User login
Over One Third of Patients Develop Exocrine Pancreatic Insufficiency After Acute Pancreatitis
TOPLINE:
Over one third of patients with acute pancreatitis develop exocrine pancreatic insufficiency (EPI) at 12 months, with the key predictors being idiopathic etiology, moderately severe or severe disease, and preexisting diabetes.
METHODOLOGY:
- EPI has traditionally been associated with chronic pancreatitis, but its prevalence and natural history following acute pancreatitis are less well defined.
- Researchers conducted a prospective cohort study including 85 hospital inpatients (mean age, 54.7 years; 48.2% women) diagnosed with acute pancreatitis from three tertiary institutions in the United States.
- Severity of acute pancreatitis was classified according to the Revised Atlanta Criteria.
- EPI was assessed by measuring fecal elastase 1 (FE-1) levels from stool samples at baseline and at 3 and 12 months after enrollment. EPI was defined by FE-1 levels ≤ 200 μg/g stool, with mild and severe EPI categorized by FE-1 levels of 101-200 μg/g stool and ≤ 100 μg/g stool, respectively.
- The prevalence of EPI was assessed at 3 and 12 months after acute pancreatitis. The study also identified the predictors of EPI, including the role of etiology and severity of acute pancreatitis and preexisting diabetes.
TAKEAWAY:
- EPI was present in 34.1% participants at 12 months after an acute pancreatitis attack, with 22.4% having severe EPI.
- Even 12.8% of those with an index mild attack of acute pancreatitis had severe EPI at 12 months.
- The odds of developing EPI at 12 months increased fourfold with idiopathic etiology of acute pancreatitis (P = .0094).
- The odds of developing EPI increased over threefold with moderately severe or severe acute pancreatitis (P = .025) and preexisting diabetes (P = .031).
- The prevalence of severe EPI after acute pancreatitis decreased from 29% at baseline to 26% at 3 months and 22% at 12 months.
IN PRACTICE:
“While specific subpopulations may have identified clinical risk factors, it will remain important to have a low threshold for testing and treatment as there remains much to learn about mechanisms leading to EPI after [acute pancreatitis],” the authors wrote.
SOURCE:
This study, led by Anna Evans Phillips, MD, MS, University of Pittsburgh School of Medicine in Pennsylvania, was published online in eClinicalMedicine.
LIMITATIONS:
Participants were often transferred from other hospitals with differing management techniques, which may have introduced selection bias. The use of FE-1 levels may have had diagnostic limitations. The study did not assess the impact of pancreatic enzyme replacement therapy on recovery from EPI. Some patients with early chronic pancreatitis may have been included owing to the lack of diagnostic clarity.
DISCLOSURES:
The study was supported by an investigator-initiated research grant from AbbVie. Some authors received funding for research from AbbVie. One of the authors declared serving as a consultant and scientific advisory board member and being an equity holder in biotechnology, biopharmaceutical, and diagnostics companies. Another author declared support from the Cystic Fibrosis Foundation and the American Society for Parenteral and Enteral Nutrition.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Over one third of patients with acute pancreatitis develop exocrine pancreatic insufficiency (EPI) at 12 months, with the key predictors being idiopathic etiology, moderately severe or severe disease, and preexisting diabetes.
METHODOLOGY:
- EPI has traditionally been associated with chronic pancreatitis, but its prevalence and natural history following acute pancreatitis are less well defined.
- Researchers conducted a prospective cohort study including 85 hospital inpatients (mean age, 54.7 years; 48.2% women) diagnosed with acute pancreatitis from three tertiary institutions in the United States.
- Severity of acute pancreatitis was classified according to the Revised Atlanta Criteria.
- EPI was assessed by measuring fecal elastase 1 (FE-1) levels from stool samples at baseline and at 3 and 12 months after enrollment. EPI was defined by FE-1 levels ≤ 200 μg/g stool, with mild and severe EPI categorized by FE-1 levels of 101-200 μg/g stool and ≤ 100 μg/g stool, respectively.
- The prevalence of EPI was assessed at 3 and 12 months after acute pancreatitis. The study also identified the predictors of EPI, including the role of etiology and severity of acute pancreatitis and preexisting diabetes.
TAKEAWAY:
- EPI was present in 34.1% participants at 12 months after an acute pancreatitis attack, with 22.4% having severe EPI.
- Even 12.8% of those with an index mild attack of acute pancreatitis had severe EPI at 12 months.
- The odds of developing EPI at 12 months increased fourfold with idiopathic etiology of acute pancreatitis (P = .0094).
- The odds of developing EPI increased over threefold with moderately severe or severe acute pancreatitis (P = .025) and preexisting diabetes (P = .031).
- The prevalence of severe EPI after acute pancreatitis decreased from 29% at baseline to 26% at 3 months and 22% at 12 months.
IN PRACTICE:
“While specific subpopulations may have identified clinical risk factors, it will remain important to have a low threshold for testing and treatment as there remains much to learn about mechanisms leading to EPI after [acute pancreatitis],” the authors wrote.
SOURCE:
This study, led by Anna Evans Phillips, MD, MS, University of Pittsburgh School of Medicine in Pennsylvania, was published online in eClinicalMedicine.
LIMITATIONS:
Participants were often transferred from other hospitals with differing management techniques, which may have introduced selection bias. The use of FE-1 levels may have had diagnostic limitations. The study did not assess the impact of pancreatic enzyme replacement therapy on recovery from EPI. Some patients with early chronic pancreatitis may have been included owing to the lack of diagnostic clarity.
DISCLOSURES:
The study was supported by an investigator-initiated research grant from AbbVie. Some authors received funding for research from AbbVie. One of the authors declared serving as a consultant and scientific advisory board member and being an equity holder in biotechnology, biopharmaceutical, and diagnostics companies. Another author declared support from the Cystic Fibrosis Foundation and the American Society for Parenteral and Enteral Nutrition.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Over one third of patients with acute pancreatitis develop exocrine pancreatic insufficiency (EPI) at 12 months, with the key predictors being idiopathic etiology, moderately severe or severe disease, and preexisting diabetes.
METHODOLOGY:
- EPI has traditionally been associated with chronic pancreatitis, but its prevalence and natural history following acute pancreatitis are less well defined.
- Researchers conducted a prospective cohort study including 85 hospital inpatients (mean age, 54.7 years; 48.2% women) diagnosed with acute pancreatitis from three tertiary institutions in the United States.
- Severity of acute pancreatitis was classified according to the Revised Atlanta Criteria.
- EPI was assessed by measuring fecal elastase 1 (FE-1) levels from stool samples at baseline and at 3 and 12 months after enrollment. EPI was defined by FE-1 levels ≤ 200 μg/g stool, with mild and severe EPI categorized by FE-1 levels of 101-200 μg/g stool and ≤ 100 μg/g stool, respectively.
- The prevalence of EPI was assessed at 3 and 12 months after acute pancreatitis. The study also identified the predictors of EPI, including the role of etiology and severity of acute pancreatitis and preexisting diabetes.
TAKEAWAY:
- EPI was present in 34.1% participants at 12 months after an acute pancreatitis attack, with 22.4% having severe EPI.
- Even 12.8% of those with an index mild attack of acute pancreatitis had severe EPI at 12 months.
- The odds of developing EPI at 12 months increased fourfold with idiopathic etiology of acute pancreatitis (P = .0094).
- The odds of developing EPI increased over threefold with moderately severe or severe acute pancreatitis (P = .025) and preexisting diabetes (P = .031).
- The prevalence of severe EPI after acute pancreatitis decreased from 29% at baseline to 26% at 3 months and 22% at 12 months.
IN PRACTICE:
“While specific subpopulations may have identified clinical risk factors, it will remain important to have a low threshold for testing and treatment as there remains much to learn about mechanisms leading to EPI after [acute pancreatitis],” the authors wrote.
SOURCE:
This study, led by Anna Evans Phillips, MD, MS, University of Pittsburgh School of Medicine in Pennsylvania, was published online in eClinicalMedicine.
LIMITATIONS:
Participants were often transferred from other hospitals with differing management techniques, which may have introduced selection bias. The use of FE-1 levels may have had diagnostic limitations. The study did not assess the impact of pancreatic enzyme replacement therapy on recovery from EPI. Some patients with early chronic pancreatitis may have been included owing to the lack of diagnostic clarity.
DISCLOSURES:
The study was supported by an investigator-initiated research grant from AbbVie. Some authors received funding for research from AbbVie. One of the authors declared serving as a consultant and scientific advisory board member and being an equity holder in biotechnology, biopharmaceutical, and diagnostics companies. Another author declared support from the Cystic Fibrosis Foundation and the American Society for Parenteral and Enteral Nutrition.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Belimumab Hits Newer Remission, Low Disease Activity Metrics
TOPLINE:
A greater proportion of patients with active systemic lupus erythematosus (SLE) treated with belimumab plus standard therapy achieved the newest definitions for remission and low disease activity compared with those treated with placebo plus standard therapy, with benefits observed as early as week 28 for remission and week 8 for disease activity, according to pooled results from five clinical trials.
METHODOLOGY:
- Researchers conducted an integrated post hoc analysis of five randomized phase 3 clinical trials to evaluate the attainment of remission and low disease activity in adult patients with active, autoantibody-positive SLE.
- A total of 3086 patients (median age, 36 years; 94% women) were randomly assigned to receive standard therapy with intravenous belimumab 10 mg/kg monthly or subcutaneous belimumab 200 mg weekly (n = 1869) or placebo (n = 1217).
- The proportion of patients who achieved definitions of remission in SLE (DORIS) remission and lupus low disease activity state (LLDAS) by visit up to week 52 was assessed.
- The analysis also evaluated the time taken to achieve sustained (at least two consecutive visits) and maintained (up to week 52) DORIS remission and LLDAS.
