Timothy F. Kirn

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 outset of the trial, patients were given a detailed test that included questions about how they stored their insulin, at what temperature they stored it, and 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, dropping from a mean of 7.03% before the test to 6.26% after, she noted. “These findings suggest that repeated instruction for insulin injection improves glycemic control, especially in patients with poorer understanding.”

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 outset of the trial, patients were given a detailed test that included questions about how they stored their insulin, at what temperature they stored it, and 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, dropping from a mean of 7.03% before the test to 6.26% after, she noted. “These findings suggest that repeated instruction for insulin injection improves glycemic control, especially in patients with poorer understanding.”

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 outset of the trial, patients were given a detailed test that included questions about how they stored their insulin, at what temperature they stored it, and 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, dropping from a mean of 7.03% before the test to 6.26% after, she noted. “These findings suggest that repeated instruction for insulin injection improves glycemic control, especially in patients with poorer understanding.”

CHICAGO – Children born to mothers with type 1 diabetes have a three times higher risk of developing type 2 diabetes as adults, according to a Danish cohort study that followed a group of adult individuals born to diabetic mothers.

The study also showed that the same individuals, who ranged in age from 18 years to 27 years, had more than twice the risk of being overweight and almost three times the risk of having metabolic syndrome, Dr. Tine D. Clausen said at the annual scientific sessions of the American Diabetes Association.

The study adds to a growing body of literature suggesting diabetes begets more diabetes, though most previous studies have investigated children born to mothers who were overweight or had type 2 diabetes.

“In the offspring born to women with type 1 diabetes, we found an association between median maternal glucose in late pregnancy and offspring risk of type 2 diabetes or prediabetes,” said Dr. Clausen, of the department of obstetrics, Rigshospitalet, Copenhagen. Her group studied 160 adults born to mothers with type 1 diabetes between 1978 and 1985, and matched them to a group of 128 similar-aged adults born to mothers without type 1 diabetes.

In the two groups, the prevalence of type 2 diabetes was 11% in the subjects born to mothers with diabetes, compared with 4% in the control group. Of the diabetic-mother subjects, 41% were overweight (a body mass index [kg/m

An additional 9% of the subjects born to diabetic mothers had impaired glucose regulation–either a high fasting glucose, or an abnormal oral glucose tolerance test result–compared with 3% of the controls.

Offspring of mothers with type 1 diabetes also were more likely to be born prematurely, to have a lower gestational age, and to be large for gestational age. Moreover, the mean hemoglobin A1c level was higher in the offspring of the mothers with type 1 diabetes (5.0% vs. 4.8%).

The groups were similar in having a family history (other than the mother) of diabetes, in the percentage of mothers who were overweight before pregnancy, and in the mother's age at delivery. They differed in that a greater proportion of the children born to mothers with diabetes were of “lower social class,” Dr. Clausen said.

After statistical adjustments for age, maternal overweight status, and social class, the researchers found that the odds ratio of the diabetic offspring having prediabetes or type 2 diabetes was 3.3, of being overweight was 2.1, and of having the metabolic syndrome was 2.8, she said. Adjusting the statistical model for preterm birth made no difference in those odds ratios.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO – Children born to mothers with type 1 diabetes have a three times higher risk of developing type 2 diabetes as adults, according to a Danish cohort study that followed a group of adult individuals born to diabetic mothers.

The study also showed that the same individuals, who ranged in age from 18 years to 27 years, had more than twice the risk of being overweight and almost three times the risk of having metabolic syndrome, Dr. Tine D. Clausen said at the annual scientific sessions of the American Diabetes Association.

The study adds to a growing body of literature suggesting diabetes begets more diabetes, though most previous studies have investigated children born to mothers who were overweight or had type 2 diabetes.

“In the offspring born to women with type 1 diabetes, we found an association between median maternal glucose in late pregnancy and offspring risk of type 2 diabetes or prediabetes,” said Dr. Clausen, of the department of obstetrics, Rigshospitalet, Copenhagen. Her group studied 160 adults born to mothers with type 1 diabetes between 1978 and 1985, and matched them to a group of 128 similar-aged adults born to mothers without type 1 diabetes.

In the two groups, the prevalence of type 2 diabetes was 11% in the subjects born to mothers with diabetes, compared with 4% in the control group. Of the diabetic-mother subjects, 41% were overweight (a body mass index [kg/m

An additional 9% of the subjects born to diabetic mothers had impaired glucose regulation–either a high fasting glucose, or an abnormal oral glucose tolerance test result–compared with 3% of the controls.

Offspring of mothers with type 1 diabetes also were more likely to be born prematurely, to have a lower gestational age, and to be large for gestational age. Moreover, the mean hemoglobin A1c level was higher in the offspring of the mothers with type 1 diabetes (5.0% vs. 4.8%).

The groups were similar in having a family history (other than the mother) of diabetes, in the percentage of mothers who were overweight before pregnancy, and in the mother's age at delivery. They differed in that a greater proportion of the children born to mothers with diabetes were of “lower social class,” Dr. Clausen said.

After statistical adjustments for age, maternal overweight status, and social class, the researchers found that the odds ratio of the diabetic offspring having prediabetes or type 2 diabetes was 3.3, of being overweight was 2.1, and of having the metabolic syndrome was 2.8, she said. Adjusting the statistical model for preterm birth made no difference in those odds ratios.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO – Children born to mothers with type 1 diabetes have a three times higher risk of developing type 2 diabetes as adults, according to a Danish cohort study that followed a group of adult individuals born to diabetic mothers.

The study also showed that the same individuals, who ranged in age from 18 years to 27 years, had more than twice the risk of being overweight and almost three times the risk of having metabolic syndrome, Dr. Tine D. Clausen said at the annual scientific sessions of the American Diabetes Association.

The study adds to a growing body of literature suggesting diabetes begets more diabetes, though most previous studies have investigated children born to mothers who were overweight or had type 2 diabetes.

“In the offspring born to women with type 1 diabetes, we found an association between median maternal glucose in late pregnancy and offspring risk of type 2 diabetes or prediabetes,” said Dr. Clausen, of the department of obstetrics, Rigshospitalet, Copenhagen. Her group studied 160 adults born to mothers with type 1 diabetes between 1978 and 1985, and matched them to a group of 128 similar-aged adults born to mothers without type 1 diabetes.

