Michele G. Sullivan

Unplanned hospitalizations are common among older adults with gastrointestinal cancers, especially in the first few months after surgery or chemotherapy.

About 60% experienced at least one unplanned admission, most often for fluid and electrolyte disorders, intestinal obstruction, or pneumonia, Dr. Joanna-Grace M. Manzano and her associates reported (J. Clin. Oncol. 2014 Oct. 6 [doi:10.1200/JCO.2014.55.3131]).

A number of demographic and clinical characteristics increased the risk of such admissions, including black race, low socioeconomic status, dual Medicare/Medicaid eligibility, multiple comorbidities, and advanced disease, said Dr. Manzano of the University of Texas MD Anderson Cancer Center, Houston, and her coauthors. Patients with pancreatic, gastric, and esophageal cancers were especially at risk, they noted.

The team reviewed the medical claims of 30,199 patients older than 66 years who had a diagnosis of gastrointestinal cancer. The mean observation time was 15 months. Among these, there were 60,837 claims; more than half of those were for unplanned hospitalizations. The mean time to first admission was about 2 months after oncologic treatment.

Of those who had such a hospitalization, 19% had undergone chemotherapy, radiotherapy, or a surgical procedure in the prior 30 days. In addition, 9% had visited an emergency department.

Understanding these risk factors could help clinicians keep a preemptive eye out for problems. “Knowing who is at risk for an unplanned hospitalization also opens up opportunities for

anticipatory guidance and patient education during the active phase of treatment,” the investigators wrote.

The authors had no financial disclosures.

[email protected]

On Twitter @alz_gal

Unplanned hospitalizations are common among older adults with gastrointestinal cancers, especially in the first few months after surgery or chemotherapy.

About 60% experienced at least one unplanned admission, most often for fluid and electrolyte disorders, intestinal obstruction, or pneumonia, Dr. Joanna-Grace M. Manzano and her associates reported (J. Clin. Oncol. 2014 Oct. 6 [doi:10.1200/JCO.2014.55.3131]).

A number of demographic and clinical characteristics increased the risk of such admissions, including black race, low socioeconomic status, dual Medicare/Medicaid eligibility, multiple comorbidities, and advanced disease, said Dr. Manzano of the University of Texas MD Anderson Cancer Center, Houston, and her coauthors. Patients with pancreatic, gastric, and esophageal cancers were especially at risk, they noted.

The team reviewed the medical claims of 30,199 patients older than 66 years who had a diagnosis of gastrointestinal cancer. The mean observation time was 15 months. Among these, there were 60,837 claims; more than half of those were for unplanned hospitalizations. The mean time to first admission was about 2 months after oncologic treatment.

Of those who had such a hospitalization, 19% had undergone chemotherapy, radiotherapy, or a surgical procedure in the prior 30 days. In addition, 9% had visited an emergency department.

Understanding these risk factors could help clinicians keep a preemptive eye out for problems. “Knowing who is at risk for an unplanned hospitalization also opens up opportunities for

anticipatory guidance and patient education during the active phase of treatment,” the investigators wrote.

The authors had no financial disclosures.

[email protected]

On Twitter @alz_gal

Unplanned hospitalizations are common among older adults with gastrointestinal cancers, especially in the first few months after surgery or chemotherapy.

About 60% experienced at least one unplanned admission, most often for fluid and electrolyte disorders, intestinal obstruction, or pneumonia, Dr. Joanna-Grace M. Manzano and her associates reported (J. Clin. Oncol. 2014 Oct. 6 [doi:10.1200/JCO.2014.55.3131]).

A number of demographic and clinical characteristics increased the risk of such admissions, including black race, low socioeconomic status, dual Medicare/Medicaid eligibility, multiple comorbidities, and advanced disease, said Dr. Manzano of the University of Texas MD Anderson Cancer Center, Houston, and her coauthors. Patients with pancreatic, gastric, and esophageal cancers were especially at risk, they noted.

The team reviewed the medical claims of 30,199 patients older than 66 years who had a diagnosis of gastrointestinal cancer. The mean observation time was 15 months. Among these, there were 60,837 claims; more than half of those were for unplanned hospitalizations. The mean time to first admission was about 2 months after oncologic treatment.

Of those who had such a hospitalization, 19% had undergone chemotherapy, radiotherapy, or a surgical procedure in the prior 30 days. In addition, 9% had visited an emergency department.

Understanding these risk factors could help clinicians keep a preemptive eye out for problems. “Knowing who is at risk for an unplanned hospitalization also opens up opportunities for

anticipatory guidance and patient education during the active phase of treatment,” the investigators wrote.

The authors had no financial disclosures.

[email protected]

On Twitter @alz_gal

VIENNA – By age 4 years, the children of women who were overweight or obese before their pregnancy scored 3-4 points below normal on measures of neurocognitive development.

The children showed deficits in motor and memory scales, as well as in general cognition, Dr. Leda Chatzi said at the annual meeting of the European Association for the Study of Diabetes.

Children whose mothers had gestational diabetes did not exhibit similar decreased cognitive scores. They were, however, significantly more likely to exhibit symptoms of attention-deficit/hyperactivity disorder, said Dr. Chatzi of the University of Crete, Heraklion, Greece.

“These findings have important public health implications, given the increasing prevalence of maternal obesity and gestational diabetes worldwide,” she said.

Dr. Chatzi presented a subanalysis of the Rhea Study, a mother-child birth cohort that began in Crete in 2007 with the aim of investigating the potential risks maternal environment and lifestyle might exert upon offspring – including maternal obesity. It comprises about 1,300 live singleton births. At entry, mothers give urine and blood samples and undergo anthropometric measurements. Cord blood is collected at birth. Mothers and children are followed from birth onward with anthropometrics, psychological and clinical exams, neurodevelopmental testing, and further biological samples. The oldest children in the cohort are now 7 years old; follow-up continues.

Dr. Chatzi’s study comprised 707 mother-child pairs; the children were 4 years old at the time of this analysis. Maternal factors considered in the analysis included fasting glucose and insulin levels at gestational weeks 10-14, body mass index before pregnancy and at the end of the first trimester, and the development of gestational diabetes.

The children underwent several tests of neurocognition, including the McCarthy Scales of Children’s Abilities; the Attentional Deficit Hyperactivity Disorder Test; and the Strengths and Difficulties Questionnaire.

The McCarthy scale includes several subscales: perceptual, quantitative, motor, verbal, memory, and general cognition. A multivariate analysis controlled for the child’s gender, body mass index (BMI), and preschool attendance; maternal demographics and smoking; and the duration of breastfeeding.

At delivery, mothers had a mean age of 30 years; 32% smoked during pregnancy. The infants’ mean gestational age was 38 weeks. Breastfeeding lasted a mean of 4 months.

About one-third of the mothers were either overweight (21%) or obese (13%). Most of those (92%) developed gestational diabetes.

As maternal prepregnancy BMI increased, child scores on general cognition, memory, and motor subscales decreased. The break point for decline below population norms seemed to be between 25 and 30 kg/m2. The children of women whose prepregnancy BMI approached 40 kg/m2 scored a mean of 3-4 points lower on general cognition and the subscales of memory, quantitative, perceptual, and motor performance.

Prepregnancy BMI had no effect on attention-deficit/hyperactivity disorder scores. However, ADHD scores increased significantly in the children of mothers who developed gestational diabetes.

The pathophysiologic link between gestational diabetes and ADHD has never been elucidated, Dr. Chatzi noted. It’s something she intends to investigate. “We’re planning to evaluate these children at later ages, including studying inflammatory markers and potential genetic markers of DNA methylation,” she said.

Dr. Chatzi had no financial disclosures.

[email protected]

On Twitter @alz_gal

VIENNA – By age 4 years, the children of women who were overweight or obese before their pregnancy scored 3-4 points below normal on measures of neurocognitive development.

The children showed deficits in motor and memory scales, as well as in general cognition, Dr. Leda Chatzi said at the annual meeting of the European Association for the Study of Diabetes.

Children whose mothers had gestational diabetes did not exhibit similar decreased cognitive scores. They were, however, significantly more likely to exhibit symptoms of attention-deficit/hyperactivity disorder, said Dr. Chatzi of the University of Crete, Heraklion, Greece.

“These findings have important public health implications, given the increasing prevalence of maternal obesity and gestational diabetes worldwide,” she said.

Dr. Chatzi presented a subanalysis of the Rhea Study, a mother-child birth cohort that began in Crete in 2007 with the aim of investigating the potential risks maternal environment and lifestyle might exert upon offspring – including maternal obesity. It comprises about 1,300 live singleton births. At entry, mothers give urine and blood samples and undergo anthropometric measurements. Cord blood is collected at birth. Mothers and children are followed from birth onward with anthropometrics, psychological and clinical exams, neurodevelopmental testing, and further biological samples. The oldest children in the cohort are now 7 years old; follow-up continues.

