In 3 clinical trials of overweight individuals on diets with a low glycemic load or with large amounts of fiber and whole grains, elevated fasting blood glucose before treatment indicated successful weight loss and maintenance. The American Journal of Clinical Nutrition analysis included information from the Diet, Obesity, and Genes trial; the OPUS Supermarket intervention trial; and the Nutrient-Gene Interactions in Human Obesity trial. For individuals with prediabetes, consuming vegetables, fruits, and wholegrains was effective for weight loss and could potentially improve diabetes markers. A diet rich in healthy fats from plant sources was most effective for patients with type 2 diabetes.
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MedPage Today reported that “newly initiated use of an SGLT2 inhibitor was associated with a roughly twofold greater risk of diabetic ketoacidosis versus new initiation of a DPP4 inhibitor,” investigators found after examining “data on 50,220 patients with type 2 diabetes from the TruvenMarketScan database of commercially insured patients,” all of whom “were started on an SGLT2 inhibitor or DPP4 inhibitor prior to the FDA warning (April 2013-December 2014).” The findings were published in The New England Journal of Medicine.
Higher Uric Acid Levels May Be Linked to Elevated Risk for Development of Nephrolithiasis in Men8/2/2017 Renal & Urology News reported that research suggests “higher serum uric acid level is modestly and independently associated with an elevated risk for development of nephrolithiasis in a dose-dependent manner in apparently healthy men, but not women.” The findings were published online in the American Journal of Kidney Diseases.
HealthDay reported that a review suggests “combining low doses of several different blood pressure drugs may be better than using a standard dose of just one medication.” Investigators “reviewed 42 studies involving ultra-low doses of multiple medications.” Review co-author Dr. Anthony Rodgers said, “What we found was that four quarter doses [of different medications] gives a lot of benefit with few apparent side effects.” The findings were published in Hypertension.
The New York Times reported, “Growing evidence suggeststhat the method by which blood sugar is lowered may make a big difference in heart risk” in people with type 2 diabetes [T2D]. What’s more, “it’s becoming clear, researchers say, that there’s far too little evidence on how diabetes drugs affect the heart to make rational evidence-based judgments.” This has now “raised a medical dilemma affecting tens of millions of people with type 2 diabetes – and for the doctors who treat them.”
A new 14-year study of 148,739 women with type 2 diabetes (mean age of 63.3 years) showed an overall 18% reduced breast cancer risk for women who used low-dose aspirin daily compared to those who did not after adjusting for confounders. The authors of the Journal of Women’s Healthstudy reported that a high cumulative dose of aspirin over the 14-year study period reduced breast cancer risk by 47%. A cumulative aspirin dosage of >88,900 mg was associated with a reduced risk of breast cancer in women with type 2 diabetes, though additional studies are necessary to confirm the findings.
Nonsteroidal anti-inflammatory drugs (NSAIDs) were linked with an increased risk of heart attack in a meta-analysis of published studies. In 8 studies including 446,763 adults, 61,460 individuals experienced a heart attack. In those who used NSAIDs at any dose for 1–7 days, the risk of heart attack increased 24% for celecoxib, 48% for ibuprofen, 50% for diclofenac, and 53% for naproxen. (There was a 58% increased risk associated with rofecoxib, which has been taken off the market.) In The BMJ analysis, risk increased with higher doses and longer treatment duration, but there was no additional increase in risk after 1 month.
A recent trial found an excess of muscle-related adverse events associated with statins only when patients were aware that statin therapy was being used. The trial included a randomized double-blind placebo-controlled phase, in which 10,180 patients received atorvastatin or a placebo, and a subsequent non-randomized non-blind extension phase, in which all patients were offered atorvastatin open label. During the blinded phase, muscle-related adverse events were reported at a similar rate between groups, but in the non-blinded phase, statin users reported a 41% higher rate of muscle pain or weakness than those taking placebo. The findings are published in The Lancet.
STAT (4/24, Ross) examines questions about whether so many orthopedic surgeries are necessary, based on an “evidence gap” of support for them and the increase in volume in procedures such as knee replacements, which have doubled since 2000 in the US and account for some $10 billion in annual costs to the health care system. Other surgeries under scrutiny include the repair of a torn meniscus, vertebroplasty, clavicle fracture repair in young people, ACL repairs, and rotator cuff repairs. Dr. David Jevsevar, who chairs the American Academy of Orthopaedic Surgeons’ council on research and quality, says general scrutiny of individual procedures may overlook that “it’s challenging to determine what the right amount is because every patient is unique and every patient has his or her own set of situations and expectations.”
People May Have Difficulty Accurately Estimating Salt Intake When Eating At Fast-Food Restaurants4/26/2017 TIME (4/24, Oaklander) reports that research published in Appetite suggests people may have difficulty accurately estimating how much salt they consume when eating at a fast-food restaurant. Investigators “stood outside fast-food restaurants and asked people to guess how much sodium they just ate.” Participants’ “answers were almost always six times too low.”
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