TAKEAWAY:
- At week 52, a higher proportion of patients receiving belimumab vs placebo achieved DORIS remission (8% vs 6%; risk ratio [RR], 1.51; P = .0055) and LLDAS (17% vs 10%; RR, 1.74; P < .0001).
- The earliest observed significant benefit of belimumab over placebo in patients with a higher baseline disease activity was at week 20 for DORIS remission (RR, 2.09; P = .043) and at week 16 for LLDAS (RR, 1.46; P = .034), with both maintained through week 52.
- The proportion of patients who attained DORIS remission and LLDAS as early as week 28 and week 8, respectively, was higher in the belimumab group than in the placebo group, with both maintained through week 52.
- Patients on belimumab were more likely to have a sustained and maintained DORIS remission (hazard ratio [HR], 1.53; P = .013) and LLDAS (HR, 1.79; P < .0001) at any timepoint.
IN PRACTICE:
“The data clearly support that belimumab is a valuable addition toward accomplishing and maintaining remission or LLDAS,” George Bertsias, MD, PhD, University of Crete Medical School, Heraklion, Greece, and Jinoos Yazdany, MD, University of California San Francisco, wrote in a related comment.
SOURCE:
This study, led by Ioannis Parodis, MD, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, was published online on August 26, 2024, in The Lancet Rheumatology.
LIMITATIONS:
Due to the post hoc nature of the analysis, the trials were not specifically designed to have adequate statistical power to demonstrate the difference between patients who did or did not achieve DORIS remission or LLDAS. The analysis was limited to patients who met the eligibility criteria, and the outcomes are not generalizable to populations outside a clinical trial setting. The study population had high disease activity, which made it challenging to attain the treatment targets.
DISCLOSURES:
The five trials included in this analysis were funded by GSK. The study was supported by the Swedish Rheumatism Association, King Gustaf V’s 80-year Foundation, the Swedish Society of Medicine, Nyckelfonden, Professor Nanna Svartz Foundation, Ulla and Roland Gustafsson Foundation, Region Stockholm, and Karolinska Institutet. Some authors reported receiving grants, speaker honoraria, or consulting fees from various pharmaceutical companies. Some authors reported being employees and owning stocks and shares of GSK.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
A greater proportion of patients with active systemic lupus erythematosus (SLE) treated with belimumab plus standard therapy achieved the newest definitions for remission and low disease activity compared with those treated with placebo plus standard therapy, with benefits observed as early as week 28 for remission and week 8 for disease activity, according to pooled results from five clinical trials.
METHODOLOGY:
- Researchers conducted an integrated post hoc analysis of five randomized phase 3 clinical trials to evaluate the attainment of remission and low disease activity in adult patients with active, autoantibody-positive SLE.
- A total of 3086 patients (median age, 36 years; 94% women) were randomly assigned to receive standard therapy with intravenous belimumab 10 mg/kg monthly or subcutaneous belimumab 200 mg weekly (n = 1869) or placebo (n = 1217).
- The proportion of patients who achieved definitions of remission in SLE (DORIS) remission and lupus low disease activity state (LLDAS) by visit up to week 52 was assessed.
- The analysis also evaluated the time taken to achieve sustained (at least two consecutive visits) and maintained (up to week 52) DORIS remission and LLDAS.
TAKEAWAY:
- At week 52, a higher proportion of patients receiving belimumab vs placebo achieved DORIS remission (8% vs 6%; risk ratio [RR], 1.51; P = .0055) and LLDAS (17% vs 10%; RR, 1.74; P < .0001).
- The earliest observed significant benefit of belimumab over placebo in patients with a higher baseline disease activity was at week 20 for DORIS remission (RR, 2.09; P = .043) and at week 16 for LLDAS (RR, 1.46; P = .034), with both maintained through week 52.
- The proportion of patients who attained DORIS remission and LLDAS as early as week 28 and week 8, respectively, was higher in the belimumab group than in the placebo group, with both maintained through week 52.
- Patients on belimumab were more likely to have a sustained and maintained DORIS remission (hazard ratio [HR], 1.53; P = .013) and LLDAS (HR, 1.79; P < .0001) at any timepoint.
IN PRACTICE:
“The data clearly support that belimumab is a valuable addition toward accomplishing and maintaining remission or LLDAS,” George Bertsias, MD, PhD, University of Crete Medical School, Heraklion, Greece, and Jinoos Yazdany, MD, University of California San Francisco, wrote in a related comment.
SOURCE:
This study, led by Ioannis Parodis, MD, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, was published online on August 26, 2024, in The Lancet Rheumatology.
LIMITATIONS:
Due to the post hoc nature of the analysis, the trials were not specifically designed to have adequate statistical power to demonstrate the difference between patients who did or did not achieve DORIS remission or LLDAS. The analysis was limited to patients who met the eligibility criteria, and the outcomes are not generalizable to populations outside a clinical trial setting. The study population had high disease activity, which made it challenging to attain the treatment targets.
DISCLOSURES:
The five trials included in this analysis were funded by GSK. The study was supported by the Swedish Rheumatism Association, King Gustaf V’s 80-year Foundation, the Swedish Society of Medicine, Nyckelfonden, Professor Nanna Svartz Foundation, Ulla and Roland Gustafsson Foundation, Region Stockholm, and Karolinska Institutet. Some authors reported receiving grants, speaker honoraria, or consulting fees from various pharmaceutical companies. Some authors reported being employees and owning stocks and shares of GSK.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
TOPLINE:
A greater proportion of patients with active systemic lupus erythematosus (SLE) treated with belimumab plus standard therapy achieved the newest definitions for remission and low disease activity compared with those treated with placebo plus standard therapy, with benefits observed as early as week 28 for remission and week 8 for disease activity, according to pooled results from five clinical trials.
METHODOLOGY:
- Researchers conducted an integrated post hoc analysis of five randomized phase 3 clinical trials to evaluate the attainment of remission and low disease activity in adult patients with active, autoantibody-positive SLE.
- A total of 3086 patients (median age, 36 years; 94% women) were randomly assigned to receive standard therapy with intravenous belimumab 10 mg/kg monthly or subcutaneous belimumab 200 mg weekly (n = 1869) or placebo (n = 1217).
- The proportion of patients who achieved definitions of remission in SLE (DORIS) remission and lupus low disease activity state (LLDAS) by visit up to week 52 was assessed.
- The analysis also evaluated the time taken to achieve sustained (at least two consecutive visits) and maintained (up to week 52) DORIS remission and LLDAS.
TAKEAWAY:
- At week 52, a higher proportion of patients receiving belimumab vs placebo achieved DORIS remission (8% vs 6%; risk ratio [RR], 1.51; P = .0055) and LLDAS (17% vs 10%; RR, 1.74; P < .0001).
- The earliest observed significant benefit of belimumab over placebo in patients with a higher baseline disease activity was at week 20 for DORIS remission (RR, 2.09; P = .043) and at week 16 for LLDAS (RR, 1.46; P = .034), with both maintained through week 52.
- The proportion of patients who attained DORIS remission and LLDAS as early as week 28 and week 8, respectively, was higher in the belimumab group than in the placebo group, with both maintained through week 52.
- Patients on belimumab were more likely to have a sustained and maintained DORIS remission (hazard ratio [HR], 1.53; P = .013) and LLDAS (HR, 1.79; P < .0001) at any timepoint.
IN PRACTICE:
“The data clearly support that belimumab is a valuable addition toward accomplishing and maintaining remission or LLDAS,” George Bertsias, MD, PhD, University of Crete Medical School, Heraklion, Greece, and Jinoos Yazdany, MD, University of California San Francisco, wrote in a related comment.
SOURCE:
This study, led by Ioannis Parodis, MD, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, was published online on August 26, 2024, in The Lancet Rheumatology.
LIMITATIONS:
Due to the post hoc nature of the analysis, the trials were not specifically designed to have adequate statistical power to demonstrate the difference between patients who did or did not achieve DORIS remission or LLDAS. The analysis was limited to patients who met the eligibility criteria, and the outcomes are not generalizable to populations outside a clinical trial setting. The study population had high disease activity, which made it challenging to attain the treatment targets.
DISCLOSURES:
The five trials included in this analysis were funded by GSK. The study was supported by the Swedish Rheumatism Association, King Gustaf V’s 80-year Foundation, the Swedish Society of Medicine, Nyckelfonden, Professor Nanna Svartz Foundation, Ulla and Roland Gustafsson Foundation, Region Stockholm, and Karolinska Institutet. Some authors reported receiving grants, speaker honoraria, or consulting fees from various pharmaceutical companies. Some authors reported being employees and owning stocks and shares of GSK.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.
Does Tailored Acupuncture Relieve Chronic Neck Pain?
TOPLINE:
Patients with chronic neck pain who received acupuncture experienced an alleviation of their symptoms, but not at clinically meaningful levels, compared with those who received sham treatment.
METHODOLOGY:
- A 24-week randomized trial was conducted at four clinical centers in China over a 2-year period starting in 2018.
- A total of 659 patients with chronic neck pain were randomly assigned to one of the four groups: Higher sensitive acupoints (mean age, 38.63 years; 70.41% women; n = 169), lower sensitive acupoints (mean age, 40.21 years; 74.4% women; n = 168), sham acupuncture (mean age, 40.16 years; 75.29% women; n = 170), and a waiting list (mean age, 38.63 years; 69.89% women; n = 176).
- Participants in the acupuncture groups had 10 sessions over 4 weeks and were followed up for 20 weeks. Those in the waiting list group received no treatment.
- The primary outcome was the change in neck pain at 4 weeks, measured on a 0-100 scale. A change of 10 points was considered clinically significant.
