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    <recommendedItem id="20090101_19_1135"
                     title="Stem Cells Appear Effective for Type 1 Diabetes"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/13714?impressionId=1265801360307"
                     
      LITTLE FALLS, N.J., April 14 -- A stem cell treatment freed most patients with type 1 diabetes from insulin injections, a single-center study showed.
              &lt;p&gt; 
              &lt;p&gt;Of 23 patients who underwent nonmyeloablative hematopoietic stem cell transplantation, 20 were able to stop taking insulin -- 12 maintained that goal through an average of more than two years, eight others relapsed, requiring low doses of insulin, according to Julio Voltarelli, M.D., Ph.D., of the University of Sao Paulo in Brazil, and colleagues.
              &lt;p&gt; 
              &lt;p&gt;All 20 had sustained increases in C-peptide levels -- which indicate improved beta-cell function -- and lasting improvement in glycemic control, the researchers reported in the April 15 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;&quot;At the present time, autologous nonmyeloablative hematopoietic stem cell transplantation remains the only treatment capable of reversing type 1 diabetes mellitus in humans,&quot; they said.
              &lt;p&gt; 
              &lt;p&gt;But they acknowledged that randomized controlled trials and further biological studies are needed.
              &lt;p&gt; 
              &lt;p&gt;The effects of the treatment, which has not been approved by the FDA, on 15 of these patients were originally reported in 2007 through a mean 18.8-month follow-up period. (See: &lt;a href=&quot;http://www.medpagetoday.com/Endocrinology/Diabetes/5413&quot; target=&quot;blank&quot;&gt;Stem Cells Tame Type 1 Diabetes in Pilot Study&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;The current study was designed to evaluate the effects over a longer time in the original cohort plus an additional eight patients.
              &lt;p&gt; 
              &lt;p&gt;It also sought to verify that the stem cell treatment resulted in preserved beta-cell function rather than transient improvements resulting from diet and exercise changes associated with close post-transplant observation, the researchers said. 
              &lt;p&gt; 
              &lt;p&gt;The patients ranged in age from 13 to 31 (mean 18.4). They had all been recently diagnosed with type 1 diabetes.
              &lt;br&gt;
              &lt;p&gt;Following transplantation, the 12 patients who remained continuously free from exogenous insulin did so for an average of 31 months (range 14 to 52).
              &lt;p&gt; 
              &lt;p&gt;Insulin-free time lasted more than four years for one patient, more than three years for four patients, more than two years for three patients, and at least one year for four patients.
              &lt;p&gt; 
              &lt;p&gt;Most patients achieved good glycemic control (HbA1c &lt;7%). Mean HbA1c dropped from a pretreatment level of 8% to 5.4%, 5.7%, 5.7%, 5.5%, and 6% at the three-, 12-, 24-, 36-, and 48-month follow-ups, respectively (&lt;em&gt;P&lt;/em&gt;&lt;0.001 for all).
              &lt;p&gt; 
              &lt;p&gt;These patients had significant increases in C-peptide levels at 24 months (&lt;em&gt;P&lt;/em&gt;&lt;0.001) and 36 months (&lt;em&gt;P&lt;/em&gt;=0.001) post-transplant.
              &lt;p&gt; 
              &lt;p&gt;The eight patients who had to go back on insulin still had significantly increased C-peptide levels by 36 months (&lt;em&gt;P&lt;/em&gt;=0.001), and sustained those levels through 48 months.
              &lt;p&gt; 
              &lt;p&gt;Two of these patients regained insulin independence after taking 100 mg of sitagliptin (Januvia) a day. The drug increased C-peptide levels.
              &lt;p&gt; 
              &lt;p&gt;&quot;Because late complications of diabetes on the microvascular compartment are inversely related to C-peptide levels, it is probable that even those patients who resumed insulin are at lower risk for long-term diabetes complications,&quot; the researchers said.
              &lt;p&gt; 
              &lt;p&gt;Most of the adverse effects related to the stem cell transplant were mild, they said, and included nausea, vomiting, fever, and alopecia.
              &lt;p&gt; 
              &lt;p&gt;Two patients developed and received successful treatment for nosocomial pneumonia, three developed late endocrine dysfunction, and nine developed oligospermia. There were no deaths.
              &lt;p&gt;
              &lt;p&gt;Co-author Richard Burt, M.D., of Northwestern University in Chicago, said the university&apos;s institutional review board has approved a randomized trial to verify the findings.

               &lt;p&gt;The researchers are still awaiting FDA approval for the trial, he said at a press conference. 
              &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;The study was supported by the Brazilian Ministry of Health, FAEPA-HCRP, FUNDHERP, CAPES, FAPESP, CNPq, FINEP, Genzyme, and Johnson &amp; Johnson-LifeScan-Brazil.
              &lt;p&gt; 
              &lt;p&gt;The authors made no other financial disclosures.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
             
    </recommendedItem>
    <recommendedItem id="20100101_19_132"
                     title="Economic Burden of Diabetes Tops $200B"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Endocrinology/Diabetes/tb/17950?impressionId=1265801360307"
                     
      &lt;p&gt;Medical costs and reduced work productivity associated with diabetes cost the U.S. $218 billion in 2007, researchers said.&lt;/p&gt;
&lt;p&gt;The annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease, according to Timothy M. Dall of the Lewin Group in Falls Church, Va., and colleagues.&lt;/p&gt;
&lt;p&gt;&quot;The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life,&quot; the researchers wrote online in &lt;em&gt;Health Affairs&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies.&quot;&lt;/p&gt;
&lt;p&gt;Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.&lt;/p&gt;
&lt;p&gt;Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had type 1 diabetes and 16.5 million had type 2 diabetes in 2007.&lt;/p&gt;
&lt;p&gt;The economic model indicated that the per-patient economic burden was $14,856 for type 1 diabetes and $9,677 for type 2 disease.&lt;/p&gt;
&lt;p&gt;National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had &quot;prediabetes,&quot; and another 6.3 million Americans had diabetes but have not been formally diagnosed.&lt;/p&gt;
&lt;p&gt;Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated.&lt;/p&gt;
&lt;p&gt;Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization.&lt;/p&gt;
&lt;p&gt;For example, ambulatory visits for neurological symptoms were nearly eight times as common among among type 1 diabetics as among nondiabetics, and five times as common among those with type 2 diabetes.&lt;/p&gt;
&lt;p&gt;Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common.&lt;/p&gt;
&lt;p&gt;Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.&lt;/p&gt;
&lt;p&gt;Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues  --  about 7% of the total national healthcare expenditure.&lt;/p&gt;
&lt;p&gt;The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.&lt;/p&gt;
&lt;p&gt;Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.&lt;/p&gt;
&lt;p&gt;Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings  --  not to mention the impaired quality of life and other intangibles.&lt;/p&gt;
&lt;p&gt;But everyone else shares the costs as well, they argued.&lt;/p&gt;
&lt;p&gt;&quot;This diabetes burden represents a hidden &apos;tax&apos; in the form of higher health insurance premiums and reduced disposable income,&quot; Dall and colleagues wrote.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_8_930"
                     title="Mortality Rates Hold Steady for Women With Diabetes"
                     score="-0.005"
                     href="