User login
PCOS Development May Begin With Insulin Resistance
INDIAN WELLS, CALIF. — Insulin resistance precedes and may set the stage for hyperandrogenism in peripubertal girls at risk for polycystic ovary syndrome, researchers concluded in what is believed to be the first prospective, longitudinal study of PCOS development.
Dr. Marc J. Kalan and his associates at the University of Southern California, Los Angeles, enrolled 57 prepubescent Hispanic girls aged 8–13 years who were at high risk for polycystic ovary syndrome (PCOS) because they were obese (defined by the investigators as a body mass index greater than or equal to the 85th percentile for age and sex), and had a first-degree family member with diabetes.
At yearly intervals for a mean of 4 years, the girls underwent interviews, physical examinations, dual-energy x-ray absorptiometry, and MRI studies to assess body composition and visceral fat accumulation, fasting serum hormone measurements, and oral and intravenous glucose tolerance testing. Dr. Kalan reported the results at the annual meeting of the Pacific Coast Reproductive Society.
Of the 57 girls, 15 (26%) developed what investigators termed a “PCOS-like” condition, in that their menses became irregular at least 2 years after menarche and they had clinical evidence of androgen excess.
No differences were seen between these girls and study subjects who did not develop PCOS-like findings in terms of adiposity, prepubertal insulin and sex hormone levels, or the age at menarche (average, 12 years).
However, within a year of menarche, they were significantly more insulin resistant than their peers (mean insulin sensitivity index [ISI]), 1.2 M/mU per liter, compared with 1.6 M/mU per liter), reported Dr. Kalan of the division of reproductive endocrinology and infertility at USC.
The girls' testosterone levels were similar to those of girls who did not develop PCOS-like findings at 1 year post menarche.
However, at 2 years post menarche, they had significantly higher mean testosterone levels (47.5 ng/dL, compared with 22.5 ng/dL).
The insulin resistance disparity widened during the second year post menarche (mean ISI, 1.2 M/mU per liter vs.1.8 M/mU per liter).
All differences in study parameters persisted after statistical adjustment for adiposity, the researcher reported.
The study results offer important evidence suggesting that testosterone is not the driver of events leading to PCOS. “Insulin resistance came first,” Dr. Kalan commented in an interview.
Assessing insulin values, specifically, insulin resistance, “may be clinically useful to predict PCOS in an overweight, high-risk [Hispanic] population,” the study investigators concluded.
Dr. Kalan said the group is still following the girls and evaluating other factors such as leptin.
Future research may be aimed at early prevention.
“Obviously, the next thing to do is to intervene earlier. Maybe you could head this off,” he said.
Dr. Kalan's research was supported by the National Institutes of Health.
INDIAN WELLS, CALIF. — Insulin resistance precedes and may set the stage for hyperandrogenism in peripubertal girls at risk for polycystic ovary syndrome, researchers concluded in what is believed to be the first prospective, longitudinal study of PCOS development.
Dr. Marc J. Kalan and his associates at the University of Southern California, Los Angeles, enrolled 57 prepubescent Hispanic girls aged 8–13 years who were at high risk for polycystic ovary syndrome (PCOS) because they were obese (defined by the investigators as a body mass index greater than or equal to the 85th percentile for age and sex), and had a first-degree family member with diabetes.
At yearly intervals for a mean of 4 years, the girls underwent interviews, physical examinations, dual-energy x-ray absorptiometry, and MRI studies to assess body composition and visceral fat accumulation, fasting serum hormone measurements, and oral and intravenous glucose tolerance testing. Dr. Kalan reported the results at the annual meeting of the Pacific Coast Reproductive Society.
Of the 57 girls, 15 (26%) developed what investigators termed a “PCOS-like” condition, in that their menses became irregular at least 2 years after menarche and they had clinical evidence of androgen excess.
No differences were seen between these girls and study subjects who did not develop PCOS-like findings in terms of adiposity, prepubertal insulin and sex hormone levels, or the age at menarche (average, 12 years).
However, within a year of menarche, they were significantly more insulin resistant than their peers (mean insulin sensitivity index [ISI]), 1.2 M/mU per liter, compared with 1.6 M/mU per liter), reported Dr. Kalan of the division of reproductive endocrinology and infertility at USC.
The girls' testosterone levels were similar to those of girls who did not develop PCOS-like findings at 1 year post menarche.
However, at 2 years post menarche, they had significantly higher mean testosterone levels (47.5 ng/dL, compared with 22.5 ng/dL).
The insulin resistance disparity widened during the second year post menarche (mean ISI, 1.2 M/mU per liter vs.1.8 M/mU per liter).
All differences in study parameters persisted after statistical adjustment for adiposity, the researcher reported.
The study results offer important evidence suggesting that testosterone is not the driver of events leading to PCOS. “Insulin resistance came first,” Dr. Kalan commented in an interview.
Assessing insulin values, specifically, insulin resistance, “may be clinically useful to predict PCOS in an overweight, high-risk [Hispanic] population,” the study investigators concluded.
Dr. Kalan said the group is still following the girls and evaluating other factors such as leptin.
Future research may be aimed at early prevention.
“Obviously, the next thing to do is to intervene earlier. Maybe you could head this off,” he said.
Dr. Kalan's research was supported by the National Institutes of Health.
INDIAN WELLS, CALIF. — Insulin resistance precedes and may set the stage for hyperandrogenism in peripubertal girls at risk for polycystic ovary syndrome, researchers concluded in what is believed to be the first prospective, longitudinal study of PCOS development.
Dr. Marc J. Kalan and his associates at the University of Southern California, Los Angeles, enrolled 57 prepubescent Hispanic girls aged 8–13 years who were at high risk for polycystic ovary syndrome (PCOS) because they were obese (defined by the investigators as a body mass index greater than or equal to the 85th percentile for age and sex), and had a first-degree family member with diabetes.
At yearly intervals for a mean of 4 years, the girls underwent interviews, physical examinations, dual-energy x-ray absorptiometry, and MRI studies to assess body composition and visceral fat accumulation, fasting serum hormone measurements, and oral and intravenous glucose tolerance testing. Dr. Kalan reported the results at the annual meeting of the Pacific Coast Reproductive Society.
Of the 57 girls, 15 (26%) developed what investigators termed a “PCOS-like” condition, in that their menses became irregular at least 2 years after menarche and they had clinical evidence of androgen excess.
No differences were seen between these girls and study subjects who did not develop PCOS-like findings in terms of adiposity, prepubertal insulin and sex hormone levels, or the age at menarche (average, 12 years).
However, within a year of menarche, they were significantly more insulin resistant than their peers (mean insulin sensitivity index [ISI]), 1.2 M/mU per liter, compared with 1.6 M/mU per liter), reported Dr. Kalan of the division of reproductive endocrinology and infertility at USC.
The girls' testosterone levels were similar to those of girls who did not develop PCOS-like findings at 1 year post menarche.
However, at 2 years post menarche, they had significantly higher mean testosterone levels (47.5 ng/dL, compared with 22.5 ng/dL).
The insulin resistance disparity widened during the second year post menarche (mean ISI, 1.2 M/mU per liter vs.1.8 M/mU per liter).
All differences in study parameters persisted after statistical adjustment for adiposity, the researcher reported.
The study results offer important evidence suggesting that testosterone is not the driver of events leading to PCOS. “Insulin resistance came first,” Dr. Kalan commented in an interview.
Assessing insulin values, specifically, insulin resistance, “may be clinically useful to predict PCOS in an overweight, high-risk [Hispanic] population,” the study investigators concluded.
Dr. Kalan said the group is still following the girls and evaluating other factors such as leptin.
Future research may be aimed at early prevention.
“Obviously, the next thing to do is to intervene earlier. Maybe you could head this off,” he said.
Dr. Kalan's research was supported by the National Institutes of Health.
Results Challenge Pregnancy Weight Gain Advice
CHICAGO — Virtually any weight gain during pregnancy by obese women with gestational diabetes resulted in high rates of large-for-gestational-age infants, according to a study released at the annual meeting of the American College of Obstetricians and Gynecologists.
Obese women in the investigation who either lost weight or maintained their prepregnancy weight during pregnancy while on a medically supervised low-carbohydrate diet gave birth to babies with “close to normal” birth weights.
They also had the lowest cesarean delivery rates (10.5%), according to study results.
In contrast, more than one in five obese women who gained a modest amount of weight during pregnancy—1–14 pounds—had large-for-gestational-age infants.
The LGA rate increased with more weight gain, accounting for 36% of infants born to women who gained 26–35 pounds, and nearly 40% of those born to women who gained more than 35 pounds.