In the two groups, the prevalence of type 2 diabetes was 11% in the subjects born to mothers with diabetes, compared with 4% in the control group. Of the diabetic-mother subjects, 41% were overweight (a body mass index [kg/m

An additional 9% of the subjects born to diabetic mothers had impaired glucose regulation–either a high fasting glucose, or an abnormal oral glucose tolerance test result–compared with 3% of the controls.

Offspring of mothers with type 1 diabetes also were more likely to be born prematurely, to have a lower gestational age, and to be large for gestational age. Moreover, the mean hemoglobin A1c level was higher in the offspring of the mothers with type 1 diabetes (5.0% vs. 4.8%).

The groups were similar in having a family history (other than the mother) of diabetes, in the percentage of mothers who were overweight before pregnancy, and in the mother's age at delivery. They differed in that a greater proportion of the children born to mothers with diabetes were of “lower social class,” Dr. Clausen said.

After statistical adjustments for age, maternal overweight status, and social class, the researchers found that the odds ratio of the diabetic offspring having prediabetes or type 2 diabetes was 3.3, of being overweight was 2.1, and of having the metabolic syndrome was 2.8, she said. Adjusting the statistical model for preterm birth made no difference in those odds ratios.

ELSEVIER GLOBAL MEDICAL NEWS

SEATTLE – 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 less than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, Dr. 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.

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

Added Challenge for LTC

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.”

Dr. Hamrick's 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 Centricity system for specific geriatric needs. For example records were added of diet and activities of daily living. In addition, the physical exam form was changed to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics,” Dr. Hamrick said.

“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

And the center found several 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,” she said. “That's what I didn't realize.”

SEATTLE – 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 less than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, Dr. 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.

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

Added Challenge for LTC

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.”

Dr. Hamrick's 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 Centricity system for specific geriatric needs. For example records were added of diet and activities of daily living. In addition, the physical exam form was changed to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics,” Dr. Hamrick said.

“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

And the center found several 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,” she said. “That's what I didn't realize.”

SEATTLE – 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 less than half are fully operational, that is, able to take notes, make lab and pharmacy orders, and get lab results, Dr. 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.

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

Added Challenge for LTC

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.”

Dr. Hamrick's 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 Centricity system for specific geriatric needs. For example records were added of diet and activities of daily living. In addition, the physical exam form was changed to include sections for foot and mental status exams.

“Very little out-of-the-box software is user friendly for geriatrics,” Dr. Hamrick said.

“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

And the center found several 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,” she said. “That's what I didn't realize.”

SEATTLE – Evidence is beginning to suggest that exercise can at least forestall Alzheimer's disease, Dr. Eric B. Larson said at the annual scientific meeting of the American Geriatrics Society.

“We now see association studies of physical activity showing a pretty convincing relationship with a delayed onset of dementia,” said Dr. Larson, the executive director of the Center for Health Studies of the Group Health Cooperative, Seattle. “I don't think we are preventing this disease from ever happening,” he added. “What we're doing is delaying it.”

Four observational studies have now shown, with consistency, a 30%–40% reduction in the incidence of Alzheimer's disease when people get regular exercise, Dr. Larson noted.

Some might find it implausible that physical exercise could affect the brain, cognitive function, and decline, since it has been thought that the brain does not develop after a young age, Dr. Larson noted. It turns out that animal experiments show that new neurons do form in the adult brain.

“Neurogenesis is possible at almost any phase of development, at least in animals,” he said.

And then, there is the human study.

In a study of humans who used functional magnetic resonance imaging, the investigators found that aerobic physical fitness measured on a treadmill correlated with frontal, parietal, and temporal lobe tissue density, such that better fitness meant higher density, which indicates less age-related loss (J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:176–80).

In his own study, Dr. Larson looked at 2,581 individuals, who were aged 65 years or older, without dementia. They were tested for cognitive functioning and interviewed about exercise habits every 2 years, starting in 1994–1996. For the analysis, the investigators threw out those individuals who scored in the bottom quartile of subjects on the cognitive testing, on the grounds that they might be persons already showing some dementia-associated decline (Ann. Intern. Med. 2006;144:73–81).

With an average follow-up of 6.2 years, during which time 158 subjects developed dementia, the researchers found that those subjects who exercised three or more times per week had a 40% reduction in the risk of developing dementia, compared with those who exercised less than three times per week.

The incidence rates of dementia were 13/1,000 person-years for those who exercised three or more times per week, compared with 19.7/1,000 person-years for those who exercised less than three times per week.

Exercise was defined as the number of days during the past year that the subjects had engaged in walking, hiking, bicycling, aerobics or calisthenics, swimming, water aerobics, weight training, stretching, or other exercise, for at least 15 minutes at a time. About 60% of those who developed dementia had developed Alzheimer's disease.

The interesting part of the findings was that those subjects who had the lowest physical performance benefited the most from exercise, Dr. Larson said.

All of the prevention was in the people in the lowest third on physical performance measures.

SEATTLE – Evidence is beginning to suggest that exercise can at least forestall Alzheimer's disease, Dr. Eric B. Larson said at the annual scientific meeting of the American Geriatrics Society.

“We now see association studies of physical activity showing a pretty convincing relationship with a delayed onset of dementia,” said Dr. Larson, the executive director of the Center for Health Studies of the Group Health Cooperative, Seattle. “I don't think we are preventing this disease from ever happening,” he added. “What we're doing is delaying it.”

Four observational studies have now shown, with consistency, a 30%–40% reduction in the incidence of Alzheimer's disease when people get regular exercise, Dr. Larson noted.

Some might find it implausible that physical exercise could affect the brain, cognitive function, and decline, since it has been thought that the brain does not develop after a young age, Dr. Larson noted. It turns out that animal experiments show that new neurons do form in the adult brain.

“Neurogenesis is possible at almost any phase of development, at least in animals,” he said.

And then, there is the human study.

In a study of humans who used functional magnetic resonance imaging, the investigators found that aerobic physical fitness measured on a treadmill correlated with frontal, parietal, and temporal lobe tissue density, such that better fitness meant higher density, which indicates less age-related loss (J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:176–80).

