Medpage Link
Maxing Out BP Meds in Diabetics Questioned
By Charles Bankhead, Staff Writer, MedPage Today
Published: May 29, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
5 comment(s)
Action Points
This is a review of performance at VA medical centers representing an analysis of over 700,000 patients during 2009 to 2010.
Point out that in this study 82% had a BP 140/90 mm Hg while 12% had a BP 140/90 mmHg but received appropriate management.
Overly aggressive treatment of hypertension in diabetic patients occurred almost as often as undertreatment at facilities included in a review of Veterans Affairs (VA) hospitals and outpatient clinics.
Overall, 94% of hypertensive diabetic patients seen at 879 VA facilities received care consistent with a clinical action measure of appropriate treatment of hypertension. However, 20% of patients had lower-than-recommended blood pressure values, and examination of records revealed potential overtreatment in 40% of the cases (8% of all diabetic patients).
Rates of overtreatment ranged as high as 20% at individual facilities, particularly facilities that achieved high rates of compliance with threshold blood pressure values, according to an article published online in Archives of Internal Medicine.
"While 94% of diabetic veterans met the action measure, rates of potential overtreatment are currently approaching the rate of undertreatment, and high rates of achieving current threshold measures are directly associated with overtreatment," Eve A. Kerr, MD, of the VA Ann Arbor Healthcare System and University of Michigan in Ann Arbor, and co-authors wrote.
"Implementing a clinical measure for hypertension management, as the Veterans Health Administration is planning to do, may result in more appropriate care and less overtreatment."
Treat-to-target has become the clinical mantra for controlling cardiovascular risk factors, particularly lipids and blood pressure. However, dichotomous threshold measures (such as blood pressure <140/90 mm Hg) fail to take into account individual variation in risk, patient preferences, treatment intensity, disease severity, or adherence, the authors explained.
Moreover, available evidence has not consistently supported a treat-to-target strategy. Randomized trials have shown causal associations between treatment and benefit, but not achievement of a specific threshold for a risk factor.
"Dichotomous threshold measures, however, are silent on the manner of achieving risk factor control," the authors continued. "Consequently, such measures can promote overtreatment and diastolic hypotension, which has been shown in multiple studies to be associated with worse cardiovascular outcomes."
In contrast, "tightly linked" clinical action measures based on evidence better reflect the complexities and nuances of clinical decision making in the treatment of hypertension. Clinical action measures do not focus solely on attainment of a risk factor level but also the implementation of evidence-based treatment when a risk factor threshold is not attained.
In collaboration with the Department of Veterans Affairs, the authors developed a clinical action measure for blood pressure management. They also identified a marker of potential overtreatment that could result in a patient receiving overly aggressive, risky treatment.
The clinical action measure consisted of four criteria for appropriate care:
Blood pressure <140/90 mm Hg
Blood pressure <150/65 mm Hg
Systolic blood pressure <150 mm Hg in patients receiving three or more appropriately dosed antihypertensives
Appropriate action within 90 days meets the definition of appropriate care
Potential overtreatment was defined as blood pressure <130/65 mm Hg in a patient taking three or more medications or who is on active medication intensification.
Data from 879 VA medical centers and community-based outpatient clinics revealed 977,282 established patients (ages 18 to 75) with diabetes between 2009 and 2010. Of those, 713,790 were eligible for the action measure.
Overall, 94% of patients received treatment in accordance with the measure: 82% as a result of blood pressure <140/90 mm Hg at the index visit, and 12% with higher blood pressure but appropriate clinical action to meet the measure.
Rates of adherence to the clinical measure ranged from 77% to 99% among the 879 facilities (P<0.001).
The authors found that 197,291 diabetic patients had blood pressure <130/65 mm Hg. Within that subgroup, 80,903 patients met the definition of overtreatment.
Among individual facilities, rates of potential overtreatment ranged from 3% to 20% (P<0.001). The authors found a significant association between high rates of adherence to the threshold measure and higher rates of potential overtreatment (P<0.001).
The authors cautioned that the action measure may have underestimated the true rate of appropriate care because they were not able to assess medications prescribed outside of the VA or contraindications to treatment other than low diastolic levels.
The finding that 94% of diabetic patients met the clinical action measure for blood pressure "is an outstanding accomplishment," Eileen Handberg, PhD, of the University of Florida in Gainesville, wrote in a commentary. Nonetheless, performance measure definitions provide reasons for concern.
Handberg said one concern is the lack of consistency between the performance measure and clinical guideline recommendations, specifically the Seventh Report of the Joint National Committee recommendations and the hypertension management guidelines developed by the American Diabetes Association.
A second concern relates to the authors' definition of overtreatment. The definitions are based on the authors critique of current research in hypertension management in patients with diabetes, but not the guidelines in place when the patients' blood pressure was assessed.
"Because there is no reporting of increased risk and no clear understanding of the complexity of comorbidities, a blanket statement that 10% of the VA population may be overtreated creates a negative impression that might not be true," Handberg wrote.
"The reporting of performance measures is important, and the development of tightly linked clinical measures as those by Kerr et al is an important step forward in evaluating the complexities of management for hypertension and serve as a model for other measures," she added.
"However, reporting and evaluating performance measures must ensure that performance is linked to guidelines at the time of performance."
The study authors reported no conflicts of interest.
Handberg reported no conflicts of interest.
Wednesday, May 30, 2012
Tuesday, May 29, 2012
Tight Glucose Control No Help to Kidneys
medpagetoday.com Link
Intensive glucose control for type 2 diabetes may help control some markers of kidney health, but doesn't clearly prevent clinical kidney problems, a meta-analysis determined.
Tighter control in clinical trials with hemoglobin A1c (HbA1c) targets ranging from 7.1% to less than 6% significantly cut down on micro- and macroalbuminuria compared with conventional glucose control, Steven G. Coca, DO, MS, of Yale and the VA Medical Center in West Haven, Conn., and colleagues found.