Dr. Chatzi’s study comprised 707 mother-child pairs; the children were 4 years old at the time of this analysis. Maternal factors considered in the analysis included fasting glucose and insulin levels at gestational weeks 10-14, body mass index before pregnancy and at the end of the first trimester, and the development of gestational diabetes.

The children underwent several tests of neurocognition, including the McCarthy Scales of Children’s Abilities; the Attentional Deficit Hyperactivity Disorder Test; and the Strengths and Difficulties Questionnaire.

The McCarthy scale includes several subscales: perceptual, quantitative, motor, verbal, memory, and general cognition. A multivariate analysis controlled for the child’s gender, body mass index (BMI), and preschool attendance; maternal demographics and smoking; and the duration of breastfeeding.

At delivery, mothers had a mean age of 30 years; 32% smoked during pregnancy. The infants’ mean gestational age was 38 weeks. Breastfeeding lasted a mean of 4 months.

About one-third of the mothers were either overweight (21%) or obese (13%). Most of those (92%) developed gestational diabetes.

As maternal prepregnancy BMI increased, child scores on general cognition, memory, and motor subscales decreased. The break point for decline below population norms seemed to be between 25 and 30 kg/m2. The children of women whose prepregnancy BMI approached 40 kg/m2 scored a mean of 3-4 points lower on general cognition and the subscales of memory, quantitative, perceptual, and motor performance.

Prepregnancy BMI had no effect on attention-deficit/hyperactivity disorder scores. However, ADHD scores increased significantly in the children of mothers who developed gestational diabetes.

The pathophysiologic link between gestational diabetes and ADHD has never been elucidated, Dr. Chatzi noted. It’s something she intends to investigate. “We’re planning to evaluate these children at later ages, including studying inflammatory markers and potential genetic markers of DNA methylation,” she said.

Dr. Chatzi had no financial disclosures.

[email protected]

On Twitter @alz_gal

VIENNA – By age 4 years, the children of women who were overweight or obese before their pregnancy scored 3-4 points below normal on measures of neurocognitive development.

The children showed deficits in motor and memory scales, as well as in general cognition, Dr. Leda Chatzi said at the annual meeting of the European Association for the Study of Diabetes.

Children whose mothers had gestational diabetes did not exhibit similar decreased cognitive scores. They were, however, significantly more likely to exhibit symptoms of attention-deficit/hyperactivity disorder, said Dr. Chatzi of the University of Crete, Heraklion, Greece.

“These findings have important public health implications, given the increasing prevalence of maternal obesity and gestational diabetes worldwide,” she said.

Dr. Chatzi presented a subanalysis of the Rhea Study, a mother-child birth cohort that began in Crete in 2007 with the aim of investigating the potential risks maternal environment and lifestyle might exert upon offspring – including maternal obesity. It comprises about 1,300 live singleton births. At entry, mothers give urine and blood samples and undergo anthropometric measurements. Cord blood is collected at birth. Mothers and children are followed from birth onward with anthropometrics, psychological and clinical exams, neurodevelopmental testing, and further biological samples. The oldest children in the cohort are now 7 years old; follow-up continues.

Dr. Chatzi’s study comprised 707 mother-child pairs; the children were 4 years old at the time of this analysis. Maternal factors considered in the analysis included fasting glucose and insulin levels at gestational weeks 10-14, body mass index before pregnancy and at the end of the first trimester, and the development of gestational diabetes.

The children underwent several tests of neurocognition, including the McCarthy Scales of Children’s Abilities; the Attentional Deficit Hyperactivity Disorder Test; and the Strengths and Difficulties Questionnaire.

The McCarthy scale includes several subscales: perceptual, quantitative, motor, verbal, memory, and general cognition. A multivariate analysis controlled for the child’s gender, body mass index (BMI), and preschool attendance; maternal demographics and smoking; and the duration of breastfeeding.

At delivery, mothers had a mean age of 30 years; 32% smoked during pregnancy. The infants’ mean gestational age was 38 weeks. Breastfeeding lasted a mean of 4 months.

About one-third of the mothers were either overweight (21%) or obese (13%). Most of those (92%) developed gestational diabetes.

As maternal prepregnancy BMI increased, child scores on general cognition, memory, and motor subscales decreased. The break point for decline below population norms seemed to be between 25 and 30 kg/m2. The children of women whose prepregnancy BMI approached 40 kg/m2 scored a mean of 3-4 points lower on general cognition and the subscales of memory, quantitative, perceptual, and motor performance.

Prepregnancy BMI had no effect on attention-deficit/hyperactivity disorder scores. However, ADHD scores increased significantly in the children of mothers who developed gestational diabetes.

The pathophysiologic link between gestational diabetes and ADHD has never been elucidated, Dr. Chatzi noted. It’s something she intends to investigate. “We’re planning to evaluate these children at later ages, including studying inflammatory markers and potential genetic markers of DNA methylation,” she said.

Dr. Chatzi had no financial disclosures.

[email protected]

On Twitter @alz_gal

Even moderate consumption of fried foods before pregnancy can significantly increase the risk of gestational diabetes, a large retrospective study has determined.

© American Heart Association

Depending on how often fried foods were consumed each week, the risk increased anywhere from 13% to more than double, compared with those who abstained from fried foods. The risks were relatively stable when body weight was controlled for, and higher for foods eaten away from home than in-home. These findings seem to support the authors’ conjecture that chemical changes, rather than calories, may be the root problem.

“The potential detrimental effects may result from the modification of foods and frying medium, and generation of harmful by-products during the frying process,” especially because frying oils in restaurants are generally reused, increasing degradation, Dr. Wei Bao, of the National Institutes of Health, and his associates wrote in the Oct. 8 issue of Diabetologia (2014 [doi: 10.1007/s00125-014-3382-x]). “Frying deteriorates oils through the processes of oxidation and hydrogenation, leading to an increase in the absorption of oil degradation products by the foods being fried, and also a loss of unsaturated fatty acids ... and an increase in the corresponding trans-fatty acids.”

Frying also results in the production of advanced glycation end products, which, because they increase oxidative stress and inflammation, have been implicated in insulin resistance, beta-cell damage, and diabetes.

The team used data from the Nurses’ Health Study to examine the relationship between consuming fried foods and the development of gestational diabetes. The cohort included 21,079 singleton pregnancies. Among these, there were 847 (4%) incident cases of gestational diabetes. The analysis compared fried foods consumed 1-3, 4-6, and 7 or more times per week, to consumption less than once per week.

The relative risks were significantly increased for each of these consumption patterns (1.13, 1.31, and 2.18, respectively). The significant association was somewhat attenuated, but remained significant, after adjustment for body mass index.

However, the results were altered when the authors broke their general analysis down into consumption of fried foods up to four times weekly, either away from or at home. Only consumption away from home remained significantly associated with gestational diabetes (relative risk, 1.63)

The National Institutes of Health funded the study. The authors had no financial disclosures.

[email protected]


On Twitter @alz_gal

Even moderate consumption of fried foods before pregnancy can significantly increase the risk of gestational diabetes, a large retrospective study has determined.

© American Heart Association

Depending on how often fried foods were consumed each week, the risk increased anywhere from 13% to more than double, compared with those who abstained from fried foods. The risks were relatively stable when body weight was controlled for, and higher for foods eaten away from home than in-home. These findings seem to support the authors’ conjecture that chemical changes, rather than calories, may be the root problem.

“The potential detrimental effects may result from the modification of foods and frying medium, and generation of harmful by-products during the frying process,” especially because frying oils in restaurants are generally reused, increasing degradation, Dr. Wei Bao, of the National Institutes of Health, and his associates wrote in the Oct. 8 issue of Diabetologia (2014 [doi: 10.1007/s00125-014-3382-x]). “Frying deteriorates oils through the processes of oxidation and hydrogenation, leading to an increase in the absorption of oil degradation products by the foods being fried, and also a loss of unsaturated fatty acids ... and an increase in the corresponding trans-fatty acids.”

Frying also results in the production of advanced glycation end products, which, because they increase oxidative stress and inflammation, have been implicated in insulin resistance, beta-cell damage, and diabetes.

The team used data from the Nurses’ Health Study to examine the relationship between consuming fried foods and the development of gestational diabetes. The cohort included 21,079 singleton pregnancies. Among these, there were 847 (4%) incident cases of gestational diabetes. The analysis compared fried foods consumed 1-3, 4-6, and 7 or more times per week, to consumption less than once per week.

The relative risks were significantly increased for each of these consumption patterns (1.13, 1.31, and 2.18, respectively). The significant association was somewhat attenuated, but remained significant, after adjustment for body mass index.

However, the results were altered when the authors broke their general analysis down into consumption of fried foods up to four times weekly, either away from or at home. Only consumption away from home remained significantly associated with gestational diabetes (relative risk, 1.63)

The National Institutes of Health funded the study. The authors had no financial disclosures.

