Miriam E. Tucker

WASHINGTON — An old drug evidently has a new trick.

Colesevelam (WelChol), approved in the United States since 2000 for lowering lipid levels, also appears to reduce postprandial glucose in patients with type 2 diabetes, Dr. Franklin Zieve and his associates reported in a poster at the annual scientific sessions of the American Diabetes Association.

The incidental observation prompted Daiichi Sankyo Inc. to sponsor a prospective study of the glucose-lowering effects of its bile acid sequestrant drug, Dr. Zieve of the Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va., said in an interview at the meeting.

A total of 65 patients with type 2 diabetes with hemoglobin A_1c levels of 7.0% or above were randomized to receive 3.75 g/day of colesevelam (6 tablets/day) or placebo for 12 weeks, following a 4-week placebo run-in period. Patients continued taking their existing antidiabetic medications, which included sulfonylurea and/or metformin. Thirty-two colesevelam and 27 placebo subjects completed the trial.

At 12 weeks, mean postprandial glucose levels were reduced by a significant 18 mg/dL (from 269 to 251) in the colesevelam group, compared with an insignificant gain of 3 mg/dL (285 to 288) in the placebo group. Fasting plasma glucose levels dropped by 5 mg/dL (170 to 165) with colesevelam, vs. a gain of 2 mg/dL with placebo. Hemoglobin A_1c levels dropped by about 0.3 percentage points from baseline with colesevelam, a 0.5 percentage-point difference from placebo at 12 weeks.

The colesevelam and placebo groups had similar incidences of treatment-emergent adverse events during the study. There were no clinically significant changes in body mass index or in hypoglycemic events when the study drugs were added to existing sulfonylurea or metformin therapy.

WASHINGTON — An old drug evidently has a new trick.

Colesevelam (WelChol), approved in the United States since 2000 for lowering lipid levels, also appears to reduce postprandial glucose in patients with type 2 diabetes, Dr. Franklin Zieve and his associates reported in a poster at the annual scientific sessions of the American Diabetes Association.

The incidental observation prompted Daiichi Sankyo Inc. to sponsor a prospective study of the glucose-lowering effects of its bile acid sequestrant drug, Dr. Zieve of the Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va., said in an interview at the meeting.

A total of 65 patients with type 2 diabetes with hemoglobin A_1c levels of 7.0% or above were randomized to receive 3.75 g/day of colesevelam (6 tablets/day) or placebo for 12 weeks, following a 4-week placebo run-in period. Patients continued taking their existing antidiabetic medications, which included sulfonylurea and/or metformin. Thirty-two colesevelam and 27 placebo subjects completed the trial.

At 12 weeks, mean postprandial glucose levels were reduced by a significant 18 mg/dL (from 269 to 251) in the colesevelam group, compared with an insignificant gain of 3 mg/dL (285 to 288) in the placebo group. Fasting plasma glucose levels dropped by 5 mg/dL (170 to 165) with colesevelam, vs. a gain of 2 mg/dL with placebo. Hemoglobin A_1c levels dropped by about 0.3 percentage points from baseline with colesevelam, a 0.5 percentage-point difference from placebo at 12 weeks.

The colesevelam and placebo groups had similar incidences of treatment-emergent adverse events during the study. There were no clinically significant changes in body mass index or in hypoglycemic events when the study drugs were added to existing sulfonylurea or metformin therapy.

WASHINGTON — An old drug evidently has a new trick.

Colesevelam (WelChol), approved in the United States since 2000 for lowering lipid levels, also appears to reduce postprandial glucose in patients with type 2 diabetes, Dr. Franklin Zieve and his associates reported in a poster at the annual scientific sessions of the American Diabetes Association.

The incidental observation prompted Daiichi Sankyo Inc. to sponsor a prospective study of the glucose-lowering effects of its bile acid sequestrant drug, Dr. Zieve of the Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va., said in an interview at the meeting.

A total of 65 patients with type 2 diabetes with hemoglobin A_1c levels of 7.0% or above were randomized to receive 3.75 g/day of colesevelam (6 tablets/day) or placebo for 12 weeks, following a 4-week placebo run-in period. Patients continued taking their existing antidiabetic medications, which included sulfonylurea and/or metformin. Thirty-two colesevelam and 27 placebo subjects completed the trial.

At 12 weeks, mean postprandial glucose levels were reduced by a significant 18 mg/dL (from 269 to 251) in the colesevelam group, compared with an insignificant gain of 3 mg/dL (285 to 288) in the placebo group. Fasting plasma glucose levels dropped by 5 mg/dL (170 to 165) with colesevelam, vs. a gain of 2 mg/dL with placebo. Hemoglobin A_1c levels dropped by about 0.3 percentage points from baseline with colesevelam, a 0.5 percentage-point difference from placebo at 12 weeks.

The colesevelam and placebo groups had similar incidences of treatment-emergent adverse events during the study. There were no clinically significant changes in body mass index or in hypoglycemic events when the study drugs were added to existing sulfonylurea or metformin therapy.

WASHINGTON — Exenatide appears beneficial as adjunctive therapy in patients with type 2 diabetes who have not achieved target glucose levels with a thiazolidinedione alone or in combination with metformin, Dr. Bernard Zinman reported at the annual scientific sessions of the American Diabetes Association.

The incretin mimetic exenatide (Byetta) is approved for use in combination with metformin, with or without a sulfonylurea. It works by several mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of glucagon secretion, slowing of gastric emptying, and improvement in beta-cell function. Thiazolidinediones (TZDs), on the other hand, work primarily by reducing peripheral insulin resistance.

“Given the pathophysiology of type 2 diabetes and the actions of exenatide and [TZDs], this combination therapy may be especially useful in long-term management,” said Dr. Zinman, a professor of medicine who holds the Sam and Judy Pencer Chair in Diabetes at the University of Toronto.

In a placebo-controlled, double-blind trial involving 233 patients with hemoglobin A_1c levels of 7.1–10% despite use of a TZD alone (20%) or a TZD plus metformin (80%), 121 were randomized to receive two daily injections of exenatide for 16 weeks (5-mg doses in the first 4 weeks, 10 mg thereafter), while the other 112 received placebo injections. The study was conducted in 49 centers, including 37 in the United States, 7 in Spain, and 5 in Canada.

Of 35 patients from the exenatide group who withdrew prior to the end of the study, 19 (15.7% of the whole exenatide group) did so because of adverse events, compared with 2 of 16 controls (1.8% of the whole control group) who withdrew.

Nausea was the most common adverse event, occurring overall in 40% of the exenatide group and 15% of the placebo group. The nausea, generally mild to moderate, tended to occur most often at weeks 4–8 while the exenatide dose was being increased from 5 mg to 10 mg, and to decline thereafter. Hypoglycemia occurred in 11% of the exenatide group and 7% with placebo, an insignificant difference, said Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes and senior scientist, Lunenfeld Research Institute at Mount Sinai Hospital, Toronto.

Mean baseline hemoglobin A_1c was 7.9% in both groups. In the intent-to-treat analysis at week 16, mean A_1c had dropped significantly to 7.1% in the exenatide group, while rising to 8.0% in the placebo group. Reductions in A_1c with exenatide were similar between patients combining it with TZD and those taking it with both a TZD and metformin, he said.

Among 86 exenatide and 96 placebo patients who completed the study, 62% of the exenatide group achieved the American Diabetes Association's A_1c target of 7% or less, vs. 16% of the placebo group. The proportions achieving the American Association of Clinical Endocrinologists' target of 6.5% or less were 30% and 8%, respectively. Both differences were significant.

Self-monitored glucose values showed that patients taking exenatide had significantly lower fasting glucose levels and postprandial glucose excursions at the end of the study, compared with baseline. The mean postprandial drop was 27 mg/dL, and was greatest after breakfast and dinner (mean drop of 34 mg/dL for both meals). The placebo group showed essentially no differences in those measures from baseline to the end of the study.

Mean body weight in the exenatide group fell by 1.54 kg over the 16 weeks, compared with an insignificant 0.2-kg loss with placebo, Dr. Zinman reported.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Exenatide appears beneficial as adjunctive therapy in patients with type 2 diabetes who have not achieved target glucose levels with a thiazolidinedione alone or in combination with metformin, Dr. Bernard Zinman reported at the annual scientific sessions of the American Diabetes Association.

The incretin mimetic exenatide (Byetta) is approved for use in combination with metformin, with or without a sulfonylurea. It works by several mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of glucagon secretion, slowing of gastric emptying, and improvement in beta-cell function. Thiazolidinediones (TZDs), on the other hand, work primarily by reducing peripheral insulin resistance.

“Given the pathophysiology of type 2 diabetes and the actions of exenatide and [TZDs], this combination therapy may be especially useful in long-term management,” said Dr. Zinman, a professor of medicine who holds the Sam and Judy Pencer Chair in Diabetes at the University of Toronto.

In a placebo-controlled, double-blind trial involving 233 patients with hemoglobin A_1c levels of 7.1–10% despite use of a TZD alone (20%) or a TZD plus metformin (80%), 121 were randomized to receive two daily injections of exenatide for 16 weeks (5-mg doses in the first 4 weeks, 10 mg thereafter), while the other 112 received placebo injections. The study was conducted in 49 centers, including 37 in the United States, 7 in Spain, and 5 in Canada.

