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    <recommendedItem id="20100101_19_394"
                     title="Even Normal Glucose in Kids Could Predict Diabetes Later (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/18291?impressionId=1265785819973"
                     
      Increases in fasting plasma glucose during childhood  --  even though levels remain in the normal range  --  can predict adult prediabetes and type 2 diabetes later in life, a retrospective cohort study showed.&lt;br&gt;
&lt;br&gt;Among individuals with a fasting plasma glucose of less than 100 mg/dL as children, increasing levels were associated with greater risks of prediabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and type 2 diabetes (&lt;em&gt;P&lt;/em&gt;=0.03) in adulthood, according to Gerald Berenson, MD, of Tulane University Health Sciences Center in New Orleans, and colleagues.&lt;br&gt;
&lt;br&gt;There appeared to be a threshold  --  85 mg/dL  --  above which the risk of adult problems began to increase, the researchers reported in the February issue of &lt;em&gt;Archives of Pediatrics and Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;It is not surprising that a higher fasting glucose level in childhood predicts prediabetes and diabetes in adulthood,&quot; Matthew Gillman, MD, of Harvard, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;More surprising, he said, was the existence of the apparent threshold, although &quot;the authors are appropriately circumspect about recommending lowering glucose cutoff points to diagnose children at risk of developing prediabetes or diabetes.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Even if there is a threshold over which children are at substantially higher risk of later prediabetes, it is unclear exactly how high the risk should be to make changing guidelines a good thing,&quot; he wrote. &quot;After all, the right interventions for individuals with prediabetes are still obscure, so identifying more of them may be more trouble than it&apos;s worth.&quot;&lt;/p&gt;
&lt;p&gt;According to Berenson and colleagues, 19 million U.S. adults have type 2 diabetes. More common is a prediabetic state of impaired fasting glucose, affecting about 54 million.&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that higher plasma glucose levels, even if still in the normal range, might be a predictor of diabetes.&lt;/p&gt;
&lt;p&gt;Berenson&apos;s group wanted to see whether elevated fasting plasma glucose in childhood would predict prediabetes or type 2 diabetes in adulthood.&lt;/p&gt;
&lt;p&gt;To find out, they turned to the Bogalusa Heart Study, which began tracking children from that Louisiana town in 1978. All had a fasting plasma glucose lower than 100 mg/dL.&lt;/p&gt;
&lt;p&gt;The current analysis included those same individuals assessed as adults after a mean follow-up of 21 years  --  1,723 were normoglycemic (99 mg/dL or lower), 79 were prediabetic (100 to 125 mg/dL), and 47 had type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Using a childhood fasting plasma glucose of 86 mg/dL or higher as a predictor for prediabetes yielded a 76.9% sensitivity and 85.2% specificity. For diabetes, sensitivity was 75% and specificity was 76%.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis controlling for anthropometric, hemodynamic, and metabolic variables from childhood to adulthood, as well as baseline fasting plasma glucose level, those individuals who had a childhood level 86 mg/dL or higher had increased risks of both prediabetes (OR 3.40, 95% CI 1.87 to 6.18) and type 2 diabetes (OR 2.06, 95% CI 1.01 to 4.23) as adults.&lt;/p&gt;
&lt;p&gt;The authors acknowledged some limitations of the study, including the lack of data on postchallenge glucose, in vivo insulin action and secretion, and glycosylated hemoglobin in childhood.&lt;/p&gt;
&lt;p&gt;Gillman, the editorialist, also noted that the findings&apos; generalizability to children today is unclear because obesity was much less prevalent when the adults in this study were children.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute on Aging and the American Heart Association.&lt;/p&gt;&lt;p&gt;The editorial was supported by a grant from the NIH.&lt;/p&gt;&lt;p&gt;Neither the study authors nor the editorialist reported any conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_291"
                     title="Obese Kids at Risk for Adult CVD (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/Endocrinology/MetabolicSyndrome/tb/18153?impressionId=1265785819973"
                     
      Obesity in children as young as 7 years old may put them at higher risk of heart disease and stroke later in life, even if they lack other cardiovascular risk factors such as high blood pressure, a new study found.&lt;br&gt;