However, the intensive strategy had no impact on doubling of serum creatinine level, risk of end-stage renal disease, or death from renal disease, they reported in the May 28 issue of the Archives of Internal Medicine.
Given the risks of severe hypoglycemia, minimal cardiovascular benefit, and potential increased risk of death seen with tight glucose control, the renal findings don't do much to justify it, Coca's group argued.
Because of the low rates of end-stage renal disease with conventional treatment, "there is little compelling reason to initiate intensive glycemic control in midstage of the disease with the aim of preventing renal failure," they wrote.
However, that message drew criticism in an accompanying editorial by David M. Nathan, MD, of Massachusetts General Hospital in Boston, who argued that it ignores the benefit of intensive intervention early in the course of diabetes.
He pointed to more than 20-year follow-up results from the UKPDS in type 2 and DCCT study in type 1 diabetes showing a reduction in more advanced clinical outcomes, including cardiovascular events.
That is proof that "early intensive therapy, combined with assiduous attention to control of other recognized risk factors, is necessary to improve long-term prospects of patients with diabetes," he wrote.
The meta-analysis largely included studies with follow up "far too brief to address the effects of intensive therapy on end-stage renal disease," he explained.
When combined with the low absolute rates of severe renal outcomes, it couldn't have hoped to do anything but rule out harm, Nathan argued.
"We should be cautious not to abandon the goal HbA1c level of less than 7% for most patients," he concluded.
The guidelines recommend a target of less than 7% but also allow for personalizing treatment goals to anywhere from less than 8% to less than 6.5% based on factors such as age, comorbidity, complications, and hypoglycemia risk.
But there's little trial evidence supporting a goal less than 7%, argued a second editorial.
The UKPDS tested treatment with metformin, a sulfonylurea, or insulin soon after diagnosis but not any specific glycemic target, wrote Karen L. Margolis, MD, MPH, and Patrick J. O'Connor, MD, MPH, both of HealthPartners Research Foundation in Minneapolis, Minn.
"It is clear that using these drugs has benefit and that they may often lower HbA1c to well below 7%, but the UKPDS did not demonstrate the benefit of sustained multidrug therapy to maintain HbA1c less than 7%," they wrote.
ACCORD and ADVANCE were the first trials to achieve and maintain HbA1c less than 7%. Both showed some reductions in early manifestations of microvascular complications with intensive treatment needed for tight glucose control, but neither reduced more advanced microvascular complications or showed benefits for cardiovascular or mortality outcomes.
Those studies were included, along with the two UKPDS cohorts and three other randomized trials, in the current meta-analysis, for a total of 28,065 adults followed over 2 to 15 years.
Compared with conventional glucose control, intensive glucose control was associated with:
But the actual median HbA1c in the intensive group didn't correlate with the magnitude of the relative risk for any of the endpoints.
The average diabetes duration prior to study enrollment ranged from 6.5 to 12 years, but that appeared to be a factor only in risk of serum creatinine doubling.
The researchers cautioned about the low cumulative incidence of the clinically important endpoints across the trials (4% doubling of the serum creatinine level, 1.5% end-stage renal disease, and 0.5% death from renal disease), which may have left the meta-analysis underpowered to detect significant differences.
"Regardless, with a baseline rate of end-stage renal disease so low in the standard therapy group and the overall lack of benefit for cardiovascular or all-cause mortality, it does not seem prudent to expose patients to this therapy to achieve an absolute risk reduction for end-stage renal disease that will be less than 1% in a best-case scenario," Coca's group concluded.
Intensive glucose control for type 2 diabetes may help control some markers of kidney health, but doesn't clearly prevent clinical kidney problems, a meta-analysis determined.
Tighter control in clinical trials with hemoglobin A1c (HbA1c) targets ranging from 7.1% to less than 6% significantly cut down on micro- and macroalbuminuria compared with conventional glucose control, Steven G. Coca, DO, MS, of Yale and the VA Medical Center in West Haven, Conn., and colleagues found.
However, the intensive strategy had no impact on doubling of serum creatinine level, risk of end-stage renal disease, or death from renal disease, they reported in the May 28 issue of the Archives of Internal Medicine.
Given the risks of severe hypoglycemia, minimal cardiovascular benefit, and potential increased risk of death seen with tight glucose control, the renal findings don't do much to justify it, Coca's group argued.
Because of the low rates of end-stage renal disease with conventional treatment, "there is little compelling reason to initiate intensive glycemic control in midstage of the disease with the aim of preventing renal failure," they wrote.
However, that message drew criticism in an accompanying editorial by David M. Nathan, MD, of Massachusetts General Hospital in Boston, who argued that it ignores the benefit of intensive intervention early in the course of diabetes.
He pointed to more than 20-year follow-up results from the UKPDS in type 2 and DCCT study in type 1 diabetes showing a reduction in more advanced clinical outcomes, including cardiovascular events.
That is proof that "early intensive therapy, combined with assiduous attention to control of other recognized risk factors, is necessary to improve long-term prospects of patients with diabetes," he wrote.
The meta-analysis largely included studies with follow up "far too brief to address the effects of intensive therapy on end-stage renal disease," he explained.
When combined with the low absolute rates of severe renal outcomes, it couldn't have hoped to do anything but rule out harm, Nathan argued.
"We should be cautious not to abandon the goal HbA1c level of less than 7% for most patients," he concluded.
The guidelines recommend a target of less than 7% but also allow for personalizing treatment goals to anywhere from less than 8% to less than 6.5% based on factors such as age, comorbidity, complications, and hypoglycemia risk.
But there's little trial evidence supporting a goal less than 7%, argued a second editorial.
The UKPDS tested treatment with metformin, a sulfonylurea, or insulin soon after diagnosis but not any specific glycemic target, wrote Karen L. Margolis, MD, MPH, and Patrick J. O'Connor, MD, MPH, both of HealthPartners Research Foundation in Minneapolis, Minn.