In his own study, Dr. Larson looked at 2,581 individuals, who were aged 65 years or older, without dementia. They were tested for cognitive functioning and interviewed about exercise habits every 2 years, starting in 1994–1996. For the analysis, the investigators threw out those individuals who scored in the bottom quartile of subjects on the cognitive testing, on the grounds that they might be persons already showing some dementia-associated decline (Ann. Intern. Med. 2006;144:73–81).

With an average follow-up of 6.2 years, during which time 158 subjects developed dementia, the researchers found that those subjects who exercised three or more times per week had a 40% reduction in the risk of developing dementia, compared with those who exercised less than three times per week.

The incidence rates of dementia were 13/1,000 person-years for those who exercised three or more times per week, compared with 19.7/1,000 person-years for those who exercised less than three times per week.

Exercise was defined as the number of days during the past year that the subjects had engaged in walking, hiking, bicycling, aerobics or calisthenics, swimming, water aerobics, weight training, stretching, or other exercise, for at least 15 minutes at a time. About 60% of those who developed dementia had developed Alzheimer's disease.

The interesting part of the findings was that those subjects who had the lowest physical performance benefited the most from exercise, Dr. Larson said.

All of the prevention was in the people in the lowest third on physical performance measures.

SEATTLE – Evidence is beginning to suggest that exercise can at least forestall Alzheimer's disease, Dr. Eric B. Larson said at the annual scientific meeting of the American Geriatrics Society.

“We now see association studies of physical activity showing a pretty convincing relationship with a delayed onset of dementia,” said Dr. Larson, the executive director of the Center for Health Studies of the Group Health Cooperative, Seattle. “I don't think we are preventing this disease from ever happening,” he added. “What we're doing is delaying it.”

Four observational studies have now shown, with consistency, a 30%–40% reduction in the incidence of Alzheimer's disease when people get regular exercise, Dr. Larson noted.

Some might find it implausible that physical exercise could affect the brain, cognitive function, and decline, since it has been thought that the brain does not develop after a young age, Dr. Larson noted. It turns out that animal experiments show that new neurons do form in the adult brain.

“Neurogenesis is possible at almost any phase of development, at least in animals,” he said.

And then, there is the human study.

In a study of humans who used functional magnetic resonance imaging, the investigators found that aerobic physical fitness measured on a treadmill correlated with frontal, parietal, and temporal lobe tissue density, such that better fitness meant higher density, which indicates less age-related loss (J. Gerontol. A Biol. Sci. Med. Sci. 2003;58:176–80).

In his own study, Dr. Larson looked at 2,581 individuals, who were aged 65 years or older, without dementia. They were tested for cognitive functioning and interviewed about exercise habits every 2 years, starting in 1994–1996. For the analysis, the investigators threw out those individuals who scored in the bottom quartile of subjects on the cognitive testing, on the grounds that they might be persons already showing some dementia-associated decline (Ann. Intern. Med. 2006;144:73–81).

With an average follow-up of 6.2 years, during which time 158 subjects developed dementia, the researchers found that those subjects who exercised three or more times per week had a 40% reduction in the risk of developing dementia, compared with those who exercised less than three times per week.

The incidence rates of dementia were 13/1,000 person-years for those who exercised three or more times per week, compared with 19.7/1,000 person-years for those who exercised less than three times per week.

Exercise was defined as the number of days during the past year that the subjects had engaged in walking, hiking, bicycling, aerobics or calisthenics, swimming, water aerobics, weight training, stretching, or other exercise, for at least 15 minutes at a time. About 60% of those who developed dementia had developed Alzheimer's disease.

The interesting part of the findings was that those subjects who had the lowest physical performance benefited the most from exercise, Dr. Larson said.

All of the prevention was in the people in the lowest third on physical performance measures.

SEATTLE – Angiotensin-converting enzyme inhibitors that cross the blood-brain barrier slow mental decline by about 50% relative to the decline seen in patients on other antihypertensives, an observational study of 1,074 hypertensive subjects followed for a median of 6 years shows.

“If there is an indication for an ACE inhibitor, we might as well use one that crosses the blood-brain barrier,” Dr. Kaycee M. Sink, principal investigator, said at the annual meeting of the American Geriatrics Society.

Hypertension itself is a risk factor for dementia, so it is important to know whether an antihypertensive treatment has the ability to cut that risk, said Dr. Sink of the division of geriatrics at Wake Forest University, Winston-Salem, N.C.

Previous trials of treatment have had mixed results. But in animal studies, the ACE inhibitors that cross the blood-brain barrier have been shown to halt cognitive decline at doses below what would be used to control blood pressure. Those studies were the basis for the investigation, Dr. Sink said.

Her group looked at patients enrolled in the multicenter Cardiovascular Health Study, selecting out those patients who had hypertension and took an antihypertensive, and those who did not have dementia at baseline. The mean age of the patients was 78 years.

The aim was to look at the incidence of dementia. There were 158 subjects diagnosed with dementia over the average 6 years of follow-up. But the only effect by type of antihypertensive the patient was exposed to was a slightly higher risk in those who took an ACE inhibitor that did not cross the blood-brain barrier, with about an 18% higher risk than that seen in the subjects on other antihypertensives. However, when the investigators looked at the subject scores on the Modified Mini-Mental State Exam, they did find a difference.

The group of patients on an antihypertensive other than an ACE inhibitor had a mean decline in exam scores of 0.64 points per year. Those on an ACE inhibitor had a mean decline of 0.38 points per year.

It is thought that some ACE inhibitors protect from dementia and mental decline by decreasing oxidative stress and inflammation in the brain, she noted.

ELSEVIER GLOBAL MEDICAL NEWS

SEATTLE – Angiotensin-converting enzyme inhibitors that cross the blood-brain barrier slow mental decline by about 50% relative to the decline seen in patients on other antihypertensives, an observational study of 1,074 hypertensive subjects followed for a median of 6 years shows.

“If there is an indication for an ACE inhibitor, we might as well use one that crosses the blood-brain barrier,” Dr. Kaycee M. Sink, principal investigator, said at the annual meeting of the American Geriatrics Society.

Hypertension itself is a risk factor for dementia, so it is important to know whether an antihypertensive treatment has the ability to cut that risk, said Dr. Sink of the division of geriatrics at Wake Forest University, Winston-Salem, N.C.