“We think this raises questions about current Institute of Medicine recommendations for obese women to gain a minimum of 15 pounds” during pregnancy, said Dr. Deborah L. Conway of the University of Texas Health Science Center at San Antonio.
Dr. Conway explained that her institution carefully monitors women with gestational diabetes and places them on a calorie-controlled, low-carbohydrate diet that includes nutritional counseling.
They also receive glyburide or insulin as necessary to achieve euglycemia.
“Although it wasn't the intention, we noticed that some of these women didn't gain weight as you might expect during pregnancy. We weren't sure that was such a bad thing,” said Dr. Conway during an interview at the meeting, where her study was presented in poster form.
To better understand gestational weight changes in this group, Dr. Poornima Kaul, a fourth-year resident, analyzed birth weights and pregnancy complications among 302 women with gestational diabetes who had a mean prepregnancy body mass index of 35.6 kg/m2 and were eligible for vaginal delivery.
The large-for-gestational-age rate among those who lost weight or maintained their prepregnancy weight was 11.8%. The macrosomia rate (weight greater than 4,000 g) among their infants was 8.8%, and the rate of small-for-gestational-age infants was 8.8%.
These rates are “pretty close to normal,” Dr. Conway said.
Infants born to women who gained a small amount of weight (1–14 pounds) had a 27.3% large-for-gestational-age rate and a 13.6% rate of macrosomia. These women had a 15.1% cesarean delivery rate.
Women who gained 15–25 pounds had rates of large-for-gestational-age, macrosomia, and cesarean delivery of 27.6%, 13.2%, and 23.4%, respectively.
Those who gained 26–35 pounds had rates of large-for-gestational-age, macrosomia, and cesarean delivery of 36.4%, 21.8%, and 26.7%, while rates in women who gained more than 35 pounds were 39.6%, 25%, and 17.2%.
Results from the study suggest that the current IOM guideline for a minimum 15-pound gestational weight gain “appears to reflect the upper limit of acceptable weight gain,” the study authors concluded.
Dr. Conway noted that new gestational weight guidelines are expected soon from the IOM and may reflect trends seen in their study.
Dr. Kaul and Dr. Conway reported no financial disclosures relevant to their study.
CHICAGO — Virtually any weight gain during pregnancy by obese women with gestational diabetes resulted in high rates of large-for-gestational-age infants, according to a study released at the annual meeting of the American College of Obstetricians and Gynecologists.
Obese women in the investigation who either lost weight or maintained their prepregnancy weight during pregnancy while on a medically supervised low-carbohydrate diet gave birth to babies with “close to normal” birth weights.
They also had the lowest cesarean delivery rates (10.5%), according to study results.
In contrast, more than one in five obese women who gained a modest amount of weight during pregnancy—1–14 pounds—had large-for-gestational-age infants.
The LGA rate increased with more weight gain, accounting for 36% of infants born to women who gained 26–35 pounds, and nearly 40% of those born to women who gained more than 35 pounds.
“We think this raises questions about current Institute of Medicine recommendations for obese women to gain a minimum of 15 pounds” during pregnancy, said Dr. Deborah L. Conway of the University of Texas Health Science Center at San Antonio.
Dr. Conway explained that her institution carefully monitors women with gestational diabetes and places them on a calorie-controlled, low-carbohydrate diet that includes nutritional counseling.
They also receive glyburide or insulin as necessary to achieve euglycemia.
“Although it wasn't the intention, we noticed that some of these women didn't gain weight as you might expect during pregnancy. We weren't sure that was such a bad thing,” said Dr. Conway during an interview at the meeting, where her study was presented in poster form.
To better understand gestational weight changes in this group, Dr. Poornima Kaul, a fourth-year resident, analyzed birth weights and pregnancy complications among 302 women with gestational diabetes who had a mean prepregnancy body mass index of 35.6 kg/m2 and were eligible for vaginal delivery.
The large-for-gestational-age rate among those who lost weight or maintained their prepregnancy weight was 11.8%. The macrosomia rate (weight greater than 4,000 g) among their infants was 8.8%, and the rate of small-for-gestational-age infants was 8.8%.
These rates are “pretty close to normal,” Dr. Conway said.
Infants born to women who gained a small amount of weight (1–14 pounds) had a 27.3% large-for-gestational-age rate and a 13.6% rate of macrosomia. These women had a 15.1% cesarean delivery rate.
Women who gained 15–25 pounds had rates of large-for-gestational-age, macrosomia, and cesarean delivery of 27.6%, 13.2%, and 23.4%, respectively.
Those who gained 26–35 pounds had rates of large-for-gestational-age, macrosomia, and cesarean delivery of 36.4%, 21.8%, and 26.7%, while rates in women who gained more than 35 pounds were 39.6%, 25%, and 17.2%.
Results from the study suggest that the current IOM guideline for a minimum 15-pound gestational weight gain “appears to reflect the upper limit of acceptable weight gain,” the study authors concluded.
Dr. Conway noted that new gestational weight guidelines are expected soon from the IOM and may reflect trends seen in their study.
Dr. Kaul and Dr. Conway reported no financial disclosures relevant to their study.
CHICAGO — Virtually any weight gain during pregnancy by obese women with gestational diabetes resulted in high rates of large-for-gestational-age infants, according to a study released at the annual meeting of the American College of Obstetricians and Gynecologists.
Obese women in the investigation who either lost weight or maintained their prepregnancy weight during pregnancy while on a medically supervised low-carbohydrate diet gave birth to babies with “close to normal” birth weights.
They also had the lowest cesarean delivery rates (10.5%), according to study results.
In contrast, more than one in five obese women who gained a modest amount of weight during pregnancy—1–14 pounds—had large-for-gestational-age infants.
The LGA rate increased with more weight gain, accounting for 36% of infants born to women who gained 26–35 pounds, and nearly 40% of those born to women who gained more than 35 pounds.
“We think this raises questions about current Institute of Medicine recommendations for obese women to gain a minimum of 15 pounds” during pregnancy, said Dr. Deborah L. Conway of the University of Texas Health Science Center at San Antonio.
Dr. Conway explained that her institution carefully monitors women with gestational diabetes and places them on a calorie-controlled, low-carbohydrate diet that includes nutritional counseling.
They also receive glyburide or insulin as necessary to achieve euglycemia.
“Although it wasn't the intention, we noticed that some of these women didn't gain weight as you might expect during pregnancy. We weren't sure that was such a bad thing,” said Dr. Conway during an interview at the meeting, where her study was presented in poster form.
To better understand gestational weight changes in this group, Dr. Poornima Kaul, a fourth-year resident, analyzed birth weights and pregnancy complications among 302 women with gestational diabetes who had a mean prepregnancy body mass index of 35.6 kg/m2 and were eligible for vaginal delivery.
The large-for-gestational-age rate among those who lost weight or maintained their prepregnancy weight was 11.8%. The macrosomia rate (weight greater than 4,000 g) among their infants was 8.8%, and the rate of small-for-gestational-age infants was 8.8%.
These rates are “pretty close to normal,” Dr. Conway said.
Infants born to women who gained a small amount of weight (1–14 pounds) had a 27.3% large-for-gestational-age rate and a 13.6% rate of macrosomia. These women had a 15.1% cesarean delivery rate.
Women who gained 15–25 pounds had rates of large-for-gestational-age, macrosomia, and cesarean delivery of 27.6%, 13.2%, and 23.4%, respectively.
Those who gained 26–35 pounds had rates of large-for-gestational-age, macrosomia, and cesarean delivery of 36.4%, 21.8%, and 26.7%, while rates in women who gained more than 35 pounds were 39.6%, 25%, and 17.2%.
Results from the study suggest that the current IOM guideline for a minimum 15-pound gestational weight gain “appears to reflect the upper limit of acceptable weight gain,” the study authors concluded.
Dr. Conway noted that new gestational weight guidelines are expected soon from the IOM and may reflect trends seen in their study.
Dr. Kaul and Dr. Conway reported no financial disclosures relevant to their study.
Hyperglycemia Linked to Poor Outcomes With TPN
Hyperglycemia prior to, and shortly after, initiation of total parenteral nutrition was strongly associated with poor clinical outcomes in critically ill hospitalized patients, whether they had a history of diabetes or not, Emory University researchers determined in a retrospective study.
Patients had an almost threefold risk of dying if their maximum blood glucose before or within 24 hours of starting total parenteral nutrition (TPN) was above 180 mg/dL, compared with those whose levels stayed below 120 mg/dL. Many other factors were taken into account for the statistical analysis, including age, sex, and diabetes status, Dr. Guillermo E. Umpierrez, professor of medicine at Emory University, Atlanta, said at the Southern regional meeting of the American Federation for Medical Research.