Of 35 patients from the exenatide group who withdrew prior to the end of the study, 19 (15.7% of the whole exenatide group) did so because of adverse events, compared with 2 of 16 controls (1.8% of the whole control group) who withdrew.

Nausea was the most common adverse event, occurring overall in 40% of the exenatide group and 15% of the placebo group. The nausea, generally mild to moderate, tended to occur most often at weeks 4–8 while the exenatide dose was being increased from 5 mg to 10 mg, and to decline thereafter. Hypoglycemia occurred in 11% of the exenatide group and 7% with placebo, an insignificant difference, said Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes and senior scientist, Lunenfeld Research Institute at Mount Sinai Hospital, Toronto.

Mean baseline hemoglobin A_1c was 7.9% in both groups. In the intent-to-treat analysis at week 16, mean A_1c had dropped significantly to 7.1% in the exenatide group, while rising to 8.0% in the placebo group. Reductions in A_1c with exenatide were similar between patients combining it with TZD and those taking it with both a TZD and metformin, he said.

Among 86 exenatide and 96 placebo patients who completed the study, 62% of the exenatide group achieved the American Diabetes Association's A_1c target of 7% or less, vs. 16% of the placebo group. The proportions achieving the American Association of Clinical Endocrinologists' target of 6.5% or less were 30% and 8%, respectively. Both differences were significant.

Self-monitored glucose values showed that patients taking exenatide had significantly lower fasting glucose levels and postprandial glucose excursions at the end of the study, compared with baseline. The mean postprandial drop was 27 mg/dL, and was greatest after breakfast and dinner (mean drop of 34 mg/dL for both meals). The placebo group showed essentially no differences in those measures from baseline to the end of the study.

Mean body weight in the exenatide group fell by 1.54 kg over the 16 weeks, compared with an insignificant 0.2-kg loss with placebo, Dr. Zinman reported.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Exenatide appears beneficial as adjunctive therapy in patients with type 2 diabetes who have not achieved target glucose levels with a thiazolidinedione alone or in combination with metformin, Dr. Bernard Zinman reported at the annual scientific sessions of the American Diabetes Association.

The incretin mimetic exenatide (Byetta) is approved for use in combination with metformin, with or without a sulfonylurea. It works by several mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of glucagon secretion, slowing of gastric emptying, and improvement in beta-cell function. Thiazolidinediones (TZDs), on the other hand, work primarily by reducing peripheral insulin resistance.

“Given the pathophysiology of type 2 diabetes and the actions of exenatide and [TZDs], this combination therapy may be especially useful in long-term management,” said Dr. Zinman, a professor of medicine who holds the Sam and Judy Pencer Chair in Diabetes at the University of Toronto.

In a placebo-controlled, double-blind trial involving 233 patients with hemoglobin A_1c levels of 7.1–10% despite use of a TZD alone (20%) or a TZD plus metformin (80%), 121 were randomized to receive two daily injections of exenatide for 16 weeks (5-mg doses in the first 4 weeks, 10 mg thereafter), while the other 112 received placebo injections. The study was conducted in 49 centers, including 37 in the United States, 7 in Spain, and 5 in Canada.

Of 35 patients from the exenatide group who withdrew prior to the end of the study, 19 (15.7% of the whole exenatide group) did so because of adverse events, compared with 2 of 16 controls (1.8% of the whole control group) who withdrew.

Nausea was the most common adverse event, occurring overall in 40% of the exenatide group and 15% of the placebo group. The nausea, generally mild to moderate, tended to occur most often at weeks 4–8 while the exenatide dose was being increased from 5 mg to 10 mg, and to decline thereafter. Hypoglycemia occurred in 11% of the exenatide group and 7% with placebo, an insignificant difference, said Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes and senior scientist, Lunenfeld Research Institute at Mount Sinai Hospital, Toronto.

Mean baseline hemoglobin A_1c was 7.9% in both groups. In the intent-to-treat analysis at week 16, mean A_1c had dropped significantly to 7.1% in the exenatide group, while rising to 8.0% in the placebo group. Reductions in A_1c with exenatide were similar between patients combining it with TZD and those taking it with both a TZD and metformin, he said.

Among 86 exenatide and 96 placebo patients who completed the study, 62% of the exenatide group achieved the American Diabetes Association's A_1c target of 7% or less, vs. 16% of the placebo group. The proportions achieving the American Association of Clinical Endocrinologists' target of 6.5% or less were 30% and 8%, respectively. Both differences were significant.

Self-monitored glucose values showed that patients taking exenatide had significantly lower fasting glucose levels and postprandial glucose excursions at the end of the study, compared with baseline. The mean postprandial drop was 27 mg/dL, and was greatest after breakfast and dinner (mean drop of 34 mg/dL for both meals). The placebo group showed essentially no differences in those measures from baseline to the end of the study.

Mean body weight in the exenatide group fell by 1.54 kg over the 16 weeks, compared with an insignificant 0.2-kg loss with placebo, Dr. Zinman reported.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — The increased risk for essential hypertension in patients with type 2 diabetes is apparent throughout the entire lifespan, Dr. Scott J. Jacober and his associates reported in a poster at the annual scientific sessions of the American Diabetes Association.

The relationship is exceptionally strong among children and adolescents, said Dr. Jacober, who was with Lilly Research Laboratories, Indianapolis, at the time of the study.

Essential hypertension and type 2 diabetes often coexist, but this retrospective study of a nationwide electronic medical records database is believed to be the first to examine the prevalence of essential hypertension by age group among individuals with and without diabetes, he noted.

The database contained more than 4 million patients, and the study population, from 49 states during 1996–2005, comprised 231,492 individuals with a physician's diagnosis of type 2 diabetes in their records.

Patients with type 1 diabetes were excluded. The study also included 1,219,047 people who did not have type 2 diabetes.

Overall, essential hypertension was diagnosed in 63% of patients with type 2 diabetes, compared with 40% of those without.

The increase in risk was less striking in adults than in children and adolescents, but it remained statistically significant for all adult age groups even after adjustment for age, gender, geographic region, and five comorbid conditions (obesity, hyperlipidemia, nephritis, ischemic heart disease, and other forms of heart disease).

Among the 2,808 young adults aged 20–29, essential hypertension was present in 21% of those with type 2 diabetes vs. 7.3% of those without, with a 50% increased risk for essential hypertension after adjustment for other factors.

Overall, the prevalence of essential hypertension among diabetic adults increased by decade of life from 36% at ages 30–39 to 70% at ages 70–79, dropping slightly thereafter to 67% among people over 80 years of age.

Among the nondiabetics, essential hypertension was present in 19.5% of the 30- to 39-year-olds, rising to 60% for those aged 70–79, and again dropping slightly thereafter to 58%. The adjusted odds ratio by decade between the diabetics and nondiabetics remained the same, at 1.3, for adults aged 30 and older, Dr. Jacober and his associates reported.

The risk differential was striking among children younger than age 12 years. Essential hypertension was present in 26.3% of the 219 children with type 2 diabetes, compared with just 0.5% of the 49,984 without, for an unadjusted odds ratio of 56.1.

Even after adjustment for the other risk factors, children aged 0–11 years with type 2 diabetes still were more than 20 times more likely than those without to have essential hypertension, Dr. Jacober and his colleagues reported.

Among adolescents aged 12–19 years, essential hypertension was present in 9.7% of the 691 with type 2 diabetes vs. 1.8% of the 61,129 without. In this age group, the unadjusted odds ratio was 4.4 and the adjusted odds ratio was 2.3, also highly significant.

WASHINGTON — The increased risk for essential hypertension in patients with type 2 diabetes is apparent throughout the entire lifespan, Dr. Scott J. Jacober and his associates reported in a poster at the annual scientific sessions of the American Diabetes Association.

The relationship is exceptionally strong among children and adolescents, said Dr. Jacober, who was with Lilly Research Laboratories, Indianapolis, at the time of the study.

Essential hypertension and type 2 diabetes often coexist, but this retrospective study of a nationwide electronic medical records database is believed to be the first to examine the prevalence of essential hypertension by age group among individuals with and without diabetes, he noted.

The database contained more than 4 million patients, and the study population, from 49 states during 1996–2005, comprised 231,492 individuals with a physician's diagnosis of type 2 diabetes in their records.

Patients with type 1 diabetes were excluded. The study also included 1,219,047 people who did not have type 2 diabetes.

Overall, essential hypertension was diagnosed in 63% of patients with type 2 diabetes, compared with 40% of those without.

The increase in risk was less striking in adults than in children and adolescents, but it remained statistically significant for all adult age groups even after adjustment for age, gender, geographic region, and five comorbid conditions (obesity, hyperlipidemia, nephritis, ischemic heart disease, and other forms of heart disease).

Among the 2,808 young adults aged 20–29, essential hypertension was present in 21% of those with type 2 diabetes vs. 7.3% of those without, with a 50% increased risk for essential hypertension after adjustment for other factors.

