Diabetes Hub

LAS VEGAS – Contrary to conventional wisdom, neither ACE inhibitors nor angiotensin receptor blockers have any role to play in primary prevention of diabetic kidney disease, according to Dr. Robert C. Stanton, chief of nephrology at the Harvard University’s Joslin Diabetes Center, Boston.

"I don’t see any unique indication for ACE inhibitors and ARBs for the primary prevention of kidney disease in diabetic patients, especially given that around 70% of diabetes patients will never develop kidney disease. They’re perfectly fine blood pressure pills. But as a magic kidney disease prevention drug, I don’t see any evidence for that. Of course, patients with proteinuria are another issue entirely. Those drugs absolutely are beneficial in that setting," he said at a meeting sponsored by the National Kidney Foundation.

When Dr. Stanton polled his audience electronically during the course of his talk, however, the majority of physicians indicated that they believe ACE inhibitors and ARBs are indeed useful for primary prevention of diabetic kidney disease. The evidence, Dr. Stanton emphasized, shows otherwise.

For example, a well-conducted, randomized, multicenter, placebo-controlled, 5-year clinical trial showed no benefit for enalapril or losartan in preventing kidney disease in patients with type 1 diabetes (N. Engl. J. Med. 2009;361:40-51). And three randomized controlled trials showed no primary preventive benefit for candesartan in more than 5,000 patients with type 1 or type 2 diabetes (Ann. Intern. Med. 2009;151:11-20).

Dr. Stanton noted that lots of other interventions have been proposed for the primary prevention of kidney disease in diabetes patients. Some are supported by solid evidence of benefit, others are not.

Here is his view of the preventive landscape:

• Intensive blood glucose control. "This is the easy one," he said. "A lot of us in the diabetes world feel that a hemoglobin A_1c of 7% is the appropriate target for preventing many complications. It’s a reasonable target and should be achieved whether you’re talking about type 1 or type 2 patients."

The nephrologist noted that recent 25-year follow-up data from the landmark Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study showed that fully 18 years after the intervention ended, patients assigned to intensive blood glucose control still showed highly impressive 50% reductions in the cumulative incidence of both microalbuminuria and end-stage renal disease compared with patients placed on less intensive control (Diabetes Care 2014;37:24-30).

• Smoking cessation. Smoking has been linked to a several-fold increased risk of diabetic kidney disease. "I think of diabetes as an endothelial cell disease, and smoking is the greatest endothelial cell poison we’ve come up with. So stopping smoking is something well worth doing," Dr. Stanton said.

• Blood pressure control. No question exists regarding its renoprotective effect. But recent guidelines are dizzyingly all over the map in terms of target pressure recommendations.

"I’m getting a major headache reading these articles right now. I can show you the data. Good luck! I personally like a target of 130/80 mm Hg or less, particularly when it’s not that hard to get there. But I’d let you decide what particular target you favor," he said.

He prefers 130/80 mm Hg as a target blood pressure for primary prevention of diabetic kidney disease in large part because of a meta-analysis showing that it was associated with a 10% reduction in the risk of developing microalbuminuria and an 11% decrease in end-stage renal disease (PloS Med 2012;9(8):e1001293).

• Weight loss. The growing bariatric surgery literature supports weight loss as a primary preventive strategy.

• Protein intake. There is no role for a low-protein diet – say, less than 0.8 g/kg per day – for primary prevention of kidney disease in diabetes patients. And Dr. Stanton believes a high-protein diet in the range of more than 1.5 or 2 g/kg per day is best avoided in patients with diabetes, although he stressed that the evidence on this score remains sketchy.

Still, "I would not go on a body-building diet or an Atkins-type diet," he cautioned.

• Targeting glomerular hyperfiltration. Studies have shown conflicting results. "For me, there’s no clear role for targeting hyperfiltration," said Dr. Stanton, who cited a comprehensive review that he finds persuasive (Diabetologia 2010;53:2093-104).

The key to developing more effective primary prevention strategies, according to Dr. Stanton, will be first to establish markers that clearly identify the 30% or so of diabetes patients who will go on to develop renal disease, then test novel interventions specifically in that high-risk group.

Promising biomarkers include circulating tumor necrosis factor alpha receptor levels, von Willebrand factor, monocyte chemoattractant factor, asymmetrical dimethylarginine, interleukin-6 and -8, and Fas receptor.

