Timothy F. Kirn

CHICAGO — Physicians who see children must be on the lookout for hyperglycemic hyperosmolar state because the rising tide of pediatric obesity and type 2 diabetes means that this diagnosis is going to occur more often in children, Dr. Arlan L. Rosenbloom said at the annual scientific sessions of the American Diabetes Association.

“We may be headed for a disastrous situation with this problem,” said Dr. Rosenbloom, professor emeritus in the division of pediatric endocrinology at the University of Florida, Gainesville.

Dr. Rosenbloom said that he first described a case of hyperglycemic hyperosmolar state (HHS) in a pediatric patient at a meeting in 2002. The response that report generated led him to find information about six more cases, which he published.

Now, just 5 years after his first presentation, 44 cases have been described in the literature.

It is not clear how commonly hyperglycemic hyperosmolar state occurs in obese children, but Dr. Rosenbloom has tried to make an estimate.

A group at Children's Hospital Philadelphia reported in 2005 that of 190 patients diagnosed with type 2 diabetes over a 5-year period, 7 patients had an episode of HHS, or almost 4%.

Extrapolation from the incidence rate of new type 2 diabetes cases in children and adolescents suggests at least 100 pediatric cases of HHS in the United States a year, he said.

Unlike in adults, most pediatric cases of HHS occur in individuals who have not been diagnosed with type 2 diabetes at the time they present, Dr. Rosenbloom said.

None of the 44 reported cases, 35 of which met the strictest criteria for HHS, had diagnosed diabetes at the time they came to medical attention. In adults, 60%–70% of cases occur in persons with known diabetes.

The risk factors for HHS in pediatric patients include obesity (37 of the 44 reported cases), African American race (35 of 44), male gender (35 of 44), acanthosis nigricans (31 of the 37 obese individuals), a family history of type 2 diabetes (all cases), and retardation, severe autism, or cerebral palsy (7 of 44).

The symptoms that precede HHS include nausea and vomiting, abdominal pain, polyuria/ polydipsia, malaise and weakness, weight loss, confusion, and headache and dizziness.

“I can't put numbers on this because the details in the reported cases vary widely,” he said.

Death occurred in 21 of the 44 patients. Mortality does not appear to be related to the severity of renal failure or the osmolality at presentation, as it is in adults. The ranges of serum creatinine and serum osmolality in the reported cases do not differ between those who died and the survivors, Dr. Rosenbloom said.

Mortality seems to be the result of organ damage caused by hypoperfusion, and therefore, patients require rapid and intense reperfusion.

Management, which should take place in the intensive care unit, requires rapid resuscitation for shock with 0.9% saline, followed by 0.45% saline at twice the maintenance level, and insulin should be held until after initial hydration. Bicarbonate should not be given.

Treating physicians must consider that the patient may have pancreatitis, rhabdomyolysis, and deep venous thrombosis.

“Prevention requires that primary care, emergency physicians have a high index of suspicion for type 2 diabetes in sick, obese youngsters, especially in African Americans, or others with a family history [of type 2 diabetes], and appreciate the difficulty in assessing hyperosmolar dehydration in the obese youngster,” he said. “Both obesity and hyperosmolality mask some of the typical signs that pediatricians are used to.

“Perform basic biochemical studies, I should say, at the drop of a hat,” Dr. Rosenbloom advised.

CHICAGO — Physicians who see children must be on the lookout for hyperglycemic hyperosmolar state because the rising tide of pediatric obesity and type 2 diabetes means that this diagnosis is going to occur more often in children, Dr. Arlan L. Rosenbloom said at the annual scientific sessions of the American Diabetes Association.

“We may be headed for a disastrous situation with this problem,” said Dr. Rosenbloom, professor emeritus in the division of pediatric endocrinology at the University of Florida, Gainesville.

Dr. Rosenbloom said that he first described a case of hyperglycemic hyperosmolar state (HHS) in a pediatric patient at a meeting in 2002. The response that report generated led him to find information about six more cases, which he published.

Now, just 5 years after his first presentation, 44 cases have been described in the literature.

It is not clear how commonly hyperglycemic hyperosmolar state occurs in obese children, but Dr. Rosenbloom has tried to make an estimate.

A group at Children's Hospital Philadelphia reported in 2005 that of 190 patients diagnosed with type 2 diabetes over a 5-year period, 7 patients had an episode of HHS, or almost 4%.

Extrapolation from the incidence rate of new type 2 diabetes cases in children and adolescents suggests at least 100 pediatric cases of HHS in the United States a year, he said.

Unlike in adults, most pediatric cases of HHS occur in individuals who have not been diagnosed with type 2 diabetes at the time they present, Dr. Rosenbloom said.

None of the 44 reported cases, 35 of which met the strictest criteria for HHS, had diagnosed diabetes at the time they came to medical attention. In adults, 60%–70% of cases occur in persons with known diabetes.

The risk factors for HHS in pediatric patients include obesity (37 of the 44 reported cases), African American race (35 of 44), male gender (35 of 44), acanthosis nigricans (31 of the 37 obese individuals), a family history of type 2 diabetes (all cases), and retardation, severe autism, or cerebral palsy (7 of 44).

The symptoms that precede HHS include nausea and vomiting, abdominal pain, polyuria/ polydipsia, malaise and weakness, weight loss, confusion, and headache and dizziness.

“I can't put numbers on this because the details in the reported cases vary widely,” he said.

Death occurred in 21 of the 44 patients. Mortality does not appear to be related to the severity of renal failure or the osmolality at presentation, as it is in adults. The ranges of serum creatinine and serum osmolality in the reported cases do not differ between those who died and the survivors, Dr. Rosenbloom said.

Mortality seems to be the result of organ damage caused by hypoperfusion, and therefore, patients require rapid and intense reperfusion.

Management, which should take place in the intensive care unit, requires rapid resuscitation for shock with 0.9% saline, followed by 0.45% saline at twice the maintenance level, and insulin should be held until after initial hydration. Bicarbonate should not be given.

Treating physicians must consider that the patient may have pancreatitis, rhabdomyolysis, and deep venous thrombosis.

“Prevention requires that primary care, emergency physicians have a high index of suspicion for type 2 diabetes in sick, obese youngsters, especially in African Americans, or others with a family history [of type 2 diabetes], and appreciate the difficulty in assessing hyperosmolar dehydration in the obese youngster,” he said. “Both obesity and hyperosmolality mask some of the typical signs that pediatricians are used to.

“Perform basic biochemical studies, I should say, at the drop of a hat,” Dr. Rosenbloom advised.

CHICAGO — Physicians who see children must be on the lookout for hyperglycemic hyperosmolar state because the rising tide of pediatric obesity and type 2 diabetes means that this diagnosis is going to occur more often in children, Dr. Arlan L. Rosenbloom said at the annual scientific sessions of the American Diabetes Association.

“We may be headed for a disastrous situation with this problem,” said Dr. Rosenbloom, professor emeritus in the division of pediatric endocrinology at the University of Florida, Gainesville.

Dr. Rosenbloom said that he first described a case of hyperglycemic hyperosmolar state (HHS) in a pediatric patient at a meeting in 2002. The response that report generated led him to find information about six more cases, which he published.

Now, just 5 years after his first presentation, 44 cases have been described in the literature.

It is not clear how commonly hyperglycemic hyperosmolar state occurs in obese children, but Dr. Rosenbloom has tried to make an estimate.

A group at Children's Hospital Philadelphia reported in 2005 that of 190 patients diagnosed with type 2 diabetes over a 5-year period, 7 patients had an episode of HHS, or almost 4%.