Although hyperglycemia is a common complication of TPN, its prevalence and impact on clinical outcomes have been uncertain. Dr. Umpierrez and his associates reviewed the records of 276 medical/surgery patients who required TPN a mean 11 days after admission. Most came from surgical or medical intensive care units or the burn unit, but nearly 25% came from non-ICU floors. Also, 23% had a history of diabetes. Patients received TPN for a mean duration of 15 days. In-hospital mortality was 27% in the study, funded by the American Diabetes Association and the National Institutes of Health.
Patients who died had a higher maximum blood glucose before TPN (mean 147 mg/dL) than those who survived (mean 131 mg/dL), as well as a higher maximum blood glucose within 24 hours of TPN initiation (mean 202 mg/dL vs. 160 mg/dL). The differences in blood glucose were highly statistically significant.
In a multivariate analysis, the risk of pneumonia and the risk of acute renal failure were independently related to maximum blood glucose above 180 mg/dL vs. below 120 mg/dL.
In a later interview, Dr. Umpierrez said that pre-TPN blood glucose levels could alert medical teams to the possibility of TPN-related hyperglycemia. “Hospitalists should pay attention to blood glucose levels, not only in those receiving TPN but in patients with hyperglycemia before TPN,” he said. “Frequent blood glucose monitoring is needed to prevent and/or correct hyperglycemia.”
At his institution, the findings prompted a change in protocol to initiate insulin infusion as TPN is begun or to start insulin infusion in patients on TPN whose blood glucose is “persistently elevated,” which he defined as a level over 140 mg/dL.
Hyperglycemia prior to, and shortly after, initiation of total parenteral nutrition was strongly associated with poor clinical outcomes in critically ill hospitalized patients, whether they had a history of diabetes or not, Emory University researchers determined in a retrospective study.
Patients had an almost threefold risk of dying if their maximum blood glucose before or within 24 hours of starting total parenteral nutrition (TPN) was above 180 mg/dL, compared with those whose levels stayed below 120 mg/dL. Many other factors were taken into account for the statistical analysis, including age, sex, and diabetes status, Dr. Guillermo E. Umpierrez, professor of medicine at Emory University, Atlanta, said at the Southern regional meeting of the American Federation for Medical Research.
Although hyperglycemia is a common complication of TPN, its prevalence and impact on clinical outcomes have been uncertain. Dr. Umpierrez and his associates reviewed the records of 276 medical/surgery patients who required TPN a mean 11 days after admission. Most came from surgical or medical intensive care units or the burn unit, but nearly 25% came from non-ICU floors. Also, 23% had a history of diabetes. Patients received TPN for a mean duration of 15 days. In-hospital mortality was 27% in the study, funded by the American Diabetes Association and the National Institutes of Health.
Patients who died had a higher maximum blood glucose before TPN (mean 147 mg/dL) than those who survived (mean 131 mg/dL), as well as a higher maximum blood glucose within 24 hours of TPN initiation (mean 202 mg/dL vs. 160 mg/dL). The differences in blood glucose were highly statistically significant.
In a multivariate analysis, the risk of pneumonia and the risk of acute renal failure were independently related to maximum blood glucose above 180 mg/dL vs. below 120 mg/dL.
In a later interview, Dr. Umpierrez said that pre-TPN blood glucose levels could alert medical teams to the possibility of TPN-related hyperglycemia. “Hospitalists should pay attention to blood glucose levels, not only in those receiving TPN but in patients with hyperglycemia before TPN,” he said. “Frequent blood glucose monitoring is needed to prevent and/or correct hyperglycemia.”
At his institution, the findings prompted a change in protocol to initiate insulin infusion as TPN is begun or to start insulin infusion in patients on TPN whose blood glucose is “persistently elevated,” which he defined as a level over 140 mg/dL.
Hyperglycemia prior to, and shortly after, initiation of total parenteral nutrition was strongly associated with poor clinical outcomes in critically ill hospitalized patients, whether they had a history of diabetes or not, Emory University researchers determined in a retrospective study.
Patients had an almost threefold risk of dying if their maximum blood glucose before or within 24 hours of starting total parenteral nutrition (TPN) was above 180 mg/dL, compared with those whose levels stayed below 120 mg/dL. Many other factors were taken into account for the statistical analysis, including age, sex, and diabetes status, Dr. Guillermo E. Umpierrez, professor of medicine at Emory University, Atlanta, said at the Southern regional meeting of the American Federation for Medical Research.
Although hyperglycemia is a common complication of TPN, its prevalence and impact on clinical outcomes have been uncertain. Dr. Umpierrez and his associates reviewed the records of 276 medical/surgery patients who required TPN a mean 11 days after admission. Most came from surgical or medical intensive care units or the burn unit, but nearly 25% came from non-ICU floors. Also, 23% had a history of diabetes. Patients received TPN for a mean duration of 15 days. In-hospital mortality was 27% in the study, funded by the American Diabetes Association and the National Institutes of Health.
Patients who died had a higher maximum blood glucose before TPN (mean 147 mg/dL) than those who survived (mean 131 mg/dL), as well as a higher maximum blood glucose within 24 hours of TPN initiation (mean 202 mg/dL vs. 160 mg/dL). The differences in blood glucose were highly statistically significant.
In a multivariate analysis, the risk of pneumonia and the risk of acute renal failure were independently related to maximum blood glucose above 180 mg/dL vs. below 120 mg/dL.
In a later interview, Dr. Umpierrez said that pre-TPN blood glucose levels could alert medical teams to the possibility of TPN-related hyperglycemia. “Hospitalists should pay attention to blood glucose levels, not only in those receiving TPN but in patients with hyperglycemia before TPN,” he said. “Frequent blood glucose monitoring is needed to prevent and/or correct hyperglycemia.”
At his institution, the findings prompted a change in protocol to initiate insulin infusion as TPN is begun or to start insulin infusion in patients on TPN whose blood glucose is “persistently elevated,” which he defined as a level over 140 mg/dL.
Internet-Based Free Chlamydia Tests Net High Rate of Positive Results
LOS ANGELES — Free home swab test kits requested via the Internet have detected hundreds of cases of chlamydia, gonorrhea, and Trichomonas using a simple online recruitment strategy that was so effective that it is now being extended to several states.
The novel “I Want the Kit” program was devised by Johns Hopkins University researchers in 2004, alerting young women to facts about chlamydia and other sexually transmitted diseases, and offering kits with prepaid postage to allow for confidential testing.
Word went out via radio, magazine, and newspaper advertisements in Baltimore initially, but soon Internet traffic began to dominate responses.
“Our original objective was to reach out to teens who might have issues with fear and privacy going to a clinic,” Dr. Charlotte A. Gaydos said at the annual meeting of the Society for Adolescent Medicine, where she presented interim study results.
Nearly 5,000 kits have been requested to date, 97% through the study's site, www.iwantthekit.org
About one-third of the kits were returned with vaginal swab samples collected at home, with positive chlamydia results in 10% and positive gonorrhea tests in 1%, said Dr. Gaydos, of the university.
Trichomonas testing was added in 2006 and has resulted in a detection rate of 12% in 1,032 returned samples.
Dr. Gaydos reported that more than 98% of women said the instructions for collection were easy, 97% said the collection itself was easy, and 92% said they would use an Internet-based program again for STD testing.
After someone requests a kit, it arrives at her home in a plain envelope, listing as the return address only the street address of the project in Baltimore. The packet contains detailed instructions, the test swab, and return packaging—including postage.
“I'm reaching out to the 14-year-old who has no money for postage and is not going to tell her mother she's sexually active,” said Dr. Gaydos.
Completed samples can be dropped off in any mailbox and are tested by nucleic acid amplification tests for all three STDs. The test method has been found in previous research to be highly accurate—and even more so with self-collected vaginal swabs than with urine specimens.
Positive test results are followed up by referrals to free treatment clinics close to the adolescents' or women's homes.
Beyond identifying cases of sexually transmitted infections that might not otherwise have been detected, the researchers were able to obtain demographic and sexual information from women who responded.
A few 14-year-olds participated but none were positive for chlamydia. However, more than one-quarter of all respondents were aged 15-19 years, and they had the highest prevalence for chlamydia of any age group, at 15%.
About one-third of the respondents were aged 20-24 years. In this group, the prevalence rate was 11%. Somewhat surprising to researchers was the high rate of participation among women 25-29 years (18% of respondents, with a prevalence rate of 7%) and those over 30 years (22% of the respondents, with a prevalence rate of 1%).