&lt;br&gt;Obese children had higher levels of biomarkers for inflammation and prothrombosis than thin children. These included 10 times higher concentrations of high sensitivity C-reactive protein, a marker associated with increased risk of developing heart disease, cardiovascular disease, or other processes involving inflammation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01), according to an online report published Jan. 26 in the &lt;em&gt;Journal of Clinical Endocrinology and Metabolism&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Fibrinogen, interleukin-6 (IL-6) and plasminogen activator inhibitor 1 (PAI-1), other markers associated with inflammation and elevated blood clotting risk, were also elevated in obese children (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;These observations reflect the unhealthy status of many youth at risk for adult cardiovascular disease in our catchment area in the southeastern U.S.,&quot; Nelly Mauras, MD, of Nemours Children&apos;s Clinic in Jacksonville, Fla., and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The number of overweight children in the U.S. has tripled in the last 30 years, and more than 17% of children between the ages of 6 and 19 are overweight, according to the authors.&lt;/p&gt;
&lt;p&gt;Overweight children often develop metabolic syndrome, a collection of findings that includes abdominal obesity, elevated triglyceride and decreased HDL concentrations, hypertension, and impaired glucose tolerance. These put the youngsters at risk for early adult cardiovascular disease. Yet the exact definition of metabolic syndrome is a matter of ongoing debate.&lt;/p&gt;
&lt;p&gt;While children are typically considered to be at low risk of tissue damage if they show no signs of carbohydrate intolerance, hypertension, and dyslipidemia, Mauras and colleagues theorized that obese children without other risk factors for metabolic syndrome could still be at risk for later cardiovascular disease.&lt;/p&gt;
&lt;p&gt;To test this, they compared markers for inflammation and prothrombosis in 115 obese children and 88 lean children between the ages of 7 and 18 years. The study was conducted at Wolfson Children&apos;s Hospital, in Jacksonville, Fla.&lt;/p&gt;
&lt;p&gt;&quot;Children with obesity show a marked increase in the concentrations of hsCRP, 351 fibrinogen, IL-6 and PAI-1, reflective of a proinflammatory and prothrombotic state, even before the comorbidities of the Metabolic Syndrome are present, and even before the onset of puberty,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;These data support the need for more aggressive interventions in very young children with obesity regardless of the absence of associated comorbidities.&quot;&lt;/p&gt;
&lt;p&gt;They also found that elevated levels of hsCRP and fibrinogen correlated with a wider waist circumference (R=0.73 and 0.40, respectively) and the percent of fat mass (r= 0.76 and 0.47) (&lt;em&gt;P&lt;/em&gt;=0.0001). Prepubertal obese children were taller than their lean counterparts (&lt;em&gt;P&lt;/em&gt;=0.005) and had higher systolic blood pressure.&lt;/p&gt;
&lt;p&gt;The authors noted that their study did not address whether the abnormalities they found are reversible with early therapeutic interventions.&lt;/p&gt;
&lt;p&gt;&quot;Weight reduction (or weight maintenance in many growing children) remains the cornerstone of any intervention in childhood obesity,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;However, further longitudinal studies adding pharmacological interventions, in addition to lifestyle changes, will soon offer much needed insight as to whether a decrease in the proinflammatory and prothrombotic state will improve long-term cardiovascular risk of obese children, even in preadolescence and before the development of the Metabolic Syndrome.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding for the study and no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1845"
                     title="ADA: Weight-Loss Drugs May Have Benefit in Diabetes"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ADA/tb/14634?impressionId=1265785819973"
                     
      NEW ORLEANS, June 10 -- Three investigational diet drugs may hold promise for preventing and treating diabetes, researchers said here.
              &lt;br&gt;&lt;br&gt;All three showed improvements in risk factors besides obesity, including blood glucose, blood pressure, and triglycerides, according to three presentations here at the American Diabetes Association meeting.
              &lt;br&gt;&lt;br&gt;&quot;Instead of sulfonylureas and thiazolidinediones, the next generation of diabetes medications will likely be weight-loss drugs,&quot; Louis Aronne, M.D., of Weill-Cornell and New York Presbyterian, who presented data as a lead investigator on a trial for Qnexa, a combination of phentermine and topiramate.