Previous trials of treatment have had mixed results. But in animal studies, the ACE inhibitors that cross the blood-brain barrier have been shown to halt cognitive decline at doses below what would be used to control blood pressure. Those studies were the basis for the investigation, Dr. Sink said.

Her group looked at patients enrolled in the multicenter Cardiovascular Health Study, selecting out those patients who had hypertension and took an antihypertensive, and those who did not have dementia at baseline. The mean age of the patients was 78 years.

The aim was to look at the incidence of dementia. There were 158 subjects diagnosed with dementia over the average 6 years of follow-up. But the only effect by type of antihypertensive the patient was exposed to was a slightly higher risk in those who took an ACE inhibitor that did not cross the blood-brain barrier, with about an 18% higher risk than that seen in the subjects on other antihypertensives. However, when the investigators looked at the subject scores on the Modified Mini-Mental State Exam, they did find a difference.

The group of patients on an antihypertensive other than an ACE inhibitor had a mean decline in exam scores of 0.64 points per year. Those on an ACE inhibitor had a mean decline of 0.38 points per year.

It is thought that some ACE inhibitors protect from dementia and mental decline by decreasing oxidative stress and inflammation in the brain, she noted.

ELSEVIER GLOBAL MEDICAL NEWS

SEATTLE – Angiotensin-converting enzyme inhibitors that cross the blood-brain barrier slow mental decline by about 50% relative to the decline seen in patients on other antihypertensives, an observational study of 1,074 hypertensive subjects followed for a median of 6 years shows.

“If there is an indication for an ACE inhibitor, we might as well use one that crosses the blood-brain barrier,” Dr. Kaycee M. Sink, principal investigator, said at the annual meeting of the American Geriatrics Society.

Hypertension itself is a risk factor for dementia, so it is important to know whether an antihypertensive treatment has the ability to cut that risk, said Dr. Sink of the division of geriatrics at Wake Forest University, Winston-Salem, N.C.

Previous trials of treatment have had mixed results. But in animal studies, the ACE inhibitors that cross the blood-brain barrier have been shown to halt cognitive decline at doses below what would be used to control blood pressure. Those studies were the basis for the investigation, Dr. Sink said.

Her group looked at patients enrolled in the multicenter Cardiovascular Health Study, selecting out those patients who had hypertension and took an antihypertensive, and those who did not have dementia at baseline. The mean age of the patients was 78 years.

The aim was to look at the incidence of dementia. There were 158 subjects diagnosed with dementia over the average 6 years of follow-up. But the only effect by type of antihypertensive the patient was exposed to was a slightly higher risk in those who took an ACE inhibitor that did not cross the blood-brain barrier, with about an 18% higher risk than that seen in the subjects on other antihypertensives. However, when the investigators looked at the subject scores on the Modified Mini-Mental State Exam, they did find a difference.

The group of patients on an antihypertensive other than an ACE inhibitor had a mean decline in exam scores of 0.64 points per year. Those on an ACE inhibitor had a mean decline of 0.38 points per year.

It is thought that some ACE inhibitors protect from dementia and mental decline by decreasing oxidative stress and inflammation in the brain, she noted.

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO – Lisdexamfetamine, the recently approved once-daily medication for attention-deficit/hyperactivity disorder 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 studies 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, of 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 in the trial were decreased appetite, headache, decreased weight, and insomnia. The study was supported by New River Pharmaceuticals Inc., Radford, Va., which is collaborating with Shire Development, and by funding from Shire.

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

In the trial, 322 subjects (aged 6–17 years) 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 6 weeks, the mean reduction in the ADHD Rating Scale score for those who got active drug was 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.

SAN DIEGO – Lisdexamfetamine, the recently approved once-daily medication for attention-deficit/hyperactivity disorder 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 studies 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, of 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 in the trial were decreased appetite, headache, decreased weight, and insomnia. The study was supported by New River Pharmaceuticals Inc., Radford, Va., which is collaborating with Shire Development, and by funding from Shire.

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

In the trial, 322 subjects (aged 6–17 years) 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 6 weeks, the mean reduction in the ADHD Rating Scale score for those who got active drug was 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.

SAN DIEGO – Lisdexamfetamine, the recently approved once-daily medication for attention-deficit/hyperactivity disorder 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 studies 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, of 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 in the trial were decreased appetite, headache, decreased weight, and insomnia. The study was supported by New River Pharmaceuticals Inc., Radford, Va., which is collaborating with Shire Development, and by funding from Shire.

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

In the trial, 322 subjects (aged 6–17 years) 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 6 weeks, the mean reduction in the ADHD Rating Scale score for those who got active drug was 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.

SEATTLE — Sex remains an important part of life for seniors, with almost one-third of persons between the ages of 65 and 74 years continuing to have sex at least once a week, according to a survey of sexual behavior in seniors.

“We hope that population-representative data on sexual activity will help older people view their sexual experience relative to that of others and that these data also will provide physicians with a reference,” said Dr. Stacy Lindau of the geriatric section of the department of medicine at the University of Chicago.

The survey of 3,005 older individuals found that 73% of those interviewed had a spouse or a significant, intimate other, and that of those, 73% were sexually active, which was defined as having had at least one sex partner in the previous 12 months.

Only one-quarter of the respondents said sex was not important to them at all.

Very few of the respondents reported more than one partner in the previous 12 months, and almost all of the sexual encounters were heterosexual, Dr. Lindau said.

The subjects of the survey were chosen to be demographically representative of the population as a whole. They were divided equally between men and women, with roughly 1,000 subjects in each of three age groups, 57–64 years, 65–74 years, and 75–85 years. The 120-minute survey was conducted in person.

Among 57- to 64-year-olds, 40% of men and 34% of women reported having sex once a week or more, and 33% of men and 37% of women reported having sex less than once a month. Among 65- to 74-year-olds, 31% of both men and women said they had sex once a week or more and 35% of both men and women said they had sex less than once a month.

In the oldest group, 75- to 85-year-olds, 23% of men and 24% of women reported having sex once a week or more, and 47% of men and 46% of women reported having sex less than once a month. Overall, the percentage of this group who reported having sex once a week or more is similar to the percentage reported in a survey of participants aged 18–59 years, Dr. Lindau noted.

However, sexual problems among the respondents were common. Among those who reported being sexually active, 62% of the men and 70% of the women reported one or more sexual problems in the previous year. And of those reporting a problem, 26% of the men and 31% of the women said they avoided sex as a result.