[email protected]


On Twitter @alz_gal

Even moderate consumption of fried foods before pregnancy can significantly increase the risk of gestational diabetes, a large retrospective study has determined.

© American Heart Association

Depending on how often fried foods were consumed each week, the risk increased anywhere from 13% to more than double, compared with those who abstained from fried foods. The risks were relatively stable when body weight was controlled for, and higher for foods eaten away from home than in-home. These findings seem to support the authors’ conjecture that chemical changes, rather than calories, may be the root problem.

“The potential detrimental effects may result from the modification of foods and frying medium, and generation of harmful by-products during the frying process,” especially because frying oils in restaurants are generally reused, increasing degradation, Dr. Wei Bao, of the National Institutes of Health, and his associates wrote in the Oct. 8 issue of Diabetologia (2014 [doi: 10.1007/s00125-014-3382-x]). “Frying deteriorates oils through the processes of oxidation and hydrogenation, leading to an increase in the absorption of oil degradation products by the foods being fried, and also a loss of unsaturated fatty acids ... and an increase in the corresponding trans-fatty acids.”

Frying also results in the production of advanced glycation end products, which, because they increase oxidative stress and inflammation, have been implicated in insulin resistance, beta-cell damage, and diabetes.

The team used data from the Nurses’ Health Study to examine the relationship between consuming fried foods and the development of gestational diabetes. The cohort included 21,079 singleton pregnancies. Among these, there were 847 (4%) incident cases of gestational diabetes. The analysis compared fried foods consumed 1-3, 4-6, and 7 or more times per week, to consumption less than once per week.

The relative risks were significantly increased for each of these consumption patterns (1.13, 1.31, and 2.18, respectively). The significant association was somewhat attenuated, but remained significant, after adjustment for body mass index.

However, the results were altered when the authors broke their general analysis down into consumption of fried foods up to four times weekly, either away from or at home. Only consumption away from home remained significantly associated with gestational diabetes (relative risk, 1.63)

The National Institutes of Health funded the study. The authors had no financial disclosures.

[email protected]


On Twitter @alz_gal

Liberian health officials have stepped up their ability to respond to the ongoing Ebola epidemic, improving facilities and boosting personnel to help meet the crisis.

In response to last spring’s increasing cases in more populous areas of the country, officials undertook a facilities and personnel assessment in four rural counties in the southeast. Conducted in August, the review found serious problems with the ability to effectively respond to any developing Ebola threat, Dr. Joseph Forrester and his colleagues wrote in the Oct. 7 issue of the Morbidity and Mortality Weekly Report (2014;63:1-3).

© Hemera / ThinkStockPhotos.com

Each of the four reviewed counties contained one referral hospital; the region had previously been served by six physicians, but three of these had fled the county because of the epidemic, said Dr. Forrester, an infectious disease specialist with the Centers for Disease Control and Prevention.

In two hospitals, nursing staff had ceased coming to work; in another, workers were still providing care despite not having been paid for 3 months. Nursing students, aides, and community volunteers were providing much of basic medical care, and even responding to obstetric and surgical emergencies.

Even the most basic supplies were depleted or absent. There were few hand-washing stations, and most of these consisted of a simple water jug. Soap, bleach, and alcohol hand gels were rare. There were only rudimentary isolation facilities in two counties, and neither of these had water, electricity, or waste disposal. Communication between the hospitals and county health officials was via cell phone or radio, with little Internet connectivity. About half of the local health care facilities had no communications at all and required site visits for assessment. Only one ambulance served the entire four-county region. There was little or no protective equipment for those who would work with patients.

Although each county had an Ebola task force, problems with transportation, communication, and resources limited their effectiveness. Health care workers had not received proper training for Ebola patient care or case investigation, including how to trace patient contacts.

Since the assessment, however, things have improved, Dr. Forrester and his coauthors wrote. Health officials in one county were able to identify their first patient – a woman who died during a spontaneous abortion on Aug. 3. She had apparently been infected in Monrovia after attending a funeral. Shortly thereafter, patient 2 was diagnosed – a man who had participated in the community funeral of patient 1 and who was attempting to flee to another Liberian county. “He was sent back ... and later reported to have died of laboratory-confirmed Ebola. This was the first evidence of secondary transmission of Ebola in southeast Liberia,” the team noted.

Since August, additional cases have surfaced in southeast Liberia, but the region is better prepared to cope with them. Local health officials have been trained in surveillance, infection control and prevention, and safe burial practices. There are regular, coordinated task force meetings. Additional ambulances are available; there are plans to establish three specialized treatment centers.

“Still,” the researchers wrote, “obstacles to prevent the spread of Ebola remain, and personal protective equipment, sufficient personnel for effective contact tracing and case management, efficient patient transport, and regional diagnostic laboratory capabilities are urgently needed.”

The latest updates, including case counts, on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/Ebola/outbreaks/guinea/index.html. The most up-to-date clinical guidelines on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/ebola/hcp/index.html.

[email protected]

On Twitter @alz_gal

Liberian health officials have stepped up their ability to respond to the ongoing Ebola epidemic, improving facilities and boosting personnel to help meet the crisis.

In response to last spring’s increasing cases in more populous areas of the country, officials undertook a facilities and personnel assessment in four rural counties in the southeast. Conducted in August, the review found serious problems with the ability to effectively respond to any developing Ebola threat, Dr. Joseph Forrester and his colleagues wrote in the Oct. 7 issue of the Morbidity and Mortality Weekly Report (2014;63:1-3).

© Hemera / ThinkStockPhotos.com

Each of the four reviewed counties contained one referral hospital; the region had previously been served by six physicians, but three of these had fled the county because of the epidemic, said Dr. Forrester, an infectious disease specialist with the Centers for Disease Control and Prevention.

In two hospitals, nursing staff had ceased coming to work; in another, workers were still providing care despite not having been paid for 3 months. Nursing students, aides, and community volunteers were providing much of basic medical care, and even responding to obstetric and surgical emergencies.

Even the most basic supplies were depleted or absent. There were few hand-washing stations, and most of these consisted of a simple water jug. Soap, bleach, and alcohol hand gels were rare. There were only rudimentary isolation facilities in two counties, and neither of these had water, electricity, or waste disposal. Communication between the hospitals and county health officials was via cell phone or radio, with little Internet connectivity. About half of the local health care facilities had no communications at all and required site visits for assessment. Only one ambulance served the entire four-county region. There was little or no protective equipment for those who would work with patients.

Although each county had an Ebola task force, problems with transportation, communication, and resources limited their effectiveness. Health care workers had not received proper training for Ebola patient care or case investigation, including how to trace patient contacts.

Since the assessment, however, things have improved, Dr. Forrester and his coauthors wrote. Health officials in one county were able to identify their first patient – a woman who died during a spontaneous abortion on Aug. 3. She had apparently been infected in Monrovia after attending a funeral. Shortly thereafter, patient 2 was diagnosed – a man who had participated in the community funeral of patient 1 and who was attempting to flee to another Liberian county. “He was sent back ... and later reported to have died of laboratory-confirmed Ebola. This was the first evidence of secondary transmission of Ebola in southeast Liberia,” the team noted.

Since August, additional cases have surfaced in southeast Liberia, but the region is better prepared to cope with them. Local health officials have been trained in surveillance, infection control and prevention, and safe burial practices. There are regular, coordinated task force meetings. Additional ambulances are available; there are plans to establish three specialized treatment centers.

“Still,” the researchers wrote, “obstacles to prevent the spread of Ebola remain, and personal protective equipment, sufficient personnel for effective contact tracing and case management, efficient patient transport, and regional diagnostic laboratory capabilities are urgently needed.”

The latest updates, including case counts, on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/Ebola/outbreaks/guinea/index.html. The most up-to-date clinical guidelines on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/ebola/hcp/index.html.

[email protected]

On Twitter @alz_gal

Liberian health officials have stepped up their ability to respond to the ongoing Ebola epidemic, improving facilities and boosting personnel to help meet the crisis.

In response to last spring’s increasing cases in more populous areas of the country, officials undertook a facilities and personnel assessment in four rural counties in the southeast. Conducted in August, the review found serious problems with the ability to effectively respond to any developing Ebola threat, Dr. Joseph Forrester and his colleagues wrote in the Oct. 7 issue of the Morbidity and Mortality Weekly Report (2014;63:1-3).

© Hemera / ThinkStockPhotos.com

Each of the four reviewed counties contained one referral hospital; the region had previously been served by six physicians, but three of these had fled the county because of the epidemic, said Dr. Forrester, an infectious disease specialist with the Centers for Disease Control and Prevention.

In two hospitals, nursing staff had ceased coming to work; in another, workers were still providing care despite not having been paid for 3 months. Nursing students, aides, and community volunteers were providing much of basic medical care, and even responding to obstetric and surgical emergencies.