The researchers found a high rate of sexual risk among women participating in the study, with 55% reporting a history of an STD, 59% reporting more than one sex partner in the previous 90 days, 39% reporting a new partner in the previous 90 days, more than half reporting drinking before sex, 31% reporting anal sex, and 23% reporting a history of forced sex.
Every state receives Centers for Disease Control and Prevention funding for free STD testing through the CDC Infertility Prevention Program, she said.
Dr. Gaydos disclosed that Gen-Probe, Inc. of San Diego provided free diagnostic kits for the study.
LOS ANGELES — Free home swab test kits requested via the Internet have detected hundreds of cases of chlamydia, gonorrhea, and Trichomonas using a simple online recruitment strategy that was so effective that it is now being extended to several states.
The novel “I Want the Kit” program was devised by Johns Hopkins University researchers in 2004, alerting young women to facts about chlamydia and other sexually transmitted diseases, and offering kits with prepaid postage to allow for confidential testing.
Word went out via radio, magazine, and newspaper advertisements in Baltimore initially, but soon Internet traffic began to dominate responses.
“Our original objective was to reach out to teens who might have issues with fear and privacy going to a clinic,” Dr. Charlotte A. Gaydos said at the annual meeting of the Society for Adolescent Medicine, where she presented interim study results.
Nearly 5,000 kits have been requested to date, 97% through the study's site, www.iwantthekit.org
About one-third of the kits were returned with vaginal swab samples collected at home, with positive chlamydia results in 10% and positive gonorrhea tests in 1%, said Dr. Gaydos, of the university.
Trichomonas testing was added in 2006 and has resulted in a detection rate of 12% in 1,032 returned samples.
Dr. Gaydos reported that more than 98% of women said the instructions for collection were easy, 97% said the collection itself was easy, and 92% said they would use an Internet-based program again for STD testing.
After someone requests a kit, it arrives at her home in a plain envelope, listing as the return address only the street address of the project in Baltimore. The packet contains detailed instructions, the test swab, and return packaging—including postage.
“I'm reaching out to the 14-year-old who has no money for postage and is not going to tell her mother she's sexually active,” said Dr. Gaydos.
Completed samples can be dropped off in any mailbox and are tested by nucleic acid amplification tests for all three STDs. The test method has been found in previous research to be highly accurate—and even more so with self-collected vaginal swabs than with urine specimens.
Positive test results are followed up by referrals to free treatment clinics close to the adolescents' or women's homes.
Beyond identifying cases of sexually transmitted infections that might not otherwise have been detected, the researchers were able to obtain demographic and sexual information from women who responded.
A few 14-year-olds participated but none were positive for chlamydia. However, more than one-quarter of all respondents were aged 15-19 years, and they had the highest prevalence for chlamydia of any age group, at 15%.
About one-third of the respondents were aged 20-24 years. In this group, the prevalence rate was 11%. Somewhat surprising to researchers was the high rate of participation among women 25-29 years (18% of respondents, with a prevalence rate of 7%) and those over 30 years (22% of the respondents, with a prevalence rate of 1%).
The researchers found a high rate of sexual risk among women participating in the study, with 55% reporting a history of an STD, 59% reporting more than one sex partner in the previous 90 days, 39% reporting a new partner in the previous 90 days, more than half reporting drinking before sex, 31% reporting anal sex, and 23% reporting a history of forced sex.
Every state receives Centers for Disease Control and Prevention funding for free STD testing through the CDC Infertility Prevention Program, she said.
Dr. Gaydos disclosed that Gen-Probe, Inc. of San Diego provided free diagnostic kits for the study.
LOS ANGELES — Free home swab test kits requested via the Internet have detected hundreds of cases of chlamydia, gonorrhea, and Trichomonas using a simple online recruitment strategy that was so effective that it is now being extended to several states.
The novel “I Want the Kit” program was devised by Johns Hopkins University researchers in 2004, alerting young women to facts about chlamydia and other sexually transmitted diseases, and offering kits with prepaid postage to allow for confidential testing.
Word went out via radio, magazine, and newspaper advertisements in Baltimore initially, but soon Internet traffic began to dominate responses.
“Our original objective was to reach out to teens who might have issues with fear and privacy going to a clinic,” Dr. Charlotte A. Gaydos said at the annual meeting of the Society for Adolescent Medicine, where she presented interim study results.
Nearly 5,000 kits have been requested to date, 97% through the study's site, www.iwantthekit.org
About one-third of the kits were returned with vaginal swab samples collected at home, with positive chlamydia results in 10% and positive gonorrhea tests in 1%, said Dr. Gaydos, of the university.
Trichomonas testing was added in 2006 and has resulted in a detection rate of 12% in 1,032 returned samples.
Dr. Gaydos reported that more than 98% of women said the instructions for collection were easy, 97% said the collection itself was easy, and 92% said they would use an Internet-based program again for STD testing.
After someone requests a kit, it arrives at her home in a plain envelope, listing as the return address only the street address of the project in Baltimore. The packet contains detailed instructions, the test swab, and return packaging—including postage.
“I'm reaching out to the 14-year-old who has no money for postage and is not going to tell her mother she's sexually active,” said Dr. Gaydos.
Completed samples can be dropped off in any mailbox and are tested by nucleic acid amplification tests for all three STDs. The test method has been found in previous research to be highly accurate—and even more so with self-collected vaginal swabs than with urine specimens.
Positive test results are followed up by referrals to free treatment clinics close to the adolescents' or women's homes.
Beyond identifying cases of sexually transmitted infections that might not otherwise have been detected, the researchers were able to obtain demographic and sexual information from women who responded.
A few 14-year-olds participated but none were positive for chlamydia. However, more than one-quarter of all respondents were aged 15-19 years, and they had the highest prevalence for chlamydia of any age group, at 15%.
About one-third of the respondents were aged 20-24 years. In this group, the prevalence rate was 11%. Somewhat surprising to researchers was the high rate of participation among women 25-29 years (18% of respondents, with a prevalence rate of 7%) and those over 30 years (22% of the respondents, with a prevalence rate of 1%).
The researchers found a high rate of sexual risk among women participating in the study, with 55% reporting a history of an STD, 59% reporting more than one sex partner in the previous 90 days, 39% reporting a new partner in the previous 90 days, more than half reporting drinking before sex, 31% reporting anal sex, and 23% reporting a history of forced sex.
Every state receives Centers for Disease Control and Prevention funding for free STD testing through the CDC Infertility Prevention Program, she said.
Dr. Gaydos disclosed that Gen-Probe, Inc. of San Diego provided free diagnostic kits for the study.
Early Use of Statins in Type 1 May Slim Carotid Thickening
LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.
A pilot study of 26 children with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.
Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained.
An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism.
In that study, adolescents (aged 12-21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452-7).
The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A1c values (8.4%–8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 30% were males and 70% were females.
After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman.
Several medical societies agree that children with type 1 diabetes should be screened for dyslipidemia. “We should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” said Dr. Kaufman who disclosed having no conflicts of interest.
'Start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range.' DR. KAUFMAN
LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.
A pilot study of 26 children with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.
Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained.
An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism.
In that study, adolescents (aged 12-21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452-7).
The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A1c values (8.4%–8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 30% were males and 70% were females.
After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman.
Several medical societies agree that children with type 1 diabetes should be screened for dyslipidemia. “We should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” said Dr. Kaufman who disclosed having no conflicts of interest.
'Start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range.' DR. KAUFMAN
LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.
A pilot study of 26 children with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.
Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained.
An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism.
In that study, adolescents (aged 12-21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452-7).
The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A1c values (8.4%–8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 30% were males and 70% were females.
After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman.
Several medical societies agree that children with type 1 diabetes should be screened for dyslipidemia. “We should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” said Dr. Kaufman who disclosed having no conflicts of interest.
'Start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range.' DR. KAUFMAN
Insulin, Education Key To Type 2 in Teens
LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.
Key factors associated with better glycemic control throughout the first 2 years of follow-up included:
▸ Initial treatment with insulin rather than an oral hypoglycemic agent.
▸ Inpatient, rather than outpatient, education at diagnosis.
▸ More frequent follow-up visits.
An estimated 39,000 U.S. adolescents now have type 2 diabetes. The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine.
Dr. Kim and associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.
Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.
Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.
Their mean BMI was 36.4 kg/m
Among the total 154 records, 133 (86%) represented patients who were seen in the Indiana University system for at least 2 follow-up visits within a mean 2.1 years of follow-up. Only the first 8 follow-up visits of these 133 were included in the analysis.
During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8.
“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” Dr. Kim said.