Overall, the prevalence of essential hypertension among diabetic adults increased by decade of life from 36% at ages 30–39 to 70% at ages 70–79, dropping slightly thereafter to 67% among people over 80 years of age.

Among the nondiabetics, essential hypertension was present in 19.5% of the 30- to 39-year-olds, rising to 60% for those aged 70–79, and again dropping slightly thereafter to 58%. The adjusted odds ratio by decade between the diabetics and nondiabetics remained the same, at 1.3, for adults aged 30 and older, Dr. Jacober and his associates reported.

The risk differential was striking among children younger than age 12 years. Essential hypertension was present in 26.3% of the 219 children with type 2 diabetes, compared with just 0.5% of the 49,984 without, for an unadjusted odds ratio of 56.1.

Even after adjustment for the other risk factors, children aged 0–11 years with type 2 diabetes still were more than 20 times more likely than those without to have essential hypertension, Dr. Jacober and his colleagues reported.

Among adolescents aged 12–19 years, essential hypertension was present in 9.7% of the 691 with type 2 diabetes vs. 1.8% of the 61,129 without. In this age group, the unadjusted odds ratio was 4.4 and the adjusted odds ratio was 2.3, also highly significant.

WASHINGTON — The increased risk for essential hypertension in patients with type 2 diabetes is apparent throughout the entire lifespan, Dr. Scott J. Jacober and his associates reported in a poster at the annual scientific sessions of the American Diabetes Association.

The relationship is exceptionally strong among children and adolescents, said Dr. Jacober, who was with Lilly Research Laboratories, Indianapolis, at the time of the study.

Essential hypertension and type 2 diabetes often coexist, but this retrospective study of a nationwide electronic medical records database is believed to be the first to examine the prevalence of essential hypertension by age group among individuals with and without diabetes, he noted.

The database contained more than 4 million patients, and the study population, from 49 states during 1996–2005, comprised 231,492 individuals with a physician's diagnosis of type 2 diabetes in their records.

Patients with type 1 diabetes were excluded. The study also included 1,219,047 people who did not have type 2 diabetes.

Overall, essential hypertension was diagnosed in 63% of patients with type 2 diabetes, compared with 40% of those without.

The increase in risk was less striking in adults than in children and adolescents, but it remained statistically significant for all adult age groups even after adjustment for age, gender, geographic region, and five comorbid conditions (obesity, hyperlipidemia, nephritis, ischemic heart disease, and other forms of heart disease).

Among the 2,808 young adults aged 20–29, essential hypertension was present in 21% of those with type 2 diabetes vs. 7.3% of those without, with a 50% increased risk for essential hypertension after adjustment for other factors.

Overall, the prevalence of essential hypertension among diabetic adults increased by decade of life from 36% at ages 30–39 to 70% at ages 70–79, dropping slightly thereafter to 67% among people over 80 years of age.

Among the nondiabetics, essential hypertension was present in 19.5% of the 30- to 39-year-olds, rising to 60% for those aged 70–79, and again dropping slightly thereafter to 58%. The adjusted odds ratio by decade between the diabetics and nondiabetics remained the same, at 1.3, for adults aged 30 and older, Dr. Jacober and his associates reported.

The risk differential was striking among children younger than age 12 years. Essential hypertension was present in 26.3% of the 219 children with type 2 diabetes, compared with just 0.5% of the 49,984 without, for an unadjusted odds ratio of 56.1.

Even after adjustment for the other risk factors, children aged 0–11 years with type 2 diabetes still were more than 20 times more likely than those without to have essential hypertension, Dr. Jacober and his colleagues reported.

Among adolescents aged 12–19 years, essential hypertension was present in 9.7% of the 691 with type 2 diabetes vs. 1.8% of the 61,129 without. In this age group, the unadjusted odds ratio was 4.4 and the adjusted odds ratio was 2.3, also highly significant.

OUR LUCAYA, BAHAMAS — Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.

Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.

A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.

The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.

Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.

Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.

But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:

▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.

▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.

▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.

▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.

▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.

During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower of—but has no financial ties to—a program called PowerPosture (www.powerposture.com

OUR LUCAYA, BAHAMAS — Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.

Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.

A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.

The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.

Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.

Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.

But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:

▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.

▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.

▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.

▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.

▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.

During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower of—but has no financial ties to—a program called PowerPosture (www.powerposture.com

OUR LUCAYA, BAHAMAS — Performing Mohs surgery or other close, long-duration procedures may cause repetitive strain injuries, Dr. Henry W. Randle said at the annual meeting of the American Society for Mohs Surgery.

Mohs surgeons are at particular risk for injuries resulting from prolonged work that involves repetitive movements and awkward body positions. "Even young surgeons are at risk. Early intervention is important," said Dr. Randle of the Mayo Clinic, Jacksonville, Fla., whose interest in the topic stemmed from his own experience with neck pain after years of performing Mohs surgery.

A survey of 17 Mohs surgeons from three Mayo Clinic sites (Florida, Minnesota, and Arizona) revealed surprising results: 16 reported symptoms of repetitive strain injuries. Of those, 12 said the symptoms started while they were performing Mohs surgery, while 4 reported preexisting conditions that worsened during the procedure. "This was really quite striking. I thought we'd find three or four," he said.

The group comprised 12 men and 5 women, with a mean age of 39.5 years. They had an average of 7 years' experience with Mohs surgery, spending approximately 24 hours per week performing the procedure. The majority (14) operated primarily while standing.

Among the 12 who reported symptoms that began while practicing Mohs, the average age of onset was 35.4 years after a mean of just 2.5 years in practice. "This was much earlier than I thought … It happens very early in your career," he said.

Neck pain was the most common complaint, affecting 10 of the 17 respondents. Shoulder pain was reported by 9, low back pain by 7, eye fatigue/burning by 5, headaches, by 4, and leg edema by 3. Low back pain was more common among the surgeons who typically worked while standing, while neck pain was more common among those who were usually seated while doing Mohs.

But on the bright side, there are ways of minimizing these problems. After analyzing videotapes of six study participants, an expert in occupational medicine and ergonomics made the following recommendations to alleviate the various symptoms:

▸ Neck pain. Often a result of too much distance between the surgeon and the patient, neck pain can be exacerbated by bulky operating tables that require the surgeon to bend over too far. Less bulky operating tables, such as dental chairs, can allow for closer access to the patient. Odd angles of the neck can also lead to pain. Repositioning yourself in front of the patient and taking frequent breaks to stretch can provide relief.

▸ Shoulder pain. Reaching over the patient is a common cause. Sometimes with older patients who can't move themselves very easily, surgeons will tend to adjust themselves around the patient. But it's better to move the patient (or have the nurse do it) than to strain. A chair that provides sternal support allows the surgeon to rest his or her elbows while leaning forward over the patient, thereby easing tension in the neck, Dr. Randle explained.

▸ Low back pain. Surgeons with low back pain who stand for Mohs surgery might try sitting. Chairs with sternal support can also help alleviate low back pain. For those who still want to stand, "sit stands" allow the surgeon to take short breaks and lean back during the procedure.

▸ Eye fatigue and headaches. Bright lights and glare contribute to both problems. Lowering the lighting in the room and using black instruments may help.

▸ Leg edema. Inactive posture is the culprit here, but the problem can be alleviated by moving around and taking frequent breaks. Sitting, foot rests/rails, and compression stockings may also help. Floor mats with surface variations have been installed in the operating rooms at Mayo to help alleviate foot pressure. Gel-containing shoe inserts available over the counter at drugstores can accomplish the same thing.

During the question and answer period, audience member and fellow conference speaker Dr. Daniel Buchen, who is in private practice in New Jersey and Staten Island, N.Y., told the audience that he is a loyal follower of—but has no financial ties to—a program called PowerPosture (www.powerposture.com

WASHINGTON — Hemoglobin A_1c levels during ages 11–19 years correlated with the risk of complications as adults among type 1 diabetes patients diagnosed before age 10, Dr. Emily J. Gallagher reported at the annual scientific sessions of the American Diabetes Association.

Medical records were reviewed for 57 men and 72 women who ranged in age from 15 to 69 years and had been diagnosed with type 1 diabetes before age 10. The mean duration of diabetes was 28 years, said Dr. Gallagher, of University College in Dublin. Mean HbA_1c values, available since 1983, were 7.5% for 30 of the patients at ages 0–10, rising to 9.4% for the 73 patients ages 11–19, then falling back to 8.5% after age 20 years in 108 patients.

Among the 129 study participants, 53% had developed at least one complication at a mean of 22 years after diagnosis. Retinopathy was present in 50% after a mean of 23 years, nephropathy in 23% after 28 years, and neuropathy in 18% after 27 years. Hypertension, HbA_1c levels, and fasting triglycerides were significant predictors for the development of nephropathy, while A_1c and hypertension predicted neuropathy.

For those with mean HbA_1c levels below 8%, there was a 50% probability of any complication at 33 years after diagnosis. For those with mean HbA_1c levels of 8%–10%, the time to a 50% probability of any complication was 26 years. For those with HbA_1c values above 10%, the time was 16 years. HbA_1c values during the 11- to 19-year age range correlated most strongly with time to development of complications, Dr. Gallagher reported.

