Bianca Nogrady

Initiating buprenorphine treatment during an emergency department visit can significantly increase the likelihood that opioid-dependent patients will seek addiction treatment, according to results of a randomized clinical trial published in April 28 in JAMA.

Researchers randomized 104 opioid-dependent patients who had presented to the ED to screening and treatment referral, screening and a brief intervention with referral to a community-based treatment service, or screening with a brief intervention and ED-initiated treatment with buprenorphine/naloxone and referral to primary care.

Significantly more patients in the buprenorphine group sought addiction treatment in the 30 days after randomization compared to the referral or intervention arms (78% vs. 37% vs. 45%, P < .001), and they showed significant reductions in the number of days of illicit opioid use per week.

“Expanded use of ED-initiated buprenorphine with community follow-up should help increase access to treatment options for this chronic and relapsing medical condition that has substantial morbidity and mortality and that affects health care use and costs,” wrote Dr. Gail D’Onofrio of Yale School of Medicine, New Haven, Ct., and coauthors (JAMA 2015; 313:1636-1644 [doi:10.1001/jama.2015.3474]).

The National Institute on Drug Abuse funded the study. Reckitt-Benckiser Pharmaceuticals provided the drug. One author reported honoraria from private industry.

Initiating buprenorphine treatment during an emergency department visit can significantly increase the likelihood that opioid-dependent patients will seek addiction treatment, according to results of a randomized clinical trial published in April 28 in JAMA.

Researchers randomized 104 opioid-dependent patients who had presented to the ED to screening and treatment referral, screening and a brief intervention with referral to a community-based treatment service, or screening with a brief intervention and ED-initiated treatment with buprenorphine/naloxone and referral to primary care.

Significantly more patients in the buprenorphine group sought addiction treatment in the 30 days after randomization compared to the referral or intervention arms (78% vs. 37% vs. 45%, P < .001), and they showed significant reductions in the number of days of illicit opioid use per week.

“Expanded use of ED-initiated buprenorphine with community follow-up should help increase access to treatment options for this chronic and relapsing medical condition that has substantial morbidity and mortality and that affects health care use and costs,” wrote Dr. Gail D’Onofrio of Yale School of Medicine, New Haven, Ct., and coauthors (JAMA 2015; 313:1636-1644 [doi:10.1001/jama.2015.3474]).

The National Institute on Drug Abuse funded the study. Reckitt-Benckiser Pharmaceuticals provided the drug. One author reported honoraria from private industry.

Initiating buprenorphine treatment during an emergency department visit can significantly increase the likelihood that opioid-dependent patients will seek addiction treatment, according to results of a randomized clinical trial published in April 28 in JAMA.

Researchers randomized 104 opioid-dependent patients who had presented to the ED to screening and treatment referral, screening and a brief intervention with referral to a community-based treatment service, or screening with a brief intervention and ED-initiated treatment with buprenorphine/naloxone and referral to primary care.

Significantly more patients in the buprenorphine group sought addiction treatment in the 30 days after randomization compared to the referral or intervention arms (78% vs. 37% vs. 45%, P < .001), and they showed significant reductions in the number of days of illicit opioid use per week.

“Expanded use of ED-initiated buprenorphine with community follow-up should help increase access to treatment options for this chronic and relapsing medical condition that has substantial morbidity and mortality and that affects health care use and costs,” wrote Dr. Gail D’Onofrio of Yale School of Medicine, New Haven, Ct., and coauthors (JAMA 2015; 313:1636-1644 [doi:10.1001/jama.2015.3474]).

The National Institute on Drug Abuse funded the study. Reckitt-Benckiser Pharmaceuticals provided the drug. One author reported honoraria from private industry.

The expansion of Medicaid in certain states is associated with an increase in the number of individuals being diagnosed with diabetes and receiving early treatment, researchers say.

The number of Medicaid patients with newly diagnosed diabetes increased by 23% from 2013 to 2014 in the 26 states that expanded Medicaid, compared to 0.4% in the states that did not, judging from an analysis of data from a national private clinical laboratory database, encompassing 434,288 patients with newly diagnosed diabetes.

Across 50 states and the District of Columbia, there was an overall increase of 13% in the number of Medicaid-enrolled patients newly diagnosed with diabetes, which was similar regardless of age or gender, according to a paper published online in Diabetes Care.

“Beyond diabetes, the trends we observed in the current study are likely to affect diagnosis of other chronic medical conditions such as hypertension, hypercholesterolemia, and chronic kidney disease,” wrote Dr. Harvey W. Kaufman of Quest Diagnostics, and his coauthors (Diabetes Care 2015;38:833-7 [doi:10.2337/dc14-2334]).

One author reported research support, consultancies, and lecture fees from private industry. No other conflicts of interest were declared.

The expansion of Medicaid in certain states is associated with an increase in the number of individuals being diagnosed with diabetes and receiving early treatment, researchers say.

The number of Medicaid patients with newly diagnosed diabetes increased by 23% from 2013 to 2014 in the 26 states that expanded Medicaid, compared to 0.4% in the states that did not, judging from an analysis of data from a national private clinical laboratory database, encompassing 434,288 patients with newly diagnosed diabetes.

Across 50 states and the District of Columbia, there was an overall increase of 13% in the number of Medicaid-enrolled patients newly diagnosed with diabetes, which was similar regardless of age or gender, according to a paper published online in Diabetes Care.