- The secondary outcomes were neck pain and movement, quality of life, and use of pain medication over 24 weeks.
TAKEAWAY:
- Acupuncture targeted at higher sensitive points led to a pain score reduction of 12.16 (95% CI, −14.45 to −9.87), while lower sensitive points reduced it by 10.19 (95% CI, −12.43 to −7.95).
- Sham acupuncture reduced the score by 6.11 (95% CI, −8.31 to −3.91), and no treatment reduced it by 2.24 (95% CI, −4.10 to −0.38).
- The higher and lower sensitive acupoint groups showed no clinically significant net differences in pain reduction and secondary outcomes compared with the sham and waiting list groups.
- Differences in reductions in pain between groups all decreased by week 24.
IN PRACTICE:
“The clinical importance of this improvement is unclear. Our results suggest that the selection of pressure pain, sensory-based objective acupoints could be considered as a treatment of CNP [chronic neck pain],” the authors wrote.
SOURCE:
This study, led by Ling Zhao, PhD, of Acupuncture and Tuina School at Chengdu University of Traditional Chinese Medicine in Chengdu, China, was published online in the Annals of Internal Medicine.
LIMITATIONS:
Blinding was not done in the waiting list group. Individuals in the higher and lower sensitive acupoint groups experienced a specific sensation after needle manipulation, which could have influenced the analysis. Additionally, the participants were middle-aged adults with moderate pain, which limited the generalizability to older individuals or those with severe pain.
DISCLOSURES:
The study was supported by grants from the National Natural Science Foundation of China, Central Guidance on Local Science and Technology Development Fund of Sichuan Province, among others. The authors declared no conflicts of interest outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Patients with chronic neck pain who received acupuncture experienced an alleviation of their symptoms, but not at clinically meaningful levels, compared with those who received sham treatment.
METHODOLOGY:
- A 24-week randomized trial was conducted at four clinical centers in China over a 2-year period starting in 2018.
- A total of 659 patients with chronic neck pain were randomly assigned to one of the four groups: Higher sensitive acupoints (mean age, 38.63 years; 70.41% women; n = 169), lower sensitive acupoints (mean age, 40.21 years; 74.4% women; n = 168), sham acupuncture (mean age, 40.16 years; 75.29% women; n = 170), and a waiting list (mean age, 38.63 years; 69.89% women; n = 176).
- Participants in the acupuncture groups had 10 sessions over 4 weeks and were followed up for 20 weeks. Those in the waiting list group received no treatment.
- The primary outcome was the change in neck pain at 4 weeks, measured on a 0-100 scale. A change of 10 points was considered clinically significant.
- The secondary outcomes were neck pain and movement, quality of life, and use of pain medication over 24 weeks.
TAKEAWAY:
- Acupuncture targeted at higher sensitive points led to a pain score reduction of 12.16 (95% CI, −14.45 to −9.87), while lower sensitive points reduced it by 10.19 (95% CI, −12.43 to −7.95).
- Sham acupuncture reduced the score by 6.11 (95% CI, −8.31 to −3.91), and no treatment reduced it by 2.24 (95% CI, −4.10 to −0.38).
- The higher and lower sensitive acupoint groups showed no clinically significant net differences in pain reduction and secondary outcomes compared with the sham and waiting list groups.
- Differences in reductions in pain between groups all decreased by week 24.
IN PRACTICE:
“The clinical importance of this improvement is unclear. Our results suggest that the selection of pressure pain, sensory-based objective acupoints could be considered as a treatment of CNP [chronic neck pain],” the authors wrote.
SOURCE:
This study, led by Ling Zhao, PhD, of Acupuncture and Tuina School at Chengdu University of Traditional Chinese Medicine in Chengdu, China, was published online in the Annals of Internal Medicine.
LIMITATIONS:
Blinding was not done in the waiting list group. Individuals in the higher and lower sensitive acupoint groups experienced a specific sensation after needle manipulation, which could have influenced the analysis. Additionally, the participants were middle-aged adults with moderate pain, which limited the generalizability to older individuals or those with severe pain.
DISCLOSURES:
The study was supported by grants from the National Natural Science Foundation of China, Central Guidance on Local Science and Technology Development Fund of Sichuan Province, among others. The authors declared no conflicts of interest outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
Patients with chronic neck pain who received acupuncture experienced an alleviation of their symptoms, but not at clinically meaningful levels, compared with those who received sham treatment.
METHODOLOGY:
- A 24-week randomized trial was conducted at four clinical centers in China over a 2-year period starting in 2018.
- A total of 659 patients with chronic neck pain were randomly assigned to one of the four groups: Higher sensitive acupoints (mean age, 38.63 years; 70.41% women; n = 169), lower sensitive acupoints (mean age, 40.21 years; 74.4% women; n = 168), sham acupuncture (mean age, 40.16 years; 75.29% women; n = 170), and a waiting list (mean age, 38.63 years; 69.89% women; n = 176).
- Participants in the acupuncture groups had 10 sessions over 4 weeks and were followed up for 20 weeks. Those in the waiting list group received no treatment.
- The primary outcome was the change in neck pain at 4 weeks, measured on a 0-100 scale. A change of 10 points was considered clinically significant.
- The secondary outcomes were neck pain and movement, quality of life, and use of pain medication over 24 weeks.
TAKEAWAY:
- Acupuncture targeted at higher sensitive points led to a pain score reduction of 12.16 (95% CI, −14.45 to −9.87), while lower sensitive points reduced it by 10.19 (95% CI, −12.43 to −7.95).
- Sham acupuncture reduced the score by 6.11 (95% CI, −8.31 to −3.91), and no treatment reduced it by 2.24 (95% CI, −4.10 to −0.38).
- The higher and lower sensitive acupoint groups showed no clinically significant net differences in pain reduction and secondary outcomes compared with the sham and waiting list groups.
- Differences in reductions in pain between groups all decreased by week 24.
IN PRACTICE:
“The clinical importance of this improvement is unclear. Our results suggest that the selection of pressure pain, sensory-based objective acupoints could be considered as a treatment of CNP [chronic neck pain],” the authors wrote.
SOURCE:
This study, led by Ling Zhao, PhD, of Acupuncture and Tuina School at Chengdu University of Traditional Chinese Medicine in Chengdu, China, was published online in the Annals of Internal Medicine.
LIMITATIONS:
Blinding was not done in the waiting list group. Individuals in the higher and lower sensitive acupoint groups experienced a specific sensation after needle manipulation, which could have influenced the analysis. Additionally, the participants were middle-aged adults with moderate pain, which limited the generalizability to older individuals or those with severe pain.
DISCLOSURES:
The study was supported by grants from the National Natural Science Foundation of China, Central Guidance on Local Science and Technology Development Fund of Sichuan Province, among others. The authors declared no conflicts of interest outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Study Reports Safety Data in Children on JAK Inhibitors
TOPLINE:
which also found that acne was the most common skin-related AE in children, and serious AEs were less common.
METHODOLOGY:
- Researchers analyzed 399,649 AEs in 133,216 adult patients and 2883 AEs in 955 pediatric patients (age, < 18 years) from November 2011 to February 2023 using the US Food and Drug Administration Adverse Event Reporting System and the Canada Vigilance Adverse Reaction Online Database.
- AEs were categorized on the basis of the Medical Dictionary for Regulatory Activities system organ class.
- Five JAK inhibitors approved for use in children were included in the study: Baricitinib, upadacitinib, abrocitinib, ruxolitinib, and tofacitinib.
TAKEAWAY:
- The most frequently reported AEs in children were blood and lymphatic system disorders, including neutropenia, thrombocytopenia, and anemia (24%); viral, fungal, and bacterial infections, such as pneumonia and sepsis (17.2%); constitutional symptoms and administrative concerns, including pyrexia and fatigue (15.7%); gastrointestinal disorders, such as vomiting and abdominal pain (13.6%); and respiratory disorders, such as cough and respiratory distress (5.3%).
- In adults, the most common AEs were viral, fungal, and bacterial infections (16.8%); constitutional symptoms and administrative concerns (13.5%); musculoskeletal and connective tissue disorders (7.04%); and gastrointestinal (5.8%) and nervous system (5%) disorders.
- Acne (30.6%), atopic dermatitis (22.2%), and psoriasis (16.7%) were the most common skin and subcutaneous tissue AEs reported in children. Skin and subcutaneous AEs were more common with upadacitinib (21.1%), abrocitinib (9.1%), and tofacitinib (6.3%) in children.
- Serious AEs included in the boxed warning for JAK inhibitors — serious infection, mortality, malignancy, cardiovascular events, and thrombosis — were similar for baricitinib in children (4 of 49 patients, 8.2%) and adults (325 of 3707, 8.8%). For other JAK inhibitors, absolute numbers of these AEs in children were small and rates were lower in children than in adults.
IN PRACTICE:
“This information can support customized treatment and minimize the potential for undesired or intolerable AEs,” the authors wrote.
SOURCE:
This study was led by Sahithi Talasila, BS, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and was published online in Pediatric Dermatology.
LIMITATIONS:
Pharmacovigilance registries did not fully capture the complete range of AEs because of potential reporting bias or recall bias. Additionally, events lacking sufficient objective evidence were underreported, while common AEs associated with JAK inhibitor therapy were overreported.
DISCLOSURES:
No specific funding sources for the study were reported. One author reported being a consultant, one reported serving as a principal investigator in clinical trials, and another reported serving on data and safety monitoring boards of various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
which also found that acne was the most common skin-related AE in children, and serious AEs were less common.
METHODOLOGY:
- Researchers analyzed 399,649 AEs in 133,216 adult patients and 2883 AEs in 955 pediatric patients (age, < 18 years) from November 2011 to February 2023 using the US Food and Drug Administration Adverse Event Reporting System and the Canada Vigilance Adverse Reaction Online Database.