WASHINGTON — Hemoglobin A_1c levels during ages 11–19 years correlated with the risk of complications as adults among type 1 diabetes patients diagnosed before age 10, Dr. Emily J. Gallagher reported at the annual scientific sessions of the American Diabetes Association.

Medical records were reviewed for 57 men and 72 women who ranged in age from 15 to 69 years and had been diagnosed with type 1 diabetes before age 10. The mean duration of diabetes was 28 years, said Dr. Gallagher, of University College in Dublin. Mean HbA_1c values, available since 1983, were 7.5% for 30 of the patients at ages 0–10, rising to 9.4% for the 73 patients ages 11–19, then falling back to 8.5% after age 20 years in 108 patients.

Among the 129 study participants, 53% had developed at least one complication at a mean of 22 years after diagnosis. Retinopathy was present in 50% after a mean of 23 years, nephropathy in 23% after 28 years, and neuropathy in 18% after 27 years. Hypertension, HbA_1c levels, and fasting triglycerides were significant predictors for the development of nephropathy, while A_1c and hypertension predicted neuropathy.

For those with mean HbA_1c levels below 8%, there was a 50% probability of any complication at 33 years after diagnosis. For those with mean HbA_1c levels of 8%–10%, the time to a 50% probability of any complication was 26 years. For those with HbA_1c values above 10%, the time was 16 years. HbA_1c values during the 11- to 19-year age range correlated most strongly with time to development of complications, Dr. Gallagher reported.

WASHINGTON — Hemoglobin A_1c levels during ages 11–19 years correlated with the risk of complications as adults among type 1 diabetes patients diagnosed before age 10, Dr. Emily J. Gallagher reported at the annual scientific sessions of the American Diabetes Association.

Medical records were reviewed for 57 men and 72 women who ranged in age from 15 to 69 years and had been diagnosed with type 1 diabetes before age 10. The mean duration of diabetes was 28 years, said Dr. Gallagher, of University College in Dublin. Mean HbA_1c values, available since 1983, were 7.5% for 30 of the patients at ages 0–10, rising to 9.4% for the 73 patients ages 11–19, then falling back to 8.5% after age 20 years in 108 patients.

Among the 129 study participants, 53% had developed at least one complication at a mean of 22 years after diagnosis. Retinopathy was present in 50% after a mean of 23 years, nephropathy in 23% after 28 years, and neuropathy in 18% after 27 years. Hypertension, HbA_1c levels, and fasting triglycerides were significant predictors for the development of nephropathy, while A_1c and hypertension predicted neuropathy.

For those with mean HbA_1c levels below 8%, there was a 50% probability of any complication at 33 years after diagnosis. For those with mean HbA_1c levels of 8%–10%, the time to a 50% probability of any complication was 26 years. For those with HbA_1c values above 10%, the time was 16 years. HbA_1c values during the 11- to 19-year age range correlated most strongly with time to development of complications, Dr. Gallagher reported.

WASHINGTON — Exenatide appears beneficial as adjunctive therapy in patients with type 2 diabetes who have not achieved target glucose levels with a thiazolidinedione alone or in combination with metformin, Dr. Bernard Zinman reported at the annual scientific sessions of the American Diabetes Association.

The incretin mimetic exenatide (Byetta) is currently approved for use in combination with metformin, with or without a sulfonylurea. It works by several mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of glucagon secretion, slowing of gastric emptying, and improvement in beta-cell function. Thiazolidinediones (TZDs), on the other hand, work primarily by reducing peripheral insulin resistance.

“Given the pathophysiology of type 2 diabetes and the actions of exenatide and [TZDs], this combination therapy may be especially useful in long-term management,” said Dr. Zinman, who is professor of medicine and holds the Sam and Judy Pencer Chair in Diabetes at the University of Toronto.

In a placebo-controlled, double-blind trial involving 233 patients with hemoglobin A_1c levels of 7.1%–10% despite use of a TZD alone (20%) or a TZD plus metformin (80%), 121 were randomized to receive two daily injections of exenatide for 16 weeks (5-mg doses in the first 4 weeks, 10 mg thereafter), while the other 112 received placebo injections. The study was conducted in 49 centers, including 37 in the United States, 7 in Spain, and 5 in Canada.

Of 35 patients from the exenatide group who withdrew prior to the end of the study, 19 (15.7% of the whole exenatide group) did so because of adverse events, compared with 2 of 16 controls (1.8% of the whole control group) who withdrew. Nausea was the most common adverse event, occurring overall in 40% of the exenatide group versus 15% of the placebo group and resulting in withdrawal in 9% and 2%, respectively.

The nausea was generally mild to moderate. It tended to occur most often at weeks 4–8 while the exenatide dose was being increased from 5 mg to 10 mg, and to decline thereafter. Hypoglycemia occurred in 11% of the exenatide group and 7% with placebo, an insignificant difference, said Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes and senior scientist, Lunenfeld Research Institute at Mount Sinai Hospital, Toronto.

Mean baseline hemoglobin A_1c was 7.9% in both groups. In the intent-to-treat analysis at week 16, mean A_1c had dropped significantly to 7.1%, in the exenatide group, while rising slightly to 8.0% in the placebo group. Reductions in A_1c with exenatide were similar between the patients combining it with TZD and those taking it with both a TZD and metformin, he said.

Among the 86 exenatide and 96 placebo patients who completed the study, 62% of the exenatide group achieved the American Diabetes Association's A_1c target of 7% or less, compared with 16% of the placebo group. The proportions achieving the American Association of Clinical Endocrinologists' target of 6.5% or less were 30% versus 8%, respectively. Both differences were significant.

Seven-point self-monitored glucose values, done at baseline and at the end of the study, showed that patients taking exenatide had significantly lower fasting glucose levels and postprandial glucose excursions at the end of the study compared with baseline.

The mean postprandial drop was 27 mg/dL, and was greatest after breakfast and dinner (mean drop of 34 mg/dL for both meals). The placebo group, in contrast, showed essentially no differences in those measures from baseline to the end of the study, Dr. Zinman reported at the meeting.

Mean body weight in the exenatide group dropped by 1.54 kg over the 16 weeks, compared with an insignificant 0.2-kg loss with placebo. Patients with the greatest decreases in A_1c also lost the most weight, although even those who didn't lose weight still had significantly better A_1c values, he noted.

WASHINGTON — Exenatide appears beneficial as adjunctive therapy in patients with type 2 diabetes who have not achieved target glucose levels with a thiazolidinedione alone or in combination with metformin, Dr. Bernard Zinman reported at the annual scientific sessions of the American Diabetes Association.

The incretin mimetic exenatide (Byetta) is currently approved for use in combination with metformin, with or without a sulfonylurea. It works by several mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of glucagon secretion, slowing of gastric emptying, and improvement in beta-cell function. Thiazolidinediones (TZDs), on the other hand, work primarily by reducing peripheral insulin resistance.

“Given the pathophysiology of type 2 diabetes and the actions of exenatide and [TZDs], this combination therapy may be especially useful in long-term management,” said Dr. Zinman, who is professor of medicine and holds the Sam and Judy Pencer Chair in Diabetes at the University of Toronto.

In a placebo-controlled, double-blind trial involving 233 patients with hemoglobin A_1c levels of 7.1%–10% despite use of a TZD alone (20%) or a TZD plus metformin (80%), 121 were randomized to receive two daily injections of exenatide for 16 weeks (5-mg doses in the first 4 weeks, 10 mg thereafter), while the other 112 received placebo injections. The study was conducted in 49 centers, including 37 in the United States, 7 in Spain, and 5 in Canada.

Of 35 patients from the exenatide group who withdrew prior to the end of the study, 19 (15.7% of the whole exenatide group) did so because of adverse events, compared with 2 of 16 controls (1.8% of the whole control group) who withdrew. Nausea was the most common adverse event, occurring overall in 40% of the exenatide group versus 15% of the placebo group and resulting in withdrawal in 9% and 2%, respectively.

The nausea was generally mild to moderate. It tended to occur most often at weeks 4–8 while the exenatide dose was being increased from 5 mg to 10 mg, and to decline thereafter. Hypoglycemia occurred in 11% of the exenatide group and 7% with placebo, an insignificant difference, said Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes and senior scientist, Lunenfeld Research Institute at Mount Sinai Hospital, Toronto.

Mean baseline hemoglobin A_1c was 7.9% in both groups. In the intent-to-treat analysis at week 16, mean A_1c had dropped significantly to 7.1%, in the exenatide group, while rising slightly to 8.0% in the placebo group. Reductions in A_1c with exenatide were similar between the patients combining it with TZD and those taking it with both a TZD and metformin, he said.

Among the 86 exenatide and 96 placebo patients who completed the study, 62% of the exenatide group achieved the American Diabetes Association's A_1c target of 7% or less, compared with 16% of the placebo group. The proportions achieving the American Association of Clinical Endocrinologists' target of 6.5% or less were 30% versus 8%, respectively. Both differences were significant.