The steady increase in HbA1c values between visit 3 and visit 8 was similarly less pronounced among patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits.
Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. The investigators reported no relevant financial disclosures.
LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.
Key factors associated with better glycemic control throughout the first 2 years of follow-up included:
▸ Initial treatment with insulin rather than an oral hypoglycemic agent.
▸ Inpatient, rather than outpatient, education at diagnosis.
▸ More frequent follow-up visits.
An estimated 39,000 U.S. adolescents now have type 2 diabetes. The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine.
Dr. Kim and associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.
Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.
Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.
Their mean BMI was 36.4 kg/m
Among the total 154 records, 133 (86%) represented patients who were seen in the Indiana University system for at least 2 follow-up visits within a mean 2.1 years of follow-up. Only the first 8 follow-up visits of these 133 were included in the analysis.
During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8.
“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” Dr. Kim said.
The steady increase in HbA1c values between visit 3 and visit 8 was similarly less pronounced among patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits.
Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. The investigators reported no relevant financial disclosures.
LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.
Key factors associated with better glycemic control throughout the first 2 years of follow-up included:
▸ Initial treatment with insulin rather than an oral hypoglycemic agent.
▸ Inpatient, rather than outpatient, education at diagnosis.
▸ More frequent follow-up visits.
An estimated 39,000 U.S. adolescents now have type 2 diabetes. The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine.
Dr. Kim and associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.
Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.
Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.
Their mean BMI was 36.4 kg/m
Among the total 154 records, 133 (86%) represented patients who were seen in the Indiana University system for at least 2 follow-up visits within a mean 2.1 years of follow-up. Only the first 8 follow-up visits of these 133 were included in the analysis.
During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8.
“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” Dr. Kim said.
The steady increase in HbA1c values between visit 3 and visit 8 was similarly less pronounced among patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits.
Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. The investigators reported no relevant financial disclosures.
Statins Improve Carotid IMT in Teens With Type 1 Diabetes
LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.
A pilot study of 26 adolescents with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.
Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained in her presentation during the meeting's “Hot Topics” session.
An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism and is director of the comprehensive childhood diabetes center.
In that study, investigators found that adolescents (aged 12–21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452–7). The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT.
Adolescents assigned to receive statins or placebo were similar in age (15–16 years), baseline HbA1c values (8.4%–8.5%), and baseline IMT (mean 0.5510–0.5656 mm); 30% were males and 70% were females. Mean LDL cholesterol levels were slightly lower in the placebo group (133 mg/dL), compared with adolescents who received a statin (147 mg/dL).
After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.
Dr. Kaufman said that the American Diabetes Association, American Academy of Pediatrics, and American Heart Association all agree that children with type 1 diabetes should be screened for dyslipidemia.
How to manage dyslipidemia in adolescents with type 1 diabetes is still an unanswered question, she said.
“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.
Dr. Kaufman said she has had no relevant financial relationships with pharmaceutical companies in the past 12 months.
After a year, IMT had increased in the control group by 0.0065 mm, while it regressed in statin takers by −0.0156 mm. DR. KAUFMAN
LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.
A pilot study of 26 adolescents with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.
Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained in her presentation during the meeting's “Hot Topics” session.
An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism and is director of the comprehensive childhood diabetes center.
In that study, investigators found that adolescents (aged 12–21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452–7). The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT.
Adolescents assigned to receive statins or placebo were similar in age (15–16 years), baseline HbA1c values (8.4%–8.5%), and baseline IMT (mean 0.5510–0.5656 mm); 30% were males and 70% were females. Mean LDL cholesterol levels were slightly lower in the placebo group (133 mg/dL), compared with adolescents who received a statin (147 mg/dL).
After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.
Dr. Kaufman said that the American Diabetes Association, American Academy of Pediatrics, and American Heart Association all agree that children with type 1 diabetes should be screened for dyslipidemia.
How to manage dyslipidemia in adolescents with type 1 diabetes is still an unanswered question, she said.
“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.
Dr. Kaufman said she has had no relevant financial relationships with pharmaceutical companies in the past 12 months.
After a year, IMT had increased in the control group by 0.0065 mm, while it regressed in statin takers by −0.0156 mm. DR. KAUFMAN
LOS ANGELES — Treating adolescents with type 1 diabetes with statins early in the course of their disease may lead to measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.
A pilot study of 26 adolescents with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.
Measurements by two-dimensional ultrasound of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, Dr. Kaufman explained in her presentation during the meeting's “Hot Topics” session.
An earlier, long-term study of carotid IMT in 115 adolescents with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism and is director of the comprehensive childhood diabetes center.
In that study, investigators found that adolescents (aged 12–21 years) with diabetes had significantly thicker IMT measurements than controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452–7). The current study explored whether early treatment of type 1 diabetes with statins might have an impact on carotid IMT.
Adolescents assigned to receive statins or placebo were similar in age (15–16 years), baseline HbA1c values (8.4%–8.5%), and baseline IMT (mean 0.5510–0.5656 mm); 30% were males and 70% were females. Mean LDL cholesterol levels were slightly lower in the placebo group (133 mg/dL), compared with adolescents who received a statin (147 mg/dL).
After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by −0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.
Dr. Kaufman said that the American Diabetes Association, American Academy of Pediatrics, and American Heart Association all agree that children with type 1 diabetes should be screened for dyslipidemia.
How to manage dyslipidemia in adolescents with type 1 diabetes is still an unanswered question, she said.
“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.
Dr. Kaufman said she has had no relevant financial relationships with pharmaceutical companies in the past 12 months.
After a year, IMT had increased in the control group by 0.0065 mm, while it regressed in statin takers by −0.0156 mm. DR. KAUFMAN
Web Sites Mislead Teens About Sexual Health
LOS ANGELES — Teenagers cruising mainstream Web sites can hardly be faulted for thinking that emergency contraception is difficult to obtain, birth control pills will make them fat, and IUDs are meant for older women, not adolescents.
That's because incomplete and inaccurate information abounds on the Internet, even on very well-known Web sites, according to an analysis performed in 2008 by Stanford (Calif.) University researchers.
“We found a lot of myths about IUDs, emergency contraception, birth control, and when women should be getting Pap smears, especially their first one,” said Alisha T. Tolani, a student in the human biology program at the university.
Ms. Tolani and her research mentor, Dr. Sophia Yen of the division of adolescent medicine at Stanford's Lucile Packard Children's Hospital, presented their findings in a poster at the annual meeting of the Society of Adolescent Medicine.
Web sites were selected for analysis based on practitioner recommendations and Google searches of key terms, such as “birth control,” “morning-after pill,” and “sexually transmitted disease.” The top 10–15 results for each search term were included. The 35 Web sites examined were assessed for accuracy on 26 topics.
In general, sites provided “fairly accurate” information on STDs, Ms. Tolani and Dr. Yen reported in their poster. For example, 100% of Web sites addressing STDs correctly noted that most sexually transmitted diseases are asymptomatic and that when symptoms are present, they may include burning with urination and discharge.
However, information about transmission was often vague or incomplete. Just 9 of 29 (31%) STD Web sites informed adolescents that herpes can be transmitted by kissing, and 14 of 29 (48%) mentioned skin-to-skin contact as a possible source of transmission.
Some contraception information was uniformly accurate, with Web sites making it clear that withdrawal is not a very effective means of preventing pregnancy, and noting that hormonal contraception does not protect against STDs.
On other topics, however, the information gleaned on Web sites was inaccurate or incomplete.
More than half of the Web sites that addressed contraception listed weight gain as a possible side effect of birth control pills, a myth contradicted by 47 randomized, controlled trials.
Five Web sites incorrectly stated that the calendar/rhythm method is effective at preventing pregnancy, and three misstated the effectiveness of emergency contraception.
Often, the Web sites omitted important information, considering that approximately a quarter of teens use the Internet to answer “some or a lot” of their questions about sexual health, Ms. Tolani said in an interview.
Although 16 of 34 (47%) Web sites noted that minors need a prescription for emergency contraception, they failed to mention that in many states, minors can obtain those prescriptions directly from authorized pharmacists. Very few sites explained exactly where emergency contraception can be obtained. (The Web sites should be revised to reflect the recent court order allowing 17-year-olds to obtain emergency contraception without a prescription.)
Nearly a third of Web sites failed to debunk common myths about emergency contraception by explaining that is not an abortifacient, and making a distinction between emergency contraception and RU-486 (mifepristone).
Just 5 of 27 (19%) Web sites dealing with contraception reflected 2007 American College of Obstetricians and Gynecologists guidelines recommending IUDs as a safe means of contraception in adolescents. Many were neutral, failing to mention adolescents and IUDs. But three sites incorrectly stated that IUDs should be reserved for parous women, the researchers found.