- AEs were categorized on the basis of the Medical Dictionary for Regulatory Activities system organ class.
- Five JAK inhibitors approved for use in children were included in the study: Baricitinib, upadacitinib, abrocitinib, ruxolitinib, and tofacitinib.
TAKEAWAY:
- The most frequently reported AEs in children were blood and lymphatic system disorders, including neutropenia, thrombocytopenia, and anemia (24%); viral, fungal, and bacterial infections, such as pneumonia and sepsis (17.2%); constitutional symptoms and administrative concerns, including pyrexia and fatigue (15.7%); gastrointestinal disorders, such as vomiting and abdominal pain (13.6%); and respiratory disorders, such as cough and respiratory distress (5.3%).
- In adults, the most common AEs were viral, fungal, and bacterial infections (16.8%); constitutional symptoms and administrative concerns (13.5%); musculoskeletal and connective tissue disorders (7.04%); and gastrointestinal (5.8%) and nervous system (5%) disorders.
- Acne (30.6%), atopic dermatitis (22.2%), and psoriasis (16.7%) were the most common skin and subcutaneous tissue AEs reported in children. Skin and subcutaneous AEs were more common with upadacitinib (21.1%), abrocitinib (9.1%), and tofacitinib (6.3%) in children.
- Serious AEs included in the boxed warning for JAK inhibitors — serious infection, mortality, malignancy, cardiovascular events, and thrombosis — were similar for baricitinib in children (4 of 49 patients, 8.2%) and adults (325 of 3707, 8.8%). For other JAK inhibitors, absolute numbers of these AEs in children were small and rates were lower in children than in adults.
IN PRACTICE:
“This information can support customized treatment and minimize the potential for undesired or intolerable AEs,” the authors wrote.
SOURCE:
This study was led by Sahithi Talasila, BS, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and was published online in Pediatric Dermatology.
LIMITATIONS:
Pharmacovigilance registries did not fully capture the complete range of AEs because of potential reporting bias or recall bias. Additionally, events lacking sufficient objective evidence were underreported, while common AEs associated with JAK inhibitor therapy were overreported.
DISCLOSURES:
No specific funding sources for the study were reported. One author reported being a consultant, one reported serving as a principal investigator in clinical trials, and another reported serving on data and safety monitoring boards of various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
TOPLINE:
which also found that acne was the most common skin-related AE in children, and serious AEs were less common.
METHODOLOGY:
- Researchers analyzed 399,649 AEs in 133,216 adult patients and 2883 AEs in 955 pediatric patients (age, < 18 years) from November 2011 to February 2023 using the US Food and Drug Administration Adverse Event Reporting System and the Canada Vigilance Adverse Reaction Online Database.
- AEs were categorized on the basis of the Medical Dictionary for Regulatory Activities system organ class.
- Five JAK inhibitors approved for use in children were included in the study: Baricitinib, upadacitinib, abrocitinib, ruxolitinib, and tofacitinib.
TAKEAWAY:
- The most frequently reported AEs in children were blood and lymphatic system disorders, including neutropenia, thrombocytopenia, and anemia (24%); viral, fungal, and bacterial infections, such as pneumonia and sepsis (17.2%); constitutional symptoms and administrative concerns, including pyrexia and fatigue (15.7%); gastrointestinal disorders, such as vomiting and abdominal pain (13.6%); and respiratory disorders, such as cough and respiratory distress (5.3%).
- In adults, the most common AEs were viral, fungal, and bacterial infections (16.8%); constitutional symptoms and administrative concerns (13.5%); musculoskeletal and connective tissue disorders (7.04%); and gastrointestinal (5.8%) and nervous system (5%) disorders.
- Acne (30.6%), atopic dermatitis (22.2%), and psoriasis (16.7%) were the most common skin and subcutaneous tissue AEs reported in children. Skin and subcutaneous AEs were more common with upadacitinib (21.1%), abrocitinib (9.1%), and tofacitinib (6.3%) in children.
- Serious AEs included in the boxed warning for JAK inhibitors — serious infection, mortality, malignancy, cardiovascular events, and thrombosis — were similar for baricitinib in children (4 of 49 patients, 8.2%) and adults (325 of 3707, 8.8%). For other JAK inhibitors, absolute numbers of these AEs in children were small and rates were lower in children than in adults.
IN PRACTICE:
“This information can support customized treatment and minimize the potential for undesired or intolerable AEs,” the authors wrote.
SOURCE:
This study was led by Sahithi Talasila, BS, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, and was published online in Pediatric Dermatology.
LIMITATIONS:
Pharmacovigilance registries did not fully capture the complete range of AEs because of potential reporting bias or recall bias. Additionally, events lacking sufficient objective evidence were underreported, while common AEs associated with JAK inhibitor therapy were overreported.
DISCLOSURES:
No specific funding sources for the study were reported. One author reported being a consultant, one reported serving as a principal investigator in clinical trials, and another reported serving on data and safety monitoring boards of various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article first appeared on Medscape.com.
Long-Term Exposure to Road Traffic Noise and Air Pollution Linked to Infertility
TOPLINE:
Long-term exposure to particulate matter < 2.5 μm in diameter (PM2.5) is linked to a higher risk for infertility in men. Exposure to road traffic noise is associated with a higher risk for infertility in women aged > 35 years and possibly in men aged > 37 years.
METHODOLOGY:
- This nationwide prospective cohort study evaluated the association between long-term exposure to road traffic noise and PM2.5 and infertility in 526,056 men (mean age, 33.6 years) and 377,850 women (mean age, 32.7 years) who were cohabiting or married, had fewer than two children, and lived in Denmark between 2000 and 2017.
- Residential exposure to road traffic noise (most exposed facade of the home) and PM2.5 was estimated using validated models and linked to data from national registers.
- Diagnoses of infertility were identified in men and women from the Danish National Patient Register over a mean follow-up of 4.3 years and 4.2 years, respectively.
TAKEAWAY:
- Each 2.9 µg/m3 increase in the 5-year average exposure to PM2.5 was associated with a 24% increase in the risk for infertility in men aged 30-45 years (adjusted hazard ratio [aHR], 1.24).
- No significant association was found between exposure to PM2.5 and infertility in women.
- Each 10.2 dB increase in the 5-year average exposure to road traffic noise was associated with a 14% increase in infertility (aHR, 1.14; 95% CI, 1.10-1.18) in women aged 35-45 years.
- Exposure to noise was associated with a reduced risk for infertility in men aged 30.0-36.9 years (aHR, 0.93; 95% CI, 0.91-0.96) and an increased risk in those aged 37-45 years (aHR, 1.06; 95% CI, 1.02-1.11).
IN PRACTICE:
“As many Western countries are facing declining birth rates and increasing maternal age at the birth of a first child, knowledge on environmental pollutants affecting fertility is crucial,” the authors of the study wrote. “It suggests that political implementation of air pollution and noise mitigations may be important tools for improving birth rates in the Western world,” they added.
SOURCE:
The study, led by Mette Sorensen, of the Danish Cancer Institute in Copenhagen, Denmark, was published online in The BMJ.
LIMITATIONS:
The study’s reliance on register data meant information on lifestyle factors such as alcohol use, body mass index, and smoking was unavailable. The lack of data on exposure to noise and PM2.5 at work and during leisure activities may affect the size and statistical precision of risk estimates.
DISCLOSURES:
The study did not receive any external funding. The authors declared no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
Long-term exposure to particulate matter < 2.5 μm in diameter (PM2.5) is linked to a higher risk for infertility in men. Exposure to road traffic noise is associated with a higher risk for infertility in women aged > 35 years and possibly in men aged > 37 years.
METHODOLOGY:
- This nationwide prospective cohort study evaluated the association between long-term exposure to road traffic noise and PM2.5 and infertility in 526,056 men (mean age, 33.6 years) and 377,850 women (mean age, 32.7 years) who were cohabiting or married, had fewer than two children, and lived in Denmark between 2000 and 2017.
- Residential exposure to road traffic noise (most exposed facade of the home) and PM2.5 was estimated using validated models and linked to data from national registers.
- Diagnoses of infertility were identified in men and women from the Danish National Patient Register over a mean follow-up of 4.3 years and 4.2 years, respectively.
TAKEAWAY:
- Each 2.9 µg/m3 increase in the 5-year average exposure to PM2.5 was associated with a 24% increase in the risk for infertility in men aged 30-45 years (adjusted hazard ratio [aHR], 1.24).
- No significant association was found between exposure to PM2.5 and infertility in women.
- Each 10.2 dB increase in the 5-year average exposure to road traffic noise was associated with a 14% increase in infertility (aHR, 1.14; 95% CI, 1.10-1.18) in women aged 35-45 years.
- Exposure to noise was associated with a reduced risk for infertility in men aged 30.0-36.9 years (aHR, 0.93; 95% CI, 0.91-0.96) and an increased risk in those aged 37-45 years (aHR, 1.06; 95% CI, 1.02-1.11).
IN PRACTICE:
“As many Western countries are facing declining birth rates and increasing maternal age at the birth of a first child, knowledge on environmental pollutants affecting fertility is crucial,” the authors of the study wrote. “It suggests that political implementation of air pollution and noise mitigations may be important tools for improving birth rates in the Western world,” they added.
SOURCE:
The study, led by Mette Sorensen, of the Danish Cancer Institute in Copenhagen, Denmark, was published online in The BMJ.
LIMITATIONS:
The study’s reliance on register data meant information on lifestyle factors such as alcohol use, body mass index, and smoking was unavailable. The lack of data on exposure to noise and PM2.5 at work and during leisure activities may affect the size and statistical precision of risk estimates.