"It is clear that using these drugs has benefit and that they may often lower HbA1c to well below 7%, but the UKPDS did not demonstrate the benefit of sustained multidrug therapy to maintain HbA1c less than 7%," they wrote.
ACCORD and ADVANCE were the first trials to achieve and maintain HbA1c less than 7%. Both showed some reductions in early manifestations of microvascular complications with intensive treatment needed for tight glucose control, but neither reduced more advanced microvascular complications or showed benefits for cardiovascular or mortality outcomes.
Those studies were included, along with the two UKPDS cohorts and three other randomized trials, in the current meta-analysis, for a total of 28,065 adults followed over 2 to 15 years.
Compared with conventional glucose control, intensive glucose control was associated with:
- 14% reduced risk of microalbuminuria (RR, 0.86, 95% CI 0.76 to 0.96)
- 24% reduced risk of macroalbuminuria (RR 0.74, 95% CI 0.65 to 0.85)
- No difference in risk of serum creatinine doubling (RR 1.06, 95% CI 0.92 to 1.22)
- No significant impact on end-stage renal disease (RR 0.69, 95% CI 0.46 to 1.05)
- No impact on risk of death from renal disease (RR 0.99, 95% CI 0.55 to 1.79)
But the actual median HbA1c in the intensive group didn't correlate with the magnitude of the relative risk for any of the endpoints.
The average diabetes duration prior to study enrollment ranged from 6.5 to 12 years, but that appeared to be a factor only in risk of serum creatinine doubling.
The researchers cautioned about the low cumulative incidence of the clinically important endpoints across the trials (4% doubling of the serum creatinine level, 1.5% end-stage renal disease, and 0.5% death from renal disease), which may have left the meta-analysis underpowered to detect significant differences.
"Regardless, with a baseline rate of end-stage renal disease so low in the standard therapy group and the overall lack of benefit for cardiovascular or all-cause mortality, it does not seem prudent to expose patients to this therapy to achieve an absolute risk reduction for end-stage renal disease that will be less than 1% in a best-case scenario," Coca's group concluded.
Krumholz
reported a grant from the National Heart, Lung, and Blood Institute and
receiving a research grant from Medtronic through Yale University.
He also reported chairing a scientific advisory board for United Healthcare.
Margolis, O'Connor, and Nathan reported no conflicts of interest.
He also reported chairing a scientific advisory board for United Healthcare.
Margolis, O'Connor, and Nathan reported no conflicts of interest.
Primary source: Archives of Internal Medicine
Source reference:
Coca SG, et al "Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus: systematic review and meta-analysis" Arch Intern Med 2012; 172: 761-769.
Additional source: Archives of Internal Medicine
Source reference:
Nathan DM "Understanding the long-term benefits and dangers of intensive therapy of diabetes" Arch Intern Med 2012; 172: 769-770.
Additional source: Archives of Internal Medicine
Source reference:
Margolis KL, O'Connor PJ "Prioritizing treatments in type 2 diabetes mellitus" Arch Intern Med 2012; 172: 770-772.
Source reference:
Coca SG, et al "Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus: systematic review and meta-analysis" Arch Intern Med 2012; 172: 761-769.
Additional source: Archives of Internal Medicine
Source reference:
Nathan DM "Understanding the long-term benefits and dangers of intensive therapy of diabetes" Arch Intern Med 2012; 172: 769-770.
Additional source: Archives of Internal Medicine
Source reference:
Margolis KL, O'Connor PJ "Prioritizing treatments in type 2 diabetes mellitus" Arch Intern Med 2012; 172: 770-772.
Friday, May 25, 2012
Free Diabetes Recipes
If you, or someone you care about has diabetes, then you'll love this book with five tasty
and easy-to-follow recipes for people with diabetes. Each recipe
includes nutrition facts for the dish to help you keep track of what you
are eating.
FDA review says tafamidis lacks evidence of benefit.
The Wall Street Journal
(5/23, Dooren, Subscription Publication) reports that a Food and Drug
Administration review in advance of Thursday's meeting of the Peripheral
and Central Nervous Systems Drugs Advisory Committee finds a lack of
evidence that tafamidis (Pfizer, Vyndaqel) benefits patients with
transthyretin familial amyloid polyneuropathy, an inherited and fatal
condition. The medication was approved last year for sale in
Europe. The review cited a study in which the medication failed to meet
its primary goal, but did meet at least one secondary goal.
Reuters
(5/23, Yukhananov) reports that most patients die within 11 years of
the onset of symptoms and that a liver transplant is the only current
treatment.
MedPage Today
(5/23, Walker) explains, "Familial amyloid polyneuropathy (FAP) is
caused by mutations of the transthyretin (TTR) gene, which leads to
build up of amyloid primarily in the peripheral nerves, as well as other
organs. Symptoms usually start between the age of 30 and 50 and include
sensory loss that can be accompanied with severe pain as well as severe
autonomic dysfunction." It "tends to be clustered in Portugal,
Sweden, and Japan," though "there are estimated to be about 2,500
patients with familial amyloid polyneuropathy" in the US.
Researchers transform skin cells of HF patients into heart-muscle cells.
Bloomberg BusinessWeek
(5/23, Hallam) reports, "Israeli scientists for the first time
succeeded in transforming the skin cells of heart-failure patients into
healthy heart-muscle cells, suggesting that it may be possible to repair
the organ with a person's own tissue." Skin "cells from two men with
the disease, once genetically reprogrammed, were able to blend in with
healthy heart tissue in rats, scientists from the
Technion-Israel Institute of Technology and Rambam Medical Center in
Haifa, wrote
today in the European Heart Journal, a publication of the European
Society of Cardiology." However, "testing the cells in human hearts may
be as long as a decade away, as scientists hone the technique in animal
studies, they said."