Even the most basic supplies were depleted or absent. There were few hand-washing stations, and most of these consisted of a simple water jug. Soap, bleach, and alcohol hand gels were rare. There were only rudimentary isolation facilities in two counties, and neither of these had water, electricity, or waste disposal. Communication between the hospitals and county health officials was via cell phone or radio, with little Internet connectivity. About half of the local health care facilities had no communications at all and required site visits for assessment. Only one ambulance served the entire four-county region. There was little or no protective equipment for those who would work with patients.

Although each county had an Ebola task force, problems with transportation, communication, and resources limited their effectiveness. Health care workers had not received proper training for Ebola patient care or case investigation, including how to trace patient contacts.

Since the assessment, however, things have improved, Dr. Forrester and his coauthors wrote. Health officials in one county were able to identify their first patient – a woman who died during a spontaneous abortion on Aug. 3. She had apparently been infected in Monrovia after attending a funeral. Shortly thereafter, patient 2 was diagnosed – a man who had participated in the community funeral of patient 1 and who was attempting to flee to another Liberian county. “He was sent back ... and later reported to have died of laboratory-confirmed Ebola. This was the first evidence of secondary transmission of Ebola in southeast Liberia,” the team noted.

Since August, additional cases have surfaced in southeast Liberia, but the region is better prepared to cope with them. Local health officials have been trained in surveillance, infection control and prevention, and safe burial practices. There are regular, coordinated task force meetings. Additional ambulances are available; there are plans to establish three specialized treatment centers.

“Still,” the researchers wrote, “obstacles to prevent the spread of Ebola remain, and personal protective equipment, sufficient personnel for effective contact tracing and case management, efficient patient transport, and regional diagnostic laboratory capabilities are urgently needed.”

The latest updates, including case counts, on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/Ebola/outbreaks/guinea/index.html. The most up-to-date clinical guidelines on the 2014 Ebola outbreak in West Africa are available at http://www.cdc.gov/vhf/ebola/hcp/index.html.

[email protected]

On Twitter @alz_gal

MILAN – The Food and Drug Administration has given full approval for ibrutinib for patients with chronic lymphocytic leukemia who have received at least one prior therapy and for those who have a deletion in chromosome 17 (17p deletion) and may or may not have received previous treatment.

At the annual congress of the European Hematology Association, Dr. Peter Hillmen discusses the results he presented from RESONATE, the study used to convert conditional, accelerated approval to full approval. The study evaluated daily ibrutinib monotherapy versus the anti-CD20 antibody ofatumumab, for patients with relapsed or refractory chronic lymphocytic leukemia (CLL).

Dr. Hillmen, professor of experimental hematology at the University of Leeds, England, also outlines some of the research in the works to evaluate ibrutinib as frontline therapy for patients with CLL and the possibility of chemotherapy-free regimens. He disclosed a consultancy role and honoraria from Pharmacyclics.

[email protected]

MILAN – The Food and Drug Administration has given full approval for ibrutinib for patients with chronic lymphocytic leukemia who have received at least one prior therapy and for those who have a deletion in chromosome 17 (17p deletion) and may or may not have received previous treatment.

At the annual congress of the European Hematology Association, Dr. Peter Hillmen discusses the results he presented from RESONATE, the study used to convert conditional, accelerated approval to full approval. The study evaluated daily ibrutinib monotherapy versus the anti-CD20 antibody ofatumumab, for patients with relapsed or refractory chronic lymphocytic leukemia (CLL).

Dr. Hillmen, professor of experimental hematology at the University of Leeds, England, also outlines some of the research in the works to evaluate ibrutinib as frontline therapy for patients with CLL and the possibility of chemotherapy-free regimens. He disclosed a consultancy role and honoraria from Pharmacyclics.

[email protected]

MILAN – The Food and Drug Administration has given full approval for ibrutinib for patients with chronic lymphocytic leukemia who have received at least one prior therapy and for those who have a deletion in chromosome 17 (17p deletion) and may or may not have received previous treatment.

At the annual congress of the European Hematology Association, Dr. Peter Hillmen discusses the results he presented from RESONATE, the study used to convert conditional, accelerated approval to full approval. The study evaluated daily ibrutinib monotherapy versus the anti-CD20 antibody ofatumumab, for patients with relapsed or refractory chronic lymphocytic leukemia (CLL).

Dr. Hillmen, professor of experimental hematology at the University of Leeds, England, also outlines some of the research in the works to evaluate ibrutinib as frontline therapy for patients with CLL and the possibility of chemotherapy-free regimens. He disclosed a consultancy role and honoraria from Pharmacyclics.

[email protected]

VIENNA – Children whose mothers had gestational diabetes and required antidiabetic medications may face a 22% increased risk of developing an autism spectrum disorder.

About a third of that increase was significantly associated with very-early diabetes diagnosis and treatment, suggesting that early first trimester hyperglycemia may affect fetal brain development, Anny H. Xiang, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes.

Michele G. Sullivan/Frontline Medical News

“My speculation is that, since fetal brain development is critical in the first and early second trimesters, exposure to high glucose during that time might damage its development,” said Dr Xiang, a senior research scientist at the Kaiser Permanente Department of Research and Evaluation in Pasadena, Calif. “Later exposure, perhaps, is not as problematic,” for the developing brain.

Her longitudinal cohort study included 315,827 singleton infants who were born at 28-44 weeks’ gestation between 1995 and 2009. This included 290,792 who were not exposed to gestational diabetes (GDM), and 25,035 who were. Of these, 5,891 had been exposed to antidiabetic medications.

All of the mothers were enrolled in Kaiser Permanente Southern California at the time of the birth, and all the children were still in the health plan by ages 1-2 years. Women who had preexisting type 1 or 2 diabetes were excluded form the study.

In accordance with the literature, mothers with GDM had lower educational levels and lower household incomes. They were older and more of them were multiparous. They were more likely to have had preeclampsia or eclampsia with a prior pregnancy. Asians and Pacific Islanders were more likely to have GDM than were other ethnicities.

Women who required antidiabetic treatment were diagnosed a mean of 4 weeks earlier than those who did not (23 vs. 27 weeks). Gestational ages at delivery did not significantly differ between the groups (39 weeks), but the infants of mothers with GDM were significantly heavier than were those of mothers without it. Infants exposed to antidiabetic medications weighed a mean of 3,453 g, compared with 3,380 g in nonmedication exposed infants, and 3,309 g in infants not exposed to GDM.

In the Kaiser system, standard well-baby care includes neurodevelopmental assessments at 1 year, 18 months, 2 years, and annually thereafter. Any concerns prompt a referral to a pediatric specialty clinic. For this study, diagnosis of autism required two diagnostic codes, one of which had to be from such a clinic.

Overall, the incidence rate of an autism spectrum disorder was 1.8/1,000 person-years. It was highest among those who had been exposed to antidiabetic medications (2.75/1,000 person-years) – significantly higher than that of both the GDM nonexposed and the non-GDM groups (1.96 and 1.77 per 1,000 person-years, respectively).

A multivariate analysis adjusted for a number of maternal and fetal factors, including maternal age, parity, race/ethnicity, comorbidity, education, income, prior preeclampsia/eclampsia, the infant’s gender, and gestational age at GDM diagnosis.

In the unadjusted analysis, infants who were exposed to the medications were significantly more likely to develop an autism spectrum disorder than were GDM infants who were not exposed (hazard ratio, 1.45). Significance remained high when each of the other confounding factors were individually considered. The final adjusted analysis, which included all of these, found an increased risk of 22%; however, this just missed statistical significance with a P value of .06.

A second analysis examined only the medication-exposed infants. The unadjusted analysis found a 36% increased risk, compared with nonexposed GDM infants. Again, significance remained strong when the individual confounders were examined separately. But the 26% risk in the fully adjusted model just missed significance – again with P value of.06.

The final analysis was adjusted for all of the confounders, plus gestational age when the mother was diagnosed. The hazard ratio of 1.17 suggested that early diagnosis and treatment explained about one-third of the overall increased risk, Dr. Xiang said.

The study continues with an investigation of the possible effect of maternal obesity on the current findings, she added.

Kaiser Permanente sponsored the study. Dr. Xiang is an employee of the company.

[email protected]

On Twitter @alz_gal

VIENNA – Children whose mothers had gestational diabetes and required antidiabetic medications may face a 22% increased risk of developing an autism spectrum disorder.

About a third of that increase was significantly associated with very-early diabetes diagnosis and treatment, suggesting that early first trimester hyperglycemia may affect fetal brain development, Anny H. Xiang, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes.

Michele G. Sullivan/Frontline Medical News

“My speculation is that, since fetal brain development is critical in the first and early second trimesters, exposure to high glucose during that time might damage its development,” said Dr Xiang, a senior research scientist at the Kaiser Permanente Department of Research and Evaluation in Pasadena, Calif. “Later exposure, perhaps, is not as problematic,” for the developing brain.

