Rosiglitazone and Obesity
Rosiglitazone may be an effective adjunct to insulin therapy in patients with type 1 diabetes and a body mass index (BMI) greater than or equal to 30 kg/m
In an 8-month, randomized, double-blind study, 50 adults with a baseline BMI of 27 or higher were assigned to receive either insulin and rosiglitazone or insulin and placebo. HbA1C levels declined significantly in treated subjects (−1.0%) and placebo subjects (−0.7%), but the placebo group required an 11% higher insulin dose (Diabetes Care 2005;28:1562–7).
Subjects with a baseline BMI of 30 or higher who were treated with rosiglitazone had significantly greater improvements in HbA1C (−1.4%) and total cholesterol (−18 mg/dL) levels, compared with rosiglitazone-treated subjects whose BMI was less than 30.
These outcomes were not observed among placebo subjects. In fact, placebo subjects with a BMI of 30 or higher had the greatest increase in insulin dose of all placebo subjects (12.3 units/day), while patients with a BMI over 30 taking rosiglitazone lowered their daily insulin requirements (−5.7 units/day).
Obesity, Smoking, and Aging
Obesity and cigarette smoking are associated with accelerated aging in white women, reported A.M. Valdes, Ph.D., of the Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital, London.
Both smoking and obesity result in oxidative stress, which increases white blood cell telomere erosion; telomeres protect chromosomes from degradation by capping the ends of the chromosomes. This suggests that obese subjects and smokers will have shortened telomeres, a marker for aging (Lancet 2005;366:662–4).
In a study of 1,122 white female twins aged 18–72 years, telomere length in white blood cells decreased steadily with age at a mean rate of 27 base pair (bp) per year. The telomere length of obese women was 240 bp shorter, compared with lean women. There was also a dose-dependent relationship between smoking and telomere length: Each pack-year smoked was equivalent to an age-adjusted average of 5 bp of telomere length lost per year, an 18% decrease, Dr. Valdes and colleagues wrote. Lean women had significantly longer telomeres than women with BMIs in the middle of the range, who in turn had longer telomeres than obese women.
The data showed that the difference in telomere length between lean and obese women corresponded to 8.8 years of aging, and current or previous smoking accounted for 4.6 years of aging.
Nutritional Adjunct Tied to Savings
Supplementation with chromium picolinate plus biotin may substantially reduce the cost of treating type 2 diabetes, reported Joseph P. Fuhr Jr., Ph.D., of Widener University, Chester, Penn., and Thomas Jefferson University, Philadelphia, and his associates, based on an economic analysis.
Studies have shown that daily use of the supplement, at an average annual cost of less than $120, improved glycemic control in patients with poorly controlled type 2 diabetes over and above the improvement achieved by oral hypoglycemic agents, the authors noted. In patients with a baseline HbA1c level of at least 10%, the average HbA1c level decreased by 1.78% in users of chromium picolinate plus biotin, compared with 0.78% in placebo users (Dis. Manag. 2005;8:265–75).
The average 3-year cost savings of decreasing HbA1c levels from 10.62% to 9.18% was estimated to be $1,636 for patients with poorly controlled type 2 diabetes and $5,435 for patients who also have heart disease and hypertension; the combination of chromium picolinate and biotin has been shown to affect both lipid and glucose levels. This could result in an average 3-year savings of between $3.9 and $52.9 billion in treating the 16.3 million patients who currently have type 2 diabetes, the authors estimated.
Body Mass and Stature
The acute response of the spine to loading may be a risk factor for low back pain in obese subjects, reported André Luiz Felix Rodacki of Paraná Federal University, Curitiba, Brazil, and his associates.
Ten obese men with a BMI greater than 30 kg/m
The obese subjects' stature loss was an average of 8.49 mm loaded and 7.02 mm unloaded, compared with the nonobese subjects, who had an average loss of 6.52 mm loaded and 3.55 mm unloaded. The obese group did not regain stature during the standing recovery period, while the nonobese group recovered stature (Clin. Biomech. 2005;20:799–805).
A longer recovery period may be necessary for obese subjects to reestablish their intervertebral disc height after loading, which “may help to explain the high incidence of back disorders in obese individuals,” the authors wrote.