MedPage Today
(5/23, Kaiser) reports that the researchers "took special precaution to
diminish the risk of these cells turning cancerous. They left out a
transcription factor called c-Myc, which is known as a cancer-causing
gene in stem cell creation." MedPage Today added, "The viral vector
also can be cancer-inducing, so the researchers devised a method for
removing the virus after it delivered the genes necessary for
reprogramming."
USAT critical of USPSTF's PSA recommendation.
In an editorial, USA Today
(5/23) criticizes the new guidelines from the US Preventive Services
Task Force (USPSTF) on PSA screening. USA Today asks, "Aren't patients
better advised to get the facts first and then the counseling if needed,
rather than being discouraged from finding out whether they have cancer
in the first place?" USPSTF's "approach seems based on the theory that
what you don't know can't hurt you. Well, it
can."
USPSTF's Moyer: Few benefits, substantial harms possible from PSA test.
In an opposing viewpoint in USA Today
(5/23), Dr. Virginia A. Moyer, USPSTF chair, writes, "Amid the many
messages you are hearing and reading about screening for prostate
cancer, I hope this one stands out most prominently: At best, there is a
very small potential benefit from the PSA test and there are
substantial known harms." Thus, "Until we improve the test and
treatment options, the US Preventive Services Task Force
recommends against screening for prostate cancer." According to Moyer,
the task force's "decision is based on science and the knowledge that
while we all want to prevent prostate cancer deaths, current PSA
screening and treatments for prostate cancer are not the answer."
New PSA recommendations may not affect Medicare coverage.
CQ
(5/23, Norman, Subscription Publication) reports, "The US Preventive
Services Task Force may have issued a controversial final recommendation
against routine prostate cancer screening for men, but the move appears
unlikely to affect Medicare coverage -- at least in the short term."
CQ adds, "In letters to members of Congress in February, Health and
Human Services Secretary Kathleen Sebelius said that 'while the
department has
discretion to modify or eliminate coverage for the PSA test based on the
Task Force's recommendation, I do not intend to eliminate coverage of
this screening test under Medicare at this time.'" Yesterday, "a
Centers for Medicare and Medicaid Services spokeswoman said Tuesday that
the secretary's statement stands."
Report: Poisoning the number one injury-related cause of death in US.
USA Today
(5/23, Lloyd) reports, "Millions of injuries could be prevented every
year if states adopted and enforced a set of laws and health policies
with proven track records for saving lives, says a report out Tuesday,
but many states are reluctant to do so when personal freedoms are at
stake and as revenue continues to decline." Linda Degutis, director of
the Centers for Disease Control and Prevention's Injury Center, which
was not involved with the new report, stated, "We know injuries are
preventable and we'd certainly rather prevent them than deal with the
aftermath, which often results in death or long-term disability."
According to Degutis, "Having certain laws in place helps people follow a
safe strategy."
Bloomberg News
(5/23, Klopott) reports, "Poisoning, primarily by drugs, kills more
people than car accidents, making it the biggest injury-related cause of
death in the US, said" the "report by the Trust for America's Health
and the Robert Wood Johnson Foundation." Across the US, "13.3 people
per 100,000 died from poisoning between 2007 and 2009, compared with
12.4 from motor-vehicle accidents during the same period, the report
found." Over "90 percent of unintentional poisoning deaths in 2007 were
caused by drugs and medicine, the report said."
The National Journal
(5/23, Sanger-Katz, Subscription Publication) reports, "The
researchers compared per-capita injury death rates with the number of
injury-prevention laws in all 50 states and found that, by and large,
the states with the most laws had the fewest injury deaths." That
"trend didn't hold uniformly, however. New Hampshire also ranked as
relatively safe, with 50 deaths per 100,000 residents, even though it
only
has four of the 10 public-policy laws tracked by the report."
CQ
(5/23, Norman, Subscription Publication) reports, "The report found
that 29 states don't require bike helmets for all children, 31 don't
require motorcycle helmets for all riders and 14 lack strong laws to
protect young people involved in sports against concussions." Some "new
trends in injuries include those connected to bullying, texting while
driving, prescription drug abuse and falls among aging members of the
baby boom
generation."
The Time
(5/23, Sifferlin) "Healthland" blog reports, "State funding for injury
prevention from the US Centers for Disease Control and Prevention (CDC)
dropped 24% from 2006 to 2011."
Also covering the story are the Boston Globe (5/23, Kotz) "Daily Dose" blog, the Orlando Sentinel (5/23, Jameson), the Columbus (OH) Dispatch (5/23, Ballentine), the Tennessean (5/23, Wilemon), the Topeka Capital-Journal (5/23), the Charleston (WV) State Journal (5/23, Ali), WebMD (5/23, Nierenberg), HealthDay (5/23), and MedPage Today (5/23, Walker).
Report: US made no overall progress in reducing motorcyclist deaths in 2011.
The Los Angeles Times
(5/23, Simon) "Nation Now" blog reports, "No progress was made last
year in reducing motorcyclist deaths, even though overall motor vehicle
fatalities dropped to their lowest level since 1949, according to the
Governors Highway Safety Assn."
HealthDay
(5/23, Preidt) reports that, according to "an analysis of preliminary
data from 50 states and the District of Columbia...there were about
4,500 motorcyclist deaths last year, the same number as in 2010."
However, "some individual states did see decreases in these fatalities
in 2011, while rates rose in other states, according to the report."
Generic Makers Say Brand-Name Producers Use FDA Rules To Prevent Competition.
The Washington Post 
(5/23, Elboghdady) reports that some makers of generic medications are
accusing the producers of brand name medications of making use of Food
and Drug Administration regulations on distribution of "drugs that are
dangerous or prone to abuse" in order to prevent them from getting
samples necessary for developing and testing generic versions. In
response to the complaints, "the Federal Trade Commission has launched
an investigation," and "the Senate is
addressing the complaint in a provision included in a broader measure
that funds the Food and Drug Administration." That "provision bars
drugmakers...from restricting sample sales to generic-drug firms that
agree to follow certain safety procedures approved by the FDA." The
measure is not in the House bill.
