Changes in Weight and Glucose Can Protect Against Progression in Early Diabetes Independent of Improvements in β-Cell Function

CONTEXT

Evidence-based strategies to prevent progression of dysglycemia in newly diagnosed type 2 diabetes are needed.

OBJECTIVE

To undertake a secondary analysis of the Early Diabetes Intervention Program (EDIP) in order to understand the features that were protective against worsening glycemia.

DESIGN

EDIP was a randomized, placebo-controlled trial.

SETTING

Two university diabetes centers.

PATIENTS

A total of 219 overweight individuals with fasting glucose < 7.8 mmol/L and 2-hour oral glucose tolerance test (OGTT) glucose > 11.1 mmol/L.

INTERVENTIONS

Acarbose versus placebo, on a background of dietary recommendations, with quarterly visits to assess glycemia and intervention adherence for up to 5 years.

MAIN OUTCOME MEASURES

Progression of fasting glucose ≥ 7.8 mmol/L on two consecutive quarterly visits. Cox proportional hazards modeling and ANOVA were performed to evaluate determinants of progression.

RESULTS

Progression-free status was associated with reductions in weight, fasting glucose, 2-hour OGTT glucose, and increases in the high-density lipoprotein/triglyceride ratio. The reduction in fasting glucose was the only effect that remained significantly associated with progression-free status in multivariable Cox modeling. The reduction in fasting glucose was in turn primarily associated with reductions in weight and in 2-hour OGTT glucose. Acarbose treatment did not explain these changes.

CONCLUSIONS

In early diabetes, reductions in glucose, driven by reductions in weight, can delay progressive metabolic worsening. These observations underscore the importance of lifestyle management including weight loss as a tool to mitigate worsening of glycemia in newly diagnosed diabetes.

Effect of acarbose to delay progression of carotid intima-media thickness in early diabetes

BACKGROUND

The anti-diabetic agent acarbose reduces postprandial glucose excursions. We have evaluated the effect of randomized treatment with acarbose on the progression of carotid intima-media thickness (IMT) in early diabetes.

METHODS

The Early Diabetes Intervention Program was a randomized trial of acarbose versus placebo in 219 participants with early diabetes characterized by glucose values over 11.1 mmol/L 2 h after a 75 g oral glucose load and a mean HbA1c of 6.3%. IMT was measured at baseline and yearly. Follow-up was discontinued if participants progressed to the study glucose endpoints; IMT readings were available for a median of 2 years, with 72 subjects followed for 5 years.

RESULTS

Progressive increases in IMT were seen in both treatment groups, but progression was reduced in participants randomized to acarbose (p = 0.047). In age, sex and smoking-adjusted analyses, IMT progression was associated with greater fasting and oral glucose tolerance test-excursion glucose, fasting insulin, cholesterol and glycated low-density lipoprotein concentrations. IMT progression was reduced with study-related changes in weight, insulin and non-esterified fatty acids; these features were more strongly associated with reduced IMT progression than acarbose treatment. Despite strong associations of baseline glycemia with IMT progression, study-related changes in glucose were not important determinants of IMT progression.

CONCLUSIONS

Acarbose can delay progression of carotid intima-media thickness in early diabetes defined by an oral glucose tolerance test. Glucose, weight, insulin and lipids contributed to risk of progression but reductions in glycemia were not major determinants of reduced rate of IMT progression. Vascular benefits of acarbose may be independent of its glycemic effects.

Use of germ-line single nucleotide polymorphisms (SNPs) in drug transporters (ABCG2/ABCB1) and tubulin (TUBB4) to predict survival in patients with metastatic castrate-resistant prostate cancer (CRPC) receiving docetaxel

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Background: Multiple treatment options now exist for metastatic CRPC patients (pts). Germ-line SNPs in docetaxel (D) transport, metabolism, binding site, and degradation genes may contribute to variability in outcomes observed in D treated CRPC pts.

Methods: Between 1/07 and 10/08, all PCa pts seen in the Indiana University Simon Cancer Center oncology clinics were approached for recruitment to the Prostate Cancer Genetic Risk Evaluation of SNPs Study (PROGRESS). Participants completed a demographic and clinical questionnaire and provided a blood sample. Only CRPC pts treated with D were included in this analysis. Germ-line DNA was analyzed for SNP genotyping on a 128-SNP chip using a TaqMan OpenArray GT Kit (Applied Biosystems). The chip included genes critical to D signaling, transport, and elimination with minor allele frequencies > 5%. Pts were followed for progression-free (PFS) and overall survival (OS). Univariable analyses were performed to identify significant associations between SNP genotype, clinical parameters, and PFS and OS outcomes.

Results: 60 pts with metastatic CRPC initiated on D enrolled. Demographics included: age (median) – 69 yrs, ECOG PS 0– 40%, prostate specific antigen (PSA) (median) – 129.9 ng/ml, PSA doubling time (median) – 1.8 months, visceral mets –25%. No clinical parameters were associated with PFS and OS. Significant SNP associations are summarized below.

Conclusions: Differences in germ-line ABCG2, ABCB1, and TUBB4 SNPs may contribute to variation in clinical outcomes in CRPC pts treated with D.

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Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population

OBJECTIVE

This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population.

DESIGN

Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (< 65 years) and Group B (> or = 65 years). Natural sputum smears and cultures positive for M. tuberculosis (M. TB) in each group were compared with FOB specimens, acid-fast bacilli (AFB) smears and cultures. Data were analyzed by chi-square tests of independence for each year, then compared to determine statistical significance.

SETTING AND PATIENTS

Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC-approved criteria for diagnosis of tuberculosis.

MEASUREMENTS

The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only.

MAIN RESULTS

In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age < 65), the difference in rates for those in Group B (age > or = 65) was statistically significant (P < 0.05).

CONCLUSIONS

A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among the elderly.