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Month: October 2015

Are Newest Screening Recommendations for Type 2 Diabetes Falling Short?

In an update to their 2008 recommendations, the US Preventive Services Task Force (USPSTF) is calling for screening of overweight and obese adults between 40 and 70 years of age for abnormal blood glucose levels and type 2 diabetes. The recommendation applies to individuals being seen in primary care settings with no symptoms of type 2 diabetes as a component of cardiovascular risk assessment. Adults who are shown to have elevated glucose levels should be referred for intensive behavioral counseling, emphasizing a healthy diet and regular physical activity. Read more

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Education of Youth Is Key to Promoting Wellness and Alleviating the Obesity Epidemic

Results of a recent study found that among children and young adults with a BMI at the 85th percentile or higher, cardiometabolic risk factors including low HDL-C, high systolic and diastolic blood pressures, and high triglyceride and glycated hemoglobin levels increased with the severity of obesity. Commenting on the study, CMHC faculty member Caroline Apovian, MD pointed out the prevalence of severe obesity in children between 2 and 19 years of age has increased at an alarming rate, from 4% to 6% for the block of years from 1999 to 2004 and 2011 to 2012. However, she said, educating the young, even those as young as preschool age, is key in combating obesity and promoting wellness, citing the Si! Program in Madrid, Spain as a successful example. Read more

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USPSTF Recommends ABPM to Confirm Hypertension Diagnosis and Yearly Screening for Higher Risk Groups

In an update to their 2007 reaffirmation recommendation statement, the US Preventive Services Task Force (USPSTF) finalized Grade A recommendations for blood pressure screening of adults. The use of ambulatory blood pressure management (ABPM) is recommended to confirm a diagnosis of hypertension outside of the clinical setting before treatment begins. (The exception to this recommendation is for cases in which therapy should begin immediately.) Further, adults 40 years of age and older and those at higher risk should undergo screening every year after a normal blood pressure finding; others can be screened every 3 to 5 years.

In response to public comments that were received after the draft version of the recommendation statement was released in December 2014, the USPSTF acknowledges there are barriers to implementing their recommendation of utilizing ABPM due to availability and affordability. In response, their final recommendation is “to include home blood pressure monitoring (HBPM) as an alternative method for confirmation of a diagnosis of hypertension when ABPM is not feasible.”

To learn more, plan to attend the Hypertension and Cardio-Renal Syndrome session at the 10th Annual CMHC on Friday, October 23, and read more on the USPSTF recommendations here.

Screening for high blood pressure in adults: US Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 13 October 2015 doi:10.7326/M15-2223.

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Bariatric Surgery Appears to Cure Half of Patients with T2DM for at Least 5 Years

In a study of obese patients with type 2 diabetes, bariatric surgery was found to be more effective than medical treatment in the long-term control of the disease (for at least 5 years). The study consisted of 60 patients randomized to either medical treatment or surgery (Roux-en-Y gastric bypass or biliopancreatic diversion). The primary endpoint was the rate of diabetes remission at 2 years (defined as HbA1c of 6.5% or less and a fasting glucose concentration of 5.6 mmol/L or less) without active pharmacologic treatment for 1 year. Patients were followed up for 5 years. Among 38 patients who underwent surgery, 19 (50%) maintained diabetes remission at 5 years compared with none of the 15 medically treated patients. The study authors advise continued monitoring of glycemic control because of a potential relapse for hyperglycemia.

Read the complete study here in The Lancet. To learn more from one of the study authors, Dr. Francesco Rubino, be sure to attend the 10th Annual CMHC where he will co-present “Long-Term and Metabolic Effects of Bariatric Surgery” on Friday, October 23, from 3:25 – 4:05 pm with Dr. Lee M. Kaplan.

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Elevated Blood Pressure Increases Risk of Type 2 Diabetes

Results of a recent study published in the Journal of the American College of Cardiology are lending weight to the widely believed hypothesis that hypertension is an independent risk factor for type 2 diabetes. The study, an analysis of electronic health records and a meta-analysis, consisted of 4.1 million adults without diabetes and cardiovascular disease. The objective was to evaluate the association between usual blood pressure and risk of diabetes.

Each 20 mmHg increase in systolic blood pressure and 10 mmHg increase in diastolic blood pressure was associated with a 58% and a 52% higher risk of new-onset diabetes. The strength of that association per 20 mmHg higher SBP decreased with age and increasing body mass index. According to the study authors, “Elevated blood pressure is associated with chronic inflammation and endothelial dysfunction, both of which appear to be mediators of diabetes risk. There is, therefore, a biological rationale to suspect that elevated blood pressure may cause new-onset diabetes.” Read more

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