“Beyond diabetes, the trends we observed in the current study are likely to affect diagnosis of other chronic medical conditions such as hypertension, hypercholesterolemia, and chronic kidney disease,” wrote Dr. Harvey W. Kaufman of Quest Diagnostics, and his coauthors (Diabetes Care 2015;38:833-7 [doi:10.2337/dc14-2334]).

One author reported research support, consultancies, and lecture fees from private industry. No other conflicts of interest were declared.

The expansion of Medicaid in certain states is associated with an increase in the number of individuals being diagnosed with diabetes and receiving early treatment, researchers say.

The number of Medicaid patients with newly diagnosed diabetes increased by 23% from 2013 to 2014 in the 26 states that expanded Medicaid, compared to 0.4% in the states that did not, judging from an analysis of data from a national private clinical laboratory database, encompassing 434,288 patients with newly diagnosed diabetes.

Across 50 states and the District of Columbia, there was an overall increase of 13% in the number of Medicaid-enrolled patients newly diagnosed with diabetes, which was similar regardless of age or gender, according to a paper published online in Diabetes Care.

“Beyond diabetes, the trends we observed in the current study are likely to affect diagnosis of other chronic medical conditions such as hypertension, hypercholesterolemia, and chronic kidney disease,” wrote Dr. Harvey W. Kaufman of Quest Diagnostics, and his coauthors (Diabetes Care 2015;38:833-7 [doi:10.2337/dc14-2334]).

One author reported research support, consultancies, and lecture fees from private industry. No other conflicts of interest were declared.

Less than 4% of adults with prediabetes are prescribed metformin for diabetes prevention, despite the fact that the condition affects one in three Americans, researchers said.

A 3-year retrospective cohort analysis of health insurance data from 17,352 working-age adults with prediabetes showed that only 3.7% had a prescription claim for metformin, although that figure rose to 7.8% among the subset of patients with a body mass index greater than 35 kg/m² or those with gestational diabetes.

Dr. Tannaz Moin and her associates defined prediabetes as either a hemoglobin A_1c level of 5.7% to 6.4%, a fasting plasma glucose level of 5.55 to 6.94 mmol/L (100-125 mg/dL), or a 2-hour plasma glucose level of 7.77 to 11.04 mmol/L (140-199 mg/dL) on an oral glucose tolerance test.

Women were almost twice as likely to receive a metformin prescription as were men (4.8% versus 2.8%), while obese individuals and those with two or more comorbid conditions also were more likely to be prescribed metformin, according to findings published in the Annals of Internal Medicine (Ann. Intern. Med. 2015;162:542-8).

“Our findings indicate that metformin is rarely prescribed for diabetes prevention despite a strong evidence base in the literature for more than 10 years and inclusion in practice guidelines for more than 6 years,” wrote Dr. Moin of the University of California, Los Angeles, and her associates. “This is a potential gap in the approach to prediabetes management and a significant missed opportunity for diabetes prevention in patients at highest risk.”

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One of the study authors was an employee of UnitedHealthcare.

Less than 4% of adults with prediabetes are prescribed metformin for diabetes prevention, despite the fact that the condition affects one in three Americans, researchers said.

A 3-year retrospective cohort analysis of health insurance data from 17,352 working-age adults with prediabetes showed that only 3.7% had a prescription claim for metformin, although that figure rose to 7.8% among the subset of patients with a body mass index greater than 35 kg/m² or those with gestational diabetes.

Dr. Tannaz Moin and her associates defined prediabetes as either a hemoglobin A_1c level of 5.7% to 6.4%, a fasting plasma glucose level of 5.55 to 6.94 mmol/L (100-125 mg/dL), or a 2-hour plasma glucose level of 7.77 to 11.04 mmol/L (140-199 mg/dL) on an oral glucose tolerance test.

Women were almost twice as likely to receive a metformin prescription as were men (4.8% versus 2.8%), while obese individuals and those with two or more comorbid conditions also were more likely to be prescribed metformin, according to findings published in the Annals of Internal Medicine (Ann. Intern. Med. 2015;162:542-8).

“Our findings indicate that metformin is rarely prescribed for diabetes prevention despite a strong evidence base in the literature for more than 10 years and inclusion in practice guidelines for more than 6 years,” wrote Dr. Moin of the University of California, Los Angeles, and her associates. “This is a potential gap in the approach to prediabetes management and a significant missed opportunity for diabetes prevention in patients at highest risk.”

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One of the study authors was an employee of UnitedHealthcare.

Less than 4% of adults with prediabetes are prescribed metformin for diabetes prevention, despite the fact that the condition affects one in three Americans, researchers said.

A 3-year retrospective cohort analysis of health insurance data from 17,352 working-age adults with prediabetes showed that only 3.7% had a prescription claim for metformin, although that figure rose to 7.8% among the subset of patients with a body mass index greater than 35 kg/m² or those with gestational diabetes.

Dr. Tannaz Moin and her associates defined prediabetes as either a hemoglobin A_1c level of 5.7% to 6.4%, a fasting plasma glucose level of 5.55 to 6.94 mmol/L (100-125 mg/dL), or a 2-hour plasma glucose level of 7.77 to 11.04 mmol/L (140-199 mg/dL) on an oral glucose tolerance test.

Women were almost twice as likely to receive a metformin prescription as were men (4.8% versus 2.8%), while obese individuals and those with two or more comorbid conditions also were more likely to be prescribed metformin, according to findings published in the Annals of Internal Medicine (Ann. Intern. Med. 2015;162:542-8).