Her longitudinal cohort study included 315,827 singleton infants who were born at 28-44 weeks’ gestation between 1995 and 2009. This included 290,792 who were not exposed to gestational diabetes (GDM), and 25,035 who were. Of these, 5,891 had been exposed to antidiabetic medications.

All of the mothers were enrolled in Kaiser Permanente Southern California at the time of the birth, and all the children were still in the health plan by ages 1-2 years. Women who had preexisting type 1 or 2 diabetes were excluded form the study.

In accordance with the literature, mothers with GDM had lower educational levels and lower household incomes. They were older and more of them were multiparous. They were more likely to have had preeclampsia or eclampsia with a prior pregnancy. Asians and Pacific Islanders were more likely to have GDM than were other ethnicities.

Women who required antidiabetic treatment were diagnosed a mean of 4 weeks earlier than those who did not (23 vs. 27 weeks). Gestational ages at delivery did not significantly differ between the groups (39 weeks), but the infants of mothers with GDM were significantly heavier than were those of mothers without it. Infants exposed to antidiabetic medications weighed a mean of 3,453 g, compared with 3,380 g in nonmedication exposed infants, and 3,309 g in infants not exposed to GDM.

In the Kaiser system, standard well-baby care includes neurodevelopmental assessments at 1 year, 18 months, 2 years, and annually thereafter. Any concerns prompt a referral to a pediatric specialty clinic. For this study, diagnosis of autism required two diagnostic codes, one of which had to be from such a clinic.

Overall, the incidence rate of an autism spectrum disorder was 1.8/1,000 person-years. It was highest among those who had been exposed to antidiabetic medications (2.75/1,000 person-years) – significantly higher than that of both the GDM nonexposed and the non-GDM groups (1.96 and 1.77 per 1,000 person-years, respectively).

A multivariate analysis adjusted for a number of maternal and fetal factors, including maternal age, parity, race/ethnicity, comorbidity, education, income, prior preeclampsia/eclampsia, the infant’s gender, and gestational age at GDM diagnosis.

In the unadjusted analysis, infants who were exposed to the medications were significantly more likely to develop an autism spectrum disorder than were GDM infants who were not exposed (hazard ratio, 1.45). Significance remained high when each of the other confounding factors were individually considered. The final adjusted analysis, which included all of these, found an increased risk of 22%; however, this just missed statistical significance with a P value of .06.

A second analysis examined only the medication-exposed infants. The unadjusted analysis found a 36% increased risk, compared with nonexposed GDM infants. Again, significance remained strong when the individual confounders were examined separately. But the 26% risk in the fully adjusted model just missed significance – again with P value of.06.

The final analysis was adjusted for all of the confounders, plus gestational age when the mother was diagnosed. The hazard ratio of 1.17 suggested that early diagnosis and treatment explained about one-third of the overall increased risk, Dr. Xiang said.

The study continues with an investigation of the possible effect of maternal obesity on the current findings, she added.

Kaiser Permanente sponsored the study. Dr. Xiang is an employee of the company.

[email protected]

On Twitter @alz_gal

VIENNA – Children whose mothers had gestational diabetes and required antidiabetic medications may face a 22% increased risk of developing an autism spectrum disorder.

About a third of that increase was significantly associated with very-early diabetes diagnosis and treatment, suggesting that early first trimester hyperglycemia may affect fetal brain development, Anny H. Xiang, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes.

Michele G. Sullivan/Frontline Medical News

“My speculation is that, since fetal brain development is critical in the first and early second trimesters, exposure to high glucose during that time might damage its development,” said Dr Xiang, a senior research scientist at the Kaiser Permanente Department of Research and Evaluation in Pasadena, Calif. “Later exposure, perhaps, is not as problematic,” for the developing brain.

Her longitudinal cohort study included 315,827 singleton infants who were born at 28-44 weeks’ gestation between 1995 and 2009. This included 290,792 who were not exposed to gestational diabetes (GDM), and 25,035 who were. Of these, 5,891 had been exposed to antidiabetic medications.

All of the mothers were enrolled in Kaiser Permanente Southern California at the time of the birth, and all the children were still in the health plan by ages 1-2 years. Women who had preexisting type 1 or 2 diabetes were excluded form the study.

In accordance with the literature, mothers with GDM had lower educational levels and lower household incomes. They were older and more of them were multiparous. They were more likely to have had preeclampsia or eclampsia with a prior pregnancy. Asians and Pacific Islanders were more likely to have GDM than were other ethnicities.

Women who required antidiabetic treatment were diagnosed a mean of 4 weeks earlier than those who did not (23 vs. 27 weeks). Gestational ages at delivery did not significantly differ between the groups (39 weeks), but the infants of mothers with GDM were significantly heavier than were those of mothers without it. Infants exposed to antidiabetic medications weighed a mean of 3,453 g, compared with 3,380 g in nonmedication exposed infants, and 3,309 g in infants not exposed to GDM.

In the Kaiser system, standard well-baby care includes neurodevelopmental assessments at 1 year, 18 months, 2 years, and annually thereafter. Any concerns prompt a referral to a pediatric specialty clinic. For this study, diagnosis of autism required two diagnostic codes, one of which had to be from such a clinic.

Overall, the incidence rate of an autism spectrum disorder was 1.8/1,000 person-years. It was highest among those who had been exposed to antidiabetic medications (2.75/1,000 person-years) – significantly higher than that of both the GDM nonexposed and the non-GDM groups (1.96 and 1.77 per 1,000 person-years, respectively).

A multivariate analysis adjusted for a number of maternal and fetal factors, including maternal age, parity, race/ethnicity, comorbidity, education, income, prior preeclampsia/eclampsia, the infant’s gender, and gestational age at GDM diagnosis.

In the unadjusted analysis, infants who were exposed to the medications were significantly more likely to develop an autism spectrum disorder than were GDM infants who were not exposed (hazard ratio, 1.45). Significance remained high when each of the other confounding factors were individually considered. The final adjusted analysis, which included all of these, found an increased risk of 22%; however, this just missed statistical significance with a P value of .06.

A second analysis examined only the medication-exposed infants. The unadjusted analysis found a 36% increased risk, compared with nonexposed GDM infants. Again, significance remained strong when the individual confounders were examined separately. But the 26% risk in the fully adjusted model just missed significance – again with P value of.06.

The final analysis was adjusted for all of the confounders, plus gestational age when the mother was diagnosed. The hazard ratio of 1.17 suggested that early diagnosis and treatment explained about one-third of the overall increased risk, Dr. Xiang said.

The study continues with an investigation of the possible effect of maternal obesity on the current findings, she added.

Kaiser Permanente sponsored the study. Dr. Xiang is an employee of the company.

[email protected]

On Twitter @alz_gal

VIENNA – Young people worldwide who have type 1 diabetes are not achieving their glycemic targets and, as a result, experience suboptimal outcomes.

About 70% of children and teens and 81% of young adults did not meet their hemoglobin A_1c targets, in a large records review. As a result, many are experiencing significantly more complications from poorly controlled diabetes, Dr. Lori Laffel and her colleagues reported at the annual meeting of the European Association for the Study of Diabetes.

“These results highlight the need for further improvements in the management of glycemic control ... in young people with type 1 diabetes, particularly for patents aged 19-25 years,” wrote Dr. Laffel, chief of the pediatric, adolescent, and young adult section at the Joslin Diabetes Center, Boston.

The study comprised the European participants (2,943) in the TEENs study, a worldwide, observational study of 5,960 young patients with type 1 diabetes (aged 8-25 years) who were treated at 219 centers in 20 countries. The target HbA_1c levels varied by age: 7.5% for patients 18 years and younger, and 7% for those 19 years and older. Younger patients were divided into two groups (8-12 and 13-18 years old), while the third group comprised those aged 19-25 years.

The overall mean HbA_1c in was 8.5%, with 35% of the entire group meeting their goals. Control rates did not vary much among the younger patients (39% in those aged 8-12 years and 37% in those aged 12-18 years). A smaller percentage of the older patients stayed on target (23%).

Associated complications were significantly more common in uncontrolled patients: In the 6 months before data were collected, about 6% of both younger groups and 7% of the older group had experienced diabetic ketoacidosis. In contrast, the incidence among well-controlled patients in all three groups was about 3%.

The oldest uncontrolled patients also had the highest incidence of severe hypoglycemia resulting in loss of consciousness or seizure – 6% compared to 36% of well-controlled patients that age.

Among the youngest uncontrolled patients, the incidence was less than 3% in each group. Severe hypoglycemia incidence was similar in the middle group, at about 2% in the uncontrolled vs. 3% in the controlled patients.

The incidence of microalbuminuria soared among the oldest uncontrolled patients, reaching almost 9%, compared with just under 6% of controlled patients. For the youngest patients, the rates were similar (about 1% of each group). It was doubled in the middle group, at 5% in uncontrolled vs. 2.4% of controlled patients.