Extrapolation from the incidence rate of new type 2 diabetes cases in children and adolescents suggests at least 100 pediatric cases of HHS in the United States a year, he said.

Unlike in adults, most pediatric cases of HHS occur in individuals who have not been diagnosed with type 2 diabetes at the time they present, Dr. Rosenbloom said.

None of the 44 reported cases, 35 of which met the strictest criteria for HHS, had diagnosed diabetes at the time they came to medical attention. In adults, 60%–70% of cases occur in persons with known diabetes.

The risk factors for HHS in pediatric patients include obesity (37 of the 44 reported cases), African American race (35 of 44), male gender (35 of 44), acanthosis nigricans (31 of the 37 obese individuals), a family history of type 2 diabetes (all cases), and retardation, severe autism, or cerebral palsy (7 of 44).

The symptoms that precede HHS include nausea and vomiting, abdominal pain, polyuria/ polydipsia, malaise and weakness, weight loss, confusion, and headache and dizziness.

“I can't put numbers on this because the details in the reported cases vary widely,” he said.

Death occurred in 21 of the 44 patients. Mortality does not appear to be related to the severity of renal failure or the osmolality at presentation, as it is in adults. The ranges of serum creatinine and serum osmolality in the reported cases do not differ between those who died and the survivors, Dr. Rosenbloom said.

Mortality seems to be the result of organ damage caused by hypoperfusion, and therefore, patients require rapid and intense reperfusion.

Management, which should take place in the intensive care unit, requires rapid resuscitation for shock with 0.9% saline, followed by 0.45% saline at twice the maintenance level, and insulin should be held until after initial hydration. Bicarbonate should not be given.

Treating physicians must consider that the patient may have pancreatitis, rhabdomyolysis, and deep venous thrombosis.

“Prevention requires that primary care, emergency physicians have a high index of suspicion for type 2 diabetes in sick, obese youngsters, especially in African Americans, or others with a family history [of type 2 diabetes], and appreciate the difficulty in assessing hyperosmolar dehydration in the obese youngster,” he said. “Both obesity and hyperosmolality mask some of the typical signs that pediatricians are used to.

“Perform basic biochemical studies, I should say, at the drop of a hat,” Dr. Rosenbloom advised.

SEATTLE — Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, Dr. Karen M. Bell said at the annual meeting of the American Geriatrics Society. “The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, Dr. Bell said.

Although it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface—every office, laboratory, pharmacy, etc.—up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved. The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues—significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C. “There really is nothing out there that is very good.”

Her institution finally chose General Electric Co.'s Centricity system because it can be used in many locations, such as the home for health care visits. But the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/ehr_links_products_services.htm

The center also found a number of products for long-term care. But the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to meet their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE — Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, Dr. Karen M. Bell said at the annual meeting of the American Geriatrics Society. “The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, Dr. Bell said.

Although it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface—every office, laboratory, pharmacy, etc.—up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved. The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues—significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C. “There really is nothing out there that is very good.”

Her institution finally chose General Electric Co.'s Centricity system because it can be used in many locations, such as the home for health care visits. But the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/ehr_links_products_services.htm

The center also found a number of products for long-term care. But the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to meet their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE — Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, Dr. Karen M. Bell said at the annual meeting of the American Geriatrics Society. “The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, Dr. Bell said.

Although it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface—every office, laboratory, pharmacy, etc.—up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved. The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues—significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C. “There really is nothing out there that is very good.”

Her institution finally chose General Electric Co.'s Centricity system because it can be used in many locations, such as the home for health care visits. But the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/ehr_links_products_services.htm

The center also found a number of products for long-term care. But the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to meet their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE – Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, said Dr. Bell at the annual meeting of the American Geriatrics Society.

“The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, said Dr. Bell.

While it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface–every office, laboratory, pharmacy–up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved.

The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues–significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C. “There really is nothing out there that is very good.”

Her institution finally chose General Electric Company's Centricity system because it can be used in many locations, such as the home for health care visits. But, the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/ehr_links_products_services.htm

Moreover, the center found a number of products for long-term care. But, the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE – Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, said Dr. Bell at the annual meeting of the American Geriatrics Society.

“The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, said Dr. Bell.

While it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface–every office, laboratory, pharmacy–up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved.

The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues–significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C. “There really is nothing out there that is very good.”

Her institution finally chose General Electric Company's Centricity system because it can be used in many locations, such as the home for health care visits. But, the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/ehr_links_products_services.htm

Moreover, the center found a number of products for long-term care. But, the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE – Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, said Dr. Bell at the annual meeting of the American Geriatrics Society.

“The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, said Dr. Bell.

While it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface–every office, laboratory, pharmacy–up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved.

The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues–significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C. “There really is nothing out there that is very good.”

Her institution finally chose General Electric Company's Centricity system because it can be used in many locations, such as the home for health care visits. But, the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/ehr_links_products_services.htm

Moreover, the center found a number of products for long-term care. But, the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

CHICAGO – A diet high in fiber and low in fat reduces the risk of gestational diabetes appreciably, as does exercise, Michelle A. Williams, Sc.D., said at the annual scientific sessions of the American Diabetes Association.

The number of observational studies that have shown that diet and exercise can affect the risk of gestational diabetes has reached a critical mass that should be taken seriously, said Dr. Williams, professor of epidemiology at the University of Washington, Seattle.

There is an “impressive consistency” in the data, she said.

“This is a time for action, and we should be thinking about moving toward translational approaches from this research,” she said. “Pregnancy really is an ideal time for promoting healthful activities.”

A connection between a high-fat diet and gestational diabetes was first documented in an observational study in 1997 (Diabetes Care 1997;20:1647-50). Since then, two subsequent studies have confirmed that connection. One study did not, but it involved women in China, where high-fat diets include polyunsaturated fat, she said.

In a United States prospective cohort study by researchers at the University of North Carolina at Chapel Hill, 1,698 pregnant women were asked about their diet. The investigators found that women who had gestational diabetes had a higher-fat diet than those who did not, with a mean percentage of 35% of their total calories from fat, compared with 33% for pregnant women without gestational diabetes (Am. J. Clin. Nutr. 2004:79:479-86). The researchers estimated that a woman with a fat intake of 40% of total calories had more than twice the risk of gestational diabetes than one whose fat intake was 20% of total calories. This was true even when the number of calories remained exactly the same. At the 40% fat level, more than 10% of women could be expected to have gestational diabetes.

In 2004, Dr. Williams' group reported results of a survey suggesting that low vitamin C intake also resulted in increased risk of gestational diabetes. After interviewing 67 patients with gestational diabetes and 260 controls, they reported that women who took fewer than 70 mg of vitamin C a day–an inadequate intake–had a 3.7 times higher risk of gestational diabetes than those who took more (J. Reprod. Med. 2004;49:257-66).

The group followed up that study by actually measuring plasma ascorbic acid in 755 women at an average 13 weeks' gestation. That study showed that the women in the lowest quartile of plasma ascorbic acid had a rate of gestational diabetes of 9%, compared with a rate of 3% in women in the highest quartile (Epidemiology 2004;15:597-604).

Regarding fiber in the diet, a group that looked at Nurses' Health Study data found that when the women had an intake of 22 gm or more of fiber per day prior to their pregnancy, their risk of gestational diabetes was reduced by 33% (Diabetes Care 2006;29:2223-30).