“Our findings indicate that metformin is rarely prescribed for diabetes prevention despite a strong evidence base in the literature for more than 10 years and inclusion in practice guidelines for more than 6 years,” wrote Dr. Moin of the University of California, Los Angeles, and her associates. “This is a potential gap in the approach to prediabetes management and a significant missed opportunity for diabetes prevention in patients at highest risk.”

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One of the study authors was an employee of UnitedHealthcare.

Less than 4% of adults with prediabetes are prescribed metformin for diabetes prevention, despite the fact that the condition affects one in three Americans, researchers said.

A 3-year retrospective cohort analysis of health insurance data from 17,352 working-age adults with prediabetes showed that only 3.7% had a prescription claim for metformin, although that figure rose to 7.8% among the subset of patients with a body mass index greater than 35 kg/m² or those with gestational diabetes.

Dr. Tannaz Moin and her associates defined prediabetes as either a hemoglobin A_1c level of 5.7% to 6.4%, a fasting plasma glucose level of 5.55 to 6.94 mmol/L (100-125 mg/dL), or a 2-hour plasma glucose level of 7.77 to 11.04 mmol/L (140-199 mg/dL) on an oral glucose tolerance test.

Women were almost twice as likely to receive a metformin prescription as were men (4.8% versus 2.8%), while obese individuals and those with two or more comorbid conditions also were more likely to be prescribed metformin, according to findings published in the Annals of Internal Medicine (Ann. Intern. Med. 2015;162:542-8).

“Our findings indicate that metformin is rarely prescribed for diabetes prevention despite a strong evidence base in the literature for more than 10 years and inclusion in practice guidelines for more than 6 years,” wrote Dr. Moin of the University of California, Los Angeles, and her associates. “This is a potential gap in the approach to prediabetes management and a significant missed opportunity for diabetes prevention in patients at highest risk.”

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One of the study authors was an employee of UnitedHealthcare.

Less than 4% of adults with prediabetes are prescribed metformin for diabetes prevention, despite the fact that the condition affects one in three Americans, researchers said.

A 3-year retrospective cohort analysis of health insurance data from 17,352 working-age adults with prediabetes showed that only 3.7% had a prescription claim for metformin, although that figure rose to 7.8% among the subset of patients with a body mass index greater than 35 kg/m² or those with gestational diabetes.

Dr. Tannaz Moin and her associates defined prediabetes as either a hemoglobin A_1c level of 5.7% to 6.4%, a fasting plasma glucose level of 5.55 to 6.94 mmol/L (100-125 mg/dL), or a 2-hour plasma glucose level of 7.77 to 11.04 mmol/L (140-199 mg/dL) on an oral glucose tolerance test.

Women were almost twice as likely to receive a metformin prescription as were men (4.8% versus 2.8%), while obese individuals and those with two or more comorbid conditions also were more likely to be prescribed metformin, according to findings published in the Annals of Internal Medicine (Ann. Intern. Med. 2015;162:542-8).

“Our findings indicate that metformin is rarely prescribed for diabetes prevention despite a strong evidence base in the literature for more than 10 years and inclusion in practice guidelines for more than 6 years,” wrote Dr. Moin of the University of California, Los Angeles, and her associates. “This is a potential gap in the approach to prediabetes management and a significant missed opportunity for diabetes prevention in patients at highest risk.”

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One of the study authors was an employee of UnitedHealthcare.

Less than 4% of adults with prediabetes are prescribed metformin for diabetes prevention, despite the fact that the condition affects one in three Americans, researchers said.

A 3-year retrospective cohort analysis of health insurance data from 17,352 working-age adults with prediabetes showed that only 3.7% had a prescription claim for metformin, although that figure rose to 7.8% among the subset of patients with a body mass index greater than 35 kg/m² or those with gestational diabetes.

Dr. Tannaz Moin and her associates defined prediabetes as either a hemoglobin A_1c level of 5.7% to 6.4%, a fasting plasma glucose level of 5.55 to 6.94 mmol/L (100-125 mg/dL), or a 2-hour plasma glucose level of 7.77 to 11.04 mmol/L (140-199 mg/dL) on an oral glucose tolerance test.

Women were almost twice as likely to receive a metformin prescription as were men (4.8% versus 2.8%), while obese individuals and those with two or more comorbid conditions also were more likely to be prescribed metformin, according to findings published in the Annals of Internal Medicine (Ann. Intern. Med. 2015;162:542-8).

“Our findings indicate that metformin is rarely prescribed for diabetes prevention despite a strong evidence base in the literature for more than 10 years and inclusion in practice guidelines for more than 6 years,” wrote Dr. Moin of the University of California, Los Angeles, and her associates. “This is a potential gap in the approach to prediabetes management and a significant missed opportunity for diabetes prevention in patients at highest risk.”

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. One of the study authors was an employee of UnitedHealthcare.

High-dose oral insulin induces an immune response in children at high risk of developing type 1 diabetes but without causing hypoglycemia or triggering immune responses typical of type 1 diabetes, a pilot study showed.

Children aged 2-7 with a family history of type 1 diabetes and susceptible human leukocyte antigen class II genotypes – but without signs of islet autoimmunity – were randomized to either an escalating daily dose of oral insulin (n = 15) from 2.5 mg up to 67.5 mg for 3-18 months, or to placebo, according to a paper published April 21 in JAMA.