Most Web sites offering information on Pap smears had been updated in the past few years. Nonetheless, their recommendations for when women should have Pap smears “were all over the place,” with 40% offering advice that contradicted ACOG's 2003 guidelines, which state that women should begin receiving Pap smears at age 21 years or 3 years post coitarche, Ms. Tolani said.
“I think physicians need to specifically debunk the myths that we know are out there,” she said.
Neither Ms. Tolani nor Dr. Yen had any conflicts of interest to disclose with regard to their study.
Common Sex Myths on the Internet
Myth: Emergency contraception is difficult to obtain.
Reality: Emergency contraception is over the counter for women who are aged 17 and older; it may be available OTC soon for younger minors as well. Minors can currently receive prescriptions directly from authorized pharmacists in nine states: Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, and Washington.
Myth: Emergency contraception induces an abortion.
Reality: Emergency contraception does not cause an abortion and is not RU-486.
Myth: IUDs are for multiparous women.
Reality: IUDs are safe for use in adolescents, including the nulliparous and serially monogamous.
Myth: Oral contraceptives cause weight gain.
Reality: A review of 47 randomized, controlled trials found no evidence that combined hormonal contraceptives caused weight gain.
Myth: Women should begin having Pap smears at age 18 years or immediately following coitarche, and should have a Pap smear after each change of sexual partner.
Reality: The American College of Obstetricians and Gynecologists recommends that women begin having Pap smears beginning at age 21 years or 3 years post coitarche.
Myth: Kissing is safe, even if your partner has herpes.
Reality: Herpes can be transmitted by kissing an infected individual.
Source: Dr. Yen
Recommended Sites for Teens
▸ Go Ask Alice! at
▸ Center for Young Women's Health at
▸ TeenWire at
▸ TeensHealth at
Sources: Ms. Tolani and Dr. Yen
LOS ANGELES — Teenagers cruising mainstream Web sites can hardly be faulted for thinking that emergency contraception is difficult to obtain, birth control pills will make them fat, and IUDs are meant for older women, not adolescents.
That's because incomplete and inaccurate information abounds on the Internet, even on very well-known Web sites, according to an analysis performed in 2008 by Stanford (Calif.) University researchers.
“We found a lot of myths about IUDs, emergency contraception, birth control, and when women should be getting Pap smears, especially their first one,” said Alisha T. Tolani, a student in the human biology program at the university.
Ms. Tolani and her research mentor, Dr. Sophia Yen of the division of adolescent medicine at Stanford's Lucile Packard Children's Hospital, presented their findings in a poster at the annual meeting of the Society of Adolescent Medicine.
Web sites were selected for analysis based on practitioner recommendations and Google searches of key terms, such as “birth control,” “morning-after pill,” and “sexually transmitted disease.” The top 10–15 results for each search term were included. The 35 Web sites examined were assessed for accuracy on 26 topics.
In general, sites provided “fairly accurate” information on STDs, Ms. Tolani and Dr. Yen reported in their poster. For example, 100% of Web sites addressing STDs correctly noted that most sexually transmitted diseases are asymptomatic and that when symptoms are present, they may include burning with urination and discharge.
However, information about transmission was often vague or incomplete. Just 9 of 29 (31%) STD Web sites informed adolescents that herpes can be transmitted by kissing, and 14 of 29 (48%) mentioned skin-to-skin contact as a possible source of transmission.
Some contraception information was uniformly accurate, with Web sites making it clear that withdrawal is not a very effective means of preventing pregnancy, and noting that hormonal contraception does not protect against STDs.
On other topics, however, the information gleaned on Web sites was inaccurate or incomplete.
More than half of the Web sites that addressed contraception listed weight gain as a possible side effect of birth control pills, a myth contradicted by 47 randomized, controlled trials.
Five Web sites incorrectly stated that the calendar/rhythm method is effective at preventing pregnancy, and three misstated the effectiveness of emergency contraception.
Often, the Web sites omitted important information, considering that approximately a quarter of teens use the Internet to answer “some or a lot” of their questions about sexual health, Ms. Tolani said in an interview.
Although 16 of 34 (47%) Web sites noted that minors need a prescription for emergency contraception, they failed to mention that in many states, minors can obtain those prescriptions directly from authorized pharmacists. Very few sites explained exactly where emergency contraception can be obtained. (The Web sites should be revised to reflect the recent court order allowing 17-year-olds to obtain emergency contraception without a prescription.)
Nearly a third of Web sites failed to debunk common myths about emergency contraception by explaining that is not an abortifacient, and making a distinction between emergency contraception and RU-486 (mifepristone).
Just 5 of 27 (19%) Web sites dealing with contraception reflected 2007 American College of Obstetricians and Gynecologists guidelines recommending IUDs as a safe means of contraception in adolescents. Many were neutral, failing to mention adolescents and IUDs. But three sites incorrectly stated that IUDs should be reserved for parous women, the researchers found.
Most Web sites offering information on Pap smears had been updated in the past few years. Nonetheless, their recommendations for when women should have Pap smears “were all over the place,” with 40% offering advice that contradicted ACOG's 2003 guidelines, which state that women should begin receiving Pap smears at age 21 years or 3 years post coitarche, Ms. Tolani said.
“I think physicians need to specifically debunk the myths that we know are out there,” she said.
Neither Ms. Tolani nor Dr. Yen had any conflicts of interest to disclose with regard to their study.
Common Sex Myths on the Internet
Myth: Emergency contraception is difficult to obtain.
Reality: Emergency contraception is over the counter for women who are aged 17 and older; it may be available OTC soon for younger minors as well. Minors can currently receive prescriptions directly from authorized pharmacists in nine states: Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, and Washington.
Myth: Emergency contraception induces an abortion.
Reality: Emergency contraception does not cause an abortion and is not RU-486.
Myth: IUDs are for multiparous women.
Reality: IUDs are safe for use in adolescents, including the nulliparous and serially monogamous.
Myth: Oral contraceptives cause weight gain.
Reality: A review of 47 randomized, controlled trials found no evidence that combined hormonal contraceptives caused weight gain.
Myth: Women should begin having Pap smears at age 18 years or immediately following coitarche, and should have a Pap smear after each change of sexual partner.
Reality: The American College of Obstetricians and Gynecologists recommends that women begin having Pap smears beginning at age 21 years or 3 years post coitarche.
Myth: Kissing is safe, even if your partner has herpes.
Reality: Herpes can be transmitted by kissing an infected individual.
Source: Dr. Yen
Recommended Sites for Teens
▸ Go Ask Alice! at
▸ Center for Young Women's Health at
▸ TeenWire at
▸ TeensHealth at
Sources: Ms. Tolani and Dr. Yen
LOS ANGELES — Teenagers cruising mainstream Web sites can hardly be faulted for thinking that emergency contraception is difficult to obtain, birth control pills will make them fat, and IUDs are meant for older women, not adolescents.
That's because incomplete and inaccurate information abounds on the Internet, even on very well-known Web sites, according to an analysis performed in 2008 by Stanford (Calif.) University researchers.
“We found a lot of myths about IUDs, emergency contraception, birth control, and when women should be getting Pap smears, especially their first one,” said Alisha T. Tolani, a student in the human biology program at the university.
Ms. Tolani and her research mentor, Dr. Sophia Yen of the division of adolescent medicine at Stanford's Lucile Packard Children's Hospital, presented their findings in a poster at the annual meeting of the Society of Adolescent Medicine.
Web sites were selected for analysis based on practitioner recommendations and Google searches of key terms, such as “birth control,” “morning-after pill,” and “sexually transmitted disease.” The top 10–15 results for each search term were included. The 35 Web sites examined were assessed for accuracy on 26 topics.
In general, sites provided “fairly accurate” information on STDs, Ms. Tolani and Dr. Yen reported in their poster. For example, 100% of Web sites addressing STDs correctly noted that most sexually transmitted diseases are asymptomatic and that when symptoms are present, they may include burning with urination and discharge.
However, information about transmission was often vague or incomplete. Just 9 of 29 (31%) STD Web sites informed adolescents that herpes can be transmitted by kissing, and 14 of 29 (48%) mentioned skin-to-skin contact as a possible source of transmission.
Some contraception information was uniformly accurate, with Web sites making it clear that withdrawal is not a very effective means of preventing pregnancy, and noting that hormonal contraception does not protect against STDs.
On other topics, however, the information gleaned on Web sites was inaccurate or incomplete.
