DECEMBER 13, 2010
Young Diabetes Patients Playing With Fire
Cigarette smoking is common among young adults with diabetes, yet health care providers do little to discourage the habit, according to a report published online in the Journal of Pediatrics.
“Smoking is preventable, so aggressive smoking prevention and cessation programs are needed to prevent or delay heart disease in youth with diabetes,” said lead author Kristi Reynolds, PhD, MPH, an epidemiologist at Kaiser Permanente.
Dr. Reynolds found smoking rates as high as 37% in her investigation of tobacco use among young adults with diabetes aged 10 to 22 years. Fewer than half of the study’s participants said they had been advised to quit by a health care provider.
The findings were based on data from SEARCH for Diabetes in Youth, a trial funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. A total of 3466 diabetes patients from racially and ethnically diverse backgrounds participated.
Among patients with type 1 diabetes, the prevalence of current cigarette smoking was 1.3% of 10- to 14-year-olds, 14.9% of 15- to 19-year-olds, and 27% of patients 20 years and older. Among those with type 2 diabetes, cigarette smokers accounted for 4.4% of 10- to 14-year-olds, 12.9% of 15- to 19-year-olds, and 37.3% of patients 20 years and older.
The results suggest an urgent need for tobacco prevention interventions that target children, teenagers, and young adults with diabetes.
Participants who smoked were already showing signs of heart disease, including high triglycerides, high LDL cholesterol, and low HDL cholesterol.
Diabetes and Depression Go Hand in Hand
Research conducted at Harvard University offers new insight into the unique relationship between type 2 diabetes and depression. The results of a report published in the Archives of Internal Medicine show that patients with diabetes are more likely to be depressed, and those with depression are more likely to develop diabetes.
Risk of comorbidity was highest in patients who took medications, such as insulin or antidepressants, to mitigate their symptoms. Study coauthor Frank Hu, MD, a professor of nutrition and epidemiology at the Harvard School of Public Health, said the results underscore the importance of preventive measures that target both conditions.
In his 10-year study involving 55,000 nurses, Dr. Hu noted a 17% higher risk of diabetes among those who were depressed. Diabetes risk was 25% higher in women taking antidepressants. Those with diabetes had a 29% higher risk of depression than healthy individuals. Risk was higher in patients who took diabetes medications.
The results show the relationship is bidirectional, but not why it occurs. A possible explanation could be the prevalence of obesity and physical inactivity among patients with either diabetes or depression. Depression may also be brought on by stressors linked to diabetes management, Dr. Hu said.
Whether or not either disease causes the other, the results provide strong support for addressing symptoms of depression in diabetes counseling and recommending lifestyle modifications for patients with depression.
Curbing Salt Intake Lowers Heart Risk in Diabetes
Diabetes patients who religiously count carbohydrates may not think twice about sodium, but salt intake is no small matter. Reducing it could lead to a dramatic improvement in the cardiovascular risks associated with diabetes, according a report published in the December issue of The Cochrane Library.
Researchers at St. George’s Hospital Medical School in London found that just 1 week of lowered salt intake reduced blood pressure in patients with type 1 and type 2 diabetes. Although hypertension is common in patients with diabetes, past studies have not investigated the benefits of short-term salt reduction for patients who have the disease.
“We were surprised to find so few studies of modest, practical salt reduction in diabetes where patients are at high cardiovascular risk and stand much to gain from interventions that reduce blood pressure,” said Rebecca Suckling of the blood pressure unit at St. George’s University. “However, despite this, there was a consistent reduction in blood pressure when salt intake was reduced.”
In their systematic review of 13 studies, Suckling and colleagues found that reducing salt intake by 8.5 grams a day led to a blood pressure reduction of 7/3 mm Hg—a result comparable to the effect of blood pressure medications. The reduction was the same in patients with type 1 and type 2 diabetes, the researchers concluded.
Treatment of Melanoma
In this Pharmacy Times program for Health Systems Pharmacists, Nanaz Amini, PharmD, RPh, MS, of the Angles Clinic, provides a pharmacist’s perspective on the management of melanoma.