For example, one study showed that patients with type 2 diabetes in the top quartile for circulating TNF receptor 1 had a cumulative 12-year incidence of end-stage renal disease of 54%, compared to just 3% in patients in the other quartiles (J. Am. Soc. Nephrol. 2012;23:507-15).

"Lots of companies are looking at these now. These markers may be coming our way as indicators of people with diabetes who are likely to progress to kidney disease," Dr. Stanton said.

He reported serving as a consultant to Boehringer Ingelheim.

[email protected]

LAS VEGAS – Contrary to conventional wisdom, neither ACE inhibitors nor angiotensin receptor blockers have any role to play in primary prevention of diabetic kidney disease, according to Dr. Robert C. Stanton, chief of nephrology at the Harvard University’s Joslin Diabetes Center, Boston.

"I don’t see any unique indication for ACE inhibitors and ARBs for the primary prevention of kidney disease in diabetic patients, especially given that around 70% of diabetes patients will never develop kidney disease. They’re perfectly fine blood pressure pills. But as a magic kidney disease prevention drug, I don’t see any evidence for that. Of course, patients with proteinuria are another issue entirely. Those drugs absolutely are beneficial in that setting," he said at a meeting sponsored by the National Kidney Foundation.

When Dr. Stanton polled his audience electronically during the course of his talk, however, the majority of physicians indicated that they believe ACE inhibitors and ARBs are indeed useful for primary prevention of diabetic kidney disease. The evidence, Dr. Stanton emphasized, shows otherwise.

For example, a well-conducted, randomized, multicenter, placebo-controlled, 5-year clinical trial showed no benefit for enalapril or losartan in preventing kidney disease in patients with type 1 diabetes (N. Engl. J. Med. 2009;361:40-51). And three randomized controlled trials showed no primary preventive benefit for candesartan in more than 5,000 patients with type 1 or type 2 diabetes (Ann. Intern. Med. 2009;151:11-20).

Dr. Stanton noted that lots of other interventions have been proposed for the primary prevention of kidney disease in diabetes patients. Some are supported by solid evidence of benefit, others are not.

Here is his view of the preventive landscape:

• Intensive blood glucose control. "This is the easy one," he said. "A lot of us in the diabetes world feel that a hemoglobin A_1c of 7% is the appropriate target for preventing many complications. It’s a reasonable target and should be achieved whether you’re talking about type 1 or type 2 patients."

The nephrologist noted that recent 25-year follow-up data from the landmark Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study showed that fully 18 years after the intervention ended, patients assigned to intensive blood glucose control still showed highly impressive 50% reductions in the cumulative incidence of both microalbuminuria and end-stage renal disease compared with patients placed on less intensive control (Diabetes Care 2014;37:24-30).

• Smoking cessation. Smoking has been linked to a several-fold increased risk of diabetic kidney disease. "I think of diabetes as an endothelial cell disease, and smoking is the greatest endothelial cell poison we’ve come up with. So stopping smoking is something well worth doing," Dr. Stanton said.

• Blood pressure control. No question exists regarding its renoprotective effect. But recent guidelines are dizzyingly all over the map in terms of target pressure recommendations.

"I’m getting a major headache reading these articles right now. I can show you the data. Good luck! I personally like a target of 130/80 mm Hg or less, particularly when it’s not that hard to get there. But I’d let you decide what particular target you favor," he said.

He prefers 130/80 mm Hg as a target blood pressure for primary prevention of diabetic kidney disease in large part because of a meta-analysis showing that it was associated with a 10% reduction in the risk of developing microalbuminuria and an 11% decrease in end-stage renal disease (PloS Med 2012;9(8):e1001293).

• Weight loss. The growing bariatric surgery literature supports weight loss as a primary preventive strategy.

• Protein intake. There is no role for a low-protein diet – say, less than 0.8 g/kg per day – for primary prevention of kidney disease in diabetes patients. And Dr. Stanton believes a high-protein diet in the range of more than 1.5 or 2 g/kg per day is best avoided in patients with diabetes, although he stressed that the evidence on this score remains sketchy.

Still, "I would not go on a body-building diet or an Atkins-type diet," he cautioned.

• Targeting glomerular hyperfiltration. Studies have shown conflicting results. "For me, there’s no clear role for targeting hyperfiltration," said Dr. Stanton, who cited a comprehensive review that he finds persuasive (Diabetologia 2010;53:2093-104).