Seven-point self-monitored glucose values, done at baseline and at the end of the study, showed that patients taking exenatide had significantly lower fasting glucose levels and postprandial glucose excursions at the end of the study compared with baseline.

The mean postprandial drop was 27 mg/dL, and was greatest after breakfast and dinner (mean drop of 34 mg/dL for both meals). The placebo group, in contrast, showed essentially no differences in those measures from baseline to the end of the study, Dr. Zinman reported at the meeting.

Mean body weight in the exenatide group dropped by 1.54 kg over the 16 weeks, compared with an insignificant 0.2-kg loss with placebo. Patients with the greatest decreases in A_1c also lost the most weight, although even those who didn't lose weight still had significantly better A_1c values, he noted.

WASHINGTON — Exenatide appears beneficial as adjunctive therapy in patients with type 2 diabetes who have not achieved target glucose levels with a thiazolidinedione alone or in combination with metformin, Dr. Bernard Zinman reported at the annual scientific sessions of the American Diabetes Association.

The incretin mimetic exenatide (Byetta) is currently approved for use in combination with metformin, with or without a sulfonylurea. It works by several mechanisms, including enhancement of glucose-dependent insulin secretion, suppression of glucagon secretion, slowing of gastric emptying, and improvement in beta-cell function. Thiazolidinediones (TZDs), on the other hand, work primarily by reducing peripheral insulin resistance.

“Given the pathophysiology of type 2 diabetes and the actions of exenatide and [TZDs], this combination therapy may be especially useful in long-term management,” said Dr. Zinman, who is professor of medicine and holds the Sam and Judy Pencer Chair in Diabetes at the University of Toronto.

In a placebo-controlled, double-blind trial involving 233 patients with hemoglobin A_1c levels of 7.1%–10% despite use of a TZD alone (20%) or a TZD plus metformin (80%), 121 were randomized to receive two daily injections of exenatide for 16 weeks (5-mg doses in the first 4 weeks, 10 mg thereafter), while the other 112 received placebo injections. The study was conducted in 49 centers, including 37 in the United States, 7 in Spain, and 5 in Canada.

Of 35 patients from the exenatide group who withdrew prior to the end of the study, 19 (15.7% of the whole exenatide group) did so because of adverse events, compared with 2 of 16 controls (1.8% of the whole control group) who withdrew. Nausea was the most common adverse event, occurring overall in 40% of the exenatide group versus 15% of the placebo group and resulting in withdrawal in 9% and 2%, respectively.

The nausea was generally mild to moderate. It tended to occur most often at weeks 4–8 while the exenatide dose was being increased from 5 mg to 10 mg, and to decline thereafter. Hypoglycemia occurred in 11% of the exenatide group and 7% with placebo, an insignificant difference, said Dr. Zinman, who is also director of the Leadership Sinai Centre for Diabetes and senior scientist, Lunenfeld Research Institute at Mount Sinai Hospital, Toronto.

Mean baseline hemoglobin A_1c was 7.9% in both groups. In the intent-to-treat analysis at week 16, mean A_1c had dropped significantly to 7.1%, in the exenatide group, while rising slightly to 8.0% in the placebo group. Reductions in A_1c with exenatide were similar between the patients combining it with TZD and those taking it with both a TZD and metformin, he said.

Among the 86 exenatide and 96 placebo patients who completed the study, 62% of the exenatide group achieved the American Diabetes Association's A_1c target of 7% or less, compared with 16% of the placebo group. The proportions achieving the American Association of Clinical Endocrinologists' target of 6.5% or less were 30% versus 8%, respectively. Both differences were significant.

Seven-point self-monitored glucose values, done at baseline and at the end of the study, showed that patients taking exenatide had significantly lower fasting glucose levels and postprandial glucose excursions at the end of the study compared with baseline.

The mean postprandial drop was 27 mg/dL, and was greatest after breakfast and dinner (mean drop of 34 mg/dL for both meals). The placebo group, in contrast, showed essentially no differences in those measures from baseline to the end of the study, Dr. Zinman reported at the meeting.

Mean body weight in the exenatide group dropped by 1.54 kg over the 16 weeks, compared with an insignificant 0.2-kg loss with placebo. Patients with the greatest decreases in A_1c also lost the most weight, although even those who didn't lose weight still had significantly better A_1c values, he noted.

WASHINGTON — Ketoacidosis at the time of diabetes onset in young children is often the result of failure to recognize the signs and symptoms of diabetes during prior medical encounters, Dr. Helen Bui reported at the annual scientific sessions of the American Diabetes Association.

Reported rates of diabetic ketoacidosis (DKA) at the time of onset of type 1 diabetes in children vary widely (15%–67%), depending on the child's age and geographic location. Now, a retrospective analysis from two large Canadian databases suggests that children who present in DKA at the time of onset are significantly more likely than those not presenting in DKA to have had one or more medical encounters during the week preceding the diagnosis. This was particularly true for children younger than age 3 years.

The fact that DKA patients had more medical encounters “actually shows that signs and symptoms of hyperglycemia are being missed. … Our findings have implications for public and medical education to improve the index of suspicion,” said Dr. Bui, of the division of endocrinology at the Hospital for Sick Children, Toronto.

Of 3,947 children diagnosed with type 1 diabetes during 1995–2000, 18.6% (735) presented with DKA. Their mean age was 8.3 years, compared with 10.3 years among those who presented without DKA. Children younger than 3 years of age were at significantly increased risk, with 40% presenting with DKA. The rate dropped to 17% among 3- to 6-year-olds, 19% in those aged 7–10 years, 17% in young adolescents aged 11–14, and just 12% among older teens aged 15–18 years.

Although the overall incidence of type 1 diabetes increased by about 4.3% per year over the study period, the proportion presenting with DKA remained relatively constant, Dr. Bui noted.

During the 7-day period prior to diagnosis, 48% of those presenting with DKA had at least one medical encounter, compared with 41% of those who did not, a significant difference. The youngest children were the most likely to have had at least one encounter in the prior week: 58% of those under age 3, compared with 39% of those aged 3–10, 40% of the 11- to 14-year-olds, and 45% of the older teens.

Upper respiratory infections and gastroenteritis were the most common specific diagnoses noted in the charts for those visits among children of all ages, whereas “urine disorder” and nausea/vomiting were often listed for the older children. However, there was no recorded diagnosis for significant proportions of all the age groups, Dr. Bui said.

It was important to note, she said, that laboratory tests specifically related to the diagnosis of diabetes—including urinalysis, blood glucose, and hemoglobin A_1c measurement—had been ordered for just 20% of the 735 children who subsequently presented with DKA, compared with 49% of the 3,212 children who were diagnosed without DKA.

These findings support the hypothesis that DKA at diagnosis represents a failure to detect the signs and symptoms of diabetes before metabolic deterioration to DKA occurs. As well, cases of DKA may signify more fulminant disease and/or symptomatology that are difficult to recognize. This appears to be particularly true in children younger than 3 years, she said.

A wall poster listing the signs and symptoms of DKA is available from the Children's Diabetes Foundation at Denver. Call 1-800-695-2873 or send an e-mail to cdfregina@qwest.net

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Ketoacidosis at the time of diabetes onset in young children is often the result of failure to recognize the signs and symptoms of diabetes during prior medical encounters, Dr. Helen Bui reported at the annual scientific sessions of the American Diabetes Association.

Reported rates of diabetic ketoacidosis (DKA) at the time of onset of type 1 diabetes in children vary widely (15%–67%), depending on the child's age and geographic location. Now, a retrospective analysis from two large Canadian databases suggests that children who present in DKA at the time of onset are significantly more likely than those not presenting in DKA to have had one or more medical encounters during the week preceding the diagnosis. This was particularly true for children younger than age 3 years.

The fact that DKA patients had more medical encounters “actually shows that signs and symptoms of hyperglycemia are being missed. … Our findings have implications for public and medical education to improve the index of suspicion,” said Dr. Bui, of the division of endocrinology at the Hospital for Sick Children, Toronto.

Of 3,947 children diagnosed with type 1 diabetes during 1995–2000, 18.6% (735) presented with DKA. Their mean age was 8.3 years, compared with 10.3 years among those who presented without DKA. Children younger than 3 years of age were at significantly increased risk, with 40% presenting with DKA. The rate dropped to 17% among 3- to 6-year-olds, 19% in those aged 7–10 years, 17% in young adolescents aged 11–14, and just 12% among older teens aged 15–18 years.

Although the overall incidence of type 1 diabetes increased by about 4.3% per year over the study period, the proportion presenting with DKA remained relatively constant, Dr. Bui noted.

During the 7-day period prior to diagnosis, 48% of those presenting with DKA had at least one medical encounter, compared with 41% of those who did not, a significant difference. The youngest children were the most likely to have had at least one encounter in the prior week: 58% of those under age 3, compared with 39% of those aged 3–10, 40% of the 11- to 14-year-olds, and 45% of the older teens.

Upper respiratory infections and gastroenteritis were the most common specific diagnoses noted in the charts for those visits among children of all ages, whereas “urine disorder” and nausea/vomiting were often listed for the older children. However, there was no recorded diagnosis for significant proportions of all the age groups, Dr. Bui said.