Dr. Williams said she found much the same reduction in risk in her own cohort of 288 cases of gestational diabetes and 444 controls. The data, which have not yet been published, shows that women in the highest quintile for fiber intake had a 40% reduction in risk of gestational diabetes, relative to women in the lowest quintile, and that the risk reduction followed a very linear trend down from the highest quintile. Less than half of the women, cases and controls alike, met the recommendation that the daily diet should include five fruits and vegetables.

“Suffice it to say, if they were consuming five a day, their risk for gestational diabetes would [have been] reduced quite substantially,” she said.

Six observational studies have shown a benefit from exercise before and during pregnancy, Dr. Williams said. One found a risk reduction of 47% when women who were obese exercised during pregnancy (Am. J. Epidemiol. 1997;146:961-65).

Analysis of her own data on 155 cases and 386 controls showed a 55% reduction in risk of gestational diabetes in those women who reported that they engaged in regular leisure time physical activity prior to their pregnancy. Leisure time physical activity during pregnancy resulted in a 48% reduction in risk, she added.

Dr. Williams' data also address the question of whether activity must be vigorous to produce a benefit, or whether it can be moderate, she said. Her analysis found that risk was reduced by 71% when that activity was vigorous, but risk was reduced by only 35% with moderate activity, such as walking.

In observational studies, it is probably impossible to control the analysis completely for variables that may confound the investigators' conclusions, hard as the researchers may try, Dr. Williams noted.

CHICAGO – A diet high in fiber and low in fat reduces the risk of gestational diabetes appreciably, as does exercise, Michelle A. Williams, Sc.D., said at the annual scientific sessions of the American Diabetes Association.

The number of observational studies that have shown that diet and exercise can affect the risk of gestational diabetes has reached a critical mass that should be taken seriously, said Dr. Williams, professor of epidemiology at the University of Washington, Seattle.

There is an “impressive consistency” in the data, she said.

“This is a time for action, and we should be thinking about moving toward translational approaches from this research,” she said. “Pregnancy really is an ideal time for promoting healthful activities.”

A connection between a high-fat diet and gestational diabetes was first documented in an observational study in 1997 (Diabetes Care 1997;20:1647-50). Since then, two subsequent studies have confirmed that connection. One study did not, but it involved women in China, where high-fat diets include polyunsaturated fat, she said.

In a United States prospective cohort study by researchers at the University of North Carolina at Chapel Hill, 1,698 pregnant women were asked about their diet. The investigators found that women who had gestational diabetes had a higher-fat diet than those who did not, with a mean percentage of 35% of their total calories from fat, compared with 33% for pregnant women without gestational diabetes (Am. J. Clin. Nutr. 2004:79:479-86). The researchers estimated that a woman with a fat intake of 40% of total calories had more than twice the risk of gestational diabetes than one whose fat intake was 20% of total calories. This was true even when the number of calories remained exactly the same. At the 40% fat level, more than 10% of women could be expected to have gestational diabetes.

In 2004, Dr. Williams' group reported results of a survey suggesting that low vitamin C intake also resulted in increased risk of gestational diabetes. After interviewing 67 patients with gestational diabetes and 260 controls, they reported that women who took fewer than 70 mg of vitamin C a day–an inadequate intake–had a 3.7 times higher risk of gestational diabetes than those who took more (J. Reprod. Med. 2004;49:257-66).

The group followed up that study by actually measuring plasma ascorbic acid in 755 women at an average 13 weeks' gestation. That study showed that the women in the lowest quartile of plasma ascorbic acid had a rate of gestational diabetes of 9%, compared with a rate of 3% in women in the highest quartile (Epidemiology 2004;15:597-604).

Regarding fiber in the diet, a group that looked at Nurses' Health Study data found that when the women had an intake of 22 gm or more of fiber per day prior to their pregnancy, their risk of gestational diabetes was reduced by 33% (Diabetes Care 2006;29:2223-30).

Dr. Williams said she found much the same reduction in risk in her own cohort of 288 cases of gestational diabetes and 444 controls. The data, which have not yet been published, shows that women in the highest quintile for fiber intake had a 40% reduction in risk of gestational diabetes, relative to women in the lowest quintile, and that the risk reduction followed a very linear trend down from the highest quintile. Less than half of the women, cases and controls alike, met the recommendation that the daily diet should include five fruits and vegetables.

“Suffice it to say, if they were consuming five a day, their risk for gestational diabetes would [have been] reduced quite substantially,” she said.

Six observational studies have shown a benefit from exercise before and during pregnancy, Dr. Williams said. One found a risk reduction of 47% when women who were obese exercised during pregnancy (Am. J. Epidemiol. 1997;146:961-65).

Analysis of her own data on 155 cases and 386 controls showed a 55% reduction in risk of gestational diabetes in those women who reported that they engaged in regular leisure time physical activity prior to their pregnancy. Leisure time physical activity during pregnancy resulted in a 48% reduction in risk, she added.

Dr. Williams' data also address the question of whether activity must be vigorous to produce a benefit, or whether it can be moderate, she said. Her analysis found that risk was reduced by 71% when that activity was vigorous, but risk was reduced by only 35% with moderate activity, such as walking.

In observational studies, it is probably impossible to control the analysis completely for variables that may confound the investigators' conclusions, hard as the researchers may try, Dr. Williams noted.

CHICAGO – A diet high in fiber and low in fat reduces the risk of gestational diabetes appreciably, as does exercise, Michelle A. Williams, Sc.D., said at the annual scientific sessions of the American Diabetes Association.

The number of observational studies that have shown that diet and exercise can affect the risk of gestational diabetes has reached a critical mass that should be taken seriously, said Dr. Williams, professor of epidemiology at the University of Washington, Seattle.

There is an “impressive consistency” in the data, she said.

“This is a time for action, and we should be thinking about moving toward translational approaches from this research,” she said. “Pregnancy really is an ideal time for promoting healthful activities.”

A connection between a high-fat diet and gestational diabetes was first documented in an observational study in 1997 (Diabetes Care 1997;20:1647-50). Since then, two subsequent studies have confirmed that connection. One study did not, but it involved women in China, where high-fat diets include polyunsaturated fat, she said.

In a United States prospective cohort study by researchers at the University of North Carolina at Chapel Hill, 1,698 pregnant women were asked about their diet. The investigators found that women who had gestational diabetes had a higher-fat diet than those who did not, with a mean percentage of 35% of their total calories from fat, compared with 33% for pregnant women without gestational diabetes (Am. J. Clin. Nutr. 2004:79:479-86). The researchers estimated that a woman with a fat intake of 40% of total calories had more than twice the risk of gestational diabetes than one whose fat intake was 20% of total calories. This was true even when the number of calories remained exactly the same. At the 40% fat level, more than 10% of women could be expected to have gestational diabetes.

In 2004, Dr. Williams' group reported results of a survey suggesting that low vitamin C intake also resulted in increased risk of gestational diabetes. After interviewing 67 patients with gestational diabetes and 260 controls, they reported that women who took fewer than 70 mg of vitamin C a day–an inadequate intake–had a 3.7 times higher risk of gestational diabetes than those who took more (J. Reprod. Med. 2004;49:257-66).

The group followed up that study by actually measuring plasma ascorbic acid in 755 women at an average 13 weeks' gestation. That study showed that the women in the lowest quartile of plasma ascorbic acid had a rate of gestational diabetes of 9%, compared with a rate of 3% in women in the highest quartile (Epidemiology 2004;15:597-604).

Regarding fiber in the diet, a group that looked at Nurses' Health Study data found that when the women had an intake of 22 gm or more of fiber per day prior to their pregnancy, their risk of gestational diabetes was reduced by 33% (Diabetes Care 2006;29:2223-30).