              &lt;p&gt; 
              &lt;p&gt;Dr. Aronne said there is &quot;no real winner&quot; among the three, with lorcaserin  (combining benzazepine and hydrochloride) and contrave (combining bupropion and naltrexone) also showing similar improvements in overall health.
              &lt;p&gt; 
              &lt;p&gt;But each reported somewhat different cardiometabolic benefits at oral and poster sessions here.
              &lt;p&gt; 
              &lt;p&gt;Patients taking lorcaserin had significantly lower levels of fasting plasma glucose and a greater decrease in fasting insulin and insulin resistance as measured by HOMA-IR than those on placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;They also had significant reductions in blood pressure, total cholesterol, and triglycerides compared with controls, according to Christen M. Anderson, M.D., Ph.D., vice president of clinical development for drugmaker Arena Pharmaceuticals.
              &lt;p&gt; 
              &lt;p&gt;Dr. Anderson presented the findings from year two of the BLOOM (Behavioral modification and Lorcaserin for Overweight and Obesity Management) trial as one of its investigators at a late-breaking poster session.
              &lt;p&gt; 
              &lt;p&gt;&quot;We had dramatic improvements in insulin resistance and in biomarkers of cardiovascular disease,&quot; Dr. Anderson said.
              &lt;p&gt; 
              &lt;p&gt;In terms of weight loss, 47.5% of patients on the drug lost at least 5% of their body weight, compared with and 20.3% of those on placebo, and 22.6% lost at least 10% of their body weight compared with 7.7% of placebo patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;After two years, patients on the drug maintained a significantly greater amount of weight loss compared with those who had switched to placebo after one year, Dr. Anderson said.
              &lt;p&gt; 
              &lt;p&gt;&quot;We are looking at long-term treatment,&quot; she said. &quot;That&apos;s the implication here.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Anderson stressed that there was no excess valvular insufficiency during two years of use. That was a problem with the combination diet drug phentermine and fenfluramine (Phen-Fen), which was pulled from the market because of cardiovascular complications.
              &lt;p&gt; 
              &lt;p&gt;Also, there was no association with an increased risk of depression or suicidal ideation, she added.
              &lt;p&gt; 
              &lt;p&gt;Qnexa showed significant reductions in hemoglobin A1c levels in both diabetic and prediabetic populations, according to two studies.
              &lt;p&gt; 
              &lt;p&gt;Among diabetic patients, those on the drug had a 1.6% reduction in HbA1c from baseline, compared with 1.1% for patients on placebo (&lt;em&gt;P&lt;/em&gt;=0.038), according to W. Timothy Garvey, M.D., of the University of Alabama at Birmingham.
              &lt;p&gt; 
              &lt;p&gt;Dr. Garvey presented the findings from a 56-week trial of 130 diabetic patients at an oral session here.
              &lt;p&gt; 
              &lt;p&gt;The patients also experienced significant reductions in blood pressure and triglycerides, as well as better reductions in fasting plasma glucose -- from 176 mg/dL to 133 mg/dL in treatment patients compared with 171 mg/dL to 145 mg/dL for the placebo group (&lt;em&gt;P&lt;/em&gt;=0.02).
              &lt;p&gt; 
              &lt;p&gt;Dr. Garvey said patients on the drug had a significant reduction in antidiabetic medication use compared with controls, as well as significant improvements in fasting glucose, systolic blood pressure, and waist circumference.
              &lt;p&gt; 
              &lt;p&gt;&quot;These results suggest that [the drug] has the potential to play an important role in diabetes management with respect to blood sugar control and sustained weight loss,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;He noted 65% of those on the drug lost at least 5% of their body weight, compared with 24% in the placebo group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). A total of 37% lost at least 10%, compared with 9% of placebo patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).
              &lt;p&gt; 
              &lt;p&gt;Among 756 nondiabetic obese patients, those who received the drug dropped their HbA1c levels by 0.01% and 0.02%, respectively, with regard to dose (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
              &lt;p&gt; 
              &lt;p&gt;In comparison, HbA1c rose by 0.09% over the six-month study period among placebo patients, said Dr. Aronne, who presented the findings of the EQUATE study at an oral session here.