(5/23, Elboghdady) reports that some makers of generic medications are
accusing the producers of brand name medications of making use of Food
and Drug Administration regulations on distribution of "drugs that are
dangerous or prone to abuse" in order to prevent them from getting
samples necessary for developing and testing generic versions. In
response to the complaints, "the Federal Trade Commission has launched
an investigation," and "the Senate is
addressing the complaint in a provision included in a broader measure
that funds the Food and Drug Administration." That "provision bars
drugmakers...from restricting sample sales to generic-drug firms that
agree to follow certain safety procedures approved by the FDA." The
measure is not in the House bill.
Novel Compound May Improve Outcomes For HF Patients With CKD.
MedPage Today
(5/23, Phend) reports, "A novel compound that acts like a diuretic but
without relying on the kidneys may improve outcomes for heart failure
patients with chronic kidney disease, an early phase study showed."
Investigators found that "the cross-linked polyelectrolyte (CLP), which
is excreted in stool rather than urine, reduced dyspnea and severity of
heart failure symptoms, while raising functional capacity and quality of
life," but "the trial missed its primary endpoint of a reduction in
potassium levels as a marker of
fluid overload, the group reported online in the European Heart Journal
and...at the Heart Failure Congress."
(5/23, Phend) reports, "A novel compound that acts like a diuretic but
without relying on the kidneys may improve outcomes for heart failure
patients with chronic kidney disease, an early phase study showed."
Investigators found that "the cross-linked polyelectrolyte (CLP), which
is excreted in stool rather than urine, reduced dyspnea and severity of
heart failure symptoms, while raising functional capacity and quality of
life," but "the trial missed its primary endpoint of a reduction in
potassium levels as a marker of
fluid overload, the group reported online in the European Heart Journal
and...at the Heart Failure Congress."
Death Rate From CV Disease Down Among Patients With Diabetes.
The Los Angeles Times
(5/23, Maugh) reports, "Better management of blood sugar levels and
improved tools for managing heart disease have led to a sharp drop in
the death rate for diabetics, researchers from the US Centers for
Disease Control and Prevention reported" in a study published in the June issue of Diabetes Care. Researchers found that, "between 1997 and 2006, deaths of diabetics from all
causes declined 23% while deaths from heart disease fell 40%."
(5/23, Maugh) reports, "Better management of blood sugar levels and
improved tools for managing heart disease have led to a sharp drop in
the death rate for diabetics, researchers from the US Centers for
Disease Control and Prevention reported" in a study published in the June issue of Diabetes Care. Researchers found that, "between 1997 and 2006, deaths of diabetics from all
causes declined 23% while deaths from heart disease fell 40%."
Reuters
(5/23, Beasley) reports that according to Edward Gregg, the study's
lead author and chief of epidemiology and statistics in CDC's Division
of Diabetes Translation, "The fact that we found substantially lower
death rates in both men and women was very encouraging," but "there's
still a long way to go." Gregg added, "The fact that type 2 diabetes
can be prevented with lifestyle intervention means that we really need
to do more."
(5/23, Beasley) reports that according to Edward Gregg, the study's
lead author and chief of epidemiology and statistics in CDC's Division
of Diabetes Translation, "The fact that we found substantially lower
death rates in both men and women was very encouraging," but "there's
still a long way to go." Gregg added, "The fact that type 2 diabetes
can be prevented with lifestyle intervention means that we really need
to do more."
The National Journal
(5/23, Fox, Subscription Publication) reports that Ann Albright,
director of CDC's Division of Diabetes Translation, said in a statement
that "although the cardiovascular disease death rate for people with
diabetes has dropped, it is still twice as high as for adults without
diabetes." The researchers wrote, "Although our analyses indicate
encouraging reduction in mortality and, indirectly, continued success in
diabetes care, these findings have ironic
implications for the future US diabetes burden." If individuals "with
diabetes are living longer, they'll also need more years of testing for
blood sugar; of checking to ensure their eyes, feet, and kidneys are
healthy; and of taking drugs to control any health conditions."
(5/23, Fox, Subscription Publication) reports that Ann Albright,
director of CDC's Division of Diabetes Translation, said in a statement
that "although the cardiovascular disease death rate for people with
diabetes has dropped, it is still twice as high as for adults without
diabetes." The researchers wrote, "Although our analyses indicate
encouraging reduction in mortality and, indirectly, continued success in
diabetes care, these findings have ironic
implications for the future US diabetes burden." If individuals "with
diabetes are living longer, they'll also need more years of testing for
blood sugar; of checking to ensure their eyes, feet, and kidneys are
healthy; and of taking drugs to control any health conditions."
HealthDay
(5/23, Preidt) reports that Dr. Tara Narula, a cardiologist at Lenox
Hill Hospital in New York City, "The encouraging news that less diabetic
patients are dying from heart disease and stroke is a testament to
multiple factors that have changed the playing field." Narula added
that "while overall obesity and diabetes rates may be climbing, our
approach to treating diabetics aggressively with medication,
intervention and teaching has improved."
(5/23, Preidt) reports that Dr. Tara Narula, a cardiologist at Lenox
Hill Hospital in New York City, "The encouraging news that less diabetic
patients are dying from heart disease and stroke is a testament to
multiple factors that have changed the playing field." Narula added
that "while overall obesity and diabetes rates may be climbing, our
approach to treating diabetics aggressively with medication,
intervention and teaching has improved."
MedPage Today
(5/23, Gever) reports, "The researchers identified several factors that
likely account for the improved life expectancy for diabetic
Americans," including "steady improvements in quality and organization
of care, self-management behaviors, and medical treatments, including
pharmacological treatment of hyperlipidemia and hypertension." WebMD (5/23, Mann) also covers the story.
