Conference Highlights

Am Fam Physician. 1999 Nov 15;60(8):2359-2360.

Incidence of Type 2 Diabetes Rising Dramatically in Children

(59th Annual Scientific Sessions of the American Diabetes Association) Results of several studies in the United States and Canada show the incidence of type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes mellitus) is increasing in children and adolescents, especially in those who are obese, have a first- or second-degree relative with diabetes, are from ethnic minorities and have acanthosis nigricans. In the Columbia University study, 19 children (10 to 17 years of age) were initially referred to the Diabetes Center at Columbia Presbyterian Center for obesity or polyuria. All were obese, had acanthosis nigricans and most had a family history of diabetes and most were from ethnic minorities (47 percent Hispanic, 37 percent black, 11 percent Caucasian and 5 percent Asian). All were diagnosed with type 2 diabetes, and 42 percent had unrecognized hyperglycemia. A study at the University of Manitoba Faculty of Medicine evaluated 82 First Nation Cree-speaking children (six to 17 years of age) who had been diagnosed with type 2 diabetes. The study compared the number of referred cases of type 2 diabetes during five-year periods ending in 1985 and 1998 and a 200 percent increase in such cases was noted (from 0.8 per year in 1985 to 8.4 per year in 1998). Another study at the Mount Sinai Hospital, University of Toronto, evaluated the prevalence of pediatric obesity and associated behavioral risk factors among the northwestern Ontario Oji Cree, who have high rates of adult obesity and type 2 diabetes. The researchers measured height, weight, fitness level, dietary intake and television viewing in 445 children two to 19 years of age. Increased television viewing was associated with obesity in those 10 to 19 years of age, while high fitness levels and fiber consumption on the previous day resulted in a decreased risk of obesity. The majority of the studies emphasized the correlation between obesity in children and the early development of type 2 diabetes. Based on the findings, the investigators are calling for increased research on diabetes in children and the development of guidelines for the screening and diagnosing of type 2 diabetes in the pediatric population.—robin s. goland, m.d., et al. Columbia University, New York, New York; heather dean, m.d., University of Manitoba, Winnipeg, Manitoba, Canada; bernard zinman, m.d.c.m., et al., Mt. Sinai Hospital, Toronto, Ontario, Canada.

Depression Increases Health Costs in Patients Who Have Diabetes

(American Diabetes Association) According to a study by the Kaiser Permanente Center for Health Research, Portland, Ore., persons with type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes mellitus) are more likely than persons who do not have diabetes to have depression and, as a result, incur higher annual health care costs. The Kaiser study used age and gender to match the records of 5,059 patients with type 2 diabetes with a control group of persons without diabetes. Consistent with smaller studies, depression was found to be much more prevalent in patients with diabetes than in the control patients (18.5 versus 11.4 percent). In both groups, the depressed patients were younger, more likely to be female, and had more comorbid conditions such as asthma or heart disease. Annual health care costs, including inpatient and out-patient care and pharmacy costs, were highest for those with diabetes and depression, averaging $6,787. There was little difference in overall costs between patients with diabetes who were not depressed ($4,233) and patients with depression who did not have diabetes ($4,337). Those patients with neither condition incurred substantially lower annual health care costs—$2,199. The additional costs associated with depression were similar in both groups, suggesting that depression may add a fixed cost regardless of other existing medical conditions.—gregory a. nichols, ph.d., et al., Kaiser Permanente Center for Health Research, Portland, Oregon.

Survey Shows More Patients with Diabetes Should Take Aspirin

(American Diabetes Association) Results of a survey conducted by the Centers for Disease Control and Prevention (CDC) showed that fewer than one in five Americans with diabetes are following the American Diabetes Association's (ADA) recommendation of taking a daily dose (81 to 325 mg) of enteric-coated aspirin to help reduce the incidence of diabetes-related cardiovascular disease. The CDC survey indicated that 98 percent of American adults with diabetes had evidence of cardiovascular disease or at least one risk factor for cardiovascular disease and were therefore eligible for aspirin therapy provided they have no contraindications, such as aspirin allergy, bleeding tendency, gastrointestinal bleeding or clinically active liver disease. The survey used a representative sample of 1,503 U.S. adults aged 20 or older with self-reported diabetes who participated in the Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III). Regular aspirin use was defined as 15 to 30 times in the past month. Thirty-two percent of those with cardiovascular disease and 12 percent of those with cardiovascular disease risk factors were regular aspirin users. Regular aspirin use was higher among non-Hispanic Caucasians, people with cardiovascular disease and among people 40 years of age or older. The ADA recommends aspirin therapy for primary prevention among those with risk factors for cardiovascular disease, including family history of cardiovascular disease, smoking, hypertension, obesity and lipid abnormalities (such as high cholesterol levels), and as secondary prevention in those with a history of heart attack, stroke, claudication or angina.—deborah b. rolka, et al., Centers for Disease Control and Prevention, Atlanta, Georgia.

Investigational Drug Shows Promise in the Treatment of Depression

(152nd Annual Meeting of the American Psychiatric Association) The investigational drug reboxetine mesylate, the first in a new class of drugs called selective norepinephrine reuptake inhibitors, shows promise in the treatment of patients with depression, according to two double-blind, randomized multicenter studies. The 549 patients in the studies had been diagnosed with major depression. Both studies included an active control group who received fluoxetine, and one of the studies was placebo-controlled. Patients were randomized to receive 8 to 10 mg per day of reboxetine (205 patients), 20 to 40 mg per day of fluoxetine (216 patients) or placebo (128 patients) for eight weeks. The primary outcome measure in both studies was mean reduction in the Hamilton Depression Scale (HAM-D) total scores. In the nonplacebo-controlled group, the mean reduction in HAM-D scores was 19.2 in patients receiving reboxetine and 16.8 in patients receiving fluoxetine. In the placebo-controlled study, the mean reduction in scores was 13.4 in the patients receiving reboxetine, 13.3 in the patients receiving fluoxetine and 8.7 in the placebo group. Adverse effects included dry mouth, insomnia, constipation, increased sweating, hypotension and related symptoms, urinary hesitancy/retention, paresthesia, tachycardia and impotence. The investigators point out that reboxetine works by selectively inhibiting a process in the brain called “reuptake,” increasing the amount of norepinephrine and its neurotransmission to various sections of the brain.—juan massana, m.d., Hospital Clinic, Barcelona, Spain.


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