Dr. Williams said she found much the same reduction in risk in her own cohort of 288 cases of gestational diabetes and 444 controls. The data, which have not yet been published, shows that women in the highest quintile for fiber intake had a 40% reduction in risk of gestational diabetes, relative to women in the lowest quintile, and that the risk reduction followed a very linear trend down from the highest quintile. Less than half of the women, cases and controls alike, met the recommendation that the daily diet should include five fruits and vegetables.

“Suffice it to say, if they were consuming five a day, their risk for gestational diabetes would [have been] reduced quite substantially,” she said.

Six observational studies have shown a benefit from exercise before and during pregnancy, Dr. Williams said. One found a risk reduction of 47% when women who were obese exercised during pregnancy (Am. J. Epidemiol. 1997;146:961-65).

Analysis of her own data on 155 cases and 386 controls showed a 55% reduction in risk of gestational diabetes in those women who reported that they engaged in regular leisure time physical activity prior to their pregnancy. Leisure time physical activity during pregnancy resulted in a 48% reduction in risk, she added.

Dr. Williams' data also address the question of whether activity must be vigorous to produce a benefit, or whether it can be moderate, she said. Her analysis found that risk was reduced by 71% when that activity was vigorous, but risk was reduced by only 35% with moderate activity, such as walking.

In observational studies, it is probably impossible to control the analysis completely for variables that may confound the investigators' conclusions, hard as the researchers may try, Dr. Williams noted.

SEATTLE — Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, said Dr. Bell at the annual meeting of the American Geriatrics Society.

“The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, said Dr. Bell.

Although it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface—every office, laboratory, pharmacy, etc.—up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved.

The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues—significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C.

“There really is nothing out there that is very good,” she added.

Her institution finally chose General Electric Company's Centricity system because it can be used in many locations, such as the home for health care visits. However, the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/

And, the center found a number of products for long-term care. But, the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE — Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, said Dr. Bell at the annual meeting of the American Geriatrics Society.

“The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, said Dr. Bell.

Although it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface—every office, laboratory, pharmacy, etc.—up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved.

The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues—significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C.

“There really is nothing out there that is very good,” she added.

Her institution finally chose General Electric Company's Centricity system because it can be used in many locations, such as the home for health care visits. However, the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/

And, the center found a number of products for long-term care. But, the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

SEATTLE — Despite the government's push to encourage the development of the electronic medical record system, only a quarter of physicians keep medical records electronically, and only 11% of hospitals have fully implemented them, according to Dr. Karen M. Bell, director of the federal government's Office of Health IT Adoption.

In addition, of the electronic record systems in use, probably fewer than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, said Dr. Bell at the annual meeting of the American Geriatrics Society.

“The reality of it is that adoption of really good functionality is really very low,” she said.

The barriers to widespread adoption continue to be the lack of good, accepted computer applications, and the time and cost, said Dr. Bell.

Although it is thought that the use of electronic health records eventually would result in financial savings, start-up costs continue to be prohibitive, she said.

The cost to get every record interface—every office, laboratory, pharmacy, etc.—up to speed with appropriate software and hardware may be $5,000 for each one, and for the nation as a whole it may cost $50 billion, Dr. Bell said.

At the same time, those who are using electronic medical records are finding that they are not exactly time saving. In part, that is because there is a learning curve involved.

The records also generally require more information than what went into records previously, as part of an effort to improve and ensure quality.

The government currently has public policy advisory committees to encourage more adoption and to deal with privacy issues—significant challenges, Dr. Bell said.

In the meantime, her office is continuing to develop an exact definition of what is going to be needed in an electronic health record, she added. “There are no standard definitions for any of this stuff.”

Other speakers at the meeting described the significant hardship they went through acquiring a system specifically for geriatrics.

The electronic health record industry and its products are geared to the acute care environment, and when they can be used for a facility that cares for older persons, they need to be modified significantly, the speakers said.

“As I was trying to figure out which electronic health records system we would use for geriatrics, I really ran into a lot of roadblocks,” said Dr. Irene Hamrick of the division of geriatrics at East Carolina University, Greenville, N.C.

“There really is nothing out there that is very good,” she added.

Her institution finally chose General Electric Company's Centricity system because it can be used in many locations, such as the home for health care visits. However, the institution found that it needed to tailor the system for specific geriatric needs, adding records of diet and activities of daily living, and changing the physical exam form to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics. None is totally acceptable to my mind. If you want to use them, you have to adapt them,” Dr. Hamrick said.

When the Gurwin Jewish Geriatric Center of Commack, N.Y., began to look for an electronic medical record system, the institution had no idea it would take so long to find and implement one, said Dr. Suzanne Fields, the medical director.

The center found that there are Web sites (such as www.providersedge.com/

And, the center found a number of products for long-term care. But, the center has both outpatient day care and clinics, and inpatient beds, and none of the products adequately accommodated both, Dr. Fields said.

They, too, found that they had to adapt a system to their needs. In the end, the center combined two products, one for long-term care and another for physician care. The system is not yet up and running.

“It has to be individualized. That's what I didn't realize,” she said.

CHICAGO — Many patients with diabetes probably could benefit from a refresher course in how to inject insulin properly, according to a report presented at the annual scientific sessions of the American Diabetes Association.

In a trial of an education program for diabetes patients, 87 adult patients who had been using insulin for at least 3 years were evaluated and then retaught how to inject, based on what they did not seem to know. The mean hemoglobin A1c (HbA1c) level in the group dropped from 6.94% at baseline to 6.28% at 4 months after the new training.

The trial showed that more than half of these highly experienced patients had a “poor” or only “moderate” understanding of how best to treat their insulin and give themselves their injections, said Dr. Mihoko Matsumura, of the department of endocrinology and metabolism at Dokkyo University, Tochigi, Japan.

At the beginning of the trial, patients were given a detailed test of their knowledge. They were asked more than 20 questions, including:

▸ How they stored their insulin.

▸ At what temperature they stored it.

▸ What type of needle they used.

▸ Whether they were satisfied with the type of needle they were using.

▸ If they reused needles.

▸ If they knew the principle of how deep they should be injecting.

▸ Whether they pinched-up the skin and fat to avoid intramuscular injection.

▸ What angle of the needle they used when injecting.

▸ Whether they used the same injection site repeatedly.

The test results were then scored and grouped according to whether the patients had poor, moderate, or good understanding. After the test, all patients were given an explanation sheet, which included the correct answers. They also received a 10-minute review of their test with a physician.

Only 28 of the 87 patients were found to have “good” understanding on the test, defined as answering more than half the questions correctly. Another 38 had “moderate” understanding, defined as answering about half the questions correctly. And 21 had “poor” understanding, getting fewer than half the answers correct.

One of the most common problems the patients had was that they tended to inject repeatedly in the same location, Dr. Matsumura said.

The patients with the poorest understanding had the most improvement in HbA1c level at 4 months after the test, dropping from a mean of 7.03% before the test to 6.26% after, she noted.

CHICAGO — Many patients with diabetes probably could benefit from a refresher course in how to inject insulin properly, according to a report presented at the annual scientific sessions of the American Diabetes Association.

In a trial of an education program for diabetes patients, 87 adult patients who had been using insulin for at least 3 years were evaluated and then retaught how to inject, based on what they did not seem to know. The mean hemoglobin A1c (HbA1c) level in the group dropped from 6.94% at baseline to 6.28% at 4 months after the new training.