Five of the six children treated with 67.5 mg insulin showed increases in IgG binding, saliva IgA binding, and CD4+ T-cell proliferative responses to insulin, but there were no incidents of hypoglycemia, IgE responses to insulin, autoantibodies to glutamic acid decarboxylase, or insulinoma-associated antigen 2 (JAMA 2015; 313:1541-9 [doi:10.1001/jama.2015.2928]).

“The immune response observed in insulin-treated children did not display the features typically associated with type 1 diabetes, such as a dominant proinflammatory IFNG CD4+ T-cell response,” wrote Dr. Ezio Bonifacio of the DFG Center for Regenerative Therapies, Dresden, Germany, and coauthors.

The study was supported by the Juvenile Diabetes Research Foundation, the Bundesministerium für Bildung und Forschung in Germany, the Deutsche Forschungs Gemeinschaft, and the German Center for Diabetes Research. Insulin crystals were provided by Lilly Pharmaceuticals. There were no other conflicts of interest declared.

High-dose oral insulin induces an immune response in children at high risk of developing type 1 diabetes but without causing hypoglycemia or triggering immune responses typical of type 1 diabetes, a pilot study showed.

Children aged 2-7 with a family history of type 1 diabetes and susceptible human leukocyte antigen class II genotypes – but without signs of islet autoimmunity – were randomized to either an escalating daily dose of oral insulin (n = 15) from 2.5 mg up to 67.5 mg for 3-18 months, or to placebo, according to a paper published April 21 in JAMA.

Five of the six children treated with 67.5 mg insulin showed increases in IgG binding, saliva IgA binding, and CD4+ T-cell proliferative responses to insulin, but there were no incidents of hypoglycemia, IgE responses to insulin, autoantibodies to glutamic acid decarboxylase, or insulinoma-associated antigen 2 (JAMA 2015; 313:1541-9 [doi:10.1001/jama.2015.2928]).

“The immune response observed in insulin-treated children did not display the features typically associated with type 1 diabetes, such as a dominant proinflammatory IFNG CD4+ T-cell response,” wrote Dr. Ezio Bonifacio of the DFG Center for Regenerative Therapies, Dresden, Germany, and coauthors.

The study was supported by the Juvenile Diabetes Research Foundation, the Bundesministerium für Bildung und Forschung in Germany, the Deutsche Forschungs Gemeinschaft, and the German Center for Diabetes Research. Insulin crystals were provided by Lilly Pharmaceuticals. There were no other conflicts of interest declared.

High-dose oral insulin induces an immune response in children at high risk of developing type 1 diabetes but without causing hypoglycemia or triggering immune responses typical of type 1 diabetes, a pilot study showed.

Children aged 2-7 with a family history of type 1 diabetes and susceptible human leukocyte antigen class II genotypes – but without signs of islet autoimmunity – were randomized to either an escalating daily dose of oral insulin (n = 15) from 2.5 mg up to 67.5 mg for 3-18 months, or to placebo, according to a paper published April 21 in JAMA.

Five of the six children treated with 67.5 mg insulin showed increases in IgG binding, saliva IgA binding, and CD4+ T-cell proliferative responses to insulin, but there were no incidents of hypoglycemia, IgE responses to insulin, autoantibodies to glutamic acid decarboxylase, or insulinoma-associated antigen 2 (JAMA 2015; 313:1541-9 [doi:10.1001/jama.2015.2928]).

“The immune response observed in insulin-treated children did not display the features typically associated with type 1 diabetes, such as a dominant proinflammatory IFNG CD4+ T-cell response,” wrote Dr. Ezio Bonifacio of the DFG Center for Regenerative Therapies, Dresden, Germany, and coauthors.

The study was supported by the Juvenile Diabetes Research Foundation, the Bundesministerium für Bildung und Forschung in Germany, the Deutsche Forschungs Gemeinschaft, and the German Center for Diabetes Research. Insulin crystals were provided by Lilly Pharmaceuticals. There were no other conflicts of interest declared.

Adolescents with type 1 diabetes experienced more rapid gastric emptying time than did healthy controls, which was linked to greater postprandial rises in blood glucose, a new study has found.

The prospective case-control study in 30 adolescents with type 1 diabetes showed a median half-emptying time of 78 minutes, compared with 109 minutes in controls (P = .2), while the postprandial increase in blood glucose strongly correlated with gastric half-emptying time, according to a paper published online April 14 in the Journal of Clinical Endocrinology and Metabolism.

The findings are in contrast with studies in adults which have previously shown that delayed gastric emptying time affects a significant number of adults with type 1 diabetes. But this current study did show that, as with adults, fasting hyperglycemia was linked to slower gastric emptying and increased upper gastrointestinal symptoms (J. Clin. Endocrinol. Metab. 2015 April 14 [doi:10.1210/jc.2015-1055]).

“Our results suggest that therapies that modify the rate of gastric emptying may be of particular benefit in optimizing postprandial glycaemia in adolescents with type 1 diabetes, and should be investigated further,” wrote Dr. Shiree J. Perano of the University of Adelaide (Australia) and her coauthors.

The study was supported by a McLeod Foundation fellowship, SA, and an Australian Pediatric Endocrine Care grant from Pfizer pharmaceuticals. Two authors declared funding, advisory board memberships, and honoraria from pharmaceutical companies. No other conflicts of interest were declared.

Adolescents with type 1 diabetes experienced more rapid gastric emptying time than did healthy controls, which was linked to greater postprandial rises in blood glucose, a new study has found.

The prospective case-control study in 30 adolescents with type 1 diabetes showed a median half-emptying time of 78 minutes, compared with 109 minutes in controls (P = .2), while the postprandial increase in blood glucose strongly correlated with gastric half-emptying time, according to a paper published online April 14 in the Journal of Clinical Endocrinology and Metabolism.

