Home Blood Sugar Monitoring Questioned

(HealthDay News) -- Home monitoring of blood sugar levels may not be as essential to the effective care of type 2 diabetes as previously thought, a new British study suggests.

The researchers found that having patients monitor their own glucose levels at home had no effect on their overall blood sugar levels. The findings do not apply to type 2 diabetics who must take insulin.

"We wanted to investigate a current controversy, which is whether monitoring blood sugar for people with type 2 diabetes, who are not using insulin, is helpful or not," explained lead researcher Dr. Andrew Farmer, a lecturer in the Department of Primary Health Care at the University of Oxford.

The study appears in the current online edition of the British Medical Journal, and Farmer planned to report on the findings Tuesday at the American Diabetes Association conference, in Chicago.

Farmer noted that some patient groups and doctors are in favor of having patients monitor their own blood sugar, but it is expensive and so some insurance companies discourage it.
"We found no conclusive evidence that home monitoring improved glucose control," Farmer said.

In the study, Farmer's team randomly assigned 453 patients with type 2 diabetes to one of three groups.

One group had their blood sugar level checked three times a month. The second group was given a meter to test their blood sugar at home and told to have their doctor interpret the results. The third group was given meters and taught how to interpret the findings.

At one year, Farmer's group found no difference in blood sugar levels between the groups. In addition, there was no evidence that having patients monitor their blood sugar improved their glucose control.

Moreover, half of the people who had been given glucose monitors stopped using them before the end of the study, Farmer said.

Home glucose monitoring is supposed to work by helping patients adjust their medications and give them a new attitude toward their diabetes, so they might take their condition more seriously and change their behavior, Farmer said.

"But in either case, if there is an effect it is relatively small, at best," Farmer said. His conclusion: "People shouldn't be hassled into using these meters."

Farmer believes that, given these findings, the current guidelines for monitoring blood sugar may need to be revised. The value of home monitoring remains necessary and worthwhile for people with type 1 diabetes, and for people with type 2 diabetes who are taking insulin, Farmer said.

"These patients can adjust their insulin much more carefully and make the necessary changes," Farmer said. "Studies have found improved outcomes from that. It's just in this situation [patients with type 2 diabetes who are not using insulin] that this technology's place is limited and should not be recommended."

More information
For more information on diabetes, visit the American Diabetes Association.

Fructose-Sweetened Drinks Tougher on Arteries

(HealthDay News) -- The type of sugar in a sugary drink may impact how healthy -- or unhealthy -- it is for arteries, a new study suggests.

Fructose-sweetened drinks are more likely to provoke the development of fatty artery deposits in overweight adults than glucose-sweetened beverages, researchers say.

Kimber Stanhope, of the University of California at Davis, and colleagues compared the results of drinking fructose-sweetened beverages versus glucose for 10 weeks in overweight and obese adults.

Participants ate a balanced diet with 30 percent fat and 55 percent complex carbohydrates. Thirteen of the participants also consumed glucose-sweetened drinks, while 10 drank fructose-sweetened drinks.

The researchers found that 9 weeks later, 24-hour post-meal triglyceride (blood fat) levels went up after 2 weeks of fructose-sweetened drink but went down in those who consumed glucose-sweetened drinks.

Those who drank fructose-sweetened drinks also had a boost in fasting blood concentrations of LDL ("bad") cholesterol and other measures. Those levels were unaltered in those consuming glucose-sweetened drinks, however.

The findings were scheduled to be presented Saturday at the annual meeting of the American Diabetes Association, in Chicago.

The bottom line, according to the researchers: "Persons at risk for developing metabolic syndrome and cardiovascular disease should avoid over-consumption of fructose-containing beverages."

The ADA notes, however, that consumption of fructose-sweetened beverages has gone up by 135 percent in the United States over the past four decades.

More information
There's more on eating right to prevent diabetes at the American Dietetic Association.

Obesity Cuts Risk of Dying After Heart Attack

(HealthDay News) -- In what doctors admit is a paradox, new European research shows that obese patients have half the risk of dying after a heart attack compared with normal-weight patients.