Most of those who reported a sexual problem described it as “bothersome,” an important point because to make a clinical diagnosis of sexual dysfunction, the individual needs not only to have a problem but also to be personally bothered by it as well, said Dr. Lindau.

Among the problems, a lack of interest was noted by 24% of the men and 44% of the women in the youngest age group, and by 24% of the men and 49% of the women in the oldest age group, numbers that, according to Dr. Landau, “are not too different from the younger population.”

With regard to medical care, 28% of the respondents said they had spoken to their physicians about sex since they had turned 50, and generally that was because the physician had broached the subject. Of those with a sexual problem, only 48% of the men and 34% of the women had ever discussed it with their physician.

Among the sexually active respondents, about half of those in the two lower age groups reported engaging in oral sex, as well as sexual intercourse, as did about 25% of those in the oldest age group. There was no significant difference in the percentages between men and women.

About half of the men and one-quarter of the women in the youngest age group reported having masturbated in the previous year, and the percentages reporting masturbation dropped in the oldest age group to 26% of men and 18% of women.

Three percent of the men and 5% of the women reported ever having had a same-sex sexual experience.

SEATTLE — Sex remains an important part of life for seniors, with almost one-third of persons between the ages of 65 and 74 years continuing to have sex at least once a week, according to a survey of sexual behavior in seniors.

“We hope that population-representative data on sexual activity will help older people view their sexual experience relative to that of others and that these data also will provide physicians with a reference,” said Dr. Stacy Lindau of the geriatric section of the department of medicine at the University of Chicago.

The survey of 3,005 older individuals found that 73% of those interviewed had a spouse or a significant, intimate other, and that of those, 73% were sexually active, which was defined as having had at least one sex partner in the previous 12 months.

Only one-quarter of the respondents said sex was not important to them at all.

Very few of the respondents reported more than one partner in the previous 12 months, and almost all of the sexual encounters were heterosexual, Dr. Lindau said.

The subjects of the survey were chosen to be demographically representative of the population as a whole. They were divided equally between men and women, with roughly 1,000 subjects in each of three age groups, 57–64 years, 65–74 years, and 75–85 years. The 120-minute survey was conducted in person.

Among 57- to 64-year-olds, 40% of men and 34% of women reported having sex once a week or more, and 33% of men and 37% of women reported having sex less than once a month. Among 65- to 74-year-olds, 31% of both men and women said they had sex once a week or more and 35% of both men and women said they had sex less than once a month.

In the oldest group, 75- to 85-year-olds, 23% of men and 24% of women reported having sex once a week or more, and 47% of men and 46% of women reported having sex less than once a month. Overall, the percentage of this group who reported having sex once a week or more is similar to the percentage reported in a survey of participants aged 18–59 years, Dr. Lindau noted.

However, sexual problems among the respondents were common. Among those who reported being sexually active, 62% of the men and 70% of the women reported one or more sexual problems in the previous year. And of those reporting a problem, 26% of the men and 31% of the women said they avoided sex as a result.

Most of those who reported a sexual problem described it as “bothersome,” an important point because to make a clinical diagnosis of sexual dysfunction, the individual needs not only to have a problem but also to be personally bothered by it as well, said Dr. Lindau.

Among the problems, a lack of interest was noted by 24% of the men and 44% of the women in the youngest age group, and by 24% of the men and 49% of the women in the oldest age group, numbers that, according to Dr. Landau, “are not too different from the younger population.”

With regard to medical care, 28% of the respondents said they had spoken to their physicians about sex since they had turned 50, and generally that was because the physician had broached the subject. Of those with a sexual problem, only 48% of the men and 34% of the women had ever discussed it with their physician.

Among the sexually active respondents, about half of those in the two lower age groups reported engaging in oral sex, as well as sexual intercourse, as did about 25% of those in the oldest age group. There was no significant difference in the percentages between men and women.

About half of the men and one-quarter of the women in the youngest age group reported having masturbated in the previous year, and the percentages reporting masturbation dropped in the oldest age group to 26% of men and 18% of women.

Three percent of the men and 5% of the women reported ever having had a same-sex sexual experience.

SEATTLE — Sex remains an important part of life for seniors, with almost one-third of persons between the ages of 65 and 74 years continuing to have sex at least once a week, according to a survey of sexual behavior in seniors.

“We hope that population-representative data on sexual activity will help older people view their sexual experience relative to that of others and that these data also will provide physicians with a reference,” said Dr. Stacy Lindau of the geriatric section of the department of medicine at the University of Chicago.

The survey of 3,005 older individuals found that 73% of those interviewed had a spouse or a significant, intimate other, and that of those, 73% were sexually active, which was defined as having had at least one sex partner in the previous 12 months.

Only one-quarter of the respondents said sex was not important to them at all.

Very few of the respondents reported more than one partner in the previous 12 months, and almost all of the sexual encounters were heterosexual, Dr. Lindau said.

The subjects of the survey were chosen to be demographically representative of the population as a whole. They were divided equally between men and women, with roughly 1,000 subjects in each of three age groups, 57–64 years, 65–74 years, and 75–85 years. The 120-minute survey was conducted in person.

Among 57- to 64-year-olds, 40% of men and 34% of women reported having sex once a week or more, and 33% of men and 37% of women reported having sex less than once a month. Among 65- to 74-year-olds, 31% of both men and women said they had sex once a week or more and 35% of both men and women said they had sex less than once a month.

In the oldest group, 75- to 85-year-olds, 23% of men and 24% of women reported having sex once a week or more, and 47% of men and 46% of women reported having sex less than once a month. Overall, the percentage of this group who reported having sex once a week or more is similar to the percentage reported in a survey of participants aged 18–59 years, Dr. Lindau noted.

However, sexual problems among the respondents were common. Among those who reported being sexually active, 62% of the men and 70% of the women reported one or more sexual problems in the previous year. And of those reporting a problem, 26% of the men and 31% of the women said they avoided sex as a result.

Most of those who reported a sexual problem described it as “bothersome,” an important point because to make a clinical diagnosis of sexual dysfunction, the individual needs not only to have a problem but also to be personally bothered by it as well, said Dr. Lindau.