The findings are in contrast with studies in adults which have previously shown that delayed gastric emptying time affects a significant number of adults with type 1 diabetes. But this current study did show that, as with adults, fasting hyperglycemia was linked to slower gastric emptying and increased upper gastrointestinal symptoms (J. Clin. Endocrinol. Metab. 2015 April 14 [doi:10.1210/jc.2015-1055]).

“Our results suggest that therapies that modify the rate of gastric emptying may be of particular benefit in optimizing postprandial glycaemia in adolescents with type 1 diabetes, and should be investigated further,” wrote Dr. Shiree J. Perano of the University of Adelaide (Australia) and her coauthors.

The study was supported by a McLeod Foundation fellowship, SA, and an Australian Pediatric Endocrine Care grant from Pfizer pharmaceuticals. Two authors declared funding, advisory board memberships, and honoraria from pharmaceutical companies. No other conflicts of interest were declared.

Adolescents with type 1 diabetes experienced more rapid gastric emptying time than did healthy controls, which was linked to greater postprandial rises in blood glucose, a new study has found.

The prospective case-control study in 30 adolescents with type 1 diabetes showed a median half-emptying time of 78 minutes, compared with 109 minutes in controls (P = .2), while the postprandial increase in blood glucose strongly correlated with gastric half-emptying time, according to a paper published online April 14 in the Journal of Clinical Endocrinology and Metabolism.

The findings are in contrast with studies in adults which have previously shown that delayed gastric emptying time affects a significant number of adults with type 1 diabetes. But this current study did show that, as with adults, fasting hyperglycemia was linked to slower gastric emptying and increased upper gastrointestinal symptoms (J. Clin. Endocrinol. Metab. 2015 April 14 [doi:10.1210/jc.2015-1055]).

“Our results suggest that therapies that modify the rate of gastric emptying may be of particular benefit in optimizing postprandial glycaemia in adolescents with type 1 diabetes, and should be investigated further,” wrote Dr. Shiree J. Perano of the University of Adelaide (Australia) and her coauthors.

The study was supported by a McLeod Foundation fellowship, SA, and an Australian Pediatric Endocrine Care grant from Pfizer pharmaceuticals. Two authors declared funding, advisory board memberships, and honoraria from pharmaceutical companies. No other conflicts of interest were declared.

Treatment with granulocyte colony-stimulating factor during chemotherapy reduces the incidence of neutropenia, but a retrospective analysis has failed to find a statistically significant impact on overall survival.

Data from three placebo-controlled and two noninferiority clinical trials of filgrastim and/or pegfilgrastim in 1,858 patients receiving myelosuppressive chemotherapy showed that 6- and 12-month survival rates were generally – but not statistically significantly – better among patients in the active arm versus placebo, according to Dr. Gary H. Lyman of the University of Washington, Seattle, and his coauthors (Ann. Oncol. 2015 April 7 [doi:10.1093/annonc/mdv174].

Patients with lung cancer who were treated with filgrastim showed a 3-month improvement in overall survival (hazard ratio, 0.81; 95% confidence interval, 0.48-1.35; P = 0.412), but a meta-analysis of placebo-controlled studies showed a nonsignificant trend towards improved overall survival.

“Prospective assessment of the effects of [granulocyte colony-stimulating factor] primary prophylaxis on long-term outcomes in patients with cancer receiving myelosuppressive chemotherapy is warranted,” the investigators wrote.

The study was funded by Amgen. Two authors declared research grants and funding from Amgen and two authors are employees of and own stock in Amgen.

Treatment with granulocyte colony-stimulating factor during chemotherapy reduces the incidence of neutropenia, but a retrospective analysis has failed to find a statistically significant impact on overall survival.

Data from three placebo-controlled and two noninferiority clinical trials of filgrastim and/or pegfilgrastim in 1,858 patients receiving myelosuppressive chemotherapy showed that 6- and 12-month survival rates were generally – but not statistically significantly – better among patients in the active arm versus placebo, according to Dr. Gary H. Lyman of the University of Washington, Seattle, and his coauthors (Ann. Oncol. 2015 April 7 [doi:10.1093/annonc/mdv174].

Patients with lung cancer who were treated with filgrastim showed a 3-month improvement in overall survival (hazard ratio, 0.81; 95% confidence interval, 0.48-1.35; P = 0.412), but a meta-analysis of placebo-controlled studies showed a nonsignificant trend towards improved overall survival.

“Prospective assessment of the effects of [granulocyte colony-stimulating factor] primary prophylaxis on long-term outcomes in patients with cancer receiving myelosuppressive chemotherapy is warranted,” the investigators wrote.

The study was funded by Amgen. Two authors declared research grants and funding from Amgen and two authors are employees of and own stock in Amgen.

Treatment with granulocyte colony-stimulating factor during chemotherapy reduces the incidence of neutropenia, but a retrospective analysis has failed to find a statistically significant impact on overall survival.

Data from three placebo-controlled and two noninferiority clinical trials of filgrastim and/or pegfilgrastim in 1,858 patients receiving myelosuppressive chemotherapy showed that 6- and 12-month survival rates were generally – but not statistically significantly – better among patients in the active arm versus placebo, according to Dr. Gary H. Lyman of the University of Washington, Seattle, and his coauthors (Ann. Oncol. 2015 April 7 [doi:10.1093/annonc/mdv174].

