Conference Update, Jun 10,2008
Coronary and aortic calcium burden strongly predictive of cardiovascular events in type 2 diabetes
Coronary artery calcium and abdominal aortic calcium both predicted future cardiovascular events in a Veterans Administration population with type 2 diabetes. The relationship between calcium scores and cardiovascular events was independent of standard cardiovascular risk factors, said Peter Reaven, MD.
Surrogate endpoints in drug approval process examined, found wanting
Surrogate endpoints in clinical trials (ie, hemoglobin [Hb] A1c) on which drug approvals may be based only explain narrow aspects of complex conditions. For this reason, even when using a drug as labeled, there is always a level of uncertainty over outcomes with the drug, said Saul Malozowski, MD, PhD, MPH.
Hyperglycemia can affect NO pathway of endothelial function
Hyperglycemia is involved in the dysregulation of endothelial nitric oxide (NO) synthase, leading to endothelial dysfunction and an increased risk of vasculopathy, said Markku Laakso, MD.
Be wary of trace element claims
Clinicians should be wary of health claims made for trace elements such as iron or chromium. While there is no doubt that trace elements are needed for health, there is significant doubt about their utility in preventing or curing diabetes and other diseases, said Eliseo Guallar, MD, DrPH, Johns Hopkins Bloomberg School of Public Health, Baltimore. There are many hypotheses about the beneficial effects of trace elements, but little high-quality data, little reliable population data, few useful biomarkers, relatively crude analytical methods and few mechanistic studies.
Separate drug classes prevent development of type 2 diabetes in susceptible patients
Pioglitazone prevented progression to type 2 diabetes in patients with impaired glucose tolerance (IGT), reported Ralph DeFronzo, MD. The effect was marked?81% fewer patients assigned to pioglitazone compared with placebo converted from IGT to type 2 diabetes in a randomized, double-blind, placebo-controlled clinical study.
Gut hormones key to appetite regulation
Gut hormones play a key and often overlooked role in weight loss and weight regulation. Changes in weight are determined largely by the balance between energy intake and energy expenditure, but gut hormones can affect both sides of the energy equation.
Basal insulin plus pramlintide at mealtime controls glucose, with lower hypoglycemia risk
Pramlintide injection added to basal insulin at mealtime is similar to titrated rapid-acting insulin in achieving glycemic control but with a lower risk of hypoglycemia and no weight gain in patients with type 2 diabetes, said Matthew Riddle, MD, head, section of diabetes, division of endocrinology/diabetes/clinical nutrition, Oregon Health and Sciences University, Portland.
Endovascular interventions for PAD proliferate
The range of endothelial interventions for peripheral artery disease (PAD) is proliferating. Today's choices include traditional balloon angioplasty, stents, drug eluting stents and fabric-covered stents. Newer technologies allow clinicians to cut out occlusions, freeze them, scrape them, laser them and kill them.