DISCLOSURES:
The study did not receive any external funding. The authors declared no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
Long-term exposure to particulate matter < 2.5 μm in diameter (PM2.5) is linked to a higher risk for infertility in men. Exposure to road traffic noise is associated with a higher risk for infertility in women aged > 35 years and possibly in men aged > 37 years.
METHODOLOGY:
- This nationwide prospective cohort study evaluated the association between long-term exposure to road traffic noise and PM2.5 and infertility in 526,056 men (mean age, 33.6 years) and 377,850 women (mean age, 32.7 years) who were cohabiting or married, had fewer than two children, and lived in Denmark between 2000 and 2017.
- Residential exposure to road traffic noise (most exposed facade of the home) and PM2.5 was estimated using validated models and linked to data from national registers.
- Diagnoses of infertility were identified in men and women from the Danish National Patient Register over a mean follow-up of 4.3 years and 4.2 years, respectively.
TAKEAWAY:
- Each 2.9 µg/m3 increase in the 5-year average exposure to PM2.5 was associated with a 24% increase in the risk for infertility in men aged 30-45 years (adjusted hazard ratio [aHR], 1.24).
- No significant association was found between exposure to PM2.5 and infertility in women.
- Each 10.2 dB increase in the 5-year average exposure to road traffic noise was associated with a 14% increase in infertility (aHR, 1.14; 95% CI, 1.10-1.18) in women aged 35-45 years.
- Exposure to noise was associated with a reduced risk for infertility in men aged 30.0-36.9 years (aHR, 0.93; 95% CI, 0.91-0.96) and an increased risk in those aged 37-45 years (aHR, 1.06; 95% CI, 1.02-1.11).
IN PRACTICE:
“As many Western countries are facing declining birth rates and increasing maternal age at the birth of a first child, knowledge on environmental pollutants affecting fertility is crucial,” the authors of the study wrote. “It suggests that political implementation of air pollution and noise mitigations may be important tools for improving birth rates in the Western world,” they added.
SOURCE:
The study, led by Mette Sorensen, of the Danish Cancer Institute in Copenhagen, Denmark, was published online in The BMJ.
LIMITATIONS:
The study’s reliance on register data meant information on lifestyle factors such as alcohol use, body mass index, and smoking was unavailable. The lack of data on exposure to noise and PM2.5 at work and during leisure activities may affect the size and statistical precision of risk estimates.
DISCLOSURES:
The study did not receive any external funding. The authors declared no relevant conflicts of interest.
A version of this article first appeared on Medscape.com.
Study Links Melasma With Comorbidities, Races, Ethnicities
TOPLINE:
A study found significant associations between melasma and several comorbidities, including hypertension and hormonal contraception use, which were the most common.
METHODOLOGY:
- Melasma predominantly affects young women of color and often worsens in hyperestrogen states; understanding the association with comorbidities can improve surveillance and treatment strategies.
- Researchers evaluated 41,283 patients with melasma (mean age, 48.8 years; 93% women) from the TriNetX database and an equal number of matched control individuals.
- The main outcome was comorbidities including allergic rhinitis, atopic dermatitis, anticonvulsants, diabetes, hormonal contraceptives, hypothyroidism, hypertension, lupus, rosacea, skin cancer, and malignancy.
TAKEAWAY:
- Among those with melasma, 25% had hypertension and 24% used hormonal contraception, the two most commonly associated risk factors identified.
- Rosacea (odds ratio [OR], 5.1), atopic dermatitis (OR, 3.3), lupus (OR, 2.5), history of skin cancer (OR, 2.5), and history of internal malignancy (OR, 2.1) were associated with the highest risk of developing melasma (P < .01 for all).
- Asian (OR, 2.0; P < .01) and “other/unknown” races (OR, 1.7; P < .01) and Hispanic ethnicity (OR, 1.3; P < .01) were also significantly associated with melasma, while the odds were slightly lower among White, Black/African American, and “not Hispanic” groups (ORs, 0.8; P < .01 for all groups).
IN PRACTICE:
the authors wrote.
SOURCE:
The study, led by Ajay N. Sharma, MD, MBA, of the Department of Dermatology at the University of California, Irvine, was published online in Journal of Drugs in Dermatology.
LIMITATIONS:
The study limitations included the retrospective design, potential misclassification of diagnoses, and the inability to establish causality.
DISCLOSURES:
The study did not disclose any funding sources. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
A study found significant associations between melasma and several comorbidities, including hypertension and hormonal contraception use, which were the most common.
METHODOLOGY:
- Melasma predominantly affects young women of color and often worsens in hyperestrogen states; understanding the association with comorbidities can improve surveillance and treatment strategies.
- Researchers evaluated 41,283 patients with melasma (mean age, 48.8 years; 93% women) from the TriNetX database and an equal number of matched control individuals.
- The main outcome was comorbidities including allergic rhinitis, atopic dermatitis, anticonvulsants, diabetes, hormonal contraceptives, hypothyroidism, hypertension, lupus, rosacea, skin cancer, and malignancy.
TAKEAWAY:
- Among those with melasma, 25% had hypertension and 24% used hormonal contraception, the two most commonly associated risk factors identified.
- Rosacea (odds ratio [OR], 5.1), atopic dermatitis (OR, 3.3), lupus (OR, 2.5), history of skin cancer (OR, 2.5), and history of internal malignancy (OR, 2.1) were associated with the highest risk of developing melasma (P < .01 for all).
- Asian (OR, 2.0; P < .01) and “other/unknown” races (OR, 1.7; P < .01) and Hispanic ethnicity (OR, 1.3; P < .01) were also significantly associated with melasma, while the odds were slightly lower among White, Black/African American, and “not Hispanic” groups (ORs, 0.8; P < .01 for all groups).
IN PRACTICE:
the authors wrote.
SOURCE:
The study, led by Ajay N. Sharma, MD, MBA, of the Department of Dermatology at the University of California, Irvine, was published online in Journal of Drugs in Dermatology.
LIMITATIONS:
The study limitations included the retrospective design, potential misclassification of diagnoses, and the inability to establish causality.
DISCLOSURES:
The study did not disclose any funding sources. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
A study found significant associations between melasma and several comorbidities, including hypertension and hormonal contraception use, which were the most common.
METHODOLOGY:
- Melasma predominantly affects young women of color and often worsens in hyperestrogen states; understanding the association with comorbidities can improve surveillance and treatment strategies.
- Researchers evaluated 41,283 patients with melasma (mean age, 48.8 years; 93% women) from the TriNetX database and an equal number of matched control individuals.
- The main outcome was comorbidities including allergic rhinitis, atopic dermatitis, anticonvulsants, diabetes, hormonal contraceptives, hypothyroidism, hypertension, lupus, rosacea, skin cancer, and malignancy.
TAKEAWAY:
- Among those with melasma, 25% had hypertension and 24% used hormonal contraception, the two most commonly associated risk factors identified.
- Rosacea (odds ratio [OR], 5.1), atopic dermatitis (OR, 3.3), lupus (OR, 2.5), history of skin cancer (OR, 2.5), and history of internal malignancy (OR, 2.1) were associated with the highest risk of developing melasma (P < .01 for all).
- Asian (OR, 2.0; P < .01) and “other/unknown” races (OR, 1.7; P < .01) and Hispanic ethnicity (OR, 1.3; P < .01) were also significantly associated with melasma, while the odds were slightly lower among White, Black/African American, and “not Hispanic” groups (ORs, 0.8; P < .01 for all groups).
IN PRACTICE:
the authors wrote.
SOURCE:
The study, led by Ajay N. Sharma, MD, MBA, of the Department of Dermatology at the University of California, Irvine, was published online in Journal of Drugs in Dermatology.
LIMITATIONS:
The study limitations included the retrospective design, potential misclassification of diagnoses, and the inability to establish causality.
DISCLOSURES:
The study did not disclose any funding sources. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
Bidirectional Link for Mental Health and Diabetic Complications
TOPLINE:
Mental health disorders increase the likelihood of developing chronic diabetic complications and vice versa across all age groups in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D).
METHODOLOGY:
- Researchers used a US national healthcare claims database (data obtained from 2001 to 2018) to analyze individuals with and without T1D and T2D, who had no prior mental health disorder or chronic diabetic complication.
- The onset and presence of chronic diabetic complications and mental health disorders were identified to determine their possible association.
- Individuals were stratified by age: 0-19, 20-39, 40-59, and ≥ 60 years.
TAKEAWAY:
- Researchers analyzed 44,735 patients with T1D (47.5% women) and 152,187 with T2D (46.0% women), who were matched with 356,630 individuals without diabetes (51.8% women).
- The presence of chronic diabetic complications increased the risk for a mental health disorder across all age groups, with the highest risk seen in patients aged ≥ 60 years (hazard ratio [HR], 2.9).
- Similarly, diagnosis of a mental health disorder increased the risk for chronic diabetic complications across all age groups, with the highest risk seen in patients aged 0-19 years (HR, 2.5).
- Patients with T2D had a significantly higher risk for a mental health disorder and a lower risk for chronic diabetic complications than those with T1D across all age groups, except those aged ≥ 60 years.
- The bidirectional association between mental health disorders and chronic diabetic complications was not affected by the diabetes type (P > .05 for all interactions).
IN PRACTICE:
“Clinicians and healthcare systems likely need to increase their focus on MHDs [mental health disorders], and innovative models of care are required to optimize care for both individuals with type 1 diabetes and those with type 2 diabetes,” the authors wrote.
SOURCE:
The study, led by Maya Watanabe, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, was published online in Diabetes Care.
LIMITATIONS:
The study relied on International Classification of Diseases 9th and 10th revision codes, which might have led to misclassification of mental health conditions, chronic diabetes complications, and diabetes type. The data did not capture the symptom onset and severity. The findings may not be generalizable to populations outside the United States.