The trial showed that more than half of these highly experienced patients had a “poor” or only “moderate” understanding of how best to treat their insulin and give themselves their injections, said Dr. Mihoko Matsumura, of the department of endocrinology and metabolism at Dokkyo University, Tochigi, Japan.

At the beginning of the trial, patients were given a detailed test of their knowledge. They were asked more than 20 questions, including:

▸ How they stored their insulin.

▸ At what temperature they stored it.

▸ What type of needle they used.

▸ Whether they were satisfied with the type of needle they were using.

▸ If they reused needles.

▸ If they knew the principle of how deep they should be injecting.

▸ Whether they pinched-up the skin and fat to avoid intramuscular injection.

▸ What angle of the needle they used when injecting.

▸ Whether they used the same injection site repeatedly.

The test results were then scored and grouped according to whether the patients had poor, moderate, or good understanding. After the test, all patients were given an explanation sheet, which included the correct answers. They also received a 10-minute review of their test with a physician.

Only 28 of the 87 patients were found to have “good” understanding on the test, defined as answering more than half the questions correctly. Another 38 had “moderate” understanding, defined as answering about half the questions correctly. And 21 had “poor” understanding, getting fewer than half the answers correct.

One of the most common problems the patients had was that they tended to inject repeatedly in the same location, Dr. Matsumura said.

The patients with the poorest understanding had the most improvement in HbA1c level at 4 months after the test, dropping from a mean of 7.03% before the test to 6.26% after, she noted.

CHICAGO — Many patients with diabetes probably could benefit from a refresher course in how to inject insulin properly, according to a report presented at the annual scientific sessions of the American Diabetes Association.

In a trial of an education program for diabetes patients, 87 adult patients who had been using insulin for at least 3 years were evaluated and then retaught how to inject, based on what they did not seem to know. The mean hemoglobin A1c (HbA1c) level in the group dropped from 6.94% at baseline to 6.28% at 4 months after the new training.

The trial showed that more than half of these highly experienced patients had a “poor” or only “moderate” understanding of how best to treat their insulin and give themselves their injections, said Dr. Mihoko Matsumura, of the department of endocrinology and metabolism at Dokkyo University, Tochigi, Japan.

At the beginning of the trial, patients were given a detailed test of their knowledge. They were asked more than 20 questions, including:

▸ How they stored their insulin.

▸ At what temperature they stored it.

▸ What type of needle they used.

▸ Whether they were satisfied with the type of needle they were using.

▸ If they reused needles.

▸ If they knew the principle of how deep they should be injecting.

▸ Whether they pinched-up the skin and fat to avoid intramuscular injection.

▸ What angle of the needle they used when injecting.

▸ Whether they used the same injection site repeatedly.

The test results were then scored and grouped according to whether the patients had poor, moderate, or good understanding. After the test, all patients were given an explanation sheet, which included the correct answers. They also received a 10-minute review of their test with a physician.

Only 28 of the 87 patients were found to have “good” understanding on the test, defined as answering more than half the questions correctly. Another 38 had “moderate” understanding, defined as answering about half the questions correctly. And 21 had “poor” understanding, getting fewer than half the answers correct.

One of the most common problems the patients had was that they tended to inject repeatedly in the same location, Dr. Matsumura said.

The patients with the poorest understanding had the most improvement in HbA1c level at 4 months after the test, dropping from a mean of 7.03% before the test to 6.26% after, she noted.

CHICAGO – A review of births at a large health maintenance organization suggests the incidence of gestational diabetes is declining, but it is being offset by an increase in preexisting diabetes.

“There is some good news that gestational diabetes mellitus [GDM] appears to have declined about 15% within our study period,” Jean M. Lawrence, Sc.D., said at the annual scientific sessions of the American Diabetes Association. “But the bad news is that we saw a doubling of preexisting diabetes in the study.”

“We don't know whether this is an increase in the prevalence of diabetes or an increasing in screening and diagnosis of previously undiagnosed diabetes,” said Dr. Lawrence, an epidemiologist in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena. “Overall, though, we saw little change in the proportion of pregnancies with the mother and fetus exposed to diabetes during the pregnancy.”

In her study, Dr. Lawrence and colleagues looked at all of the births at 11 Kaiser Permanente hospitals in Southern California from 1999 to 2005, with a total of 209,532 deliveries of infants who were at 20 weeks' gestation or later.

Overall, 8% of the births were to mothers with diabetes, either gestational or preexisting, in each of the years reviewed, with a peak of almost 9% in 2000, and a slight decline totaling less than 1% since then.

The annual prevalence of GDM also peaked in 2000, at the rate of 7.01 cases per 100 women delivered. After that it declined steadily, to a rate of 6.32 cases per 100 women delivered in 2005.

At the same time, the annual prevalence of preexisting diabetes increased steadily from a rate of 1.08 cases per 100 in 1999 to a rate of 2.80 per 100 in 2005.

After adjusting for maternal age and race/ethnicity, the investigators found that GDM declined during the study period at an average annual rate of 4%, whereas preexisting diabetes increased by an average of 15% annually, Dr. Lawrence said.

Both types of diabetes were more common in women of other races than they were in non-Hispanic white women.

Asian women had the highest annual prevalence of GDM, with about double the prevalence of white women.

Black women had the highest annual prevalence of preexisting diabetes, with a 43% higher prevalence than white women.

“We saw changes in all the groups,” Dr. Lawrence said.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO – A review of births at a large health maintenance organization suggests the incidence of gestational diabetes is declining, but it is being offset by an increase in preexisting diabetes.

“There is some good news that gestational diabetes mellitus [GDM] appears to have declined about 15% within our study period,” Jean M. Lawrence, Sc.D., said at the annual scientific sessions of the American Diabetes Association. “But the bad news is that we saw a doubling of preexisting diabetes in the study.”

“We don't know whether this is an increase in the prevalence of diabetes or an increasing in screening and diagnosis of previously undiagnosed diabetes,” said Dr. Lawrence, an epidemiologist in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena. “Overall, though, we saw little change in the proportion of pregnancies with the mother and fetus exposed to diabetes during the pregnancy.”

In her study, Dr. Lawrence and colleagues looked at all of the births at 11 Kaiser Permanente hospitals in Southern California from 1999 to 2005, with a total of 209,532 deliveries of infants who were at 20 weeks' gestation or later.

Overall, 8% of the births were to mothers with diabetes, either gestational or preexisting, in each of the years reviewed, with a peak of almost 9% in 2000, and a slight decline totaling less than 1% since then.

The annual prevalence of GDM also peaked in 2000, at the rate of 7.01 cases per 100 women delivered. After that it declined steadily, to a rate of 6.32 cases per 100 women delivered in 2005.

At the same time, the annual prevalence of preexisting diabetes increased steadily from a rate of 1.08 cases per 100 in 1999 to a rate of 2.80 per 100 in 2005.

After adjusting for maternal age and race/ethnicity, the investigators found that GDM declined during the study period at an average annual rate of 4%, whereas preexisting diabetes increased by an average of 15% annually, Dr. Lawrence said.

Both types of diabetes were more common in women of other races than they were in non-Hispanic white women.

Asian women had the highest annual prevalence of GDM, with about double the prevalence of white women.

Black women had the highest annual prevalence of preexisting diabetes, with a 43% higher prevalence than white women.

“We saw changes in all the groups,” Dr. Lawrence said.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO – A review of births at a large health maintenance organization suggests the incidence of gestational diabetes is declining, but it is being offset by an increase in preexisting diabetes.

“There is some good news that gestational diabetes mellitus [GDM] appears to have declined about 15% within our study period,” Jean M. Lawrence, Sc.D., said at the annual scientific sessions of the American Diabetes Association. “But the bad news is that we saw a doubling of preexisting diabetes in the study.”