(5/23, Gever) reports, "The researchers identified several factors that
likely account for the improved life expectancy for diabetic
Americans," including "steady improvements in quality and organization
of care, self-management behaviors, and medical treatments, including
pharmacological treatment of hyperlipidemia and hypertension." WebMD (5/23, Mann) also covers the story.
Treating Apnea May Help BP
medpagetoday link for more details
Treating obstructive sleep apnea in patients who have daytime sleepiness as a symptom may have an additional benefit -- a reduction in the risk of hypertension.
A pair of studies published in the May 23/30 issue of the Journal of the American Medical Association point to a possible link between a reduction in hypertension and the use of continuous positive airway pressure (CPAP), but only one of the studies -- an observational one -- found a significant reduction in new onset hypertension.
Treating obstructive sleep apnea in patients who have daytime sleepiness as a symptom may have an additional benefit -- a reduction in the risk of hypertension.
A pair of studies published in the May 23/30 issue of the Journal of the American Medical Association point to a possible link between a reduction in hypertension and the use of continuous positive airway pressure (CPAP), but only one of the studies -- an observational one -- found a significant reduction in new onset hypertension.
DaVita Purchase Of Healthcare Partners Seen As Effort To Build National System.The Wall Street Journal Share to FacebookShare to Twitter (5/22, B3, Mathews, Athavaley, Subscription Publication) reports on DaVita Inc.'s $4.42 billion purchase of HealthCare Partners LLC, which employs about 700 physicians directly and has over 8,000 affiliated physicians. The purchase is seen as DaVita's bet that US healthcare is moving towards large systems that take responsibility for patients' total healthcare needs in exchange for fixed per patient fees. The AP Share to FacebookShare to Twitter (5/22) reports, "DaVita operates or provides administrative services at 1,841 dialysis facilities in the United States and also runs 15 outpatient dialysis centers in three other countries." The New York Times Share to FacebookShare to Twitter (5/22, Scott, Subscription Publication) "DealBook" blog reports, "DaVita said its purchase of HealthCare Partners, which is expected to close by the end of the year, would allow DaVita to expand its business in California, Nevada and Florida, where HealthCare Partners has large operations." The Denver Post Share to FacebookShare to Twitter (5/22, Pankratz, Booth) reports that DaVita, which is based in Denver, is part of the company's effort to be allowed to oversee all healthcare for its patients instead of just dialysis. The story points out that the company already has a clinic in the state of Washington where it manages all the healthcare of its patients. The Los Angeles Times Share to FacebookShare to Twitter (5/22, Terhune) reports, "The deal represents the latest sign of insurers, hospitals and other large healthcare companies buying up physician practices in order to better position themselves for changes in how the federal government is reimbursing for medical care." The Wall Street Journal Share to FacebookShare to Twitter (5/22, B3, Mathews, Athavaley, Subscription Publication) reports on DaVita Inc.'s $4.42 billion purchase of HealthCare Partners LLC, which employs about 700 physicians directly and has over 8,000 affiliated physicians. The purchase is seen as DaVita's bet that US healthcare is moving towards large systems that take responsibility for patients' total healthcare needs in exchange for fixed per patient fees. The AP Share to FacebookShare to Twitter (5/22) reports, "DaVita operates or provides administrative services at 1,841 dialysis facilities in the United States and also runs 15 outpatient dialysis centers in three other countries." The New York Times Share to FacebookShare to Twitter (5/22, Scott, Subscription Publication) "DealBook" blog reports, "DaVita said its purchase of HealthCare Partners, which is expected to close by the end of the year, would allow DaVita to expand its business in California, Nevada and Florida, where HealthCare Partners has large operations." The Denver Post Share to FacebookShare to Twitter (5/22, Pankratz, Booth) reports that DaVita, which is based in Denver, is part of the company's effort to be allowed to oversee all healthcare for its patients instead of just dialysis. The story points out that the company already has a clinic in the state of Washington where it manages all the healthcare of its patients. The Los Angeles Times Share to FacebookShare to Twitter (5/22, Terhune) reports, "The deal represents the latest sign of insurers, hospitals and other large healthcare companies buying up physician practices in order to better position themselves for changes in how the federal government is reimbursing for medical care."
The Wall Street Journal
(5/22, B3, Mathews, Athavaley, Subscription Publication) reports on
DaVita Inc.'s $4.42 billion purchase of HealthCare Partners LLC, which
employs about 700 physicians directly and has over 8,000 affiliated
physicians. The purchase is seen as DaVita's bet that US healthcare is
moving towards large systems that take responsibility for patients'
total healthcare needs in exchange for fixed per patient fees.
(5/22, B3, Mathews, Athavaley, Subscription Publication) reports on
DaVita Inc.'s $4.42 billion purchase of HealthCare Partners LLC, which
employs about 700 physicians directly and has over 8,000 affiliated
physicians. The purchase is seen as DaVita's bet that US healthcare is
moving towards large systems that take responsibility for patients'
total healthcare needs in exchange for fixed per patient fees.
The AP
(5/22) reports, "DaVita operates or provides administrative services
at 1,841 dialysis facilities in the United States and also runs 15
outpatient dialysis centers in three other countries."
(5/22) reports, "DaVita operates or provides administrative services
at 1,841 dialysis facilities in the United States and also runs 15
outpatient dialysis centers in three other countries."
The New York Times
(5/22, Scott, Subscription Publication) "DealBook" blog reports,
"DaVita said its purchase of HealthCare Partners, which is expected to
close by the end of the year, would allow DaVita to expand its business
in California, Nevada and Florida, where HealthCare Partners has large
operations."
(5/22, Scott, Subscription Publication) "DealBook" blog reports,
"DaVita said its purchase of HealthCare Partners, which is expected to
close by the end of the year, would allow DaVita to expand its business
in California, Nevada and Florida, where HealthCare Partners has large
operations."