DISCLOSURES:
The study was supported by the Juvenile Diabetes Research Foundation (now Breakthrough T1D). Some authors reported receiving speaker or expert testimony honoraria and research support, and some declared serving on medical or digital advisory boards or as consultants for various pharmaceutical and medical device companies.
A version of this article first appeared on Medscape.com.
TOPLINE:
Mental health disorders increase the likelihood of developing chronic diabetic complications and vice versa across all age groups in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D).
METHODOLOGY:
- Researchers used a US national healthcare claims database (data obtained from 2001 to 2018) to analyze individuals with and without T1D and T2D, who had no prior mental health disorder or chronic diabetic complication.
- The onset and presence of chronic diabetic complications and mental health disorders were identified to determine their possible association.
- Individuals were stratified by age: 0-19, 20-39, 40-59, and ≥ 60 years.
TAKEAWAY:
- Researchers analyzed 44,735 patients with T1D (47.5% women) and 152,187 with T2D (46.0% women), who were matched with 356,630 individuals without diabetes (51.8% women).
- The presence of chronic diabetic complications increased the risk for a mental health disorder across all age groups, with the highest risk seen in patients aged ≥ 60 years (hazard ratio [HR], 2.9).
- Similarly, diagnosis of a mental health disorder increased the risk for chronic diabetic complications across all age groups, with the highest risk seen in patients aged 0-19 years (HR, 2.5).
- Patients with T2D had a significantly higher risk for a mental health disorder and a lower risk for chronic diabetic complications than those with T1D across all age groups, except those aged ≥ 60 years.
- The bidirectional association between mental health disorders and chronic diabetic complications was not affected by the diabetes type (P > .05 for all interactions).
IN PRACTICE:
“Clinicians and healthcare systems likely need to increase their focus on MHDs [mental health disorders], and innovative models of care are required to optimize care for both individuals with type 1 diabetes and those with type 2 diabetes,” the authors wrote.
SOURCE:
The study, led by Maya Watanabe, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, was published online in Diabetes Care.
LIMITATIONS:
The study relied on International Classification of Diseases 9th and 10th revision codes, which might have led to misclassification of mental health conditions, chronic diabetes complications, and diabetes type. The data did not capture the symptom onset and severity. The findings may not be generalizable to populations outside the United States.
DISCLOSURES:
The study was supported by the Juvenile Diabetes Research Foundation (now Breakthrough T1D). Some authors reported receiving speaker or expert testimony honoraria and research support, and some declared serving on medical or digital advisory boards or as consultants for various pharmaceutical and medical device companies.
A version of this article first appeared on Medscape.com.
TOPLINE:
Mental health disorders increase the likelihood of developing chronic diabetic complications and vice versa across all age groups in patients with type 1 diabetes (T1D) or type 2 diabetes (T2D).
METHODOLOGY:
- Researchers used a US national healthcare claims database (data obtained from 2001 to 2018) to analyze individuals with and without T1D and T2D, who had no prior mental health disorder or chronic diabetic complication.
- The onset and presence of chronic diabetic complications and mental health disorders were identified to determine their possible association.
- Individuals were stratified by age: 0-19, 20-39, 40-59, and ≥ 60 years.
TAKEAWAY:
- Researchers analyzed 44,735 patients with T1D (47.5% women) and 152,187 with T2D (46.0% women), who were matched with 356,630 individuals without diabetes (51.8% women).
- The presence of chronic diabetic complications increased the risk for a mental health disorder across all age groups, with the highest risk seen in patients aged ≥ 60 years (hazard ratio [HR], 2.9).
- Similarly, diagnosis of a mental health disorder increased the risk for chronic diabetic complications across all age groups, with the highest risk seen in patients aged 0-19 years (HR, 2.5).
- Patients with T2D had a significantly higher risk for a mental health disorder and a lower risk for chronic diabetic complications than those with T1D across all age groups, except those aged ≥ 60 years.
- The bidirectional association between mental health disorders and chronic diabetic complications was not affected by the diabetes type (P > .05 for all interactions).
IN PRACTICE:
“Clinicians and healthcare systems likely need to increase their focus on MHDs [mental health disorders], and innovative models of care are required to optimize care for both individuals with type 1 diabetes and those with type 2 diabetes,” the authors wrote.
SOURCE:
The study, led by Maya Watanabe, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, was published online in Diabetes Care.
LIMITATIONS:
The study relied on International Classification of Diseases 9th and 10th revision codes, which might have led to misclassification of mental health conditions, chronic diabetes complications, and diabetes type. The data did not capture the symptom onset and severity. The findings may not be generalizable to populations outside the United States.
DISCLOSURES:
The study was supported by the Juvenile Diabetes Research Foundation (now Breakthrough T1D). Some authors reported receiving speaker or expert testimony honoraria and research support, and some declared serving on medical or digital advisory boards or as consultants for various pharmaceutical and medical device companies.
A version of this article first appeared on Medscape.com.
Study: AFib May Be Linked to Dementia in T2D
TOPLINE:
New-onset atrial fibrillation (AF) is associated with a substantially higher risk for all-cause dementia in patients with type 2 diabetes (T2D).
METHODOLOGY:
- Studies suggest a potential link between AF and dementia in the broader population, but evidence is scarce in people with diabetes, who are at increased risk for both conditions.
- This longitudinal observational study assessed the association between new-onset AF and dementia in 22,989 patients with T2D (median age at enrollment, 61.0 years; 62.3% men; 86.3% White individuals).
- New-onset AF was identified through hospital admission records using the International Classification of Diseases – 9th Revision (ICD-9) and ICD-10 codes, and dementia cases were identified using an algorithm developed by the UK Biobank.
- Time-varying Cox proportional hazard regression models were used to determine the association between incident dementia and new-onset AF.
TAKEAWAY:
- Over a median follow-up duration of about 12 years, 844 patients developed all-cause dementia, 342 were diagnosed with Alzheimer’s disease, and 246 had vascular dementia.
- Patients with incident AF had a higher risk of developing all-cause dementia (hazard ratio [HR], 2.15; 95% CI, 1.80-2.57), Alzheimer’s disease (HR, 1.44; 95% CI, 1.06-1.96), and vascular dementia (HR, 3.11; 95% CI, 2.32-4.17) than those without incident AF.
- The results are independent of common dementia risk factors, such as sociodemographic characteristics and lifestyle factors.
- The mean time intervals from the onset of AF to all-cause dementia, Alzheimer’s disease and vascular dementia were 2.95, 2.81, and 3.37 years, respectively.
IN PRACTICE:
“AF is a significant risk factor for dementia in patients with type 2 diabetes, suggesting the importance of timely and effective treatment of AF, such as early rhythm control strategies and anticoagulant use, in preventing dementia among this demographic,” the authors wrote.
SOURCE:
The study, led by Ying Zhou, PhD, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The study could not explore the link between different AF subtypes and dementia owing to its small sample size. The effects of AF treatment on the risk for dementia in patients with type 2 diabetes were not considered because of lack of information. The mostly White study population limits the generalizability of the findings to other races and ethnicities.
DISCLOSURES:
The study was supported by the National Social Science Fund of China. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
New-onset atrial fibrillation (AF) is associated with a substantially higher risk for all-cause dementia in patients with type 2 diabetes (T2D).
METHODOLOGY:
- Studies suggest a potential link between AF and dementia in the broader population, but evidence is scarce in people with diabetes, who are at increased risk for both conditions.
- This longitudinal observational study assessed the association between new-onset AF and dementia in 22,989 patients with T2D (median age at enrollment, 61.0 years; 62.3% men; 86.3% White individuals).
- New-onset AF was identified through hospital admission records using the International Classification of Diseases – 9th Revision (ICD-9) and ICD-10 codes, and dementia cases were identified using an algorithm developed by the UK Biobank.
- Time-varying Cox proportional hazard regression models were used to determine the association between incident dementia and new-onset AF.
TAKEAWAY:
- Over a median follow-up duration of about 12 years, 844 patients developed all-cause dementia, 342 were diagnosed with Alzheimer’s disease, and 246 had vascular dementia.
- Patients with incident AF had a higher risk of developing all-cause dementia (hazard ratio [HR], 2.15; 95% CI, 1.80-2.57), Alzheimer’s disease (HR, 1.44; 95% CI, 1.06-1.96), and vascular dementia (HR, 3.11; 95% CI, 2.32-4.17) than those without incident AF.
- The results are independent of common dementia risk factors, such as sociodemographic characteristics and lifestyle factors.
- The mean time intervals from the onset of AF to all-cause dementia, Alzheimer’s disease and vascular dementia were 2.95, 2.81, and 3.37 years, respectively.
IN PRACTICE:
“AF is a significant risk factor for dementia in patients with type 2 diabetes, suggesting the importance of timely and effective treatment of AF, such as early rhythm control strategies and anticoagulant use, in preventing dementia among this demographic,” the authors wrote.
SOURCE:
The study, led by Ying Zhou, PhD, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The study could not explore the link between different AF subtypes and dementia owing to its small sample size. The effects of AF treatment on the risk for dementia in patients with type 2 diabetes were not considered because of lack of information. The mostly White study population limits the generalizability of the findings to other races and ethnicities.
DISCLOSURES:
The study was supported by the National Social Science Fund of China. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
New-onset atrial fibrillation (AF) is associated with a substantially higher risk for all-cause dementia in patients with type 2 diabetes (T2D).
METHODOLOGY:
- Studies suggest a potential link between AF and dementia in the broader population, but evidence is scarce in people with diabetes, who are at increased risk for both conditions.
- This longitudinal observational study assessed the association between new-onset AF and dementia in 22,989 patients with T2D (median age at enrollment, 61.0 years; 62.3% men; 86.3% White individuals).
