Archive for September, 2009

LONDON, ENGLAND, UK – Research recently published in the open access journal, Public Library of Science Medicine, suggests that there is an association between thiazolidinediones – a type of drug introduced in the 1990s to treat type 2 diabetes – and bone fracture.

Ian Douglas of the London School of Hygiene and Tropical Medicine and colleagues searched the UK General Practice Research Database, a computerised record of clinical records from over 6 million patients registered at 400 general practice surgeries in the United Kingdom. They identified 1,819 individuals aged 40 years or older who had a recorded bone fracture and who had been prescribed a thiazolidinedione at least once and conducted a self-controlled case-series study. This is a study that compares how often an event (in this case bone fracture) occurs in a population of people during the period when they are taking a particular medication (in this case a thiazolidinedione drug) against the period when they are not taking that medication. Adjusting for age (as older people are at a higher risk of bone fracture), the researchers found that in the group of people identified nearly one and half times as many fractures occurred when people were taking thiazolidinediones than when they were not taking these drugs. The increased risk of fracture was observed in both men and women and applied to a wide range of fracture sites on the body. The study also found that the risk of fracture increased as the duration of treatment with the drug increased.

The main advantage of the study design is that it eliminates the possibility that differences between people who do and do not get prescribed a drug contribute to the results. The researchers acknowledge that as with any study there could be other sources of bias because it is observational and not a randomised trial. Nevertheless, the findings are in keeping with findings from recent trials that suggested a link between thiazolidinediones and bone fracture. The researchers conclude that the results “should be taken into consideration in the wider debate surrounding the possible risks and benefits of treatment with thiazolidinediones.

- MFP Wire Services
- 9-30-2009

PHILADELPHIA, PA – More than 12 million people in the U.S. suffer from sleep apnea, most common among the overweight and obese. More than just loud snoring, it can lead to high blood pressure, stroke, cardiovascular disease and a poor quality of life. For years, doctors have told patients with sleep apnea that their best bet for alleviating it would be to lose weight, but there’s been very little research-based evidence to prove that.

“Existing research has been limited by a number of factors, so there are very few studies that show whether the recommended amount of weight loss – about 10 percent – is enough to sufficiently improve sleep apnea,” said Gary Foster, director of the Center for Obesity Research and Education.

Foster and colleagues from six other universities recently completed the largest randomized study on the effects of weight loss on sleep apnea in patients with type 2 diabetes. They found that among patients with severe sleep apnea, those who lost the recommended weight were three times more likely to nearly eliminate the number of sleep apnea episodes compared to those who did not lose weight. The results are published in a recent issue of the Archives of Internal Medicine.

The new study, called Sleep AHEAD, looked at 264 obese patients with type 2 diabetes already enrolled in the Look AHEAD trial, an ongoing 16-site study investigating the long-term health impact of an intensive lifestyle intervention in 5,145 overweight or obese adults with type 2 diabetes. Participants were between 45 and 75 years old.

The 264 participants were broken into two randomized groups: the first received a group behavioral weight loss program developed especially for obese patients with type 2 diabetes, portion-controlled diets, and a prescribed exercise regimen of 175 minutes per week. The second attended three group informational sessions over a one-year period that focused on diabetes management through diet, physical activity and social support.

After one year, members of the first group lost an average of 24 pounds. More than three times as many participants in this group had complete remission of their sleep apnea (13.6 percent compared to 3.5 percent), and also had about half the instances of severe sleep apnea as the second group. Further, participants in the second group only lost about a pound, and saw significant worsening of their sleep apnea, which suggested to Foster and his team that without treatment, the disorder can progress rapidly.

“These results show that doctors as well as patients can expect a significant improvement in their sleep apnea with weight loss,” said Foster, the study’s lead author. “And a reduction in sleep apnea has a number of benefits for overall health and well-being.”

- MFP Wire Services
- 9-30-2009

LUND, SKANE, SWEDEN – In older age groups, repeated suicide attempts constitute an increased risk for completed suicide in depressed women, while severe attempts constitute an increased risk for depressed men. Researchers writing in the open access journal BioMed Central Psychiatry studied suicide attempts in 100 patients who committed suicide and in an age- and sex-matched control group, investigating the effects of age on suicidal behaviour, as a risk factor for accomplished suicide.

Louise Brådvik and Mats Berglund, from Lund University, Sweden, studied the hospital records of patients admitted between 1956 and 1969 and followed up until 2006. According to Brådvik, “Men and women showed different patterns of suicide attempts in the older age groups. The risk for an initial suicide attempt reduced with age in all females and in male controls, but not in male victims, repetition and severity then showing a special pattern”.

Speaking about the results, Brådvik said, “Suicide attempt is known to be one of the main predictors for suicide in depression. If attempts are repeated or serious, the risk for suicide is considered to be increased. However, to our knowledge, there has been no investigation into the predictive value of age at repeated and severe suicide attempt for accomplished suicide. In our study it appears that from middle age onwards, repeated attempts are a risk factor for suicide in women and so are severe attempts for men. In other words, though all suicide attempts should be taken seriously, an older woman who makes a repeated attempt is at higher risk for suicide and needs more observation and treatment than a young female repeater. Correspondingly, an older man who makes a severe attempt (or an initial attempt) is in need of more observation”.

The study concerns patients with severe depression (with psychotic and melancholic features) only. It is unknown if the findings are applicable for other depressives.

- MFP Wire Services
- 9-30-2009