              &lt;p&gt; 
              &lt;p&gt;The findings show that the drug can help &quot;halt the progression towards type 2 diabetes,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;Taken together, both trials show that the drug &quot;lowers HbA1c in diabetic patients, and for patients that haven&apos;t been diagnosed with diabetes, [it] can prevent increases in HbA1c levels,&quot; Dr. Aronne said.
              &lt;p&gt; 
              &lt;p&gt;Contrave also showed benefits for cardiometabolic parameters, but results of a late-stage phase III trial primarily focused on the drug&apos;s safety and efficacy with regard to weight loss.
              &lt;p&gt; 
              &lt;p&gt;Overall, 66.4% of patients on the drug lost at least 5% of their body weight, compared with 42.5% of placebo patients, and 41.5% lost at least 10% of their weight compared with 20.2% of placebo patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), according to Thomas Wadden, Ph.D., of the University of Pennsylvania, who presented the findings at an oral session here.
              &lt;p&gt; 
              &lt;p&gt;Dr. Wadden did not provide many details with regard to effects on diabetic and prediabetic patients, but he said those on the drug saw &quot;greater improvements in cardiometabolic risk factors such as waist circumference, triglycerides, and LDL cholesterol.&quot;
              &lt;p&gt; 
              &lt;p&gt;Nearly all of the researchers agreed that all three drugs, once approved, will play a role in both obesity and diabetes treatment.
              &lt;p&gt; 
              &lt;p&gt;&quot;There will definitely be a place for all three,&quot; Dr. Anderson said.
              &lt;p&gt; 
              &lt;p&gt;Dr. Aronne said that since one medication &quot;may work better for one person than for another,&quot; physicians &quot;need many different options.&quot;
              &lt;p&gt; 
              &lt;p&gt;&quot;We need this whole group of treatments,&quot; he said, &quot;in order to better manage both obesity and diabetes.&quot;
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Anderson is an employee of Arena Pharmaceuticals.
              &lt;p&gt;Dr. Aronne reported relationships with Amylin, Arena Pharmaceuticals, Orexigen Therapeutics, sanofi-aventis, and Vivus.
              &lt;p&gt;Dr. Wadden is an adviser for Orexigen Therapeutics and Meck Pharmaceuticals.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
           
    </recommendedItem>
    <recommendedItem id="20090101_19_3707"
                     title="Intestinal Sleeve May Improve Glycemic Control (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/17008?impressionId=1265785819973"
                     
      &lt;p&gt;Noninvasive implantation of a sleeve in the small intestine just beyond the stomach quickly improves glycemic control in obese diabetes patients, researchers say.&lt;/p&gt;
&lt;p&gt;In a small pilot study, fasting plasma glucose levels for patients who received the duodenal-jejunal bypass liner (EndoBarrier) fell 55 mg/dL, while levels among those who had a sham procedure rose 42 mg/dL (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.05), according to Christopher Sorli, MD, of the Billings Clinic in Billings, Mont., and colleagues.&lt;/p&gt;
&lt;p&gt;They reported their findings online in &lt;em&gt;Diabetes Technology &amp;amp; Therapeutics.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;But differences in this measure of glycemic control did not remain significant after the 24 weeks of the study were completed. Also, the study was scheduled to run for 52 weeks but too many patients had to have the device removed because of pain or anchor migration before that time.&lt;/p&gt;
&lt;p&gt;Still, the researchers said the results are hopeful.&lt;/p&gt;
&lt;p&gt;&quot;The ability of the [sleeve] to rapidly normalize glycemic control in obese diabetes patients represents a promising development in the search for novel therapies that provide relief to the clinical progression of this disease and are less invasive than bariatric surgery,&quot; the researchers said. &quot;The results of this diabetes-specific pilot study are encouraging and support further clinical investigations.&quot;&lt;/p&gt;
&lt;p&gt;Although bariatric surgery has been effective in reversing diabetes, particularly with regard to normalization of plasma glucose, insulin, and HbA1c, some concerns exist about its associated morbidity and mortality.&lt;/p&gt;