The key to developing more effective primary prevention strategies, according to Dr. Stanton, will be first to establish markers that clearly identify the 30% or so of diabetes patients who will go on to develop renal disease, then test novel interventions specifically in that high-risk group.

Promising biomarkers include circulating tumor necrosis factor alpha receptor levels, von Willebrand factor, monocyte chemoattractant factor, asymmetrical dimethylarginine, interleukin-6 and -8, and Fas receptor.

For example, one study showed that patients with type 2 diabetes in the top quartile for circulating TNF receptor 1 had a cumulative 12-year incidence of end-stage renal disease of 54%, compared to just 3% in patients in the other quartiles (J. Am. Soc. Nephrol. 2012;23:507-15).

"Lots of companies are looking at these now. These markers may be coming our way as indicators of people with diabetes who are likely to progress to kidney disease," Dr. Stanton said.

He reported serving as a consultant to Boehringer Ingelheim.

[email protected]

LAS VEGAS – Contrary to conventional wisdom, neither ACE inhibitors nor angiotensin receptor blockers have any role to play in primary prevention of diabetic kidney disease, according to Dr. Robert C. Stanton, chief of nephrology at the Harvard University’s Joslin Diabetes Center, Boston.

"I don’t see any unique indication for ACE inhibitors and ARBs for the primary prevention of kidney disease in diabetic patients, especially given that around 70% of diabetes patients will never develop kidney disease. They’re perfectly fine blood pressure pills. But as a magic kidney disease prevention drug, I don’t see any evidence for that. Of course, patients with proteinuria are another issue entirely. Those drugs absolutely are beneficial in that setting," he said at a meeting sponsored by the National Kidney Foundation.

When Dr. Stanton polled his audience electronically during the course of his talk, however, the majority of physicians indicated that they believe ACE inhibitors and ARBs are indeed useful for primary prevention of diabetic kidney disease. The evidence, Dr. Stanton emphasized, shows otherwise.

For example, a well-conducted, randomized, multicenter, placebo-controlled, 5-year clinical trial showed no benefit for enalapril or losartan in preventing kidney disease in patients with type 1 diabetes (N. Engl. J. Med. 2009;361:40-51). And three randomized controlled trials showed no primary preventive benefit for candesartan in more than 5,000 patients with type 1 or type 2 diabetes (Ann. Intern. Med. 2009;151:11-20).

Dr. Stanton noted that lots of other interventions have been proposed for the primary prevention of kidney disease in diabetes patients. Some are supported by solid evidence of benefit, others are not.

Here is his view of the preventive landscape:

• Intensive blood glucose control. "This is the easy one," he said. "A lot of us in the diabetes world feel that a hemoglobin A_1c of 7% is the appropriate target for preventing many complications. It’s a reasonable target and should be achieved whether you’re talking about type 1 or type 2 patients."

The nephrologist noted that recent 25-year follow-up data from the landmark Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study showed that fully 18 years after the intervention ended, patients assigned to intensive blood glucose control still showed highly impressive 50% reductions in the cumulative incidence of both microalbuminuria and end-stage renal disease compared with patients placed on less intensive control (Diabetes Care 2014;37:24-30).

• Smoking cessation. Smoking has been linked to a several-fold increased risk of diabetic kidney disease. "I think of diabetes as an endothelial cell disease, and smoking is the greatest endothelial cell poison we’ve come up with. So stopping smoking is something well worth doing," Dr. Stanton said.

• Blood pressure control. No question exists regarding its renoprotective effect. But recent guidelines are dizzyingly all over the map in terms of target pressure recommendations.

"I’m getting a major headache reading these articles right now. I can show you the data. Good luck! I personally like a target of 130/80 mm Hg or less, particularly when it’s not that hard to get there. But I’d let you decide what particular target you favor," he said.

He prefers 130/80 mm Hg as a target blood pressure for primary prevention of diabetic kidney disease in large part because of a meta-analysis showing that it was associated with a 10% reduction in the risk of developing microalbuminuria and an 11% decrease in end-stage renal disease (PloS Med 2012;9(8):e1001293).

• Weight loss. The growing bariatric surgery literature supports weight loss as a primary preventive strategy.

• Protein intake. There is no role for a low-protein diet – say, less than 0.8 g/kg per day – for primary prevention of kidney disease in diabetes patients. And Dr. Stanton believes a high-protein diet in the range of more than 1.5 or 2 g/kg per day is best avoided in patients with diabetes, although he stressed that the evidence on this score remains sketchy.