Among the problems, a lack of interest was noted by 24% of the men and 44% of the women in the youngest age group, and by 24% of the men and 49% of the women in the oldest age group, numbers that, according to Dr. Landau, “are not too different from the younger population.”

With regard to medical care, 28% of the respondents said they had spoken to their physicians about sex since they had turned 50, and generally that was because the physician had broached the subject. Of those with a sexual problem, only 48% of the men and 34% of the women had ever discussed it with their physician.

Among the sexually active respondents, about half of those in the two lower age groups reported engaging in oral sex, as well as sexual intercourse, as did about 25% of those in the oldest age group. There was no significant difference in the percentages between men and women.

About half of the men and one-quarter of the women in the youngest age group reported having masturbated in the previous year, and the percentages reporting masturbation dropped in the oldest age group to 26% of men and 18% of women.

Three percent of the men and 5% of the women reported ever having had a same-sex sexual experience.

CHICAGO — Two years following bariatric surgery, 73% of patients had remission of their type 2 diabetes, compared with 15% of control patients who did not receive the surgery, according to study findings.

Dr. John B. Dixon of Monash University, Melbourne, presented the findings in a poster at the annual scientific sessions of the American Diabetes Association.

The study enrolled 30 patients in each group, all of whom had a body mass index (BMI) greater than 30 kg/m

At 2 years, patients who had surgery achieved a mean weight loss of 21% of body weight, compared with 2% for those who did not have surgery. Patients in the surgery group lost a mean of 65% of their excess body weight, compared with 6% in the control group.

At baseline, 23% of the surgically treated patients had a hemoglobin A_1c level below 7%, and that percentage rose to 87% at 2 years. In the control group, 37% had an HbA_1c level below 7% at baseline, and that rose to 50% at 2 years.

By the trial's end, 10% of the surgically treated patients were using metformin, compared with more than 90% of the controls.

The surgical group had greater improvements in triglyceride levels and HDL cholesterol levels as well.

Adverse events in the surgical group included one patient with a superficial wound infection, two patients who needed nonurgent revision, and one patient who had the band removed after 15 days because of persistent regurgitation.

Further analysis showed that a 10% weight loss provided an 85% sensitivity and an 86% specificity for remission, Dr. Dixon said.

CHICAGO — Two years following bariatric surgery, 73% of patients had remission of their type 2 diabetes, compared with 15% of control patients who did not receive the surgery, according to study findings.

Dr. John B. Dixon of Monash University, Melbourne, presented the findings in a poster at the annual scientific sessions of the American Diabetes Association.

The study enrolled 30 patients in each group, all of whom had a body mass index (BMI) greater than 30 kg/m

At 2 years, patients who had surgery achieved a mean weight loss of 21% of body weight, compared with 2% for those who did not have surgery. Patients in the surgery group lost a mean of 65% of their excess body weight, compared with 6% in the control group.

At baseline, 23% of the surgically treated patients had a hemoglobin A_1c level below 7%, and that percentage rose to 87% at 2 years. In the control group, 37% had an HbA_1c level below 7% at baseline, and that rose to 50% at 2 years.

By the trial's end, 10% of the surgically treated patients were using metformin, compared with more than 90% of the controls.

The surgical group had greater improvements in triglyceride levels and HDL cholesterol levels as well.

Adverse events in the surgical group included one patient with a superficial wound infection, two patients who needed nonurgent revision, and one patient who had the band removed after 15 days because of persistent regurgitation.

Further analysis showed that a 10% weight loss provided an 85% sensitivity and an 86% specificity for remission, Dr. Dixon said.

CHICAGO — Two years following bariatric surgery, 73% of patients had remission of their type 2 diabetes, compared with 15% of control patients who did not receive the surgery, according to study findings.

Dr. John B. Dixon of Monash University, Melbourne, presented the findings in a poster at the annual scientific sessions of the American Diabetes Association.

The study enrolled 30 patients in each group, all of whom had a body mass index (BMI) greater than 30 kg/m

At 2 years, patients who had surgery achieved a mean weight loss of 21% of body weight, compared with 2% for those who did not have surgery. Patients in the surgery group lost a mean of 65% of their excess body weight, compared with 6% in the control group.

At baseline, 23% of the surgically treated patients had a hemoglobin A_1c level below 7%, and that percentage rose to 87% at 2 years. In the control group, 37% had an HbA_1c level below 7% at baseline, and that rose to 50% at 2 years.

By the trial's end, 10% of the surgically treated patients were using metformin, compared with more than 90% of the controls.

The surgical group had greater improvements in triglyceride levels and HDL cholesterol levels as well.

Adverse events in the surgical group included one patient with a superficial wound infection, two patients who needed nonurgent revision, and one patient who had the band removed after 15 days because of persistent regurgitation.

Further analysis showed that a 10% weight loss provided an 85% sensitivity and an 86% specificity for remission, Dr. Dixon said.

CHICAGO — The use of metformin for weight loss in nondiabetic, obese adolescents—a practice that is becoming increasingly popular—produces about a 6- to 7-pound loss over 1 year, according to a study presented at the annual scientific sessions of the American Diabetes Association.

“My conclusion from this study is that metformin XR [extended release] provides a modest weight benefit in obese, nondiabetic adolescents over 1 year of treatment,” Dr. Darrell Wilson, chief of pediatric endocrinology at Lucile M. Packard Children's Hospital, Stanford, Calif., said.

The study randomized 77 patients with a body mass index (BMI) above the 95th percentile to either extended-release metformin or placebo. Their average BMI was 36 kg/m

Seventy percent of the patients (27 in each group) were followed for the entire 52 weeks of the trial.

Over 1 year, the average BMI of the placebo-treated patients rose slightly, while that of the metformin-treated patients decreased. However, there was considerable overlap of weight loss and gain among the subjects in the two groups, and though the study was designed with the assumption that the difference in average BMI between the two groups would be about 1.5 kg/m

The magnitude of that loss was equal to about 6–7 pounds for a child whose height is 65 inches.

The trial was conducted by the Glaser Pediatric Research Network at five separate centers, and the medication and placebo were donated by Bristol-Myers-Squibb.

The magnitude of that loss was equal to about 6–7 pounds for a child whose height is 65 inches. DR. WILSON

CHICAGO — The use of metformin for weight loss in nondiabetic, obese adolescents—a practice that is becoming increasingly popular—produces about a 6- to 7-pound loss over 1 year, according to a study presented at the annual scientific sessions of the American Diabetes Association.