Patients with lung cancer who were treated with filgrastim showed a 3-month improvement in overall survival (hazard ratio, 0.81; 95% confidence interval, 0.48-1.35; P = 0.412), but a meta-analysis of placebo-controlled studies showed a nonsignificant trend towards improved overall survival.

“Prospective assessment of the effects of [granulocyte colony-stimulating factor] primary prophylaxis on long-term outcomes in patients with cancer receiving myelosuppressive chemotherapy is warranted,” the investigators wrote.

The study was funded by Amgen. Two authors declared research grants and funding from Amgen and two authors are employees of and own stock in Amgen.

Insulin glargine therapy was associated with significantly greater reductions in liver fat burden in patients with type 2 diabetes than was liraglutide, judging from the findings of a prospective randomized controlled trial.

Both treatments significantly improved glycosylated hemoglobin. However, neither led to a significant change in liver fat fraction, as measured with magnetic resonance spectroscopy (MRS), according to a study published online March 26 in Diabetes Care.

Wavebreakmedia Ltd

Researchers randomized 35 patients, whose type 2 diabetes was inadequately controlled on either metformin monotherapy or combination therapy, to 12 weeks therapy starting with 10 IU of subcutaneous insulin glargine daily or a starting dose of 0.6 mg of subcutaneous liraglutide, titrated to 1.8 mg or the maximal tolerated dose.

Patients on insulin glargine showed significant reductions in MRS-based liver proton density fat fraction (13.8% to 10.6%; P = .005), and MRI-based liver volume (2,010.6 mL to 1,858.7 mL; P = .01) and total liver fat index (304.4 vs. 209.3%; P = .01).

They also showed a trend toward a decreased MRS-based liver proton density fat fraction (12.6% to 9.9%; P = 0.06).

However patients treated with liraglutide showed no significant changes in any of these indexes (Diabetes Care 2015, March 26 [doi:10.2337/dc14-2548]).

While insulin is associated with weight gain and may be lipogenic, previous imaging studies have actually showed a reduction in liver fat with insulin therapy.

“The mechanisms by which insulin therapy may reduce liver fat include inhibition of lipolysis, which may reduce free fatty acid flux to the liver and decreased production of endogenous insulin passing through the liver to stimulate hepatic lipogenesis,” wrote Dr. An Tang, from the University of Montreal, and coauthors.

At the same time, GLP-1 agonists such as liraglutide promote weight loss and were thought to decrease liver fat by increasing fatty acid uptake and very low density–lipoprotein transport.

However, the study failed to find any significant change in biomarkers of liver fat burden among those patients randomized to liraglutide.

“It is possible that the postprandial increase in insulin secretion in the portal circulation and the decrease in glucagon secretion induced by the GLP-1 analogs could favor lipogenesis and therefore explain the lack of effect of liraglutide on hepatic steatosis observed in the current study,” the authors wrote.

The study found that patients taking liraglutide showed a significant reduction in body mass index or BMI (31.3 to 30.1 kg/m²; P = .008) while those on insulin glargine did not (31.2 to 31.3 kg/m²; P = .92).

“Interestingly, the improvement in BMI in patients randomized to liraglutide therapy was not associated with concomitant changes in the liver fat burden,” they wrote.

They noted a similar rate of adverse events in the insulin glargine and liraglutide groups.

The authors said that while the study’s short duration may have worked against liraglutide, because its impact on BMI may have had a longer term impact on liver fat fraction, they argued it was enough to address the primary end point.

“This reduction in liver fat burden on insulin therapy is reassuring and important because many patients with type 2 diabetes and NALFD [nonalcoholic fatty liver disease] have to be treated with insulin to achieve adequate glycemic control,” the authors wrote.

The study was supported by the Radiological Society of North America Research and Education Foundation, and Diabète Québec. Authors reported grants, honorarium, personal fees, and research funds from private industry.

Insulin glargine therapy was associated with significantly greater reductions in liver fat burden in patients with type 2 diabetes than was liraglutide, judging from the findings of a prospective randomized controlled trial.

Both treatments significantly improved glycosylated hemoglobin. However, neither led to a significant change in liver fat fraction, as measured with magnetic resonance spectroscopy (MRS), according to a study published online March 26 in Diabetes Care.

Wavebreakmedia Ltd

Researchers randomized 35 patients, whose type 2 diabetes was inadequately controlled on either metformin monotherapy or combination therapy, to 12 weeks therapy starting with 10 IU of subcutaneous insulin glargine daily or a starting dose of 0.6 mg of subcutaneous liraglutide, titrated to 1.8 mg or the maximal tolerated dose.

Patients on insulin glargine showed significant reductions in MRS-based liver proton density fat fraction (13.8% to 10.6%; P = .005), and MRI-based liver volume (2,010.6 mL to 1,858.7 mL; P = .01) and total liver fat index (304.4 vs. 209.3%; P = .01).

They also showed a trend toward a decreased MRS-based liver proton density fat fraction (12.6% to 9.9%; P = 0.06).

However patients treated with liraglutide showed no significant changes in any of these indexes (Diabetes Care 2015, March 26 [doi:10.2337/dc14-2548]).

While insulin is associated with weight gain and may be lipogenic, previous imaging studies have actually showed a reduction in liver fat with insulin therapy.

“The mechanisms by which insulin therapy may reduce liver fat include inhibition of lipolysis, which may reduce free fatty acid flux to the liver and decreased production of endogenous insulin passing through the liver to stimulate hepatic lipogenesis,” wrote Dr. An Tang, from the University of Montreal, and coauthors.