Still, "I would not go on a body-building diet or an Atkins-type diet," he cautioned.

• Targeting glomerular hyperfiltration. Studies have shown conflicting results. "For me, there’s no clear role for targeting hyperfiltration," said Dr. Stanton, who cited a comprehensive review that he finds persuasive (Diabetologia 2010;53:2093-104).

The key to developing more effective primary prevention strategies, according to Dr. Stanton, will be first to establish markers that clearly identify the 30% or so of diabetes patients who will go on to develop renal disease, then test novel interventions specifically in that high-risk group.

Promising biomarkers include circulating tumor necrosis factor alpha receptor levels, von Willebrand factor, monocyte chemoattractant factor, asymmetrical dimethylarginine, interleukin-6 and -8, and Fas receptor.

For example, one study showed that patients with type 2 diabetes in the top quartile for circulating TNF receptor 1 had a cumulative 12-year incidence of end-stage renal disease of 54%, compared to just 3% in patients in the other quartiles (J. Am. Soc. Nephrol. 2012;23:507-15).

"Lots of companies are looking at these now. These markers may be coming our way as indicators of people with diabetes who are likely to progress to kidney disease," Dr. Stanton said.

He reported serving as a consultant to Boehringer Ingelheim.

[email protected]

The Food and Drug Administration’s review of the safety of olmesartan has found "no clear evidence" of increased cardiovascular risks associated with the use of the drug in people with diabetes, but some concern remains about the possible risk with high doses, the agency reported on June 24.

The review, prompted by the ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention) study of patients with type 2 diabetes – which unexpectedly found an increased risk of cardiovascular death among patients on olmesartan, compared with those on placebo – has been completed, and recommendations for the use of the angiotensin receptor blocker (ARB) in people with diabetes will remain unchanged, according to the FDA.

Information about some of the studies reviewed by the FDA, however, including a large observational study of Medicare patients, will be included in the labels of olmesartan products, which include Benicar, Benicar HCT, AZO, Tribenzor, and generic formulations, the statement said.

"While data from the ROADMAP trial and the Medicare study have suggested that high-dose olmesartan may increase CV risk in diabetic patients, when considering the data from all trials and studies, they are not conclusive," the FDA statement said, adding, "Overall, we determined these studies do not clearly show an increased cardiovascular risk. Thus, the collective evidence available at this time does not support changing our recommendations for olmesartan use and does not support recommending that its use be avoided in patients with diabetes."

The risk of nonfatal MI, however, was lower among those on olmesartan in the ROADMAP study, which was designed to determine whether olmesartan could delay kidney damage in patients with type 2 diabetes (N. Engl. J. Med. 2011;364:907-17).

In the Medicare study of patients aged 65 years and older, the risk of death was increased among patients with diabetes, who received the highest (40 mg/day) dose of olmesartan for more than 6 months (hazard ratio, 2.0). Among patients who did not have diabetes, however, the highest dose was associated with a reduced risk of death (HR, 0.46). The conflicting results in these two patient groups in the study "are difficult to reconcile and raise uncertainty about the credibility of the findings in either group," the FDA said.

Other studies reviewed include a U.K. study of primary care medical records that compared outcomes of patients receiving high-dose olmesartan with those treated with high doses of other ARBs in over 58,000 patients. The study found an increased risk of overall death and of acute myocardial infarction associated with the use of high-dose olmesartan, which was not statistically significant (Pharmacoepidemiol. Drug Saf. 2014;23:340-7).

"Overall, these data raise concern of possible increased cardiovascular risk associated with the use of high-dose olmesartan in diabetic patients," the FDA concluded.

The FDA’s first safety communication on this issue was posted in June 2010, followed by an update in April 2011.

In 2013, about 1.8 million people received a dispensed prescription for olmesartan products from U.S. outpatient retail pharmacies, according to the FDA.

Serious adverse events in patients treated with olmesartan products should be reported to the FDA’s MedWatch program at 800-332-1088 or www.fda.gov/medwatch.

[email protected]

The Food and Drug Administration’s review of the safety of olmesartan has found "no clear evidence" of increased cardiovascular risks associated with the use of the drug in people with diabetes, but some concern remains about the possible risk with high doses, the agency reported on June 24.