- New-onset AF was identified through hospital admission records using the International Classification of Diseases – 9th Revision (ICD-9) and ICD-10 codes, and dementia cases were identified using an algorithm developed by the UK Biobank.
- Time-varying Cox proportional hazard regression models were used to determine the association between incident dementia and new-onset AF.
TAKEAWAY:
- Over a median follow-up duration of about 12 years, 844 patients developed all-cause dementia, 342 were diagnosed with Alzheimer’s disease, and 246 had vascular dementia.
- Patients with incident AF had a higher risk of developing all-cause dementia (hazard ratio [HR], 2.15; 95% CI, 1.80-2.57), Alzheimer’s disease (HR, 1.44; 95% CI, 1.06-1.96), and vascular dementia (HR, 3.11; 95% CI, 2.32-4.17) than those without incident AF.
- The results are independent of common dementia risk factors, such as sociodemographic characteristics and lifestyle factors.
- The mean time intervals from the onset of AF to all-cause dementia, Alzheimer’s disease and vascular dementia were 2.95, 2.81, and 3.37 years, respectively.
IN PRACTICE:
“AF is a significant risk factor for dementia in patients with type 2 diabetes, suggesting the importance of timely and effective treatment of AF, such as early rhythm control strategies and anticoagulant use, in preventing dementia among this demographic,” the authors wrote.
SOURCE:
The study, led by Ying Zhou, PhD, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The study could not explore the link between different AF subtypes and dementia owing to its small sample size. The effects of AF treatment on the risk for dementia in patients with type 2 diabetes were not considered because of lack of information. The mostly White study population limits the generalizability of the findings to other races and ethnicities.
DISCLOSURES:
The study was supported by the National Social Science Fund of China. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
Emergency Department Visits for Suicide Attempts Rise Across the United States
TOPLINE:
Emergency department (ED) visits in the United States for suicide attempts and intentional self-harm show an increasing trend from 2011 to 2020, with visits being most common among adolescents and the largest increase in visits being seen in adults aged 65 years or older.
METHODOLOGY:
- This study used data from the National Hospital Ambulatory Medical Care Survey, an annual nationwide cross-sectional survey, to track trends in ED visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020.
- Researchers identified visits for suicide attempts and intentional self-harm, along with diagnoses of any co-occurring mental health conditions, using discharge diagnosis codes or reason-for-visit codes.
- The focus was to identify the percentages of ED visits for suicide attempts and intentional self-harm, with analyses done per 100,000 persons and for changes possibly linked to the COVID-19 pandemic in 2019-2020.
TAKEAWAY:
- The number of ED visits owing to suicide attempts and intentional self-harm increased from 1.43 million in 2011-2012 to 5.37 million in 2019-2020 (average annual percent change, 19.5%; 95% confidence interval, 16.9-22.2).
- The rate of ED visits for suicide attempts and intentional self-harm was higher among adolescents and young adults, particularly women, and lower among children.
- Despite a surge in ED visits for self-harm, less than 16% included a mental health evaluation, with visits among patients with mood disorders decreasing by 5.5% annually and those among patients with drug-related disorders increasing by 6.8% annually.
- In 2019-2020, those aged 15-20 years had the highest rate of ED visits (1552 visits per 100,000 persons), with a significant increase seen across all age groups; the largest increase was among those aged 65 years or older.
IN PRACTICE:
“Given that suicide attempts are the single greatest risk factor for suicide, evidence-based management of individuals presenting to emergency departments with suicide attempts and intentional self-harm is a critical component of comprehensive suicide prevention strategies,” the authors wrote.
SOURCE:
The investigation, led by Tanner J. Bommersbach, MD, MPH, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, was published online in The American Journal of Psychiatry.
LIMITATIONS:
Visits for suicide attempts and intentional self-harm were identified based on discharge diagnostic and reason-for-visit codes, which may have led to an underestimation of visits for suicide attempts. ED visits for suicidal vs nonsuicidal self-injury could not be distinguished due to reliance on discharge diagnostic codes. Visits for suicidal ideation, which was not the focus of the study, may have been miscoded as suicide attempts and intentional self-harm.
DISCLOSURES:
No funding source was reported for the study. Some authors received funding grants from various institutions, and one author disclosed receiving honoraria for service as a review committee member and serving as a stakeholder/consultant and as an advisory committee member for some institutes and agencies.
A version of this article appeared on Medscape.com.
TOPLINE:
Emergency department (ED) visits in the United States for suicide attempts and intentional self-harm show an increasing trend from 2011 to 2020, with visits being most common among adolescents and the largest increase in visits being seen in adults aged 65 years or older.
METHODOLOGY:
- This study used data from the National Hospital Ambulatory Medical Care Survey, an annual nationwide cross-sectional survey, to track trends in ED visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020.
- Researchers identified visits for suicide attempts and intentional self-harm, along with diagnoses of any co-occurring mental health conditions, using discharge diagnosis codes or reason-for-visit codes.
- The focus was to identify the percentages of ED visits for suicide attempts and intentional self-harm, with analyses done per 100,000 persons and for changes possibly linked to the COVID-19 pandemic in 2019-2020.
TAKEAWAY:
- The number of ED visits owing to suicide attempts and intentional self-harm increased from 1.43 million in 2011-2012 to 5.37 million in 2019-2020 (average annual percent change, 19.5%; 95% confidence interval, 16.9-22.2).
- The rate of ED visits for suicide attempts and intentional self-harm was higher among adolescents and young adults, particularly women, and lower among children.
- Despite a surge in ED visits for self-harm, less than 16% included a mental health evaluation, with visits among patients with mood disorders decreasing by 5.5% annually and those among patients with drug-related disorders increasing by 6.8% annually.
- In 2019-2020, those aged 15-20 years had the highest rate of ED visits (1552 visits per 100,000 persons), with a significant increase seen across all age groups; the largest increase was among those aged 65 years or older.
IN PRACTICE:
“Given that suicide attempts are the single greatest risk factor for suicide, evidence-based management of individuals presenting to emergency departments with suicide attempts and intentional self-harm is a critical component of comprehensive suicide prevention strategies,” the authors wrote.
SOURCE:
The investigation, led by Tanner J. Bommersbach, MD, MPH, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, was published online in The American Journal of Psychiatry.
LIMITATIONS:
Visits for suicide attempts and intentional self-harm were identified based on discharge diagnostic and reason-for-visit codes, which may have led to an underestimation of visits for suicide attempts. ED visits for suicidal vs nonsuicidal self-injury could not be distinguished due to reliance on discharge diagnostic codes. Visits for suicidal ideation, which was not the focus of the study, may have been miscoded as suicide attempts and intentional self-harm.
DISCLOSURES:
No funding source was reported for the study. Some authors received funding grants from various institutions, and one author disclosed receiving honoraria for service as a review committee member and serving as a stakeholder/consultant and as an advisory committee member for some institutes and agencies.
A version of this article appeared on Medscape.com.
TOPLINE:
Emergency department (ED) visits in the United States for suicide attempts and intentional self-harm show an increasing trend from 2011 to 2020, with visits being most common among adolescents and the largest increase in visits being seen in adults aged 65 years or older.
METHODOLOGY:
- This study used data from the National Hospital Ambulatory Medical Care Survey, an annual nationwide cross-sectional survey, to track trends in ED visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020.
- Researchers identified visits for suicide attempts and intentional self-harm, along with diagnoses of any co-occurring mental health conditions, using discharge diagnosis codes or reason-for-visit codes.
- The focus was to identify the percentages of ED visits for suicide attempts and intentional self-harm, with analyses done per 100,000 persons and for changes possibly linked to the COVID-19 pandemic in 2019-2020.
TAKEAWAY:
- The number of ED visits owing to suicide attempts and intentional self-harm increased from 1.43 million in 2011-2012 to 5.37 million in 2019-2020 (average annual percent change, 19.5%; 95% confidence interval, 16.9-22.2).
- The rate of ED visits for suicide attempts and intentional self-harm was higher among adolescents and young adults, particularly women, and lower among children.
- Despite a surge in ED visits for self-harm, less than 16% included a mental health evaluation, with visits among patients with mood disorders decreasing by 5.5% annually and those among patients with drug-related disorders increasing by 6.8% annually.
- In 2019-2020, those aged 15-20 years had the highest rate of ED visits (1552 visits per 100,000 persons), with a significant increase seen across all age groups; the largest increase was among those aged 65 years or older.
IN PRACTICE:
“Given that suicide attempts are the single greatest risk factor for suicide, evidence-based management of individuals presenting to emergency departments with suicide attempts and intentional self-harm is a critical component of comprehensive suicide prevention strategies,” the authors wrote.
SOURCE:
The investigation, led by Tanner J. Bommersbach, MD, MPH, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, was published online in The American Journal of Psychiatry.
LIMITATIONS:
Visits for suicide attempts and intentional self-harm were identified based on discharge diagnostic and reason-for-visit codes, which may have led to an underestimation of visits for suicide attempts. ED visits for suicidal vs nonsuicidal self-injury could not be distinguished due to reliance on discharge diagnostic codes. Visits for suicidal ideation, which was not the focus of the study, may have been miscoded as suicide attempts and intentional self-harm.
DISCLOSURES:
No funding source was reported for the study. Some authors received funding grants from various institutions, and one author disclosed receiving honoraria for service as a review committee member and serving as a stakeholder/consultant and as an advisory committee member for some institutes and agencies.
A version of this article appeared on Medscape.com.
Fine Particulate Matter Raises Type 2 Diabetes Risk in Women
TOPLINE:
Long-term exposure to fine particulate matter is associated with higher fasting blood glucose (FBG) levels and an increased type 2 diabetes risk, significantly contributing to the diabetes-related health burden among women of reproductive age.