"Once a heart attack has occurred and been optimally treated, obese patients switch to a more favorable prognosis compared to normal-weight patients," said lead researcher Dr. Heinz Joachim Buettner, the head of interventional cardiology at Herz-Zentrum Bad Krozingen, Germany.

But the finding is no license for Americans to pile on the pounds, since obesity has long been known as a major factor for bringing on heart attack in the first place.

"Every effort should continue to prevent and treat obesity, and this study should not be taken to mean that it is good for one's health to be overweight or obese," said Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles.

He was not involved in the new study, which is published in the June 20 issue of the European Heart Journal.

In the study, Buettner's group tracked the health outcomes of almost 1,700 people who were hospitalized and treated for a common type of heart attack known as unstable angina/non-ST-segment elevation.

Among the patients, a third were normal weight, half were overweight, and 18 percent were either obese or very obese. The obese and very obese patients were by-in-large younger and more likely to have high blood pressure and diabetes.

In addition, for most of the obese patients, this was their first heart attack. They were also more likely to leave the hospital with prescriptions for heart medications, such as statins, ACE-inhibitors and beta-blockers.

During three years of follow-up, Buettner's team found that obese and very obese patients had less than half the risk of dying compared with normal weight patients. Among all the patients, 9.9 percent of normal-weight patients died, compared to 7.7 percent of overweight patients.

However, only 3.6 percent of obese patients had died, and none of the very obese patients died.
How might obesity lessen risk for death after heart attack?

The reasons for the paradox remain unclear, but Fonarow speculates that obese people may have more biological resources to draw on than thinner people.

"Patients who are overweight and obese may be able to drawn on greater metabolic reserve than patients who are in the underweight or healthy weight categories," Fonarow said.

"We have previously published on an obesity paradox in patients with acute as well as chronic heart failure, so this paradox applies to a number of cardiovascular disease states," he added.
Buettner stressed that, despite these findings, staying slim dramatically lowers your risk for having a heart attack in the first place.

"It is well known that even a modest intentional weight loss can improve or prevent obesity-related cardiovascular risk factors like diabetes mellitus and arterial hypertension," he said. This means that "obese people have a great potential to influence their prognosis, and they should start the effort before an acute coronary event occurs," he added.

Fonarow agreed that becoming obese is definitely not a good way to protect yourself from having a heart attack or even dying after suffering one.

"The findings from this study further confirm the finding of a number of prior studies that demonstrated an obesity paradox exists in patients with established cardiovascular disease, including those presenting with acute coronary syndromes receiving therapy," he said.

However, even though obese patients with acute coronary syndrome had a lower risk of post-heart attack death, obesity strongly contributes to an increased risk of heart trouble, diabetes, and cardiovascular death, Fonarow added.

More information
For more information on heart attack, visit the American Heart Association.

Antibiotic Use in Infants May Up Asthma Risk

(HealthDay News) -- Giving antibiotics for a non-respiratory tract infection to an infant younger than 1 greatly increases the odds that the child will develop asthma, according to new research.

The study found that the risk was highest for those infants who received multiple courses of antibiotics and those who received prescriptions for broad-spectrum antibiotics. Broad-spectrum antibiotics tend to kill a wide range of bacteria -- both good and bad.

"Asthma is a multi-factorial disease, and we've found evidence of an association with first-year-of-life antibiotic use and asthma," said the study's lead author, Anita Kozyrskyj, an associate professor at the University of Manitoba in Winnipeg, Canada.

One hypothesis, Kozyrskyj added, is that broad-spectrum antibiotics are killing off too many good bacteria.

"It may be that you need the presence of good bacteria during the first year of life for the immune system to develop normally, and the antibiotics are killing off some of the natural microflora in the gut," she said.

The study findings are published in the June issue of the journal Chest.

Each year, about 4 million American children have active asthma, resulting in about 14 million missed school days, according to the American Lung Association. Because asthma can't currently be cured, only controlled, researchers are focusing on factors that may play a role in the initial development of the lung disease.

For the new study, Kozyrskyj and her colleagues followed almost 14,000 children from birth in 1995 until 2003, when all of the children had reached 7 years of age. Data came from the Manitoba Health Services Insurance Program and included information on physician visits, prescriptions, hospitalizations and health diagnoses.