It was important to note, she said, that laboratory tests specifically related to the diagnosis of diabetes—including urinalysis, blood glucose, and hemoglobin A_1c measurement—had been ordered for just 20% of the 735 children who subsequently presented with DKA, compared with 49% of the 3,212 children who were diagnosed without DKA.

These findings support the hypothesis that DKA at diagnosis represents a failure to detect the signs and symptoms of diabetes before metabolic deterioration to DKA occurs. As well, cases of DKA may signify more fulminant disease and/or symptomatology that are difficult to recognize. This appears to be particularly true in children younger than 3 years, she said.

A wall poster listing the signs and symptoms of DKA is available from the Children's Diabetes Foundation at Denver. Call 1-800-695-2873 or send an e-mail to cdfregina@qwest.net

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Ketoacidosis at the time of diabetes onset in young children is often the result of failure to recognize the signs and symptoms of diabetes during prior medical encounters, Dr. Helen Bui reported at the annual scientific sessions of the American Diabetes Association.

Reported rates of diabetic ketoacidosis (DKA) at the time of onset of type 1 diabetes in children vary widely (15%–67%), depending on the child's age and geographic location. Now, a retrospective analysis from two large Canadian databases suggests that children who present in DKA at the time of onset are significantly more likely than those not presenting in DKA to have had one or more medical encounters during the week preceding the diagnosis. This was particularly true for children younger than age 3 years.

The fact that DKA patients had more medical encounters “actually shows that signs and symptoms of hyperglycemia are being missed. … Our findings have implications for public and medical education to improve the index of suspicion,” said Dr. Bui, of the division of endocrinology at the Hospital for Sick Children, Toronto.

Of 3,947 children diagnosed with type 1 diabetes during 1995–2000, 18.6% (735) presented with DKA. Their mean age was 8.3 years, compared with 10.3 years among those who presented without DKA. Children younger than 3 years of age were at significantly increased risk, with 40% presenting with DKA. The rate dropped to 17% among 3- to 6-year-olds, 19% in those aged 7–10 years, 17% in young adolescents aged 11–14, and just 12% among older teens aged 15–18 years.

Although the overall incidence of type 1 diabetes increased by about 4.3% per year over the study period, the proportion presenting with DKA remained relatively constant, Dr. Bui noted.

During the 7-day period prior to diagnosis, 48% of those presenting with DKA had at least one medical encounter, compared with 41% of those who did not, a significant difference. The youngest children were the most likely to have had at least one encounter in the prior week: 58% of those under age 3, compared with 39% of those aged 3–10, 40% of the 11- to 14-year-olds, and 45% of the older teens.

Upper respiratory infections and gastroenteritis were the most common specific diagnoses noted in the charts for those visits among children of all ages, whereas “urine disorder” and nausea/vomiting were often listed for the older children. However, there was no recorded diagnosis for significant proportions of all the age groups, Dr. Bui said.

It was important to note, she said, that laboratory tests specifically related to the diagnosis of diabetes—including urinalysis, blood glucose, and hemoglobin A_1c measurement—had been ordered for just 20% of the 735 children who subsequently presented with DKA, compared with 49% of the 3,212 children who were diagnosed without DKA.

These findings support the hypothesis that DKA at diagnosis represents a failure to detect the signs and symptoms of diabetes before metabolic deterioration to DKA occurs. As well, cases of DKA may signify more fulminant disease and/or symptomatology that are difficult to recognize. This appears to be particularly true in children younger than 3 years, she said.

A wall poster listing the signs and symptoms of DKA is available from the Children's Diabetes Foundation at Denver. Call 1-800-695-2873 or send an e-mail to cdfregina@qwest.net

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — If 80% of Americans with type 2 diabetes met recommended treatment goals, over $150 billion in medical costs would be saved over the next 30 years, Dr. Robert A. Rizza said in his presidential address at the annual scientific sessions of the American Diabetes Association.

If 80% of patients achieved just five goals—a hemoglobin A_1c less than 7%, blood pressure less than 130/80 mm Hg, LDL cholesterol below 100 mg/dL, HDL greater than 40 mg/dL for men and greater than 50 mg/dL for women, and use of a daily baby aspirin—there would be 5 million fewer heart attacks, 600,000 fewer strokes, 1.2 million fewer cases of renal failure, 1.8 million fewer cases of blindness/eye surgery, and 1.8 million fewer premature deaths.

The increased costs of achieving the goals would be offset by the savings that result from prevention of the complications, explained Dr. Rizza, of the Mayo Clinic, Rochester, Minn., who just completed his term as ADA's president of medicine & science.

“Friends, this is doable. We simply have to commit ourselves to achieving the ADA goals in 80% of our patients. It's not pie-in-the-sky,” he said.

The projections were generated using Archimedes (www.archimedesmodel.com

The model—which was originally developed by Kaiser Permanente and is supported by an unrestricted grant from Novo Nordisk—has already accurately predicted the results of several large-scale clinical trials prior to their completion, Dr. Rizza noted.

Archimedes also predicted that if 80% of type 2 diabetics took a daily generic “polypill” consisting of 1,000 mg metformin, 75 mg aspirin, 40 mg statin, and 10 mg of an ACE inhibitor, the number of heart attacks over the next 30 years would drop by 50%, renal failure by 4%, and blindness and eye surgery by 33%. Such a pill—with an all-generic formulation—would cost approximately $100 per year while saving about $400 per year. And even if the treatments cost $500, the health care system would still see a savings within 5 years.

“This confirms what has been intuitively obvious to [us], but which seems to have escaped the policy makers. Namely, that it costs less to properly treat diabetes than it does to treat the complications that you get if you don't properly treat diabetes. It's a wise investment no matter how you look at it,” he said.

Of course, a cure for diabetes would go much farther, saving 8.4 million lives and preventing 41 million serious diabetes-related complications over 30 years. In the absence of a cure, the U.S. health care system will spend $6.6 trillion on diabetes complications over the next 30 years. A cure would save over $700 billion, suggesting that “There is an overwhelming and irrefutable economic case for finding a cure.”

Given these projections, Dr. Rizza outlined a four-point proposal that the ADA plans to issue in an upcoming official document:

▸ America must invest heavily in diabetes research aimed at finding a cure.

▸ The size of the investment must be commensurate with the risk that diabetes represents to the country.

▸ Financial support must be established to sustain systems of care that ensure every person with diabetes the best possible care.

▸ And a message for physicians: “We must all renew our commitment to our patients, acknowledge that the current level of care for people with diabetes is simply not acceptable, and do everything in our power to make it better.”

WASHINGTON — If 80% of Americans with type 2 diabetes met recommended treatment goals, over $150 billion in medical costs would be saved over the next 30 years, Dr. Robert A. Rizza said in his presidential address at the annual scientific sessions of the American Diabetes Association.

If 80% of patients achieved just five goals—a hemoglobin A_1c less than 7%, blood pressure less than 130/80 mm Hg, LDL cholesterol below 100 mg/dL, HDL greater than 40 mg/dL for men and greater than 50 mg/dL for women, and use of a daily baby aspirin—there would be 5 million fewer heart attacks, 600,000 fewer strokes, 1.2 million fewer cases of renal failure, 1.8 million fewer cases of blindness/eye surgery, and 1.8 million fewer premature deaths.

The increased costs of achieving the goals would be offset by the savings that result from prevention of the complications, explained Dr. Rizza, of the Mayo Clinic, Rochester, Minn., who just completed his term as ADA's president of medicine & science.

“Friends, this is doable. We simply have to commit ourselves to achieving the ADA goals in 80% of our patients. It's not pie-in-the-sky,” he said.

The projections were generated using Archimedes (www.archimedesmodel.com

The model—which was originally developed by Kaiser Permanente and is supported by an unrestricted grant from Novo Nordisk—has already accurately predicted the results of several large-scale clinical trials prior to their completion, Dr. Rizza noted.

Archimedes also predicted that if 80% of type 2 diabetics took a daily generic “polypill” consisting of 1,000 mg metformin, 75 mg aspirin, 40 mg statin, and 10 mg of an ACE inhibitor, the number of heart attacks over the next 30 years would drop by 50%, renal failure by 4%, and blindness and eye surgery by 33%. Such a pill—with an all-generic formulation—would cost approximately $100 per year while saving about $400 per year. And even if the treatments cost $500, the health care system would still see a savings within 5 years.

“This confirms what has been intuitively obvious to [us], but which seems to have escaped the policy makers. Namely, that it costs less to properly treat diabetes than it does to treat the complications that you get if you don't properly treat diabetes. It's a wise investment no matter how you look at it,” he said.

Of course, a cure for diabetes would go much farther, saving 8.4 million lives and preventing 41 million serious diabetes-related complications over 30 years. In the absence of a cure, the U.S. health care system will spend $6.6 trillion on diabetes complications over the next 30 years. A cure would save over $700 billion, suggesting that “There is an overwhelming and irrefutable economic case for finding a cure.”