Neuropathy occurred in 10% of the oldest uncontrolled patients vs. 8% of well controlled. For the youngest, the rates doubled (3% vs. 1.5%, respectively). They more than doubled in the middle group (almost 6% vs. 2%).

The rates of retinopathy needing treatment were also elevated in the oldest uncontrolled patients, compared with the controlled patients (4% vs. 1.5%). However, in both younger groups, they were well under 1% regardless of control.

A multivariate analysis determined that diabetic ketoacidosis and diabetic neuropathy were significantly associated with uncontrolled HbA_1c (odds ratio, 0.53 and 0.47, respectively).

Dr Laffel has received research support from Sanofi-Aventis, which funded the study, as well as other pharmaceutical companies. Two coauthors were Sanofi employees.

[email protected]

On Twitter @alz_gal

VIENNA – Young people worldwide who have type 1 diabetes are not achieving their glycemic targets and, as a result, experience suboptimal outcomes.

About 70% of children and teens and 81% of young adults did not meet their hemoglobin A_1c targets, in a large records review. As a result, many are experiencing significantly more complications from poorly controlled diabetes, Dr. Lori Laffel and her colleagues reported at the annual meeting of the European Association for the Study of Diabetes.

“These results highlight the need for further improvements in the management of glycemic control ... in young people with type 1 diabetes, particularly for patents aged 19-25 years,” wrote Dr. Laffel, chief of the pediatric, adolescent, and young adult section at the Joslin Diabetes Center, Boston.

The study comprised the European participants (2,943) in the TEENs study, a worldwide, observational study of 5,960 young patients with type 1 diabetes (aged 8-25 years) who were treated at 219 centers in 20 countries. The target HbA_1c levels varied by age: 7.5% for patients 18 years and younger, and 7% for those 19 years and older. Younger patients were divided into two groups (8-12 and 13-18 years old), while the third group comprised those aged 19-25 years.

The overall mean HbA_1c in was 8.5%, with 35% of the entire group meeting their goals. Control rates did not vary much among the younger patients (39% in those aged 8-12 years and 37% in those aged 12-18 years). A smaller percentage of the older patients stayed on target (23%).

Associated complications were significantly more common in uncontrolled patients: In the 6 months before data were collected, about 6% of both younger groups and 7% of the older group had experienced diabetic ketoacidosis. In contrast, the incidence among well-controlled patients in all three groups was about 3%.

The oldest uncontrolled patients also had the highest incidence of severe hypoglycemia resulting in loss of consciousness or seizure – 6% compared to 36% of well-controlled patients that age.

Among the youngest uncontrolled patients, the incidence was less than 3% in each group. Severe hypoglycemia incidence was similar in the middle group, at about 2% in the uncontrolled vs. 3% in the controlled patients.

The incidence of microalbuminuria soared among the oldest uncontrolled patients, reaching almost 9%, compared with just under 6% of controlled patients. For the youngest patients, the rates were similar (about 1% of each group). It was doubled in the middle group, at 5% in uncontrolled vs. 2.4% of controlled patients.

Neuropathy occurred in 10% of the oldest uncontrolled patients vs. 8% of well controlled. For the youngest, the rates doubled (3% vs. 1.5%, respectively). They more than doubled in the middle group (almost 6% vs. 2%).

The rates of retinopathy needing treatment were also elevated in the oldest uncontrolled patients, compared with the controlled patients (4% vs. 1.5%). However, in both younger groups, they were well under 1% regardless of control.

A multivariate analysis determined that diabetic ketoacidosis and diabetic neuropathy were significantly associated with uncontrolled HbA_1c (odds ratio, 0.53 and 0.47, respectively).

Dr Laffel has received research support from Sanofi-Aventis, which funded the study, as well as other pharmaceutical companies. Two coauthors were Sanofi employees.

[email protected]

On Twitter @alz_gal

VIENNA – Young people worldwide who have type 1 diabetes are not achieving their glycemic targets and, as a result, experience suboptimal outcomes.

About 70% of children and teens and 81% of young adults did not meet their hemoglobin A_1c targets, in a large records review. As a result, many are experiencing significantly more complications from poorly controlled diabetes, Dr. Lori Laffel and her colleagues reported at the annual meeting of the European Association for the Study of Diabetes.

“These results highlight the need for further improvements in the management of glycemic control ... in young people with type 1 diabetes, particularly for patents aged 19-25 years,” wrote Dr. Laffel, chief of the pediatric, adolescent, and young adult section at the Joslin Diabetes Center, Boston.

The study comprised the European participants (2,943) in the TEENs study, a worldwide, observational study of 5,960 young patients with type 1 diabetes (aged 8-25 years) who were treated at 219 centers in 20 countries. The target HbA_1c levels varied by age: 7.5% for patients 18 years and younger, and 7% for those 19 years and older. Younger patients were divided into two groups (8-12 and 13-18 years old), while the third group comprised those aged 19-25 years.

The overall mean HbA_1c in was 8.5%, with 35% of the entire group meeting their goals. Control rates did not vary much among the younger patients (39% in those aged 8-12 years and 37% in those aged 12-18 years). A smaller percentage of the older patients stayed on target (23%).

Associated complications were significantly more common in uncontrolled patients: In the 6 months before data were collected, about 6% of both younger groups and 7% of the older group had experienced diabetic ketoacidosis. In contrast, the incidence among well-controlled patients in all three groups was about 3%.

The oldest uncontrolled patients also had the highest incidence of severe hypoglycemia resulting in loss of consciousness or seizure – 6% compared to 36% of well-controlled patients that age.

Among the youngest uncontrolled patients, the incidence was less than 3% in each group. Severe hypoglycemia incidence was similar in the middle group, at about 2% in the uncontrolled vs. 3% in the controlled patients.

The incidence of microalbuminuria soared among the oldest uncontrolled patients, reaching almost 9%, compared with just under 6% of controlled patients. For the youngest patients, the rates were similar (about 1% of each group). It was doubled in the middle group, at 5% in uncontrolled vs. 2.4% of controlled patients.

Neuropathy occurred in 10% of the oldest uncontrolled patients vs. 8% of well controlled. For the youngest, the rates doubled (3% vs. 1.5%, respectively). They more than doubled in the middle group (almost 6% vs. 2%).

The rates of retinopathy needing treatment were also elevated in the oldest uncontrolled patients, compared with the controlled patients (4% vs. 1.5%). However, in both younger groups, they were well under 1% regardless of control.

A multivariate analysis determined that diabetic ketoacidosis and diabetic neuropathy were significantly associated with uncontrolled HbA_1c (odds ratio, 0.53 and 0.47, respectively).

Dr Laffel has received research support from Sanofi-Aventis, which funded the study, as well as other pharmaceutical companies. Two coauthors were Sanofi employees.

[email protected]

On Twitter @alz_gal

VIENNA – Among patients with ischemic heart failure, type 2 diabetes increased the risk of death by 70% over 2 years.

Even patients with a prior revascularization were in danger, with a 60% increased risk of death. The findings were slightly better for patients with a preserved ejection fraction of at least 50%; type 2 diabetes increased their mortality risk by 40%, Dr. Anna Norhammar and Dr. Isabelle Johansson of Karolinska Institute, Stockholm, reported at the annual meeting of the European Society for the Study of Diabetes.

The results were drawn from the large Swedish Heart Failure Registry. It contains data on about 41,000 patients who have been treated for heart failure since 2003. Of these, 17,673 had ischemic heart failure, and 30% had both type 2 diabetes and ischemic heart failure.

These patients were younger than those without diabetes (75 vs. 77 years), and congestive heart failure of at least 6 months was present in 61% of those with diabetes and 54% of those without it. Those with diabetes had more severe heart failure, with a New York Heart Association class of III/IV in 53%, compared with 46% of those without diabetes, Dr. Norhammar reported.

Hypertension and atrial fibrillation were significantly more common among those with diabetes. A prior revascularization had occurred in 48% of those without diabetes, compared with 54% of those with diabetes.

In a multivariate model that adjusted for 29 variables, the investigators found that type 2 diabetes increased the risk of death by 70% over a median follow-up of 22 months. Prior revascularization cut the risk by 60%.

Dr. Johansson presented a separate analysis of patients who had a preserved ejection fraction of at least 50% (6,705). Of these, 1,658 had type 2 diabetes. Again, these patients were younger (76 vs. 78 years), more likely to have congestive heart failure (53% vs. 48%), and more likely to be in the NYHA class III/IV (44% vs. 39%). More of those with diabetes had concomitant ischemic heart disease, hypertension, atrial fibrillation, and valvular heart disease.

In this multivariate analysis, having type 2 diabetes increased the risk of death by 40%, Dr. Johansson said.

Dr. Norhammar and Dr. Johansson had no relevant financial disclosures.