More than half of the Web sites that addressed contraception listed weight gain as a possible side effect of birth control pills, a myth contradicted by 47 randomized, controlled trials.
Five Web sites incorrectly stated that the calendar/rhythm method is effective at preventing pregnancy, and three misstated the effectiveness of emergency contraception.
Often, the Web sites omitted important information, considering that approximately a quarter of teens use the Internet to answer “some or a lot” of their questions about sexual health, Ms. Tolani said in an interview.
Although 16 of 34 (47%) Web sites noted that minors need a prescription for emergency contraception, they failed to mention that in many states, minors can obtain those prescriptions directly from authorized pharmacists. Very few sites explained exactly where emergency contraception can be obtained. (The Web sites should be revised to reflect the recent court order allowing 17-year-olds to obtain emergency contraception without a prescription.)
Nearly a third of Web sites failed to debunk common myths about emergency contraception by explaining that is not an abortifacient, and making a distinction between emergency contraception and RU-486 (mifepristone).
Just 5 of 27 (19%) Web sites dealing with contraception reflected 2007 American College of Obstetricians and Gynecologists guidelines recommending IUDs as a safe means of contraception in adolescents. Many were neutral, failing to mention adolescents and IUDs. But three sites incorrectly stated that IUDs should be reserved for parous women, the researchers found.
Most Web sites offering information on Pap smears had been updated in the past few years. Nonetheless, their recommendations for when women should have Pap smears “were all over the place,” with 40% offering advice that contradicted ACOG's 2003 guidelines, which state that women should begin receiving Pap smears at age 21 years or 3 years post coitarche, Ms. Tolani said.
“I think physicians need to specifically debunk the myths that we know are out there,” she said.
Neither Ms. Tolani nor Dr. Yen had any conflicts of interest to disclose with regard to their study.
Common Sex Myths on the Internet
Myth: Emergency contraception is difficult to obtain.
Reality: Emergency contraception is over the counter for women who are aged 17 and older; it may be available OTC soon for younger minors as well. Minors can currently receive prescriptions directly from authorized pharmacists in nine states: Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, and Washington.
Myth: Emergency contraception induces an abortion.
Reality: Emergency contraception does not cause an abortion and is not RU-486.
Myth: IUDs are for multiparous women.
Reality: IUDs are safe for use in adolescents, including the nulliparous and serially monogamous.
Myth: Oral contraceptives cause weight gain.
Reality: A review of 47 randomized, controlled trials found no evidence that combined hormonal contraceptives caused weight gain.
Myth: Women should begin having Pap smears at age 18 years or immediately following coitarche, and should have a Pap smear after each change of sexual partner.
Reality: The American College of Obstetricians and Gynecologists recommends that women begin having Pap smears beginning at age 21 years or 3 years post coitarche.
Myth: Kissing is safe, even if your partner has herpes.
Reality: Herpes can be transmitted by kissing an infected individual.
Source: Dr. Yen
Recommended Sites for Teens
▸ Go Ask Alice! at
▸ Center for Young Women's Health at
▸ TeenWire at
▸ TeensHealth at
Sources: Ms. Tolani and Dr. Yen
Inpatient Education Tied to Glucose Control in Adolescents
LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.
Key factors associated with better glycemic control throughout the first 2 years of follow-up included:
▸ Initial treatment with insulin rather than an oral hypoglycemic agent.
▸ Inpatient, rather than outpatient, education at diagnosis.
▸ More frequent follow-up visits.
An estimated 39,000 U.S. adolescents now have type 2 diabetes, and another 2.8 million have impaired fasting glucose.
The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine. With no randomized clinical trials for guidance, many centers are devising their own protocols based on what is known about newly diagnosed type 2 diabetes in adults.
To better delineate what factors might be important in establishing early glucose control and good habits in adolescents, Dr. Kim and his associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.
Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.
Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.
Their mean BMI was 36.4 kg/m
Nearly 60% received inpatient education at Riley Children's Hospital, while others received outpatient education at Riley Children's or education (in- or outpatient) at other institutions.
Among patient records that contained details about initial management, treatment strategies varied. Approximately equal percentages of patients began on oral hypoglycemic medication (mostly metformin) only or combination therapy (oral medication and insulin). Some patients received insulin only, and a few initially received only lifestyle modification advice.
Of the total 154 records, 133 (86%) represented patients seen in the Indiana University system for at least two follow-up visits within a mean 2.1 years of follow-up. Only the first eight follow-up visits of these 133 were included in the analysis.
During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8, reported Dr. Kim.
“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” he said.
The steady increase in HbA1c values between the third and eighth visits was similarly less pronounced in patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits. Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. A subgroup analysis failed to detect any distinguishing characteristics in these patients.
The dip in glycemic control at about 1 year after diagnosis would not seem to bode well for young people with type 2 diabetes, Dr. Kim said, and may warrant special attention and interventions.
“Perhaps this is because of a decline in motivation,” Dr. Kim said. “Therefore, re-education or an intensification of clinical management may be important at that time.”
Dr. Kim and his associates reported no relevant financial disclosures.
LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.
Key factors associated with better glycemic control throughout the first 2 years of follow-up included:
▸ Initial treatment with insulin rather than an oral hypoglycemic agent.
▸ Inpatient, rather than outpatient, education at diagnosis.
▸ More frequent follow-up visits.
An estimated 39,000 U.S. adolescents now have type 2 diabetes, and another 2.8 million have impaired fasting glucose.
The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine. With no randomized clinical trials for guidance, many centers are devising their own protocols based on what is known about newly diagnosed type 2 diabetes in adults.
To better delineate what factors might be important in establishing early glucose control and good habits in adolescents, Dr. Kim and his associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.
Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.
Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.
Their mean BMI was 36.4 kg/m
Nearly 60% received inpatient education at Riley Children's Hospital, while others received outpatient education at Riley Children's or education (in- or outpatient) at other institutions.
Among patient records that contained details about initial management, treatment strategies varied. Approximately equal percentages of patients began on oral hypoglycemic medication (mostly metformin) only or combination therapy (oral medication and insulin). Some patients received insulin only, and a few initially received only lifestyle modification advice.
Of the total 154 records, 133 (86%) represented patients seen in the Indiana University system for at least two follow-up visits within a mean 2.1 years of follow-up. Only the first eight follow-up visits of these 133 were included in the analysis.
During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8, reported Dr. Kim.
“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” he said.
The steady increase in HbA1c values between the third and eighth visits was similarly less pronounced in patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits. Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. A subgroup analysis failed to detect any distinguishing characteristics in these patients.
The dip in glycemic control at about 1 year after diagnosis would not seem to bode well for young people with type 2 diabetes, Dr. Kim said, and may warrant special attention and interventions.
“Perhaps this is because of a decline in motivation,” Dr. Kim said. “Therefore, re-education or an intensification of clinical management may be important at that time.”
Dr. Kim and his associates reported no relevant financial disclosures.
LOS ANGELES — Adolescents newly diagnosed with type 2 diabetes rapidly achieved an improvement in their glycemic control, but they tended to backslide within about a year in a longitudinal study conducted at Indiana University.
Key factors associated with better glycemic control throughout the first 2 years of follow-up included:
▸ Initial treatment with insulin rather than an oral hypoglycemic agent.
▸ Inpatient, rather than outpatient, education at diagnosis.
▸ More frequent follow-up visits.
An estimated 39,000 U.S. adolescents now have type 2 diabetes, and another 2.8 million have impaired fasting glucose.
The best initial management strategy for these youth “remains unclear,” Dr. Paul S. Kim said at the annual meeting of the Society for Adolescent Medicine. With no randomized clinical trials for guidance, many centers are devising their own protocols based on what is known about newly diagnosed type 2 diabetes in adults.
To better delineate what factors might be important in establishing early glucose control and good habits in adolescents, Dr. Kim and his associates analyzed 13 years' worth of medical records for patients diagnosed with type 2 diabetes before the age of 21.
Among 154 cases identified, 72% were female. The average age at diagnosis was 13 years, said Dr. Kim, a fellow in adolescent medicine at the medical school and Riley Children's Hospital in Indianapolis.
Equal percentages of the cohort were African American and white, at 46% each, with the remaining patients representing other racial/ethnic groups.
Their mean BMI was 36.4 kg/m
Nearly 60% received inpatient education at Riley Children's Hospital, while others received outpatient education at Riley Children's or education (in- or outpatient) at other institutions.
Among patient records that contained details about initial management, treatment strategies varied. Approximately equal percentages of patients began on oral hypoglycemic medication (mostly metformin) only or combination therapy (oral medication and insulin). Some patients received insulin only, and a few initially received only lifestyle modification advice.