The Denver Post
(5/22, Pankratz, Booth) reports that DaVita, which is based in Denver,
is part of the company's effort to be allowed to oversee all healthcare
for its patients instead of just dialysis. The story points out that
the company already has a clinic in the state of Washington where it
manages all the healthcare of its patients.
(5/22, Pankratz, Booth) reports that DaVita, which is based in Denver,
is part of the company's effort to be allowed to oversee all healthcare
for its patients instead of just dialysis. The story points out that
the company already has a clinic in the state of Washington where it
manages all the healthcare of its patients.
The Los Angeles Times
(5/22, Terhune) reports, "The deal represents the latest sign of
insurers, hospitals and other large healthcare companies buying up
physician practices in order to better position themselves for changes
in how the federal government is reimbursing for medical care."
(5/22, Terhune) reports, "The deal represents the latest sign of
insurers, hospitals and other large healthcare companies buying up
physician practices in order to better position themselves for changes
in how the federal government is reimbursing for medical care."
Partial Nephrectomy May Reduce Mortality Risk In Early Stage Kidney Cancer.
MedPage Today
(5/22, Bankhead) reports, "Mortality risk decreased by more than 40%
in patients whose early-stage kidney cancer was treated by partial
versus radical nephrectomy," according to research presented at a
urology meeting. The analysis of a National Cancer Institute (NCI)
database revealed that "patients younger than 75 had a 53% reduction in
the mortality hazard when they underwent nephron-sparing surgery instead
of radical nephrectomy, and a higher comorbidity score was associated
with an even greater mortality benefit."
The study's lead author pointed out, "The magnitude of the benefit
increased with follow-up."
(5/22, Bankhead) reports, "Mortality risk decreased by more than 40%
in patients whose early-stage kidney cancer was treated by partial
versus radical nephrectomy," according to research presented at a
urology meeting. The analysis of a National Cancer Institute (NCI)
database revealed that "patients younger than 75 had a 53% reduction in
the mortality hazard when they underwent nephron-sparing surgery instead
of radical nephrectomy, and a higher comorbidity score was associated
with an even greater mortality benefit."
The study's lead author pointed out, "The magnitude of the benefit
increased with follow-up."
Axitinib May Help As First-Line Treatment For Metastatic Renal Cell Carcinoma.
MedPage Today
(5/22, Gever) reports, "The angiogenesis blocking drug axitinib
(Inlyta), currently approved as a second-line treatment in advanced
kidney cancer, might also be useful in treatment-naive patients,"
according to a phase II study of "previously untreated patients with
metastatic renal cell carcinoma." Notably, "much of the benefit was
concentrated in patients with high blood levels of the drug, which has
notoriously unpredictable pharmacokinetics. Patients showing substantial
increases in diastolic blood pressure also were
more likely to achieve objective responses."
(5/22, Gever) reports, "The angiogenesis blocking drug axitinib
(Inlyta), currently approved as a second-line treatment in advanced
kidney cancer, might also be useful in treatment-naive patients,"
according to a phase II study of "previously untreated patients with
metastatic renal cell carcinoma." Notably, "much of the benefit was
concentrated in patients with high blood levels of the drug, which has
notoriously unpredictable pharmacokinetics. Patients showing substantial
increases in diastolic blood pressure also were
more likely to achieve objective responses."
Renal Nerve Ablation May Safely Lower Resistant Hypertension In CKD.
MedPage Today
(5/19, Kaiser) reported, "Catheter-based renal nerve ablation helps
lower resistant hypertension, but now researchers have found that it
works as well in those with chronic kidney disease (CKD)," according to a
study
published online May 17 in the Journal of the American Society of
Nephrology. "In 15 patients with resistant hypertension and stage 3 and
4 CKD, bilateral renal denervation lowered blood pressure by a mean of
34/14 mmHg at one
month and 32/15 mmHg at six months," researchers reported. "The mean
estimated glomerular filtration rate (eGFR) did not change after the
procedure, even though patients received contrast media for renal
catheterization or CO2 angiography," the study found.
(5/19, Kaiser) reported, "Catheter-based renal nerve ablation helps
lower resistant hypertension, but now researchers have found that it
works as well in those with chronic kidney disease (CKD)," according to a
study
published online May 17 in the Journal of the American Society of
Nephrology. "In 15 patients with resistant hypertension and stage 3 and
4 CKD, bilateral renal denervation lowered blood pressure by a mean of
34/14 mmHg at one
month and 32/15 mmHg at six months," researchers reported. "The mean
estimated glomerular filtration rate (eGFR) did not change after the
procedure, even though patients received contrast media for renal
catheterization or CO2 angiography," the study found.
Renal Denervation Systems May Help Reduce Hypertension.
MedPage Today
(5/19, Phend) reported, "Results of pilot studies on a variety of
novel renal sympathetic nerve ablation catheters are achieving in the
range of 28/10 to 32/15 mm Hg blood pressure reductions at one month,
researchers reported...at the EuroPCR meeting." In fact, "clinical
trials of the first such device -- the Symplicity single-electrode
radiofrequency ablation device, on the market in Europe -- showed a
one-month drop in BP of 14/10 to 20/7 mm Hg in clinical trials."
(5/19, Phend) reported, "Results of pilot studies on a variety of
novel renal sympathetic nerve ablation catheters are achieving in the
range of 28/10 to 32/15 mm Hg blood pressure reductions at one month,
researchers reported...at the EuroPCR meeting." In fact, "clinical
trials of the first such device -- the Symplicity single-electrode
radiofrequency ablation device, on the market in Europe -- showed a
one-month drop in BP of 14/10 to 20/7 mm Hg in clinical trials."
HeartWire
(5/19, Wood) reported, "Upwards of 20 other companies, according to Dr
Ron Waksman (Washington Hospital, DC), are busy developing competing
systems." The article went on to list the various systems, source of
data (animal or human), and the "BP drop, mm Hg."