VIENNA – Among patients with ischemic heart failure, type 2 diabetes increased the risk of death by 70% over 2 years.

Even patients with a prior revascularization were in danger, with a 60% increased risk of death. The findings were slightly better for patients with a preserved ejection fraction of at least 50%; type 2 diabetes increased their mortality risk by 40%, Dr. Anna Norhammar and Dr. Isabelle Johansson of Karolinska Institute, Stockholm, reported at the annual meeting of the European Society for the Study of Diabetes.

The results were drawn from the large Swedish Heart Failure Registry. It contains data on about 41,000 patients who have been treated for heart failure since 2003. Of these, 17,673 had ischemic heart failure, and 30% had both type 2 diabetes and ischemic heart failure.

These patients were younger than those without diabetes (75 vs. 77 years), and congestive heart failure of at least 6 months was present in 61% of those with diabetes and 54% of those without it. Those with diabetes had more severe heart failure, with a New York Heart Association class of III/IV in 53%, compared with 46% of those without diabetes, Dr. Norhammar reported.

Hypertension and atrial fibrillation were significantly more common among those with diabetes. A prior revascularization had occurred in 48% of those without diabetes, compared with 54% of those with diabetes.

In a multivariate model that adjusted for 29 variables, the investigators found that type 2 diabetes increased the risk of death by 70% over a median follow-up of 22 months. Prior revascularization cut the risk by 60%.

Dr. Johansson presented a separate analysis of patients who had a preserved ejection fraction of at least 50% (6,705). Of these, 1,658 had type 2 diabetes. Again, these patients were younger (76 vs. 78 years), more likely to have congestive heart failure (53% vs. 48%), and more likely to be in the NYHA class III/IV (44% vs. 39%). More of those with diabetes had concomitant ischemic heart disease, hypertension, atrial fibrillation, and valvular heart disease.

In this multivariate analysis, having type 2 diabetes increased the risk of death by 40%, Dr. Johansson said.

Dr. Norhammar and Dr. Johansson had no relevant financial disclosures.

VIENNA – Among patients with ischemic heart failure, type 2 diabetes increased the risk of death by 70% over 2 years.

Even patients with a prior revascularization were in danger, with a 60% increased risk of death. The findings were slightly better for patients with a preserved ejection fraction of at least 50%; type 2 diabetes increased their mortality risk by 40%, Dr. Anna Norhammar and Dr. Isabelle Johansson of Karolinska Institute, Stockholm, reported at the annual meeting of the European Society for the Study of Diabetes.

The results were drawn from the large Swedish Heart Failure Registry. It contains data on about 41,000 patients who have been treated for heart failure since 2003. Of these, 17,673 had ischemic heart failure, and 30% had both type 2 diabetes and ischemic heart failure.

These patients were younger than those without diabetes (75 vs. 77 years), and congestive heart failure of at least 6 months was present in 61% of those with diabetes and 54% of those without it. Those with diabetes had more severe heart failure, with a New York Heart Association class of III/IV in 53%, compared with 46% of those without diabetes, Dr. Norhammar reported.

Hypertension and atrial fibrillation were significantly more common among those with diabetes. A prior revascularization had occurred in 48% of those without diabetes, compared with 54% of those with diabetes.

In a multivariate model that adjusted for 29 variables, the investigators found that type 2 diabetes increased the risk of death by 70% over a median follow-up of 22 months. Prior revascularization cut the risk by 60%.

Dr. Johansson presented a separate analysis of patients who had a preserved ejection fraction of at least 50% (6,705). Of these, 1,658 had type 2 diabetes. Again, these patients were younger (76 vs. 78 years), more likely to have congestive heart failure (53% vs. 48%), and more likely to be in the NYHA class III/IV (44% vs. 39%). More of those with diabetes had concomitant ischemic heart disease, hypertension, atrial fibrillation, and valvular heart disease.

In this multivariate analysis, having type 2 diabetes increased the risk of death by 40%, Dr. Johansson said.

Dr. Norhammar and Dr. Johansson had no relevant financial disclosures.

VIENNA – Among patients with ischemic heart failure, type 2 diabetes increased the risk of death by 70% over 2 years.

Even patients with a prior revascularization were in danger, with a 60% increased risk of death. The findings were slightly better for patients with a preserved ejection fraction of at least 50%; type 2 diabetes increased their mortality risk by 40%, Dr. Anna Norhammar and Dr. Isabelle Johansson of Karolinska Institute, Stockholm, reported at the annual meeting of the European Society for the Study of Diabetes.

The results were drawn from the large Swedish Heart Failure Registry. It contains data on about 41,000 patients who have been treated for heart failure since 2003. Of these, 17,673 had ischemic heart failure, and 30% had both type 2 diabetes and ischemic heart failure.

These patients were younger than those without diabetes (75 vs. 77 years), and congestive heart failure of at least 6 months was present in 61% of those with diabetes and 54% of those without it. Those with diabetes had more severe heart failure, with a New York Heart Association class of III/IV in 53%, compared with 46% of those without diabetes, Dr. Norhammar reported.

Hypertension and atrial fibrillation were significantly more common among those with diabetes. A prior revascularization had occurred in 48% of those without diabetes, compared with 54% of those with diabetes.

In a multivariate model that adjusted for 29 variables, the investigators found that type 2 diabetes increased the risk of death by 70% over a median follow-up of 22 months. Prior revascularization cut the risk by 60%.

Dr. Johansson presented a separate analysis of patients who had a preserved ejection fraction of at least 50% (6,705). Of these, 1,658 had type 2 diabetes. Again, these patients were younger (76 vs. 78 years), more likely to have congestive heart failure (53% vs. 48%), and more likely to be in the NYHA class III/IV (44% vs. 39%). More of those with diabetes had concomitant ischemic heart disease, hypertension, atrial fibrillation, and valvular heart disease.

In this multivariate analysis, having type 2 diabetes increased the risk of death by 40%, Dr. Johansson said.

Dr. Norhammar and Dr. Johansson had no relevant financial disclosures.

[email protected]

On Twitter @alz_gal

VIENNA – Among patients with ischemic heart failure, type 2 diabetes increased the risk of death by 70% over 2 years.

Even patients with a prior revascularization were in danger, with a 60% increased risk of death. The findings were slightly better for patients with a preserved ejection fraction of at least 50%; type 2 diabetes increased their mortality risk by 40%, Dr. Anna Norhammar and Dr. Isabelle Johansson of Karolinska Institute, Stockholm, reported at the annual meeting of the European Society for the Study of Diabetes.

The results were drawn from the large Swedish Heart Failure Registry. It contains data on about 41,000 patients who have been treated for heart failure since 2003. Of these, 17,673 had ischemic heart failure, and 30% had both type 2 diabetes and ischemic heart failure.

These patients were younger than those without diabetes (75 vs. 77 years), and congestive heart failure of at least 6 months was present in 61% of those with diabetes and 54% of those without it. Those with diabetes had more severe heart failure, with a New York Heart Association class of III/IV in 53%, compared with 46% of those without diabetes, Dr. Norhammar reported.

Hypertension and atrial fibrillation were significantly more common among those with diabetes. A prior revascularization had occurred in 48% of those without diabetes, compared with 54% of those with diabetes.

In a multivariate model that adjusted for 29 variables, the investigators found that type 2 diabetes increased the risk of death by 70% over a median follow-up of 22 months. Prior revascularization cut the risk by 60%.

Dr. Johansson presented a separate analysis of patients who had a preserved ejection fraction of at least 50% (6,705). Of these, 1,658 had type 2 diabetes. Again, these patients were younger (76 vs. 78 years), more likely to have congestive heart failure (53% vs. 48%), and more likely to be in the NYHA class III/IV (44% vs. 39%). More of those with diabetes had concomitant ischemic heart disease, hypertension, atrial fibrillation, and valvular heart disease.

In this multivariate analysis, having type 2 diabetes increased the risk of death by 40%, Dr. Johansson said.

Dr. Norhammar and Dr. Johansson had no relevant financial disclosures.

[email protected]

On Twitter @alz_gal

VIENNA – Among patients with ischemic heart failure, type 2 diabetes increased the risk of death by 70% over 2 years.

Even patients with a prior revascularization were in danger, with a 60% increased risk of death. The findings were slightly better for patients with a preserved ejection fraction of at least 50%; type 2 diabetes increased their mortality risk by 40%, Dr. Anna Norhammar and Dr. Isabelle Johansson of Karolinska Institute, Stockholm, reported at the annual meeting of the European Society for the Study of Diabetes.

The results were drawn from the large Swedish Heart Failure Registry. It contains data on about 41,000 patients who have been treated for heart failure since 2003. Of these, 17,673 had ischemic heart failure, and 30% had both type 2 diabetes and ischemic heart failure.

