Wednesday, September 30, 2015
Friday, September 18, 2015
The New York Times (9/18, B2, Pollack, Subscription Publication) reports that “for the first time, a widely used modern diabetes” medication “has been shown to reduce deaths from cardiovascular disease, a long-sought goal of treatment, researchers announced” yesterday. The research(9/18) was presented at the annual meeting of the European Association for the Study of Diabetes and published in The New England Journal of Medicine.
On its website, NBC News (9/17) reports that the medication, “called Jardiance [empagliflozin], lowered heart disease deaths by 38 percent and deaths from any cause by 32 percent over three years.”
The AP (9/18, Johnson) reports that the findings “were particularly striking because nearly four-fifths of the participants were already taking standard medicines to control blood sugar, blood pressure and cholesterol, plus taking either Jardiance or a” placebo.
The CBS Evening News (9/17, story 12, 1:45, Pelley) reported that this year’s influenza vaccine may be more effective than last year’s. According to Dr. Jon Lapook, “Last year, the vaccine was only 23 percent effective because the predominant strain mutated after the vaccine had already been manufactured.” CDC “officials say this year’s flu vaccine is well-matched right now to circulating viruses.”
The Los Angeles Times (9/18, Kaplan) reports that this year, “flu watchdogs at the CDC have scrutinized 199 flu specimens collected in the United States and elsewhere between May 24 and Sept. 5.” They found that “the majority of those specimens – 118 of them – were H3N2 viruses, and all of them were built in a way that should make them vulnerable to this year’s vaccines.”
McClatchy (9/18, Mueller) reports that “by including components of H3N2 in this season’s flu vaccine, health care professionals hope to raise vaccine effectiveness against predominant strains back up to the 50 to 60 percent range.”
The AP (9/18, Neergaard) reports that, “all told, at least 171 million doses of flu vaccine are expected this year.” Meanwhile, Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said “it doesn’t matter which flu vaccine you get, just get one.”
Tuesday, September 15, 2015
Monday, September 14, 2015
Sunday, September 13, 2015
More patients would be eligible for metformin use if estimated glomerular filtration rate (eGFR) were used to define kidney disease rather than serum creatinine (sCr), a recent study concluded.
Researchers used data from the 1999 to 2010 National Health and Nutrition Examination Survey (NHANES) to analyze 3,902 adult participants with diabetes (defined by self-report or an HbA1c ≥6.5%) who reported a routine site for health care. Results were published online on Aug. 25 by Diabetes Care.
Across all 12 years, 66.4% of adults with diabetes were treated with a diabetes medication, and this percentage increased over time, from 61.3% in 1999 to 2000 to 69.7% in 2009 to 2010. Metformin use among those with diabetes and a routine site for health care increased from 26.1% to 44.5%.
Among NHANES adults with diabetes and routine care access, 8.8% were ineligible for metformin because of the FDA's contraindication among individuals with sCr ≥1.4 mg/dL for women and ≥1.5 mg/dL for men. Compared with those who were eligible for the drug, those ineligible were older and more likely to be non-Hispanic black or to have a yearly family income less than $45,000.
Researchers also looked at the patients using (eGFR) categories: likely safe to take metformin, ≥45 mL/min/1.73 m2; contraindicated, <30 mL/min/1.73 m2; and indeterminate, 30 to 44 mL/min/1.73 m2. Evidence has shown eGFR to be a more accurate estimate of kidney function than sCr, the authors noted.
Among individuals ineligible for metformin using conventional sCr thresholds, 14.6% had an eGFR ≥45 mL/min/1.73 m2 and 50% had an eGFR between 30 and 44 mL/min/1.73 m2. Only 35.7% of study participants would be ineligible for metformin based on an eGFR <30 mL/min/1.73 m2.
Based on these results, just by adding those for whom metformin is safe according to eGFR criteria, the researchers estimated the number of individuals eligible for metformin in the U.S. can be expanded by between 86,900 and 834,800 people, depending on which method is used to estimate GFR. Most of the potentially eligible patients are male and non-Hispanic blacks. This figure does not take into account the population with eGFR of indeterminate safety (30 to 44 mL/min/1.73 m2), which could range from 784,700 to 1,636,000 people. A randomized controlled trial is needed to clarify whether metformin use in this subgroup would be safe and efficacious, the authors noted.
Limitations of the study are that NHANES is not a clinical database, although the researchers restricted the study population to those who self-reported a routine site for health care. They also noted that they could not determine the reasoning behind low levels of metformin use, which could include non-renal clinical conditions that contraindicate the use of metformin, such as liver disease.