Additionally, the researchers linked this data to data on the mothers of these children to see if there was a maternal history of asthma. Parents also completed surveys on home and environmental exposures.

All of the children were from Manitoba. Half were male, and 57 percent lived in urban areas. One-quarter of the children were from low-income families; 90 percent had siblings; 5 percent had a maternal history of asthma, and 6 percent developed asthma by age 7, the researchers found.

Two-thirds of the youngsters had received at least one antibiotic prescription during their first year of life, many of them for broad-spectrum antibiotics, according to the study. And, the more antibiotics received, the greater the risk of asthma.

Kids who received one to two courses of antibiotics had a 21 percent increased risk of asthma; those given three to four courses of antibiotics had a 30 percent rise in risk; while youngsters given more than four courses of antibiotics had a 46 percent increased risk of asthma.

Children given antibiotics for non-respiratory tract infections, such as urinary-tract infections, were as much as 86 percent more likely to develop asthma than those treated for respiratory infections.

Other factors that increased the risk of asthma included a family history, living in an urban area and being male. Having a sibling conferred a slight protective effect, as did having a dog for children who received multiple courses of antibiotics. In kids who had more than four courses of antibiotics before age 1, having a dog decreased the risk of asthma by 28 percent. However, in kids who received fewer antibiotics, that protective effect wasn't there.

Dr. Alan Khadavi, a pediatric asthma specialist at New York University Medical Center, said that prevention of asthma isn't a reason to get a dog. "If you already have a dog, that's fine, but the studies are conflicting about whether they're helpful or harmful," he added.

As for antibiotic use, Khadavi said, "If your child under 1 year is sick, have him or her evaluated. Don't push for antibiotics. But. on the other hand, if it's a serious infection that needs to be treated, I wouldn't worry too much about the asthma risk. If it's a mild infection, a watch-and-wait approach won't be harmful if they're under a physician's care."

Dr. Sai Nimmagadda, an attending physician in the division of allergy at Children's Memorial Hospital in Chicago, said this study points to the need for "more judicious use of antibiotics, especially broad-spectrum antibiotics in kids under a year."

"Once wheezing has developed, it's difficult to alter the course of asthma, so now we're looking back to see if there are any risk factors we can change," he said.

Kozyrskyj recommended that physicians start by prescribing narrow-spectrum antibiotics, such as amoxicillin, for their youngest patients, and then if necessary, try a broad-spectrum medication.

More information
To learn more about childhood Asthma, visit the American Lung Association.

FDA Seeks Strictest Warning for Diabetes Drugs

(HealthDay News) -- The U.S. Food and Drug Administration has asked that two controversial type 2 diabetes drugs carry a "black box" warning on the potentially heightened risk of congestive heart failure in some patients.

In prepared testimony before a Congressional committee that was convened Wednesday following a published report on the cardiac dangers of Avandia, FDA Commissioner Dr. Andrew von Eschenbach said the agency had asked that Avandia, made by GlaxoSmithKline, and Actos, made by Takeda Pharmaceuticals, carry the more prominent warning because "despite existing warnings, these drugs were being prescribed to patients with significant heart failure."

According to von Eschenbach's testimony, the request for the warning -- the strictest one possible -- was issued to both companies May 23, two days after publication of a study in the New England Journal of Medicine that found Avandia (rosiglitazone) increased the risk of heart attack by as much as 43 percent.

But the decision to request the heightened warning wasn't made public until von Eschenbach's appearance before the House Committee on Oversight and Government Reform, which is reviewing the FDA's role in the Avandia controversy.

The May 21 Avandia study was led by Dr. Steven Nissen, a Cleveland Clinic cardiologist who was among the first to warn about the heart risks posed by the now-banned arthritis drug Vioxx.

Following the release of the NEJM study on Avandia, the FDA issued a safety alert, but stopped short of asking for a stronger warning label, saying more analysis was needed.

"The Food and Drug Administration is aware of a potential safety issue related to rosiglitazone," Dr. Robert J. Meyer, director of FDA's Office of Drug Evaluation II, said during a May 21 teleconference. But, he added, "At this point, we have not reached a definitive conclusion on the data. We don't feel there is consistent enough data to make a decision from a regulatory standpoint. We are not ready to make an action."