“We don't know whether this is an increase in the prevalence of diabetes or an increasing in screening and diagnosis of previously undiagnosed diabetes,” said Dr. Lawrence, an epidemiologist in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena. “Overall, though, we saw little change in the proportion of pregnancies with the mother and fetus exposed to diabetes during the pregnancy.”

In her study, Dr. Lawrence and colleagues looked at all of the births at 11 Kaiser Permanente hospitals in Southern California from 1999 to 2005, with a total of 209,532 deliveries of infants who were at 20 weeks' gestation or later.

Overall, 8% of the births were to mothers with diabetes, either gestational or preexisting, in each of the years reviewed, with a peak of almost 9% in 2000, and a slight decline totaling less than 1% since then.

The annual prevalence of GDM also peaked in 2000, at the rate of 7.01 cases per 100 women delivered. After that it declined steadily, to a rate of 6.32 cases per 100 women delivered in 2005.

At the same time, the annual prevalence of preexisting diabetes increased steadily from a rate of 1.08 cases per 100 in 1999 to a rate of 2.80 per 100 in 2005.

After adjusting for maternal age and race/ethnicity, the investigators found that GDM declined during the study period at an average annual rate of 4%, whereas preexisting diabetes increased by an average of 15% annually, Dr. Lawrence said.

Both types of diabetes were more common in women of other races than they were in non-Hispanic white women.

Asian women had the highest annual prevalence of GDM, with about double the prevalence of white women.

Black women had the highest annual prevalence of preexisting diabetes, with a 43% higher prevalence than white women.

“We saw changes in all the groups,” Dr. Lawrence said.

ELSEVIER GLOBAL MEDICAL NEWS

SEATTLE – Nursing home patients have a higher rate of adverse drug reactions than is sometimes seen in intensive care units, and many of these events occur right after the patient gets out of the hospital, where medication regimens generally get changed, Joseph T. Hanlon, Pharm.D., said at the annual meeting of the American Geriatrics Society.

Studies suggest that up to 50% of persons in a nursing home have some kind of adverse drug event every 6 months, and while many of those are relatively minor events, they can be serious. Older persons have a fourfold higher risk of hospitalization from an adverse drug reaction than younger people, said Dr. Hanlon, a professor of pharmacology and geriatric medicine at the University of Pittsburgh.

“Medication-related adverse patient events are really common and a major source of morbidity in older people,” he said.

Adverse drug reactions can and do occur at any time. But one study found that 20% of elderly persons had an adverse drug reaction in the first month after hospitalization, with most of those events caused by a prescription that was new to the patient.

Moreover, in his own study of 808 elderly patients discharged from 1 of 11 Veterans Affairs hospitals, Dr. Hanlon found that one-third of the patients had an adverse drug event, and most of those events occurred within 3 months of the hospitalization. Forty percent of the events were preventable, his study concluded.

“The point is, going to the hospital is a bad thing,” Dr. Hanlon said. However, the research is not very clear on what can be done to reduce adverse drug events in the elderly, Dr. Hanlon said. Most trials have looked at using a geriatrics team or a pharmacist to review medications. One randomized, controlled study found that pharmacist review cut adverse drug events 32%. But most of the other studies have found that while that type of approach may improve the quality of prescribing, it has not shown a reduction in adverse events.

Clearly, the complexity of the drug regimens that elderly people are put on is partly to blame, and in the U.K., pharmacists review a patients' medications every year in order to prune unnecessary or redundant medications, Dr. Hanlon said.

In Australia, the medical schools have started teaching medical students simple pharmacotherapy about of the most commonly used drugs and five basic things they need to know about each one.

“I haven't heard much about us embracing that in the [United States], and I think that is an area that we need to move forward on,” he said

Dr. Hanlon said when he talks to physicians, he recommends they take the simple step of having patients bring in a list of their medications for review, matching each of the drugs to their conditions, and getting rid of what is not needed.

That step can actually solve two-thirds of the medication problems, he said.

SEATTLE – Nursing home patients have a higher rate of adverse drug reactions than is sometimes seen in intensive care units, and many of these events occur right after the patient gets out of the hospital, where medication regimens generally get changed, Joseph T. Hanlon, Pharm.D., said at the annual meeting of the American Geriatrics Society.

Studies suggest that up to 50% of persons in a nursing home have some kind of adverse drug event every 6 months, and while many of those are relatively minor events, they can be serious. Older persons have a fourfold higher risk of hospitalization from an adverse drug reaction than younger people, said Dr. Hanlon, a professor of pharmacology and geriatric medicine at the University of Pittsburgh.

“Medication-related adverse patient events are really common and a major source of morbidity in older people,” he said.

Adverse drug reactions can and do occur at any time. But one study found that 20% of elderly persons had an adverse drug reaction in the first month after hospitalization, with most of those events caused by a prescription that was new to the patient.

Moreover, in his own study of 808 elderly patients discharged from 1 of 11 Veterans Affairs hospitals, Dr. Hanlon found that one-third of the patients had an adverse drug event, and most of those events occurred within 3 months of the hospitalization. Forty percent of the events were preventable, his study concluded.

“The point is, going to the hospital is a bad thing,” Dr. Hanlon said. However, the research is not very clear on what can be done to reduce adverse drug events in the elderly, Dr. Hanlon said. Most trials have looked at using a geriatrics team or a pharmacist to review medications. One randomized, controlled study found that pharmacist review cut adverse drug events 32%. But most of the other studies have found that while that type of approach may improve the quality of prescribing, it has not shown a reduction in adverse events.

Clearly, the complexity of the drug regimens that elderly people are put on is partly to blame, and in the U.K., pharmacists review a patients' medications every year in order to prune unnecessary or redundant medications, Dr. Hanlon said.

In Australia, the medical schools have started teaching medical students simple pharmacotherapy about of the most commonly used drugs and five basic things they need to know about each one.

“I haven't heard much about us embracing that in the [United States], and I think that is an area that we need to move forward on,” he said

Dr. Hanlon said when he talks to physicians, he recommends they take the simple step of having patients bring in a list of their medications for review, matching each of the drugs to their conditions, and getting rid of what is not needed.

That step can actually solve two-thirds of the medication problems, he said.

SEATTLE – Nursing home patients have a higher rate of adverse drug reactions than is sometimes seen in intensive care units, and many of these events occur right after the patient gets out of the hospital, where medication regimens generally get changed, Joseph T. Hanlon, Pharm.D., said at the annual meeting of the American Geriatrics Society.

Studies suggest that up to 50% of persons in a nursing home have some kind of adverse drug event every 6 months, and while many of those are relatively minor events, they can be serious. Older persons have a fourfold higher risk of hospitalization from an adverse drug reaction than younger people, said Dr. Hanlon, a professor of pharmacology and geriatric medicine at the University of Pittsburgh.

“Medication-related adverse patient events are really common and a major source of morbidity in older people,” he said.

Adverse drug reactions can and do occur at any time. But one study found that 20% of elderly persons had an adverse drug reaction in the first month after hospitalization, with most of those events caused by a prescription that was new to the patient.

Moreover, in his own study of 808 elderly patients discharged from 1 of 11 Veterans Affairs hospitals, Dr. Hanlon found that one-third of the patients had an adverse drug event, and most of those events occurred within 3 months of the hospitalization. Forty percent of the events were preventable, his study concluded.