Of the total 154 records, 133 (86%) represented patients seen in the Indiana University system for at least two follow-up visits within a mean 2.1 years of follow-up. Only the first eight follow-up visits of these 133 were included in the analysis.
During a mean 5.6 follow-up visits, patients' mean HbA1c values declined from a baseline value of 9% to 6.8% by follow-up visit 3, and then gradually increased to 8% by visit 8, reported Dr. Kim.
“Having inpatient education and insulin treatment at diagnosis was associated with a more rapid decrease in HbA1c levels during [the initial postdiagnosis] time period,” he said.
The steady increase in HbA1c values between the third and eighth visits was similarly less pronounced in patients who received inpatient education, insulin at baseline, and shorter intervals between follow-up visits. Slightly more than 20% of patients showed a significant increase in HbA1c during the study period: at least a 1% increase from the lowest value they achieved. A subgroup analysis failed to detect any distinguishing characteristics in these patients.
The dip in glycemic control at about 1 year after diagnosis would not seem to bode well for young people with type 2 diabetes, Dr. Kim said, and may warrant special attention and interventions.
“Perhaps this is because of a decline in motivation,” Dr. Kim said. “Therefore, re-education or an intensification of clinical management may be important at that time.”
Dr. Kim and his associates reported no relevant financial disclosures.
Hyperglycemia Before TPN Portends Poor Outcomes
Hyperglycemia prior to, and shortly after, initiation of total parenteral nutrition was strongly associated with poor clinical outcomes in critically ill hospitalized patients, whether or not they had a history of diabetes, Emory University researchers determined in a retrospective study.
Patients had an almost threefold risk of dying if their maximum blood glucose before or within 24 hours of beginning total parenteral nutrition (TPN) was more than 180 mg/dL, compared with patients whose maximum blood glucose was less than 120 mg/dL in the same time period.
Many other factors were taken into account for the statistical analysis, including age, sex, and diabetes status, Dr. Guillermo E. Umpierrez, professor of medicine at Emory University, Atlanta, said at the Southern regional meeting of the American Federation for Medical Research.
He described hyperglycemia as a common complication of TPN, but said its prevalence and impact on clinical outcomes have been uncertain.
Dr. Umpierrez and his associates reviewed the records of 276 medical/surgery patients who required TPN a mean 11 days after admission. The majority came from surgical or medical intensive care units or the burn unit, but nearly 25% came from non-ICU floors. Twenty-three percent had a history of diabetes.
Patients received TPN for a mean duration of 15 days. In-hospital mortality was 27% (75 patients).
Patients who died had a higher maximum blood glucose before initiation of TPN (mean 147 mg/dL) than those who survived (mean 131 mg/dL), as well as a higher maximum blood glucose reading within 24 hours of TPN initiation (mean 202 mg/dL, compared with mean 160 mg/dL). The differences in blood glucose were highly statistically significant at both time points.
A multivariate analysis found that not only mortality but the risk of pneumonia and acute renal failure were independently related to maximum blood glucose levels of greater than 180 mg/dL versus mean blood glucose levels of less than 120 mg/dL.
In a later interview, Dr. Umpierrez said that pre-TPN blood glucose levels could alert medical teams to the possibility of TPN-related hyperglycemia, allowing for anticipatory management.
“Hospitalists should pay attention to blood glucose levels, not only in those receiving TPN but in patients with hyperglycemia before TPN,” Dr. Umpierrez said. “Frequent blood glucose monitoring is needed to prevent and/or correct hyperglycemia.”
At his institution, the findings prompted a change in protocol to initiate insulin infusion as TPN is begun or to start insulin infusion in patients on TPN whose blood glucose is “persistently elevated,” which he defined as a level over 140 mg/dL.
Dr. Umpierrez' research is supported by grants from the American Diabetes Association and the National Institutes of Health.
Hyperglycemia prior to, and shortly after, initiation of total parenteral nutrition was strongly associated with poor clinical outcomes in critically ill hospitalized patients, whether or not they had a history of diabetes, Emory University researchers determined in a retrospective study.
Patients had an almost threefold risk of dying if their maximum blood glucose before or within 24 hours of beginning total parenteral nutrition (TPN) was more than 180 mg/dL, compared with patients whose maximum blood glucose was less than 120 mg/dL in the same time period.
Many other factors were taken into account for the statistical analysis, including age, sex, and diabetes status, Dr. Guillermo E. Umpierrez, professor of medicine at Emory University, Atlanta, said at the Southern regional meeting of the American Federation for Medical Research.
He described hyperglycemia as a common complication of TPN, but said its prevalence and impact on clinical outcomes have been uncertain.
Dr. Umpierrez and his associates reviewed the records of 276 medical/surgery patients who required TPN a mean 11 days after admission. The majority came from surgical or medical intensive care units or the burn unit, but nearly 25% came from non-ICU floors. Twenty-three percent had a history of diabetes.
Patients received TPN for a mean duration of 15 days. In-hospital mortality was 27% (75 patients).
Patients who died had a higher maximum blood glucose before initiation of TPN (mean 147 mg/dL) than those who survived (mean 131 mg/dL), as well as a higher maximum blood glucose reading within 24 hours of TPN initiation (mean 202 mg/dL, compared with mean 160 mg/dL). The differences in blood glucose were highly statistically significant at both time points.
A multivariate analysis found that not only mortality but the risk of pneumonia and acute renal failure were independently related to maximum blood glucose levels of greater than 180 mg/dL versus mean blood glucose levels of less than 120 mg/dL.
In a later interview, Dr. Umpierrez said that pre-TPN blood glucose levels could alert medical teams to the possibility of TPN-related hyperglycemia, allowing for anticipatory management.
“Hospitalists should pay attention to blood glucose levels, not only in those receiving TPN but in patients with hyperglycemia before TPN,” Dr. Umpierrez said. “Frequent blood glucose monitoring is needed to prevent and/or correct hyperglycemia.”
At his institution, the findings prompted a change in protocol to initiate insulin infusion as TPN is begun or to start insulin infusion in patients on TPN whose blood glucose is “persistently elevated,” which he defined as a level over 140 mg/dL.
Dr. Umpierrez' research is supported by grants from the American Diabetes Association and the National Institutes of Health.
Hyperglycemia prior to, and shortly after, initiation of total parenteral nutrition was strongly associated with poor clinical outcomes in critically ill hospitalized patients, whether or not they had a history of diabetes, Emory University researchers determined in a retrospective study.
Patients had an almost threefold risk of dying if their maximum blood glucose before or within 24 hours of beginning total parenteral nutrition (TPN) was more than 180 mg/dL, compared with patients whose maximum blood glucose was less than 120 mg/dL in the same time period.
Many other factors were taken into account for the statistical analysis, including age, sex, and diabetes status, Dr. Guillermo E. Umpierrez, professor of medicine at Emory University, Atlanta, said at the Southern regional meeting of the American Federation for Medical Research.
He described hyperglycemia as a common complication of TPN, but said its prevalence and impact on clinical outcomes have been uncertain.
Dr. Umpierrez and his associates reviewed the records of 276 medical/surgery patients who required TPN a mean 11 days after admission. The majority came from surgical or medical intensive care units or the burn unit, but nearly 25% came from non-ICU floors. Twenty-three percent had a history of diabetes.
Patients received TPN for a mean duration of 15 days. In-hospital mortality was 27% (75 patients).
Patients who died had a higher maximum blood glucose before initiation of TPN (mean 147 mg/dL) than those who survived (mean 131 mg/dL), as well as a higher maximum blood glucose reading within 24 hours of TPN initiation (mean 202 mg/dL, compared with mean 160 mg/dL). The differences in blood glucose were highly statistically significant at both time points.
A multivariate analysis found that not only mortality but the risk of pneumonia and acute renal failure were independently related to maximum blood glucose levels of greater than 180 mg/dL versus mean blood glucose levels of less than 120 mg/dL.
In a later interview, Dr. Umpierrez said that pre-TPN blood glucose levels could alert medical teams to the possibility of TPN-related hyperglycemia, allowing for anticipatory management.
“Hospitalists should pay attention to blood glucose levels, not only in those receiving TPN but in patients with hyperglycemia before TPN,” Dr. Umpierrez said. “Frequent blood glucose monitoring is needed to prevent and/or correct hyperglycemia.”
At his institution, the findings prompted a change in protocol to initiate insulin infusion as TPN is begun or to start insulin infusion in patients on TPN whose blood glucose is “persistently elevated,” which he defined as a level over 140 mg/dL.
Dr. Umpierrez' research is supported by grants from the American Diabetes Association and the National Institutes of Health.