At the same time, GLP-1 agonists such as liraglutide promote weight loss and were thought to decrease liver fat by increasing fatty acid uptake and very low density–lipoprotein transport.

However, the study failed to find any significant change in biomarkers of liver fat burden among those patients randomized to liraglutide.

“It is possible that the postprandial increase in insulin secretion in the portal circulation and the decrease in glucagon secretion induced by the GLP-1 analogs could favor lipogenesis and therefore explain the lack of effect of liraglutide on hepatic steatosis observed in the current study,” the authors wrote.

The study found that patients taking liraglutide showed a significant reduction in body mass index or BMI (31.3 to 30.1 kg/m²; P = .008) while those on insulin glargine did not (31.2 to 31.3 kg/m²; P = .92).

“Interestingly, the improvement in BMI in patients randomized to liraglutide therapy was not associated with concomitant changes in the liver fat burden,” they wrote.

They noted a similar rate of adverse events in the insulin glargine and liraglutide groups.

The authors said that while the study’s short duration may have worked against liraglutide, because its impact on BMI may have had a longer term impact on liver fat fraction, they argued it was enough to address the primary end point.

“This reduction in liver fat burden on insulin therapy is reassuring and important because many patients with type 2 diabetes and NALFD [nonalcoholic fatty liver disease] have to be treated with insulin to achieve adequate glycemic control,” the authors wrote.

The study was supported by the Radiological Society of North America Research and Education Foundation, and Diabète Québec. Authors reported grants, honorarium, personal fees, and research funds from private industry.

Insulin glargine therapy was associated with significantly greater reductions in liver fat burden in patients with type 2 diabetes than was liraglutide, judging from the findings of a prospective randomized controlled trial.

Both treatments significantly improved glycosylated hemoglobin. However, neither led to a significant change in liver fat fraction, as measured with magnetic resonance spectroscopy (MRS), according to a study published online March 26 in Diabetes Care.

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Researchers randomized 35 patients, whose type 2 diabetes was inadequately controlled on either metformin monotherapy or combination therapy, to 12 weeks therapy starting with 10 IU of subcutaneous insulin glargine daily or a starting dose of 0.6 mg of subcutaneous liraglutide, titrated to 1.8 mg or the maximal tolerated dose.

Patients on insulin glargine showed significant reductions in MRS-based liver proton density fat fraction (13.8% to 10.6%; P = .005), and MRI-based liver volume (2,010.6 mL to 1,858.7 mL; P = .01) and total liver fat index (304.4 vs. 209.3%; P = .01).

They also showed a trend toward a decreased MRS-based liver proton density fat fraction (12.6% to 9.9%; P = 0.06).

However patients treated with liraglutide showed no significant changes in any of these indexes (Diabetes Care 2015, March 26 [doi:10.2337/dc14-2548]).

While insulin is associated with weight gain and may be lipogenic, previous imaging studies have actually showed a reduction in liver fat with insulin therapy.

“The mechanisms by which insulin therapy may reduce liver fat include inhibition of lipolysis, which may reduce free fatty acid flux to the liver and decreased production of endogenous insulin passing through the liver to stimulate hepatic lipogenesis,” wrote Dr. An Tang, from the University of Montreal, and coauthors.

At the same time, GLP-1 agonists such as liraglutide promote weight loss and were thought to decrease liver fat by increasing fatty acid uptake and very low density–lipoprotein transport.

However, the study failed to find any significant change in biomarkers of liver fat burden among those patients randomized to liraglutide.

“It is possible that the postprandial increase in insulin secretion in the portal circulation and the decrease in glucagon secretion induced by the GLP-1 analogs could favor lipogenesis and therefore explain the lack of effect of liraglutide on hepatic steatosis observed in the current study,” the authors wrote.

The study found that patients taking liraglutide showed a significant reduction in body mass index or BMI (31.3 to 30.1 kg/m²; P = .008) while those on insulin glargine did not (31.2 to 31.3 kg/m²; P = .92).

“Interestingly, the improvement in BMI in patients randomized to liraglutide therapy was not associated with concomitant changes in the liver fat burden,” they wrote.

They noted a similar rate of adverse events in the insulin glargine and liraglutide groups.

The authors said that while the study’s short duration may have worked against liraglutide, because its impact on BMI may have had a longer term impact on liver fat fraction, they argued it was enough to address the primary end point.

“This reduction in liver fat burden on insulin therapy is reassuring and important because many patients with type 2 diabetes and NALFD [nonalcoholic fatty liver disease] have to be treated with insulin to achieve adequate glycemic control,” the authors wrote.

The study was supported by the Radiological Society of North America Research and Education Foundation, and Diabète Québec. Authors reported grants, honorarium, personal fees, and research funds from private industry.

A relatively rare genetic variant in the CCND2 gene halves the risk of type 2 diabetes by improving insulin secretion and sensitivity, but it does not appear to impact insulin processing, new data suggest.

In an effort to replicate earlier work that identified a low-frequency variant at CCND2 associated with lower risk of type 2 diabetes, enhanced insulin response to a glucose challenge, higher height and, paradoxically, higher body mass index, researchers examined associations between the variant and type 2 diabetes in 29,956 European individuals, finding a 51% lower incidence of type 2 diabetes among carriers of the allele, which ranged in frequency from 1.51% to 2.14%, according to a paper published online March 24 in Diabetes.