“The point is, going to the hospital is a bad thing,” Dr. Hanlon said. However, the research is not very clear on what can be done to reduce adverse drug events in the elderly, Dr. Hanlon said. Most trials have looked at using a geriatrics team or a pharmacist to review medications. One randomized, controlled study found that pharmacist review cut adverse drug events 32%. But most of the other studies have found that while that type of approach may improve the quality of prescribing, it has not shown a reduction in adverse events.

Clearly, the complexity of the drug regimens that elderly people are put on is partly to blame, and in the U.K., pharmacists review a patients' medications every year in order to prune unnecessary or redundant medications, Dr. Hanlon said.

In Australia, the medical schools have started teaching medical students simple pharmacotherapy about of the most commonly used drugs and five basic things they need to know about each one.

“I haven't heard much about us embracing that in the [United States], and I think that is an area that we need to move forward on,” he said

Dr. Hanlon said when he talks to physicians, he recommends they take the simple step of having patients bring in a list of their medications for review, matching each of the drugs to their conditions, and getting rid of what is not needed.

That step can actually solve two-thirds of the medication problems, he said.

SAN DIEGO – Lisdexamfetamine, the recently approved once-daily medication for ADHD that appears to have low abuse potential, was safe and effective when given for a full year, and guanfacine, an investigational alpha-2A-adrenoreceptor, produced substantial improvement in a phase III trial, according to study findings presented at the annual meeting of the American Psychiatric Association.

These studies were among several presented at the meeting on new ADHD medications and formulations expected to greatly broaden the number of treatments for ADHD.

Lisdexamfetamine is a prodrug of dextroamphetamine that is thought to have less abuse potential because the central nervous system is not rapidly exposed to high levels.

In the study, the 272 individuals aged 6-12 years who had been treated in previous short-term trials were followed for up to 1 year.

The subjects had a mean improvement of 63% from their baseline ADHD Rating Scale score, and 95% were judged by their treating physicians to be much improved or very much improved, Dr. Ann C. Childress, a psychiatrist from Las Vegas, said in a poster presentation.

The most frequently reported adverse events among the trial's subjects were decreased appetite, headache, decreased weight, and insomnia.

In another poster presented at the meeting, lisdexamfetamine demonstrated less pharmacokinetic variation than extended-release mixed amphetamine salts, said James C. Elmer of Shire Pharmacueticals, Wayne, Pa.

That study, with 17 subjects aged 6-12 years, showed that plasma levels peaked between 4.5 and 6 hours for the individuals taking lisdexamfetamine, with a coefficient of variation of 15%.

The subjects who were taking the mixed amphetamine salts had peak plasma levels anywhere from 3 hours after administration to 12 hours, with a coefficient of variation of 53%.

Both lisdexamfetamine studies were supported by New River Pharmaceuticals Inc., Radford, Va., which is collaborating with Shire.

Guanfacine, in an extended-release, once-daily-dosing formulation, was shown in a phase III clinical trial to improve all of the core symptoms of ADHD, including inattention.

In the trial, 322 subjects (6-17 years of age) with ADHD received one of four doses, ranging from 1 to 4 mg/day, or placebo, Dr. Floyd R. Sallee said in a poster presentation.

After taking the drug for 6 weeks, those who got active drug had a mean reduction in the ADHD Rating Scale score of 19.6 points, from a baseline of about 40 points, compared with a mean reduction of 12.2 points for the placebo group, also from a baseline of about 40 points, reported Dr. Sallee, professor of psychiatry and pediatrics at the University of Cincinnati.

In addition, investigators rated about half of patients as much improved or very much improved, compared with only about 30% of patients who got placebo.

The least-square mean improvements in the inattentive subscale, compared with placebo, ranged from 2.96 points in the 2-mg-dose group to 4.16 points for the 1-mg-dose group.

As was the case in previous experiments that were done with clonidine, which is also an α₂-agonist, many of the patients reported that they were made sleepy and were sedated by the medication (42%).

That effect, however, generally occurred during the first 2 weeks of treatment and had worn off by 3 weeks, Dr. Sallee said.

Small to modest changes were seen in blood pressure, pulse, and ECG in the patients who took guanfacine.

Dr. Sallee' disclosed that his study was supported by funding from Shire Development Inc.

SAN DIEGO – Lisdexamfetamine, the recently approved once-daily medication for ADHD that appears to have low abuse potential, was safe and effective when given for a full year, and guanfacine, an investigational alpha-2A-adrenoreceptor, produced substantial improvement in a phase III trial, according to study findings presented at the annual meeting of the American Psychiatric Association.

These studies were among several presented at the meeting on new ADHD medications and formulations expected to greatly broaden the number of treatments for ADHD.

Lisdexamfetamine is a prodrug of dextroamphetamine that is thought to have less abuse potential because the central nervous system is not rapidly exposed to high levels.

In the study, the 272 individuals aged 6-12 years who had been treated in previous short-term trials were followed for up to 1 year.

The subjects had a mean improvement of 63% from their baseline ADHD Rating Scale score, and 95% were judged by their treating physicians to be much improved or very much improved, Dr. Ann C. Childress, a psychiatrist from Las Vegas, said in a poster presentation.

The most frequently reported adverse events among the trial's subjects were decreased appetite, headache, decreased weight, and insomnia.

In another poster presented at the meeting, lisdexamfetamine demonstrated less pharmacokinetic variation than extended-release mixed amphetamine salts, said James C. Elmer of Shire Pharmacueticals, Wayne, Pa.

That study, with 17 subjects aged 6-12 years, showed that plasma levels peaked between 4.5 and 6 hours for the individuals taking lisdexamfetamine, with a coefficient of variation of 15%.

The subjects who were taking the mixed amphetamine salts had peak plasma levels anywhere from 3 hours after administration to 12 hours, with a coefficient of variation of 53%.

Both lisdexamfetamine studies were supported by New River Pharmaceuticals Inc., Radford, Va., which is collaborating with Shire.

Guanfacine, in an extended-release, once-daily-dosing formulation, was shown in a phase III clinical trial to improve all of the core symptoms of ADHD, including inattention.

In the trial, 322 subjects (6-17 years of age) with ADHD received one of four doses, ranging from 1 to 4 mg/day, or placebo, Dr. Floyd R. Sallee said in a poster presentation.

After taking the drug for 6 weeks, those who got active drug had a mean reduction in the ADHD Rating Scale score of 19.6 points, from a baseline of about 40 points, compared with a mean reduction of 12.2 points for the placebo group, also from a baseline of about 40 points, reported Dr. Sallee, professor of psychiatry and pediatrics at the University of Cincinnati.

In addition, investigators rated about half of patients as much improved or very much improved, compared with only about 30% of patients who got placebo.

The least-square mean improvements in the inattentive subscale, compared with placebo, ranged from 2.96 points in the 2-mg-dose group to 4.16 points for the 1-mg-dose group.

As was the case in previous experiments that were done with clonidine, which is also an α₂-agonist, many of the patients reported that they were made sleepy and were sedated by the medication (42%).

That effect, however, generally occurred during the first 2 weeks of treatment and had worn off by 3 weeks, Dr. Sallee said.

Small to modest changes were seen in blood pressure, pulse, and ECG in the patients who took guanfacine.

Dr. Sallee' disclosed that his study was supported by funding from Shire Development Inc.

SAN DIEGO – Lisdexamfetamine, the recently approved once-daily medication for ADHD that appears to have low abuse potential, was safe and effective when given for a full year, and guanfacine, an investigational alpha-2A-adrenoreceptor, produced substantial improvement in a phase III trial, according to study findings presented at the annual meeting of the American Psychiatric Association.