(5/19, Wood) reported, "Upwards of 20 other companies, according to Dr
Ron Waksman (Washington Hospital, DC), are busy developing competing
systems." The article went on to list the various systems, source of
data (animal or human), and the "BP drop, mm Hg."
Off-Pump CABG May Improve Outcomes For Patients With Impaired Renal Function.
MedPage Today
(5/18, Neale) reports, "For patients with impaired renal function,
performing CABG off-pump rather than on-pump appears to improve
outcomes," according to a study
published online May 17 in the Journal of the American Society of
Nephrology. "Across the range of renal function, off-pump CABG was
associated with a slightly lower rate of in-hospital death or the need
for renal replacement therapy compared with on-pump CABG (1.8% versus
2%)," researchers reported.
"The benefit of off-pump CABG increased as renal function worsened," the
study based on data derived from 742,909 CABG cases found.
(5/18, Neale) reports, "For patients with impaired renal function,
performing CABG off-pump rather than on-pump appears to improve
outcomes," according to a study
published online May 17 in the Journal of the American Society of
Nephrology. "Across the range of renal function, off-pump CABG was
associated with a slightly lower rate of in-hospital death or the need
for renal replacement therapy compared with on-pump CABG (1.8% versus
2%)," researchers reported.
"The benefit of off-pump CABG increased as renal function worsened," the
study based on data derived from 742,909 CABG cases found.
FDA approves several generic versions of clopidogrel.
The AP
(5/18, Johnson) reports, "Patients taking the popular blood thinner
Plavix [clopidogrel] now have the option of getting a less-expensive
pill, following the" FDA "approval Thursday of the first generic
versions in the US." The agency "said it has given seven companies
permission to sell generic Plavix, or clopidogrel, in the standard
75-milligram dose." The FDA "also gave four generic drugmakers approval
to sell a
300-milligram dose of Plavix."
HealthDay
(5/18, Reinberg) reports that in a news release, Keith Webber, deputy
director of the Office of Pharmaceutical Sciences in the FDA's Center
for Drug Evaluation and Research, said, "For people who must manage
chronic health conditions, having effective and affordable treatment
options is important. The generic products approved today will expand
those options for patients."
MedPage Today
(5/18, Gever) reports, "Bristol-Myers Squibb has set up a program that
will keep patients' out-of-pocket cost of brand-name Plavix down to $37
per month through the end of this year."
Forbes
(5/18, Husten) points out that "in recent years the FDA approved two
newer antiplatelet drugs that had been designed to take over the central
role of Plavix in treating acute coronary syndromes. However, these
drugs, prasugrel (Effient) and ticagrelor (Brilinta) have been
struggling in the marketplace, and at this point appear very unlikely to
command a significant share of the market." Medscape (5/18, Lowes) also covers the story.
FDA says it will review azithromycin study.
euters (5/18) reports that, following the release of a study
indicating that azithromycin may be linked to increase risk of death
in certain adult patients, the US Food and Drug Administration said that
individuals should not discontinue use of the drug without
consulting a physician.
On NBC Nightly News (5/17, story 8, 2:40, Williams) NBC's chief
medical editor, Nancy Snyderman, MD, said, "There have been isolated
reports from the FDA of problems with this drug with heart disease.
Researchers at Vanderbilt have found the drug could increase the risk of
sudden cardiac death in some patients."
Meanwhile, on ABC World News (5/17, story 6, 1:50, Sawyer), ABC
News medical editor Richard Besser, MD, said, "The researchers found
that in a million patients taking" the drug, "there were 45 more deaths
from heart disease. The risk is higher for those with heart problems."
Medscape
(5/18) reports that the FDA also indicated that it "will review" the
"new study," which was published in the New England Journal of Medicine.
The agency, "in its announcement...reminded clinicians that QT
interval prolongation, which can trigger an abnormal and sometimes fatal
heart arrhythmia called torsades de pointes (TdP), has been linked not
only with azithromycin but also with other" macrolides. The agency
"said
that it would update the public on any new information on azithromycin
or the potential risk for QT interval prolongation after it reviews the
NEJM study."
Increasing HDL Cholesterol Levels May Not Impact Heart Disease Risk.
In a front-page story, the New York Times (5/17, A1, Kolata, Subscription Publication) reports that "a new study
that makes use of powerful databases of genetic information has found
that raising HDL" cholesterol "levels may not make any difference to
heart disease risk."
(5/17, A1, Kolata, Subscription Publication) reports that "a new study
that makes use of powerful databases of genetic information has found
that raising HDL" cholesterol "levels may not make any difference to
heart disease risk."
The Boston Globe
(5/17, A1, Johnson, Kotz) reports on its front page, "In the study
appearing in the medical journal The Lancet, a team led by researchers
from Massachusetts General Hospital and the Broad Institute examined the
health of more than 100,000 people, some of them with genetic
variations that elevated their levels of HDL." The researchers "found
that those variations did not protect against heart attacks."
(5/17, A1, Johnson, Kotz) reports on its front page, "In the study
appearing in the medical journal The Lancet, a team led by researchers
from Massachusetts General Hospital and the Broad Institute examined the
health of more than 100,000 people, some of them with genetic
variations that elevated their levels of HDL." The researchers "found
that those variations did not protect against heart attacks."
MedPage Today (5/17, Neale) reports, "In an accompanying editorial
, Steve Humphries, PhD, of University College London, and colleagues
noted that the study is consistent with previous mendelian randomization
analyses focused on the same issue and adds to an increasing number of
mendelian randomization studies of coronary heart disease biomarkers."
(5/17, Neale) reports, "In an accompanying editorial
, Steve Humphries, PhD, of University College London, and colleagues
noted that the study is consistent with previous mendelian randomization
analyses focused on the same issue and adds to an increasing number of
mendelian randomization studies of coronary heart disease biomarkers."
Subscribe to:
Posts (Atom)