“My conclusion from this study is that metformin XR [extended release] provides a modest weight benefit in obese, nondiabetic adolescents over 1 year of treatment,” Dr. Darrell Wilson, chief of pediatric endocrinology at Lucile M. Packard Children's Hospital, Stanford, Calif., said.

The study randomized 77 patients with a body mass index (BMI) above the 95th percentile to either extended-release metformin or placebo. Their average BMI was 36 kg/m

Seventy percent of the patients (27 in each group) were followed for the entire 52 weeks of the trial.

Over 1 year, the average BMI of the placebo-treated patients rose slightly, while that of the metformin-treated patients decreased. However, there was considerable overlap of weight loss and gain among the subjects in the two groups, and though the study was designed with the assumption that the difference in average BMI between the two groups would be about 1.5 kg/m

The magnitude of that loss was equal to about 6–7 pounds for a child whose height is 65 inches.

The trial was conducted by the Glaser Pediatric Research Network at five separate centers, and the medication and placebo were donated by Bristol-Myers-Squibb.

The magnitude of that loss was equal to about 6–7 pounds for a child whose height is 65 inches. DR. WILSON

CHICAGO — The use of metformin for weight loss in nondiabetic, obese adolescents—a practice that is becoming increasingly popular—produces about a 6- to 7-pound loss over 1 year, according to a study presented at the annual scientific sessions of the American Diabetes Association.

“My conclusion from this study is that metformin XR [extended release] provides a modest weight benefit in obese, nondiabetic adolescents over 1 year of treatment,” Dr. Darrell Wilson, chief of pediatric endocrinology at Lucile M. Packard Children's Hospital, Stanford, Calif., said.

The study randomized 77 patients with a body mass index (BMI) above the 95th percentile to either extended-release metformin or placebo. Their average BMI was 36 kg/m

Seventy percent of the patients (27 in each group) were followed for the entire 52 weeks of the trial.

Over 1 year, the average BMI of the placebo-treated patients rose slightly, while that of the metformin-treated patients decreased. However, there was considerable overlap of weight loss and gain among the subjects in the two groups, and though the study was designed with the assumption that the difference in average BMI between the two groups would be about 1.5 kg/m

The magnitude of that loss was equal to about 6–7 pounds for a child whose height is 65 inches.

The trial was conducted by the Glaser Pediatric Research Network at five separate centers, and the medication and placebo were donated by Bristol-Myers-Squibb.

The magnitude of that loss was equal to about 6–7 pounds for a child whose height is 65 inches. DR. WILSON

SAN DIEGO — More than 400,000 cases of pulmonary thromboembolism are missed by doctors every year in the United States.

Over the past few years, it has become clearer why many of those cases are missed and how they could be diagnosed, Dr. Daniel J. Sullivan said at a congress of the American College of Emergency Physicians.

Most often, the patient has an abnormal vital sign that should alert the emergency physician to the possibility of pulmonary embolism (PE), but that single, critical sign sometimes is missed in the complexity of the situation, said Dr. Sullivan, a faculty member in the department of emergency medicine at Rush Medical College, Chicago.

“Syncope, dyspnea, rapid pulse, risk factors such as immobilization—please think PE,” he said. “Every case seems to have good clues.”

Dr. Sullivan presented two cases to illustrate his point. The first case involved a nurse who came into the emergency department (ED) complaining of pain, redness, and possible infection of a wound on her leg.

She had been in a car accident 2 weeks before. In the accident, she sustained two fractures of the arm, a dislocated hip, and a laceration on the shin. In the patient history, the examining physician noted that the patient had a closed reduction of a hip fracture and had spent a week in the hospital before being discharged 1 week earlier.

The patient's initial vital signs were a temperature of 98.3° F and blood pressure of 140/80 mm Hg. Most important, her respiratory rate was 20 breaths per minute, and her pulse was 88 beats per minute.

Her respiratory rate was the clue the physician overlooked, Dr. Sullivan cautioned, together with the fact that her history said she had had hip surgery recently—and thus had spent time immobilized. In addition, the patient arrived in a wheelchair.

Instead, the physician focused on her complaint about her leg. He assumed he saw signs of cellulitis, and treated that with no further work-up.

The patient went home, only to develop respiratory distress 12 hours later. She was brought back to the ED and died of a massive pulmonary embolism.

The second case Dr. Sullivan outlined was like the first, in that the history should have given the clinician pause.

The patient in the second case was a 55-year-old obese woman who came to the emergency department complaining of nausea, vomiting, and diarrhea that had continued for 4 days.

When the patient arrived at the ED, both the triage nurse and the examining physician noted that they saw no specific signs of illness—the patient's color was good, and she had no upper airway congestion, chest pain, sweating, or cyanosis. Her abdominal exam was normal, her laboratory tests were normal, and a chest x-ray showed nothing.

However, the physician did note that the patient was in moderate distress. The patient's respiratory rate, noted by the triage nurse, was 34 breaths per minute. But the nurse recorded that as a normal rate, and nobody questioned it. Moreover, the patient's pulse was 96 beats per minute, and her temperature was not very high, at 100° F.

The medical history taken in the emergency department did not include the fact that the patient had had a prior PE. That was a fatal error, Dr. Sullivan continued, because the medical history did say that she was obese and had a clinical picture that did not really fit an infection.

When the woman became short of breath before leaving the emergency department, no one informed the physician. She collapsed and died as she was leaving the hospital.

In both of the cases, the patients' breathing and/or vital signs offered warnings that should have prevented premature diagnosis, Dr. Sullivan said.

One particularly tricky situation occurs when the patient might have pneumonia or some other infection, he cautioned. In cases that turn out to involve pulmonary embolism, patients often have a pulse that is too high and a temperature that is only mildly elevated. That combination should always raise a red flag for possible PE, Dr. Sullivan said.

SAN DIEGO — More than 400,000 cases of pulmonary thromboembolism are missed by doctors every year in the United States.

Over the past few years, it has become clearer why many of those cases are missed and how they could be diagnosed, Dr. Daniel J. Sullivan said at a congress of the American College of Emergency Physicians.

