alternative to improving lifestyles through diet and exercise.

“What we need to bear in mind is that this may well cut the likelihood of dying of heart disease dramatically. Fantastic. But it’s not going to stop you getting arthritis, it’s not going to stop you get lung disease,” she said.

In most cases a selection of your comments will be published, displaying your name and location unless you state otherwise in the box below.

Source: BBC NEWS

Popularity: 3% [?]

AstraZeneca’s Crestor (rosuvastatin) significantly reduced the risk of venous thromboembolism (VTE) in people with low to normal LDL cholesterol levels but elevated levels of high-sensitivity C-reactive protein (hsCRP), compared with placebo, according to new results from the JUPITER study. The findings were presented at the American College of Cardiology conference and published in The New England Journal of Medicine.

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The study involved 17 802 people who had normal LDL cholesterol levels but were considered to be at increased cardiovascular risk due to elevated hsCRP levels and age. Participants received either Crestor or placebo and were followed for a median of 1.9 years. A secondary analysis of the data showed that AstraZeneca’s product lowered the risk of VTE by 43 percent, compared with placebo. Additionally, those administered Crestor had a significant 55-percent reduction in the risk of deep vein thrombosis, compared with those in the placebo group.

“This is apparently a substantial extra benefit of this drug, in addition to the benefit on arteries,” commented study researcher Robert Glynn. However, other doctors suggested that the data do not justify administering Crestor or other statins for the primary goal of preventing VTE. Rather, the findings indicate that the reduction in the risk of VTE is an “additive bonus” for those who receive Crestor to lower cholesterol, according to Aaron Kugelmass, chief of cardiology at Baystate Medical Center.

Other data from the trial presented at the conference and published in The Lancet demonstrated that people taking Crestor who had the lowest risk of cardiovascular events also had low cholesterol and low CRP levels. Previous results from the JUPITER study released in 2008 indicated that Crestor significantly reduced the risk of cardiovascular events and related deaths, compared with placebo.

The drugmaker reiterated its intention to submit data from the study to regulators in the first half of this year. The compound generated $3.6 billion in sales last year.

Source: FirstWord

Popularity: 3% [?]