METHODOLOGY:
- Exposure to fine particulate matter < 2.5 µm (PM2.5) is a known risk factor for type 2 diabetes, but its effect on women of reproductive age, who undergo hormonal fluctuations during reproductive events, is not well studied.
- Researchers evaluated the association of long-term exposure to PM2.5 with FBG levels and diabetes risk in 20,076,032 eligible women of reproductive age (average age, 27.04 years) across 350 cities in China between 2010 and 2015.
- They assessed PM2.5 exposure at the participants’ residential addresses and calculated average long-term exposure at 1 (lag 1 year), 2 (lag 2 years), and 3 years (lag 3 years) before the survey date, as defined by the World Health Organization (WHO).
- The primary outcomes were FBG levels and diabetes prevalence (FBG, ≥ 7 mmol/L, classified as diabetes; FBG, 6.1-7 mmol/L, classified as prediabetes).
- The study also evaluated the diabetes burden attributed to long-term PM2.5 exposure as per the Chinese National Ambient Air Quality Standards (annual mean PM2.5 exposure limit, > 35 µg/m3) and the WHO air quality guideline (annual mean PM2.5 exposure limit, > 5 µg/m3).
TAKEAWAY:
- The median PM2.5 exposure levels over lag periods of 1, 2, and 3 years were 67, 67, and 66 µg/m3, respectively, exceeding the WHO limit by more than 13-fold.
- Each interquartile range increase in the 3-year average PM2.5 exposure by 27 μg/m3 raised FBG levels by 0.078 mmol/L (P < .05), risk for diabetes by 18% (odds ratio [OR], 1.18; 95% CI, 1.16-1.19), and risk for prediabetes by 5% (OR, 1.05; 95% CI, 1.04-1.05).
- Long-term exposure to PM2.5 > 5 µg/m3 and 35 µg/m3 in the previous 3 years corresponded to an additional 41.7 (95% CI, 39.3-44.0) and 78.6 (95% CI, 74.5-82.6) thousand cases of diabetes nationwide, respectively.
- A higher PM2.5 exposure increased FBG levels and risk for diabetes in women with overweight or obesity vs those without and in those aged ≥ 35 years vs < 35 years (P < .001).
IN PRACTICE:
“These findings carry significant public health implications for formulating effective intervention strategies and environmental policies to better protect women’s health, particularly in countries with relatively high levels of air pollution and a large population with diabetes, such as China,” the authors wrote.
SOURCE:
The study, led by Yang Shen, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China, was published online in Diabetes Care.
LIMITATIONS:
An error in the measurement of particulate matter exposure may have been possible as residential address estimates were used as a proxy for actual personal exposure. Questionnaires were used to retrospectively collect information on parameters such as smoking and alcohol consumption, which may have introduced recall bias. Data on potential confounders, such as diet and physical activity, were not included. Distinction between type 1 and type 2 diabetes was not reported owing to data collection–related limitations.
DISCLOSURES:
The study was supported by the National Key Research and Development Program of China, Henan Key Research and Development Program, State Key Laboratory of Resources and Environmental Information System, and Three-Year Public Health Action Plan of Shanghai. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
Long-term exposure to fine particulate matter is associated with higher fasting blood glucose (FBG) levels and an increased type 2 diabetes risk, significantly contributing to the diabetes-related health burden among women of reproductive age.
METHODOLOGY:
- Exposure to fine particulate matter < 2.5 µm (PM2.5) is a known risk factor for type 2 diabetes, but its effect on women of reproductive age, who undergo hormonal fluctuations during reproductive events, is not well studied.
- Researchers evaluated the association of long-term exposure to PM2.5 with FBG levels and diabetes risk in 20,076,032 eligible women of reproductive age (average age, 27.04 years) across 350 cities in China between 2010 and 2015.
- They assessed PM2.5 exposure at the participants’ residential addresses and calculated average long-term exposure at 1 (lag 1 year), 2 (lag 2 years), and 3 years (lag 3 years) before the survey date, as defined by the World Health Organization (WHO).
- The primary outcomes were FBG levels and diabetes prevalence (FBG, ≥ 7 mmol/L, classified as diabetes; FBG, 6.1-7 mmol/L, classified as prediabetes).
- The study also evaluated the diabetes burden attributed to long-term PM2.5 exposure as per the Chinese National Ambient Air Quality Standards (annual mean PM2.5 exposure limit, > 35 µg/m3) and the WHO air quality guideline (annual mean PM2.5 exposure limit, > 5 µg/m3).
TAKEAWAY:
- The median PM2.5 exposure levels over lag periods of 1, 2, and 3 years were 67, 67, and 66 µg/m3, respectively, exceeding the WHO limit by more than 13-fold.
- Each interquartile range increase in the 3-year average PM2.5 exposure by 27 μg/m3 raised FBG levels by 0.078 mmol/L (P < .05), risk for diabetes by 18% (odds ratio [OR], 1.18; 95% CI, 1.16-1.19), and risk for prediabetes by 5% (OR, 1.05; 95% CI, 1.04-1.05).
- Long-term exposure to PM2.5 > 5 µg/m3 and 35 µg/m3 in the previous 3 years corresponded to an additional 41.7 (95% CI, 39.3-44.0) and 78.6 (95% CI, 74.5-82.6) thousand cases of diabetes nationwide, respectively.
- A higher PM2.5 exposure increased FBG levels and risk for diabetes in women with overweight or obesity vs those without and in those aged ≥ 35 years vs < 35 years (P < .001).
IN PRACTICE:
“These findings carry significant public health implications for formulating effective intervention strategies and environmental policies to better protect women’s health, particularly in countries with relatively high levels of air pollution and a large population with diabetes, such as China,” the authors wrote.
SOURCE:
The study, led by Yang Shen, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China, was published online in Diabetes Care.
LIMITATIONS:
An error in the measurement of particulate matter exposure may have been possible as residential address estimates were used as a proxy for actual personal exposure. Questionnaires were used to retrospectively collect information on parameters such as smoking and alcohol consumption, which may have introduced recall bias. Data on potential confounders, such as diet and physical activity, were not included. Distinction between type 1 and type 2 diabetes was not reported owing to data collection–related limitations.
DISCLOSURES:
The study was supported by the National Key Research and Development Program of China, Henan Key Research and Development Program, State Key Laboratory of Resources and Environmental Information System, and Three-Year Public Health Action Plan of Shanghai. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
Long-term exposure to fine particulate matter is associated with higher fasting blood glucose (FBG) levels and an increased type 2 diabetes risk, significantly contributing to the diabetes-related health burden among women of reproductive age.
METHODOLOGY:
- Exposure to fine particulate matter < 2.5 µm (PM2.5) is a known risk factor for type 2 diabetes, but its effect on women of reproductive age, who undergo hormonal fluctuations during reproductive events, is not well studied.
- Researchers evaluated the association of long-term exposure to PM2.5 with FBG levels and diabetes risk in 20,076,032 eligible women of reproductive age (average age, 27.04 years) across 350 cities in China between 2010 and 2015.
- They assessed PM2.5 exposure at the participants’ residential addresses and calculated average long-term exposure at 1 (lag 1 year), 2 (lag 2 years), and 3 years (lag 3 years) before the survey date, as defined by the World Health Organization (WHO).
- The primary outcomes were FBG levels and diabetes prevalence (FBG, ≥ 7 mmol/L, classified as diabetes; FBG, 6.1-7 mmol/L, classified as prediabetes).
- The study also evaluated the diabetes burden attributed to long-term PM2.5 exposure as per the Chinese National Ambient Air Quality Standards (annual mean PM2.5 exposure limit, > 35 µg/m3) and the WHO air quality guideline (annual mean PM2.5 exposure limit, > 5 µg/m3).
TAKEAWAY:
- The median PM2.5 exposure levels over lag periods of 1, 2, and 3 years were 67, 67, and 66 µg/m3, respectively, exceeding the WHO limit by more than 13-fold.
- Each interquartile range increase in the 3-year average PM2.5 exposure by 27 μg/m3 raised FBG levels by 0.078 mmol/L (P < .05), risk for diabetes by 18% (odds ratio [OR], 1.18; 95% CI, 1.16-1.19), and risk for prediabetes by 5% (OR, 1.05; 95% CI, 1.04-1.05).
- Long-term exposure to PM2.5 > 5 µg/m3 and 35 µg/m3 in the previous 3 years corresponded to an additional 41.7 (95% CI, 39.3-44.0) and 78.6 (95% CI, 74.5-82.6) thousand cases of diabetes nationwide, respectively.
- A higher PM2.5 exposure increased FBG levels and risk for diabetes in women with overweight or obesity vs those without and in those aged ≥ 35 years vs < 35 years (P < .001).
IN PRACTICE:
“These findings carry significant public health implications for formulating effective intervention strategies and environmental policies to better protect women’s health, particularly in countries with relatively high levels of air pollution and a large population with diabetes, such as China,” the authors wrote.
SOURCE:
The study, led by Yang Shen, Key Laboratory of Public Health Safety of the Ministry of Education and National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China, was published online in Diabetes Care.
LIMITATIONS:
An error in the measurement of particulate matter exposure may have been possible as residential address estimates were used as a proxy for actual personal exposure. Questionnaires were used to retrospectively collect information on parameters such as smoking and alcohol consumption, which may have introduced recall bias. Data on potential confounders, such as diet and physical activity, were not included. Distinction between type 1 and type 2 diabetes was not reported owing to data collection–related limitations.
DISCLOSURES:
The study was supported by the National Key Research and Development Program of China, Henan Key Research and Development Program, State Key Laboratory of Resources and Environmental Information System, and Three-Year Public Health Action Plan of Shanghai. The authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.