Given these projections, Dr. Rizza outlined a four-point proposal that the ADA plans to issue in an upcoming official document:

▸ America must invest heavily in diabetes research aimed at finding a cure.

▸ The size of the investment must be commensurate with the risk that diabetes represents to the country.

▸ Financial support must be established to sustain systems of care that ensure every person with diabetes the best possible care.

▸ And a message for physicians: “We must all renew our commitment to our patients, acknowledge that the current level of care for people with diabetes is simply not acceptable, and do everything in our power to make it better.”

WASHINGTON — If 80% of Americans with type 2 diabetes met recommended treatment goals, over $150 billion in medical costs would be saved over the next 30 years, Dr. Robert A. Rizza said in his presidential address at the annual scientific sessions of the American Diabetes Association.

If 80% of patients achieved just five goals—a hemoglobin A_1c less than 7%, blood pressure less than 130/80 mm Hg, LDL cholesterol below 100 mg/dL, HDL greater than 40 mg/dL for men and greater than 50 mg/dL for women, and use of a daily baby aspirin—there would be 5 million fewer heart attacks, 600,000 fewer strokes, 1.2 million fewer cases of renal failure, 1.8 million fewer cases of blindness/eye surgery, and 1.8 million fewer premature deaths.

The increased costs of achieving the goals would be offset by the savings that result from prevention of the complications, explained Dr. Rizza, of the Mayo Clinic, Rochester, Minn., who just completed his term as ADA's president of medicine & science.

“Friends, this is doable. We simply have to commit ourselves to achieving the ADA goals in 80% of our patients. It's not pie-in-the-sky,” he said.

The projections were generated using Archimedes (www.archimedesmodel.com

The model—which was originally developed by Kaiser Permanente and is supported by an unrestricted grant from Novo Nordisk—has already accurately predicted the results of several large-scale clinical trials prior to their completion, Dr. Rizza noted.

Archimedes also predicted that if 80% of type 2 diabetics took a daily generic “polypill” consisting of 1,000 mg metformin, 75 mg aspirin, 40 mg statin, and 10 mg of an ACE inhibitor, the number of heart attacks over the next 30 years would drop by 50%, renal failure by 4%, and blindness and eye surgery by 33%. Such a pill—with an all-generic formulation—would cost approximately $100 per year while saving about $400 per year. And even if the treatments cost $500, the health care system would still see a savings within 5 years.

“This confirms what has been intuitively obvious to [us], but which seems to have escaped the policy makers. Namely, that it costs less to properly treat diabetes than it does to treat the complications that you get if you don't properly treat diabetes. It's a wise investment no matter how you look at it,” he said.

Of course, a cure for diabetes would go much farther, saving 8.4 million lives and preventing 41 million serious diabetes-related complications over 30 years. In the absence of a cure, the U.S. health care system will spend $6.6 trillion on diabetes complications over the next 30 years. A cure would save over $700 billion, suggesting that “There is an overwhelming and irrefutable economic case for finding a cure.”

Given these projections, Dr. Rizza outlined a four-point proposal that the ADA plans to issue in an upcoming official document:

▸ America must invest heavily in diabetes research aimed at finding a cure.

▸ The size of the investment must be commensurate with the risk that diabetes represents to the country.

▸ Financial support must be established to sustain systems of care that ensure every person with diabetes the best possible care.

▸ And a message for physicians: “We must all renew our commitment to our patients, acknowledge that the current level of care for people with diabetes is simply not acceptable, and do everything in our power to make it better.”

WASHINGTON — Statin-induced myopathy and myalgia may be higher than reported previously in patients with diabetes, but myositis and rhabdomyolysis are rare, Gregory A. Nichols, Ph.D., and Carol E. Koro, Ph.D., reported in a poster at the annual scientific sessions of the American Diabetes Association.

Clinical trial results suggest that statin-induced myopathy occurs in less than 1% of patients, but no previously published reports of muscle syndromes following statin initiation have come from real-world settings, said Dr. Nichols and Dr. Koro, both of Kaiser Permanente Northwest, Portland, Ore.

They compared electronic pharmacy records for 10,247 Kaiser enrollees who have type 2 diabetes and initiated statins between 1997 and 2004.

Their results were compared with those of the same number of diabetic patients who did not take statins during that time period.

Study subjects were followed until they experienced a myopathic event or until the end of 2005.

Kaiser Permanente recommends that any patient who presents with muscle complaints while taking statins undergo a creatine kinase (CK) test and suspend statin use pending the results. Therefore, myopathy was defined as the presence of any creatine kinase test during a break in statin dispense records, any CK test greater than three times the upper limit of normal (ULN), or any diagnosis of myopathy. Myalgia was defined as the presence of a normal CK test during a break in the statin dispense records or a diagnosis of myalgia.

During the study period, myopathy developed in 7.1% of the statin initiators and 5.5% of the controls, a statistically significant difference. The unadjusted incidence of myopathy/1,000 person-years was also significantly greater for the statin users, 21.9, than for the nonusers, 18.1. Also, the rates of CK levels between 1 and 3 times the ULN were significantly different, seen in 1.7% of the statin users and 0.6% of the controls, translating to unadjusted incidence rates of 5.5/1,000 vs. 2.0/1,000 person-years.

Similarly, the proportion developing myalgia was also significantly greater with statins (5.8%), compared with controls (4.7%), as was the incidence rate of myalgia (18.3/1,000 vs. 15.4/1,000), Dr. Nichols and Dr. Koro reported.

On the other hand, myositis—defined as a CK test with a result 3–10 times the ULN or a diagnosis—was not significantly more common among statin users, occurring in 0.21% of statin users and 0.14% of controls, with rates of 0.70/1,000 vs. 0.46/1,000. Similarly, comparable rates of rhabdomyolysis, defined as a CK test result more than 10 times above the ULN (0.13% vs. 0.12%) or a diagnosis (0.41/1,000 vs. 0.17/1,000), were seen.

Concurrent use of fibrates and corticosteroids were the strongest predictors of myopathy (hazard ratios 2.11 and 1.80, respectively). Older age, presence of cardiovascular disease, and higher body-mass index also contributed to the myopathy risk. After adjustment for those factors, the incidence rates were not significantly different between statin users and controls (21.1/1,000 vs. 19.4/1,000).

Older age, higher BMI, concurrent fibrate use, concurrent corticosteroid use, and the presence of cardiovascular disease also increased the risk for myalgia; male sex and metformin use appeared to be protective. As with myopathy, adjusting for those factors eliminated the difference between statin users and nonusers (17.3/1,000 vs. 16.4/1,000).

However, the rates of elevated CK test results of 1–3 times the ULN remained significantly higher for statin users even after adjusting for predictors such as younger age, longer duration of diabetes, male sex, concurrent fibrate use, higher BMI, and poor kidney function (4.1/1,000 vs. 1.3/1,000).

WASHINGTON — Statin-induced myopathy and myalgia may be higher than reported previously in patients with diabetes, but myositis and rhabdomyolysis are rare, Gregory A. Nichols, Ph.D., and Carol E. Koro, Ph.D., reported in a poster at the annual scientific sessions of the American Diabetes Association.

Clinical trial results suggest that statin-induced myopathy occurs in less than 1% of patients, but no previously published reports of muscle syndromes following statin initiation have come from real-world settings, said Dr. Nichols and Dr. Koro, both of Kaiser Permanente Northwest, Portland, Ore.

They compared electronic pharmacy records for 10,247 Kaiser enrollees who have type 2 diabetes and initiated statins between 1997 and 2004.

Their results were compared with those of the same number of diabetic patients who did not take statins during that time period.

Study subjects were followed until they experienced a myopathic event or until the end of 2005.

Kaiser Permanente recommends that any patient who presents with muscle complaints while taking statins undergo a creatine kinase (CK) test and suspend statin use pending the results. Therefore, myopathy was defined as the presence of any creatine kinase test during a break in statin dispense records, any CK test greater than three times the upper limit of normal (ULN), or any diagnosis of myopathy. Myalgia was defined as the presence of a normal CK test during a break in the statin dispense records or a diagnosis of myalgia.

During the study period, myopathy developed in 7.1% of the statin initiators and 5.5% of the controls, a statistically significant difference. The unadjusted incidence of myopathy/1,000 person-years was also significantly greater for the statin users, 21.9, than for the nonusers, 18.1. Also, the rates of CK levels between 1 and 3 times the ULN were significantly different, seen in 1.7% of the statin users and 0.6% of the controls, translating to unadjusted incidence rates of 5.5/1,000 vs. 2.0/1,000 person-years.

Similarly, the proportion developing myalgia was also significantly greater with statins (5.8%), compared with controls (4.7%), as was the incidence rate of myalgia (18.3/1,000 vs. 15.4/1,000), Dr. Nichols and Dr. Koro reported.

On the other hand, myositis—defined as a CK test with a result 3–10 times the ULN or a diagnosis—was not significantly more common among statin users, occurring in 0.21% of statin users and 0.14% of controls, with rates of 0.70/1,000 vs. 0.46/1,000. Similarly, comparable rates of rhabdomyolysis, defined as a CK test result more than 10 times above the ULN (0.13% vs. 0.12%) or a diagnosis (0.41/1,000 vs. 0.17/1,000), were seen.