&lt;p&gt;So researchers have been looking for an alternative. The duodenal-jejunal bypass liner is a candidate because it is placed endoscopically and is easily removable. It&apos;s also made of an impermeable fluoropolymer sleeve and is fastened in place via a barbed metal anchor at the duodenal entrance.&lt;/p&gt;
&lt;p&gt;For 24 weeks between January 2007 and February 2008 at the Hospital DIPRECA in Santiago, Chile, the researchers studied 18 obese diabetic patients  --  12 of whom received the sleeve, and another six who got sham endoscopy.&lt;/p&gt;
&lt;p&gt;They looked at baseline weight, HbA1c, a meal tolerance test, fasting glucose, and seven-point glucose profiles.&lt;/p&gt;
&lt;p&gt;At baseline, all patients were taking at least one oral diabetes drug. Their baseline HbA1c was 9.1 and baseline body mass index (BMI) was 38.9.&lt;/p&gt;
&lt;p&gt;The researchers found that within the first week, the device reduced fasting plasma glucose by 55 mg/dL in the sleeve group, while those in the sham group had a 42 mg/dL increase (&lt;em&gt;P&lt;/em&gt;&amp;#8804;0.05).&lt;/p&gt;
&lt;p&gt;By the end of the study, fasting plasma glucose dropped 83 mg/dL in the treatment group and rose 16 mg/dL in the sham group, but this difference was not significant.&lt;/p&gt;
&lt;p&gt;Also at one week, mean postprandial glucose area-under-the-curve was reduced in the treatment group by 22% and was increased 16% in the sham arm (&lt;em&gt;P&lt;/em&gt;=0.016).&lt;/p&gt;
&lt;p&gt;Meanwhile, the seven-point glucose profile was reduced and flattened at one week but was not changed in the sham group, the researchers said.&lt;/p&gt;
&lt;p&gt;Although HbA1c decreased substantially more in the device arm than in the sham arm, the trial missed its primary endpoint because this difference did not reach statistical significance.&lt;/p&gt;
&lt;p&gt;At week 12, HbA1c dropped 1.3% in the treatment group and 0.8% in the sham arm, and at 24 weeks, it dropped 2.4% in the treatment group and 0.7% in the sham group, with no significant differences at either time point.&lt;/p&gt;
&lt;p&gt;But the device did appear to reduce the number of oral diabetes medications patients were taking.&lt;/p&gt;
&lt;p&gt;In the intent-to-treat population, after 12 weeks, 42% of patients with the sleeve were able to stop their diabetes medications, compared with only 17% of those in the placebo group who quit their drugs.&lt;/p&gt;
&lt;p&gt;In the full population, after 12 weeks, 50% and 25% had ceased use, respectively.&lt;/p&gt;
&lt;p&gt;By week 24, 40% of treated patients and 25% of sham patients remaining in the study had stopped taking diabetes medications.&lt;/p&gt;
&lt;p&gt;The researchers said that device migrations required endoscopic removal before the 52-week mark.&lt;/p&gt;
&lt;p&gt;Three patients had the sleeve removed after an adverse event related to migration or turning, including moderate abdominal pain and moderate nausea and vomiting.&lt;/p&gt;
&lt;p&gt;Two other migrations occurred but the patients had no symptoms, they added.&lt;/p&gt;
&lt;p&gt;They noted that all 12 treated patients had at least one episode of mild or moderate abdominal pain and four of them had mild or moderate vomiting, but none requested the device be removed for these reasons.&lt;/p&gt;
&lt;p&gt;Weight loss was also similar in both groups. The device arm tended towards more weight loss after week 12, but this was not statistically significant because the study was designed to minimize differences in weight loss between groups so the researchers could analyze glycemic changes independent of weight loss.&lt;/p&gt;
&lt;p&gt;Patients with the device began to lose more weight, but because of the small number of patients in the sham arm and because one of them lost a significant amount of weight, the differences didn&apos;t reach statistical significance.&lt;/p&gt;
&lt;p&gt;The study was limited in its statistical power and by the need to remove three devices due to abdominal pain or anchor migration.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Four of the researchers are paid consultants for GI Dynamics, which makes the device, and one is also a shareholder and medical director of the company.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_267"
                     title="The Year in Diabetes, 2005"
                     score="-0.005"
                     href="