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Am Fam Physician. 1998;58(6):1399-1400

Treatment for Cervical Carcinoma May Affect Pregnancy Outcome

(31st Annual Meeting of the Society for Epidemiologic Research) Results of a retrospective study show that the risk of giving birth to a premature or low-birth-weight infant is increased in women who have been treated with conization for cervical carcinoma in situ, compared with women who have not undergone cone biopsy. Records of 1,851 women diagnosed with cervical carcinoma in situ between 1984 and 1992 were linked to records of their first subsequent birth following diagnosis of cancer. These data were compared with records of infants born to women without cervical cancer. After adjusting for maternal smoking, race, parity, marital status and history of induced pregnancy termination, women with cervical carcinoma who were not treated with conization were found to have a small increase in the risk of premature delivery (odds ratio: 1.4) and no increase in the risk of delivering a low-birth-weight infant (odds ratio: 1.0), compared with women without cervical carcinoma. However, women with cervical carcinoma who underwent conization were more likely to give birth to premature infants (odds ratio: 1.6) and low-birth-weight infants (odds ratio: 1.8) than were women without cervical carcinoma, after adjustment for the same confounders. These women were also more likely to have an incompetent cervix.—amira youssef elbastawissi, m.d., et al., Fred Hutchinson Cancer Research Center, Seattle, Wash.

Rate of Asymptomatic CAD Is High in Young Persons with Diabetes

(58th Annual Meeting and Scientific Sessions of the American Diabetes Association) Asymptomatic coronary atherosclerosis is more prevalent in young persons with type 1 diabetes mellitus (formerly known as insulin-dependent diabetes mellitus, or IDDM), compared with the general population. This is the conclusion of a study of 135 patients 20 to 49 years of age who have had type 1 diabetes for two to 48 years (median: 21 years). The participants (70 women and 65 men) had no reported history of coronary artery disease (CAD) or angina. An assessment was made on the basis of electron beam computed tomography that identified calcium deposits inside the coronary arteries. Test scores were compared with those in a control group of 1,093 subjects who did not have diabetes or symptoms of CAD. Most of the subjects who had diabetes for over 10 years and who were older than 30 years of age had coronary artery calcium deposits (71 percent of the men and 54 percent of the women). Of these, 29 percent were receiving antihypertensive medication, 10 percent were taking lipid-lowering drugs and 17 percent were current smokers. Forty-five percent of the women with diabetes had calcium deposits before the age of 30 years, compared with only 6 percent of the control subjects. The investigators believe that aggressive intervention to treat all of the risk factors for coronary disease should begin before the age of 30 in persons with diabetes.—robert h. eckel, m.d., et al., University of Colorado Health Science Center, Denver.

Hormone Replacement Therapy May Help Control Diabetes in Women

(American Diabetes Association) Results of a study that examined whether hemoglobin A1c (HbA1c) levels vary with the use of hormone replacement therapy (HRT) show that postmenopausal women with type 2 diabetes mellitus (formerly known as non–insulin-dependent diabetes mellitus, or NIDDM) who use HRT are better able to maintain good blood glucose control, decreasing their risks of complications, compared with women not receiving HRT. The multi-ethnic cohort of 14,601 women older than 50 years of age was identified by the Northern California Kaiser Permanente Diabetes Registry. Fifteen percent of the women in the study were African American, 12 percent were Asian/Pacific Islander, 13 percent were Hispanic and 50 percent were non-Hispanic white women; all had type 2 diabetes. Overall, an average of 25 percent of the women used HRT. In each subgroup, women using HRT were younger and better educated than the women not using HRT. No differences were observed in body mass index (BMI) between those who used HRT and those who did not. After controlling for age, BMI, education and type of hypoglycemic therapy, the women using HRT were found to have significantly lower HbA1c levels in all of the groups, compared with the women not using HRT. The investigators believe that more studies are necessary to understand the extent to which HRT may improve metabolic control in women with type 2 diabetes.—joe v. selby, m.d., m.p.h., et al., Division of Research, Kaiser Permanente, Oakland, Calif.

Use of the Hormone Leptin May Be Effective for Weight Loss

(American Diabetes Association) Use of the hormone leptin may be effective in helping individuals lose weight, according to results of a multicenter, placebo-controlled study in which some subjects received recombinant methionyl human leptin, a synthesized form of the natural human hormone. Fifty-three lean subjects and 70 moderately obese subjects were randomly assigned to receive placebo or one of four doses of leptin by subcutaneous injection daily for one month. The doses of leptin ranged from 0.01 to 0.30 mg per kg. All of the participants followed a weight reduction diet. At the end of the first month, a statistically significant dose response for weight loss was noted in all of the subjects. Average weight losses ranged from 0.04 kg (0.09 lb) for those on placebo to 1.9 kg (4.18 lb) for those receiving the highest leptin dose. Sixty of the obese patients continued in the study, and 76 percent of these completed the study. After six months, average weight losses ranged from 0.7 kg (1.54 lb) to 7.1 kg (15.6 lb) in those receiving the highest dose of leptin.—andrew s. greenberg, m.d., et al., Jean Mayer U.S.D.A. Human Nutrition Center, Tufts University, Boston.

Inhaled Insulin Shown Effective in Treatment of Diabetes

(American Diabetes Association) Two major multicenter trials in which an inhaled form of insulin was used over a three-month period in the treatment of type 1 diabetes mellitus (formerly called insulin-dependent diabetes mellitus, or IDDM) and type 2 diabetes mellitus (formerly called non–insulin-dependent diabetes mellitus, or NIDDM) have shown that patients using inhaled insulin can achieve good blood glucose control. In the study of persons with type 1 diabetes, 70 subjects were randomized to receive either inhaled insulin or subcutaneous insulin injections for three months. The subjects receiving injections continued their prior regimen of two to three injections of insulin daily. The subjects receiving the inhaled insulin took one or two inhalations before each meal, as well as one injection of insulin at bedtime. Glycemic control did not differ in the two groups, and there was no difference in the incidence and severity of hypoglycemia. The inhaled therapy was well tolerated, and 80 percent of these subjects opted for a one-year extension of the inhaled therapy. In the second study, 51 patients with type 2 diabetes were randomized to receive either inhaled insulin or subcutaneous injections for three months, using the same regimen as in the study of patients with type 1 diabetes. After three months, glycemic control was similar in the subjects receiving inhaled insulin and those receiving injections. Ninety-two percent of the patients with type 2 diabetes opted to continue receiving the inhaled insulin for one year. The investigators conclude that a regimen using inhaled insulin represents a well tolerated and comparably effective alternative to an insulin regimen using subcutaneous injections in the management of both types of diabetes.—jay a. skyler, m.d., et al., University of Miami, Fla. (type 1 diabetes study), and william t. cefalu, m.d., et al., University of Vermont College of Medicine, Burlington (type 2 diabetes study).

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Copyright © 1998 by the American Academy of Family Physicians.

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