©ktsimage/Thinkstock.com

Individuals with the variant had significantly improved insulin secretion in response to a glucose challenge test, a higher disposition index of beta-cell function, as well as being significantly taller and of slightly greater BMI than controls (Diabetes 2015 [doi:10.2337/db14-1456]).

“The associations with improved disposition index and insulinogenic index but smaller effects with the Matsuda index, in up to 13,181 individuals, show that the protective diabetes effect operates primarily through a mechanism of relatively favorable insulin secretory response to a glucose challenge and to lower blood sugar more effectively than noncarriers,” wrote Dr. Hanieh Yaghootkar of the University of Exeter (England) and coauthors.

“Our best estimate of the effect of the variant on BMI suggests that the effect is smaller than reported in the original publication due to index event bias. Further studies are needed to establish the size of the BMI association. Our data, together with the original finding, show a mechanism through improved insulin secretion which results in lower fasting glucose levels, lower 2-hour OGTT glucose levels, and a lower risk of type 2 diabetes. Combining all data including 19,586 type 2 diabetes cases and 83,554 controls from the original study and our study provides evidence that carrying this variant reduces the risk of type 2 diabetes by approximately 50% relative to noncarriers,” the investigators wrote.

The study was supported by European Research Council, the Wellcome Trust, the University of Exeter Medical School, Novo Nordisk, and various government agencies, universities, and nonprofit organizations. There were no conflicts of interest declared.

A relatively rare genetic variant in the CCND2 gene halves the risk of type 2 diabetes by improving insulin secretion and sensitivity, but it does not appear to impact insulin processing, new data suggest.

In an effort to replicate earlier work that identified a low-frequency variant at CCND2 associated with lower risk of type 2 diabetes, enhanced insulin response to a glucose challenge, higher height and, paradoxically, higher body mass index, researchers examined associations between the variant and type 2 diabetes in 29,956 European individuals, finding a 51% lower incidence of type 2 diabetes among carriers of the allele, which ranged in frequency from 1.51% to 2.14%, according to a paper published online March 24 in Diabetes.

©ktsimage/Thinkstock.com

Individuals with the variant had significantly improved insulin secretion in response to a glucose challenge test, a higher disposition index of beta-cell function, as well as being significantly taller and of slightly greater BMI than controls (Diabetes 2015 [doi:10.2337/db14-1456]).

“The associations with improved disposition index and insulinogenic index but smaller effects with the Matsuda index, in up to 13,181 individuals, show that the protective diabetes effect operates primarily through a mechanism of relatively favorable insulin secretory response to a glucose challenge and to lower blood sugar more effectively than noncarriers,” wrote Dr. Hanieh Yaghootkar of the University of Exeter (England) and coauthors.

“Our best estimate of the effect of the variant on BMI suggests that the effect is smaller than reported in the original publication due to index event bias. Further studies are needed to establish the size of the BMI association. Our data, together with the original finding, show a mechanism through improved insulin secretion which results in lower fasting glucose levels, lower 2-hour OGTT glucose levels, and a lower risk of type 2 diabetes. Combining all data including 19,586 type 2 diabetes cases and 83,554 controls from the original study and our study provides evidence that carrying this variant reduces the risk of type 2 diabetes by approximately 50% relative to noncarriers,” the investigators wrote.

The study was supported by European Research Council, the Wellcome Trust, the University of Exeter Medical School, Novo Nordisk, and various government agencies, universities, and nonprofit organizations. There were no conflicts of interest declared.

A relatively rare genetic variant in the CCND2 gene halves the risk of type 2 diabetes by improving insulin secretion and sensitivity, but it does not appear to impact insulin processing, new data suggest.

In an effort to replicate earlier work that identified a low-frequency variant at CCND2 associated with lower risk of type 2 diabetes, enhanced insulin response to a glucose challenge, higher height and, paradoxically, higher body mass index, researchers examined associations between the variant and type 2 diabetes in 29,956 European individuals, finding a 51% lower incidence of type 2 diabetes among carriers of the allele, which ranged in frequency from 1.51% to 2.14%, according to a paper published online March 24 in Diabetes.

©ktsimage/Thinkstock.com

Individuals with the variant had significantly improved insulin secretion in response to a glucose challenge test, a higher disposition index of beta-cell function, as well as being significantly taller and of slightly greater BMI than controls (Diabetes 2015 [doi:10.2337/db14-1456]).

“The associations with improved disposition index and insulinogenic index but smaller effects with the Matsuda index, in up to 13,181 individuals, show that the protective diabetes effect operates primarily through a mechanism of relatively favorable insulin secretory response to a glucose challenge and to lower blood sugar more effectively than noncarriers,” wrote Dr. Hanieh Yaghootkar of the University of Exeter (England) and coauthors.

“Our best estimate of the effect of the variant on BMI suggests that the effect is smaller than reported in the original publication due to index event bias. Further studies are needed to establish the size of the BMI association. Our data, together with the original finding, show a mechanism through improved insulin secretion which results in lower fasting glucose levels, lower 2-hour OGTT glucose levels, and a lower risk of type 2 diabetes. Combining all data including 19,586 type 2 diabetes cases and 83,554 controls from the original study and our study provides evidence that carrying this variant reduces the risk of type 2 diabetes by approximately 50% relative to noncarriers,” the investigators wrote.

The study was supported by European Research Council, the Wellcome Trust, the University of Exeter Medical School, Novo Nordisk, and various government agencies, universities, and nonprofit organizations. There were no conflicts of interest declared.