These studies were among several presented at the meeting on new ADHD medications and formulations expected to greatly broaden the number of treatments for ADHD.

Lisdexamfetamine is a prodrug of dextroamphetamine that is thought to have less abuse potential because the central nervous system is not rapidly exposed to high levels.

In the study, the 272 individuals aged 6-12 years who had been treated in previous short-term trials were followed for up to 1 year.

The subjects had a mean improvement of 63% from their baseline ADHD Rating Scale score, and 95% were judged by their treating physicians to be much improved or very much improved, Dr. Ann C. Childress, a psychiatrist from Las Vegas, said in a poster presentation.

The most frequently reported adverse events among the trial's subjects were decreased appetite, headache, decreased weight, and insomnia.

In another poster presented at the meeting, lisdexamfetamine demonstrated less pharmacokinetic variation than extended-release mixed amphetamine salts, said James C. Elmer of Shire Pharmacueticals, Wayne, Pa.

That study, with 17 subjects aged 6-12 years, showed that plasma levels peaked between 4.5 and 6 hours for the individuals taking lisdexamfetamine, with a coefficient of variation of 15%.

The subjects who were taking the mixed amphetamine salts had peak plasma levels anywhere from 3 hours after administration to 12 hours, with a coefficient of variation of 53%.

Both lisdexamfetamine studies were supported by New River Pharmaceuticals Inc., Radford, Va., which is collaborating with Shire.

Guanfacine, in an extended-release, once-daily-dosing formulation, was shown in a phase III clinical trial to improve all of the core symptoms of ADHD, including inattention.

In the trial, 322 subjects (6-17 years of age) with ADHD received one of four doses, ranging from 1 to 4 mg/day, or placebo, Dr. Floyd R. Sallee said in a poster presentation.

After taking the drug for 6 weeks, those who got active drug had a mean reduction in the ADHD Rating Scale score of 19.6 points, from a baseline of about 40 points, compared with a mean reduction of 12.2 points for the placebo group, also from a baseline of about 40 points, reported Dr. Sallee, professor of psychiatry and pediatrics at the University of Cincinnati.

In addition, investigators rated about half of patients as much improved or very much improved, compared with only about 30% of patients who got placebo.

The least-square mean improvements in the inattentive subscale, compared with placebo, ranged from 2.96 points in the 2-mg-dose group to 4.16 points for the 1-mg-dose group.

As was the case in previous experiments that were done with clonidine, which is also an α₂-agonist, many of the patients reported that they were made sleepy and were sedated by the medication (42%).

That effect, however, generally occurred during the first 2 weeks of treatment and had worn off by 3 weeks, Dr. Sallee said.

Small to modest changes were seen in blood pressure, pulse, and ECG in the patients who took guanfacine.

Dr. Sallee' disclosed that his study was supported by funding from Shire Development Inc.

CHICAGO – A review of births at a large health maintenance organization suggests the incidence of gestational diabetes is declining, but it is being offset by an increase in pre-existing diabetes.

“Gestational diabetes mellitus [GDM] appears to have declined about 15% within our study period but … we saw a doubling of pre-existing diabetes in the study,” Jean M. Lawrence, Sc.D., said at the annual scientific sessions of the American Diabetes Association. “We don't know whether this is an increase in the prevalence of diabetes or an increase in screening and diagnosis of previously undiagnosed diabetes. Overall, we saw little change in the proportion of pregnancies with the mother and fetus exposed to diabetes during the pregnancy.”

Dr. Lawrence, an epidemiologist in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena, and colleagues looked at all of the births at 11 Kaiser Permanente hospitals in Southern California from 1999 to 2005, with a total of 209,532 deliveries of infants who were at 20 weeks' gestation or later.

Overall, 8% of the births were to mothers with diabetes, either gestational or pre-existing, in each of the years reviewed, with a peak of almost 9% in 2000, and a slight decline totaling less than 1% since then.

The annual prevalence of GDM also peaked in 2000, at the rate of 7.01 cases per 100 women delivered. After that it declined steadily, to a rate of 6.32 cases per 100 women delivered in 2005. At the same time, the annual prevalence of pre-existing diabetes increased steadily from a rate of 1.08 cases per 100 in 1999 to a rate of 2.80 per 100 in 2005.

After adjustment for maternal age and race/ethnicity, GDM declined during the study period at an average annual rate of 4%, whereas pre-existing diabetes increased by an average of 15% annually.

CHICAGO – A review of births at a large health maintenance organization suggests the incidence of gestational diabetes is declining, but it is being offset by an increase in pre-existing diabetes.

“Gestational diabetes mellitus [GDM] appears to have declined about 15% within our study period but … we saw a doubling of pre-existing diabetes in the study,” Jean M. Lawrence, Sc.D., said at the annual scientific sessions of the American Diabetes Association. “We don't know whether this is an increase in the prevalence of diabetes or an increase in screening and diagnosis of previously undiagnosed diabetes. Overall, we saw little change in the proportion of pregnancies with the mother and fetus exposed to diabetes during the pregnancy.”

Dr. Lawrence, an epidemiologist in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena, and colleagues looked at all of the births at 11 Kaiser Permanente hospitals in Southern California from 1999 to 2005, with a total of 209,532 deliveries of infants who were at 20 weeks' gestation or later.

Overall, 8% of the births were to mothers with diabetes, either gestational or pre-existing, in each of the years reviewed, with a peak of almost 9% in 2000, and a slight decline totaling less than 1% since then.

The annual prevalence of GDM also peaked in 2000, at the rate of 7.01 cases per 100 women delivered. After that it declined steadily, to a rate of 6.32 cases per 100 women delivered in 2005. At the same time, the annual prevalence of pre-existing diabetes increased steadily from a rate of 1.08 cases per 100 in 1999 to a rate of 2.80 per 100 in 2005.

After adjustment for maternal age and race/ethnicity, GDM declined during the study period at an average annual rate of 4%, whereas pre-existing diabetes increased by an average of 15% annually.

CHICAGO – A review of births at a large health maintenance organization suggests the incidence of gestational diabetes is declining, but it is being offset by an increase in pre-existing diabetes.

“Gestational diabetes mellitus [GDM] appears to have declined about 15% within our study period but … we saw a doubling of pre-existing diabetes in the study,” Jean M. Lawrence, Sc.D., said at the annual scientific sessions of the American Diabetes Association. “We don't know whether this is an increase in the prevalence of diabetes or an increase in screening and diagnosis of previously undiagnosed diabetes. Overall, we saw little change in the proportion of pregnancies with the mother and fetus exposed to diabetes during the pregnancy.”

Dr. Lawrence, an epidemiologist in the department of research and evaluation at Kaiser Permanente Southern California, Pasadena, and colleagues looked at all of the births at 11 Kaiser Permanente hospitals in Southern California from 1999 to 2005, with a total of 209,532 deliveries of infants who were at 20 weeks' gestation or later.

Overall, 8% of the births were to mothers with diabetes, either gestational or pre-existing, in each of the years reviewed, with a peak of almost 9% in 2000, and a slight decline totaling less than 1% since then.

The annual prevalence of GDM also peaked in 2000, at the rate of 7.01 cases per 100 women delivered. After that it declined steadily, to a rate of 6.32 cases per 100 women delivered in 2005. At the same time, the annual prevalence of pre-existing diabetes increased steadily from a rate of 1.08 cases per 100 in 1999 to a rate of 2.80 per 100 in 2005.

After adjustment for maternal age and race/ethnicity, GDM declined during the study period at an average annual rate of 4%, whereas pre-existing diabetes increased by an average of 15% annually.