These patients were younger than those without diabetes (75 vs. 77 years), and congestive heart failure of at least 6 months was present in 61% of those with diabetes and 54% of those without it. Those with diabetes had more severe heart failure, with a New York Heart Association class of III/IV in 53%, compared with 46% of those without diabetes, Dr. Norhammar reported.

Hypertension and atrial fibrillation were significantly more common among those with diabetes. A prior revascularization had occurred in 48% of those without diabetes, compared with 54% of those with diabetes.

In a multivariate model that adjusted for 29 variables, the investigators found that type 2 diabetes increased the risk of death by 70% over a median follow-up of 22 months. Prior revascularization cut the risk by 60%.

Dr. Johansson presented a separate analysis of patients who had a preserved ejection fraction of at least 50% (6,705). Of these, 1,658 had type 2 diabetes. Again, these patients were younger (76 vs. 78 years), more likely to have congestive heart failure (53% vs. 48%), and more likely to be in the NYHA class III/IV (44% vs. 39%). More of those with diabetes had concomitant ischemic heart disease, hypertension, atrial fibrillation, and valvular heart disease.

In this multivariate analysis, having type 2 diabetes increased the risk of death by 40%, Dr. Johansson said.

Dr. Norhammar and Dr. Johansson had no relevant financial disclosures.

[email protected]

On Twitter @alz_gal

VIENNA – Urinary tract infections are relatively common and can be quite expensive among patients with newly diagnosed diabetes.

In a large patient database, the infection rate was about 128/1,000 patients, Shengsheng Yu, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes. While only about 4% of these patients were hospitalized, their treatment costs hovered around $3,407 in Germany, where the study was conducted.

These data were extracted from a large German patient claims database, said Dr. Yu of Merck Sharp & Dohme, Whitehouse Station, N.J. The cohort comprised 530,918 patients who had type 2 diabetes during the study years of 2010-2012. Of these, 64,332 had incident disease.

Patients with newly diagnosed diabetes were significantly younger than was the diabetes-prevalent population (70 vs. 73 years), and had a significantly lower than the Charlson comorbidity index (5.4 vs. 7.3 years). Their diabetes was also less severe when measured by the adapted Diabetes Complication Severity Index (1.5 vs. 2.4).

During the study period, roughly 20% of patients had at least 1 urinary tract infection (UTI); 6% had two or more.

UTIs were twice as common in women. Prevalence also grew with advancing age in both sexes. Among those with newly diagnosed diabetes, women developed their UTI significantly more quickly than did men. By the end of the study, 20% of those women had developed one, compared with 10% of the men.

A multivariate analysis determined the risk factors associated with UTIs. These included having had a previous UTI (odds ratio, 3.5), female gender (OR, 1.7), higher Charlson comorbidity status (OR, 1.5), and age (OR, 1.4 for those older than 79 years).

Hemoglobin A1c levels were also a significant independent predictor of UTI, with an odds ratio of 1.5 for levels of 9.5%-10%, compared with 7%-7.5%.

In an analysis of the development of a first UTI after diagnosis, all of those predictive factors remained significant.

The investigators also examined costs associated with inpatient and outpatient treatment. Total costs included antibiotics and the cost of either ambulatory, outpatient, or in-hospital care.

The majority were treated by a physicians as an outpatient, with a median cost of 86 euros (US$111). About 46,500 received a prescription only, at a median cost of 22 euros (US$25). The smallest number (3,445) required hospitalization – a very expensive experience – with a mean cost of 2,627 euros (US$3,407).

During the discussion period, the issue of infection validation was a concern. Many physicians treat on symptoms only, or on a single urinalysis that might show a small amount of blood or protein. The number of culture-proven UTIs is much less, it was suggested.

Dr. Yu admitted that this is a common occurrence and could be affecting the validity of her conclusions somewhat.

She is an employee of Merck.

[email protected]

On Twitter @alz_gal

VIENNA – Urinary tract infections are relatively common and can be quite expensive among patients with newly diagnosed diabetes.

In a large patient database, the infection rate was about 128/1,000 patients, Shengsheng Yu, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes. While only about 4% of these patients were hospitalized, their treatment costs hovered around $3,407 in Germany, where the study was conducted.

These data were extracted from a large German patient claims database, said Dr. Yu of Merck Sharp & Dohme, Whitehouse Station, N.J. The cohort comprised 530,918 patients who had type 2 diabetes during the study years of 2010-2012. Of these, 64,332 had incident disease.

Patients with newly diagnosed diabetes were significantly younger than was the diabetes-prevalent population (70 vs. 73 years), and had a significantly lower than the Charlson comorbidity index (5.4 vs. 7.3 years). Their diabetes was also less severe when measured by the adapted Diabetes Complication Severity Index (1.5 vs. 2.4).

During the study period, roughly 20% of patients had at least 1 urinary tract infection (UTI); 6% had two or more.

UTIs were twice as common in women. Prevalence also grew with advancing age in both sexes. Among those with newly diagnosed diabetes, women developed their UTI significantly more quickly than did men. By the end of the study, 20% of those women had developed one, compared with 10% of the men.

A multivariate analysis determined the risk factors associated with UTIs. These included having had a previous UTI (odds ratio, 3.5), female gender (OR, 1.7), higher Charlson comorbidity status (OR, 1.5), and age (OR, 1.4 for those older than 79 years).

Hemoglobin A1c levels were also a significant independent predictor of UTI, with an odds ratio of 1.5 for levels of 9.5%-10%, compared with 7%-7.5%.

In an analysis of the development of a first UTI after diagnosis, all of those predictive factors remained significant.

The investigators also examined costs associated with inpatient and outpatient treatment. Total costs included antibiotics and the cost of either ambulatory, outpatient, or in-hospital care.

The majority were treated by a physicians as an outpatient, with a median cost of 86 euros (US$111). About 46,500 received a prescription only, at a median cost of 22 euros (US$25). The smallest number (3,445) required hospitalization – a very expensive experience – with a mean cost of 2,627 euros (US$3,407).

During the discussion period, the issue of infection validation was a concern. Many physicians treat on symptoms only, or on a single urinalysis that might show a small amount of blood or protein. The number of culture-proven UTIs is much less, it was suggested.

Dr. Yu admitted that this is a common occurrence and could be affecting the validity of her conclusions somewhat.

She is an employee of Merck.

[email protected]

On Twitter @alz_gal

VIENNA – Urinary tract infections are relatively common and can be quite expensive among patients with newly diagnosed diabetes.

In a large patient database, the infection rate was about 128/1,000 patients, Shengsheng Yu, Ph.D., said at the annual meeting of the European Association for the Study of Diabetes. While only about 4% of these patients were hospitalized, their treatment costs hovered around $3,407 in Germany, where the study was conducted.

These data were extracted from a large German patient claims database, said Dr. Yu of Merck Sharp & Dohme, Whitehouse Station, N.J. The cohort comprised 530,918 patients who had type 2 diabetes during the study years of 2010-2012. Of these, 64,332 had incident disease.

Patients with newly diagnosed diabetes were significantly younger than was the diabetes-prevalent population (70 vs. 73 years), and had a significantly lower than the Charlson comorbidity index (5.4 vs. 7.3 years). Their diabetes was also less severe when measured by the adapted Diabetes Complication Severity Index (1.5 vs. 2.4).

During the study period, roughly 20% of patients had at least 1 urinary tract infection (UTI); 6% had two or more.

UTIs were twice as common in women. Prevalence also grew with advancing age in both sexes. Among those with newly diagnosed diabetes, women developed their UTI significantly more quickly than did men. By the end of the study, 20% of those women had developed one, compared with 10% of the men.

A multivariate analysis determined the risk factors associated with UTIs. These included having had a previous UTI (odds ratio, 3.5), female gender (OR, 1.7), higher Charlson comorbidity status (OR, 1.5), and age (OR, 1.4 for those older than 79 years).

Hemoglobin A1c levels were also a significant independent predictor of UTI, with an odds ratio of 1.5 for levels of 9.5%-10%, compared with 7%-7.5%.

In an analysis of the development of a first UTI after diagnosis, all of those predictive factors remained significant.

The investigators also examined costs associated with inpatient and outpatient treatment. Total costs included antibiotics and the cost of either ambulatory, outpatient, or in-hospital care.

The majority were treated by a physicians as an outpatient, with a median cost of 86 euros (US$111). About 46,500 received a prescription only, at a median cost of 22 euros (US$25). The smallest number (3,445) required hospitalization – a very expensive experience – with a mean cost of 2,627 euros (US$3,407).

During the discussion period, the issue of infection validation was a concern. Many physicians treat on symptoms only, or on a single urinalysis that might show a small amount of blood or protein. The number of culture-proven UTIs is much less, it was suggested.

Dr. Yu admitted that this is a common occurrence and could be affecting the validity of her conclusions somewhat.

She is an employee of Merck.

[email protected]

On Twitter @alz_gal