Concurrent use of fibrates and corticosteroids were the strongest predictors of myopathy (hazard ratios 2.11 and 1.80, respectively). Older age, presence of cardiovascular disease, and higher body-mass index also contributed to the myopathy risk. After adjustment for those factors, the incidence rates were not significantly different between statin users and controls (21.1/1,000 vs. 19.4/1,000).

Older age, higher BMI, concurrent fibrate use, concurrent corticosteroid use, and the presence of cardiovascular disease also increased the risk for myalgia; male sex and metformin use appeared to be protective. As with myopathy, adjusting for those factors eliminated the difference between statin users and nonusers (17.3/1,000 vs. 16.4/1,000).

However, the rates of elevated CK test results of 1–3 times the ULN remained significantly higher for statin users even after adjusting for predictors such as younger age, longer duration of diabetes, male sex, concurrent fibrate use, higher BMI, and poor kidney function (4.1/1,000 vs. 1.3/1,000).

WASHINGTON — Statin-induced myopathy and myalgia may be higher than reported previously in patients with diabetes, but myositis and rhabdomyolysis are rare, Gregory A. Nichols, Ph.D., and Carol E. Koro, Ph.D., reported in a poster at the annual scientific sessions of the American Diabetes Association.

Clinical trial results suggest that statin-induced myopathy occurs in less than 1% of patients, but no previously published reports of muscle syndromes following statin initiation have come from real-world settings, said Dr. Nichols and Dr. Koro, both of Kaiser Permanente Northwest, Portland, Ore.

They compared electronic pharmacy records for 10,247 Kaiser enrollees who have type 2 diabetes and initiated statins between 1997 and 2004.

Their results were compared with those of the same number of diabetic patients who did not take statins during that time period.

Study subjects were followed until they experienced a myopathic event or until the end of 2005.

Kaiser Permanente recommends that any patient who presents with muscle complaints while taking statins undergo a creatine kinase (CK) test and suspend statin use pending the results. Therefore, myopathy was defined as the presence of any creatine kinase test during a break in statin dispense records, any CK test greater than three times the upper limit of normal (ULN), or any diagnosis of myopathy. Myalgia was defined as the presence of a normal CK test during a break in the statin dispense records or a diagnosis of myalgia.

During the study period, myopathy developed in 7.1% of the statin initiators and 5.5% of the controls, a statistically significant difference. The unadjusted incidence of myopathy/1,000 person-years was also significantly greater for the statin users, 21.9, than for the nonusers, 18.1. Also, the rates of CK levels between 1 and 3 times the ULN were significantly different, seen in 1.7% of the statin users and 0.6% of the controls, translating to unadjusted incidence rates of 5.5/1,000 vs. 2.0/1,000 person-years.

Similarly, the proportion developing myalgia was also significantly greater with statins (5.8%), compared with controls (4.7%), as was the incidence rate of myalgia (18.3/1,000 vs. 15.4/1,000), Dr. Nichols and Dr. Koro reported.

On the other hand, myositis—defined as a CK test with a result 3–10 times the ULN or a diagnosis—was not significantly more common among statin users, occurring in 0.21% of statin users and 0.14% of controls, with rates of 0.70/1,000 vs. 0.46/1,000. Similarly, comparable rates of rhabdomyolysis, defined as a CK test result more than 10 times above the ULN (0.13% vs. 0.12%) or a diagnosis (0.41/1,000 vs. 0.17/1,000), were seen.

Concurrent use of fibrates and corticosteroids were the strongest predictors of myopathy (hazard ratios 2.11 and 1.80, respectively). Older age, presence of cardiovascular disease, and higher body-mass index also contributed to the myopathy risk. After adjustment for those factors, the incidence rates were not significantly different between statin users and controls (21.1/1,000 vs. 19.4/1,000).

Older age, higher BMI, concurrent fibrate use, concurrent corticosteroid use, and the presence of cardiovascular disease also increased the risk for myalgia; male sex and metformin use appeared to be protective. As with myopathy, adjusting for those factors eliminated the difference between statin users and nonusers (17.3/1,000 vs. 16.4/1,000).

However, the rates of elevated CK test results of 1–3 times the ULN remained significantly higher for statin users even after adjusting for predictors such as younger age, longer duration of diabetes, male sex, concurrent fibrate use, higher BMI, and poor kidney function (4.1/1,000 vs. 1.3/1,000).

Physicians are strongly advised to assess patients for their global risk of cardiovascular disease and diabetes, according to a “call to action” from the American Heart Association and the American Diabetes Association.

“The overweight or obese patient deserves major clinical attention. The growing prevalence of this condition threatens to undermine all of our recent gains to prevent and control chronic disease,” the authors wrote (Circulation 2006;113:2943–6, Diabetes Care DOI: 10.2337/dc06-9911).

Cowritten by the presidents and chief science advisors of the two organizations, the document was issued in part to dispel the notion that there is disagreement between the ADA and AHA about the need to assess patients for risk factors such as prediabetes, hypertension, dyslipidemia, obesity, and smoking. In fact, the debate has been specifically about the clinical utility of the term “metabolic syndrome,” not about the overall need to screen patients for risk of cardiovascular disease (CVD), they said.

“Unfortunately, some of the medical press have positioned the scientific issues related to the metabolic syndrome as a 'battle' between the [ADA and AHA], implicitly suggesting that CVD risk factor identification and treatment is now questionable. We are concerned that the presumed dispute will lead to a reduction in the favorable trend of many aspects of CVD risk factor reduction,” said AHA president Dr. Robert H. Eckel and ADA president Dr. Robert Rizza, along with science advisors Richard Kahn, Ph.D., of the ADA and Dr. Rose Marie Robertson of the AHA.

Another reason for issuing the statement, they noted, is the recent evidence suggesting that risk assessment and adherence to national guidelines remains “woefully suboptimal.”

The ADA has an online tool, at www.diabetes.org/diabetesphd

Physicians are strongly advised to assess patients for their global risk of cardiovascular disease and diabetes, according to a “call to action” from the American Heart Association and the American Diabetes Association.

“The overweight or obese patient deserves major clinical attention. The growing prevalence of this condition threatens to undermine all of our recent gains to prevent and control chronic disease,” the authors wrote (Circulation 2006;113:2943–6, Diabetes Care DOI: 10.2337/dc06-9911).

Cowritten by the presidents and chief science advisors of the two organizations, the document was issued in part to dispel the notion that there is disagreement between the ADA and AHA about the need to assess patients for risk factors such as prediabetes, hypertension, dyslipidemia, obesity, and smoking. In fact, the debate has been specifically about the clinical utility of the term “metabolic syndrome,” not about the overall need to screen patients for risk of cardiovascular disease (CVD), they said.

“Unfortunately, some of the medical press have positioned the scientific issues related to the metabolic syndrome as a 'battle' between the [ADA and AHA], implicitly suggesting that CVD risk factor identification and treatment is now questionable. We are concerned that the presumed dispute will lead to a reduction in the favorable trend of many aspects of CVD risk factor reduction,” said AHA president Dr. Robert H. Eckel and ADA president Dr. Robert Rizza, along with science advisors Richard Kahn, Ph.D., of the ADA and Dr. Rose Marie Robertson of the AHA.

Another reason for issuing the statement, they noted, is the recent evidence suggesting that risk assessment and adherence to national guidelines remains “woefully suboptimal.”

The ADA has an online tool, at www.diabetes.org/diabetesphd

Physicians are strongly advised to assess patients for their global risk of cardiovascular disease and diabetes, according to a “call to action” from the American Heart Association and the American Diabetes Association.

“The overweight or obese patient deserves major clinical attention. The growing prevalence of this condition threatens to undermine all of our recent gains to prevent and control chronic disease,” the authors wrote (Circulation 2006;113:2943–6, Diabetes Care DOI: 10.2337/dc06-9911).

Cowritten by the presidents and chief science advisors of the two organizations, the document was issued in part to dispel the notion that there is disagreement between the ADA and AHA about the need to assess patients for risk factors such as prediabetes, hypertension, dyslipidemia, obesity, and smoking. In fact, the debate has been specifically about the clinical utility of the term “metabolic syndrome,” not about the overall need to screen patients for risk of cardiovascular disease (CVD), they said.

“Unfortunately, some of the medical press have positioned the scientific issues related to the metabolic syndrome as a 'battle' between the [ADA and AHA], implicitly suggesting that CVD risk factor identification and treatment is now questionable. We are concerned that the presumed dispute will lead to a reduction in the favorable trend of many aspects of CVD risk factor reduction,” said AHA president Dr. Robert H. Eckel and ADA president Dr. Robert Rizza, along with science advisors Richard Kahn, Ph.D., of the ADA and Dr. Rose Marie Robertson of the AHA.

Another reason for issuing the statement, they noted, is the recent evidence suggesting that risk assessment and adherence to national guidelines remains “woefully suboptimal.”

The ADA has an online tool, at www.diabetes.org/diabetesphd