On Tuesday, results of a British study, funded by GlaxoSmithKline, were released and showed no significant increased risk for heart attack or death from heart disease associated with Avandia.

The study, which was released early by the New England Journal of Medicine to coincide with the House hearing, also found no increased risk for cardiac events among diabetics taking Avandia and those not taking it.

"Overall, there was no significant difference between those on rosiglitazone and those not on rosiglitazone," study co-author Stuart J. Pocock, of the London School of Hygiene & Tropical Medicine, said Tuesday. "The concern about cardiovascular death, I think, we have clearly deflated. The concern on heart attack -- our data are modifying that concern, but it's still inconclusive."

But one expert pointed out Tuesday that the original goal of the new study was to show a benefit of rosiglitazone in preventing heart disease.

"When you get a finding that is against the hypothesis, it makes me sit up and take note," said Dr. David M. Nathan, of Massachusetts General Hospital, and author of an accompanying editorial in the journal. "None of the data is reassuring. You don't give the drug the benefit of the doubt -- you give safety the benefit of the doubt."

And another expert, Dr. Bruce M. Psaty, who wrote a second editorial in the journal, said Wednesday of the Avandia findings, "I combined the results from this study with the study by Nissen, and there was still a 33 percent increase in risk of a heart attack."

Psaty, of the University of Washington in Seattle, also testified at Wednesday's House hearing.

Afterwards, he said that the FDA needs to have a "black box" warning about heart attack risk, not just heart failure risk, which he said has been known for a long time.

"It sounds like the FDA has had this data on heart attack risk since 2005," he said. "In Europe, the label was revised back in September."

Psaty added that the FDA needs to mandate post-marketing studies to uncover safety problems.

"You need a drug safety system that is complementary to the rapid approval system that we have in place," Psaty said. "What we are seeing with Avandia and Vioxx is the fallout of the system where you sped up approval and did not do anything to test safety."

Meanwhile, the FDA announced Wednesday that an advisory panel will meet on July 30 to weigh the cardiovascular risks of the class of diabetes drugs that includes Avandia.

In response to that announcement, the Cleveland Clinic's Nissen said in a prepared statement: "We published our meta-analysis on the cardiovascular safety of Avandia because we felt it was our obligation to alert the medical and patient community to a potentially serious drug safety problem and urged comprehensive evaluations to clarify the risks."

He added, "We encourage a lively scientific debate about these issues and look forward to the results of the FDA advisory board hearings in July. During today's congressional hearings, we learned that meta-analyses conducted by the FDA and GlaxoSmithKline showed similar results to our findings. We would like to see those analyses published in peer-reviewed journals so that the totality of information on the cardiovascular safety of Avandia is available to doctors and patients."

Also Wednesday, Takeda Pharmaceuticals announced that it would add the boxed warning requested by the FDA to prescription labels for Actos (pioglitazone).

Dr. Robert Spanheimer, the company's senior medical director for diabetes and metabolism, said in a prepared statement, "Takeda remains confident in the safety and efficacy of Actos when used according to its label, and with this revision, we can heighten patient and physician awareness of an already known, but serious side effect."

On Tuesday, GlaxoSmithKline had issued a prepared statement saying that the British study should reassure type 2 diabetes patients that Avandia was safe.

"They [the findings] add to the weight of evidence, from both previously published long-term clinical trials and other studies, that the overall ischemic cardiovascular safety profile of Avandia is comparable to the traditional anti-diabetes treatments. Patients and physicians should find these data reassuring," said Moncef Slaoui, the company's chairman for research and development.

In response to the growing controversy over Avandia's safety profile, the American Diabetes Association on Wednesday issued an advisory statement.

"As a result of all of this information, the American Diabetes Association strongly encourages patients taking this medication to consult with their physician as to its benefits and risks," the statement read. "The Association also reminds patients, however, that they should not stop taking any prescribed medications without first discussing the issue with their health-care provider."

More information
There's much more on type 2 diabetes at the American Diabetes Association.