Most often, the patient has an abnormal vital sign that should alert the emergency physician to the possibility of pulmonary embolism (PE), but that single, critical sign sometimes is missed in the complexity of the situation, said Dr. Sullivan, a faculty member in the department of emergency medicine at Rush Medical College, Chicago.

“Syncope, dyspnea, rapid pulse, risk factors such as immobilization—please think PE,” he said. “Every case seems to have good clues.”

Dr. Sullivan presented two cases to illustrate his point. The first case involved a nurse who came into the emergency department (ED) complaining of pain, redness, and possible infection of a wound on her leg.

She had been in a car accident 2 weeks before. In the accident, she sustained two fractures of the arm, a dislocated hip, and a laceration on the shin. In the patient history, the examining physician noted that the patient had a closed reduction of a hip fracture and had spent a week in the hospital before being discharged 1 week earlier.

The patient's initial vital signs were a temperature of 98.3° F and blood pressure of 140/80 mm Hg. Most important, her respiratory rate was 20 breaths per minute, and her pulse was 88 beats per minute.

Her respiratory rate was the clue the physician overlooked, Dr. Sullivan cautioned, together with the fact that her history said she had had hip surgery recently—and thus had spent time immobilized. In addition, the patient arrived in a wheelchair.

Instead, the physician focused on her complaint about her leg. He assumed he saw signs of cellulitis, and treated that with no further work-up.

The patient went home, only to develop respiratory distress 12 hours later. She was brought back to the ED and died of a massive pulmonary embolism.

The second case Dr. Sullivan outlined was like the first, in that the history should have given the clinician pause.

The patient in the second case was a 55-year-old obese woman who came to the emergency department complaining of nausea, vomiting, and diarrhea that had continued for 4 days.

When the patient arrived at the ED, both the triage nurse and the examining physician noted that they saw no specific signs of illness—the patient's color was good, and she had no upper airway congestion, chest pain, sweating, or cyanosis. Her abdominal exam was normal, her laboratory tests were normal, and a chest x-ray showed nothing.

However, the physician did note that the patient was in moderate distress. The patient's respiratory rate, noted by the triage nurse, was 34 breaths per minute. But the nurse recorded that as a normal rate, and nobody questioned it. Moreover, the patient's pulse was 96 beats per minute, and her temperature was not very high, at 100° F.

The medical history taken in the emergency department did not include the fact that the patient had had a prior PE. That was a fatal error, Dr. Sullivan continued, because the medical history did say that she was obese and had a clinical picture that did not really fit an infection.

When the woman became short of breath before leaving the emergency department, no one informed the physician. She collapsed and died as she was leaving the hospital.

In both of the cases, the patients' breathing and/or vital signs offered warnings that should have prevented premature diagnosis, Dr. Sullivan said.

One particularly tricky situation occurs when the patient might have pneumonia or some other infection, he cautioned. In cases that turn out to involve pulmonary embolism, patients often have a pulse that is too high and a temperature that is only mildly elevated. That combination should always raise a red flag for possible PE, Dr. Sullivan said.

SAN DIEGO — More than 400,000 cases of pulmonary thromboembolism are missed by doctors every year in the United States.

Over the past few years, it has become clearer why many of those cases are missed and how they could be diagnosed, Dr. Daniel J. Sullivan said at a congress of the American College of Emergency Physicians.

Most often, the patient has an abnormal vital sign that should alert the emergency physician to the possibility of pulmonary embolism (PE), but that single, critical sign sometimes is missed in the complexity of the situation, said Dr. Sullivan, a faculty member in the department of emergency medicine at Rush Medical College, Chicago.

“Syncope, dyspnea, rapid pulse, risk factors such as immobilization—please think PE,” he said. “Every case seems to have good clues.”

Dr. Sullivan presented two cases to illustrate his point. The first case involved a nurse who came into the emergency department (ED) complaining of pain, redness, and possible infection of a wound on her leg.

She had been in a car accident 2 weeks before. In the accident, she sustained two fractures of the arm, a dislocated hip, and a laceration on the shin. In the patient history, the examining physician noted that the patient had a closed reduction of a hip fracture and had spent a week in the hospital before being discharged 1 week earlier.

The patient's initial vital signs were a temperature of 98.3° F and blood pressure of 140/80 mm Hg. Most important, her respiratory rate was 20 breaths per minute, and her pulse was 88 beats per minute.

Her respiratory rate was the clue the physician overlooked, Dr. Sullivan cautioned, together with the fact that her history said she had had hip surgery recently—and thus had spent time immobilized. In addition, the patient arrived in a wheelchair.

Instead, the physician focused on her complaint about her leg. He assumed he saw signs of cellulitis, and treated that with no further work-up.

The patient went home, only to develop respiratory distress 12 hours later. She was brought back to the ED and died of a massive pulmonary embolism.

The second case Dr. Sullivan outlined was like the first, in that the history should have given the clinician pause.

The patient in the second case was a 55-year-old obese woman who came to the emergency department complaining of nausea, vomiting, and diarrhea that had continued for 4 days.

When the patient arrived at the ED, both the triage nurse and the examining physician noted that they saw no specific signs of illness—the patient's color was good, and she had no upper airway congestion, chest pain, sweating, or cyanosis. Her abdominal exam was normal, her laboratory tests were normal, and a chest x-ray showed nothing.

However, the physician did note that the patient was in moderate distress. The patient's respiratory rate, noted by the triage nurse, was 34 breaths per minute. But the nurse recorded that as a normal rate, and nobody questioned it. Moreover, the patient's pulse was 96 beats per minute, and her temperature was not very high, at 100° F.

The medical history taken in the emergency department did not include the fact that the patient had had a prior PE. That was a fatal error, Dr. Sullivan continued, because the medical history did say that she was obese and had a clinical picture that did not really fit an infection.

When the woman became short of breath before leaving the emergency department, no one informed the physician. She collapsed and died as she was leaving the hospital.

In both of the cases, the patients' breathing and/or vital signs offered warnings that should have prevented premature diagnosis, Dr. Sullivan said.

One particularly tricky situation occurs when the patient might have pneumonia or some other infection, he cautioned. In cases that turn out to involve pulmonary embolism, patients often have a pulse that is too high and a temperature that is only mildly elevated. That combination should always raise a red flag for possible PE, Dr. Sullivan said.