The review, prompted by the ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention) study of patients with type 2 diabetes – which unexpectedly found an increased risk of cardiovascular death among patients on olmesartan, compared with those on placebo – has been completed, and recommendations for the use of the angiotensin receptor blocker (ARB) in people with diabetes will remain unchanged, according to the FDA.

Information about some of the studies reviewed by the FDA, however, including a large observational study of Medicare patients, will be included in the labels of olmesartan products, which include Benicar, Benicar HCT, AZO, Tribenzor, and generic formulations, the statement said.

"While data from the ROADMAP trial and the Medicare study have suggested that high-dose olmesartan may increase CV risk in diabetic patients, when considering the data from all trials and studies, they are not conclusive," the FDA statement said, adding, "Overall, we determined these studies do not clearly show an increased cardiovascular risk. Thus, the collective evidence available at this time does not support changing our recommendations for olmesartan use and does not support recommending that its use be avoided in patients with diabetes."

The risk of nonfatal MI, however, was lower among those on olmesartan in the ROADMAP study, which was designed to determine whether olmesartan could delay kidney damage in patients with type 2 diabetes (N. Engl. J. Med. 2011;364:907-17).

In the Medicare study of patients aged 65 years and older, the risk of death was increased among patients with diabetes, who received the highest (40 mg/day) dose of olmesartan for more than 6 months (hazard ratio, 2.0). Among patients who did not have diabetes, however, the highest dose was associated with a reduced risk of death (HR, 0.46). The conflicting results in these two patient groups in the study "are difficult to reconcile and raise uncertainty about the credibility of the findings in either group," the FDA said.

Other studies reviewed include a U.K. study of primary care medical records that compared outcomes of patients receiving high-dose olmesartan with those treated with high doses of other ARBs in over 58,000 patients. The study found an increased risk of overall death and of acute myocardial infarction associated with the use of high-dose olmesartan, which was not statistically significant (Pharmacoepidemiol. Drug Saf. 2014;23:340-7).

"Overall, these data raise concern of possible increased cardiovascular risk associated with the use of high-dose olmesartan in diabetic patients," the FDA concluded.

The FDA’s first safety communication on this issue was posted in June 2010, followed by an update in April 2011.

In 2013, about 1.8 million people received a dispensed prescription for olmesartan products from U.S. outpatient retail pharmacies, according to the FDA.

Serious adverse events in patients treated with olmesartan products should be reported to the FDA’s MedWatch program at 800-332-1088 or www.fda.gov/medwatch.

[email protected]

The Food and Drug Administration’s review of the safety of olmesartan has found "no clear evidence" of increased cardiovascular risks associated with the use of the drug in people with diabetes, but some concern remains about the possible risk with high doses, the agency reported on June 24.

The review, prompted by the ROADMAP (Randomized Olmesartan and Diabetes Microalbuminuria Prevention) study of patients with type 2 diabetes – which unexpectedly found an increased risk of cardiovascular death among patients on olmesartan, compared with those on placebo – has been completed, and recommendations for the use of the angiotensin receptor blocker (ARB) in people with diabetes will remain unchanged, according to the FDA.

Information about some of the studies reviewed by the FDA, however, including a large observational study of Medicare patients, will be included in the labels of olmesartan products, which include Benicar, Benicar HCT, AZO, Tribenzor, and generic formulations, the statement said.

"While data from the ROADMAP trial and the Medicare study have suggested that high-dose olmesartan may increase CV risk in diabetic patients, when considering the data from all trials and studies, they are not conclusive," the FDA statement said, adding, "Overall, we determined these studies do not clearly show an increased cardiovascular risk. Thus, the collective evidence available at this time does not support changing our recommendations for olmesartan use and does not support recommending that its use be avoided in patients with diabetes."

The risk of nonfatal MI, however, was lower among those on olmesartan in the ROADMAP study, which was designed to determine whether olmesartan could delay kidney damage in patients with type 2 diabetes (N. Engl. J. Med. 2011;364:907-17).

In the Medicare study of patients aged 65 years and older, the risk of death was increased among patients with diabetes, who received the highest (40 mg/day) dose of olmesartan for more than 6 months (hazard ratio, 2.0). Among patients who did not have diabetes, however, the highest dose was associated with a reduced risk of death (HR, 0.46). The conflicting results in these two patient groups in the study "are difficult to reconcile and raise uncertainty about the credibility of the findings in either group," the FDA said.

Other studies reviewed include a U.K. study of primary care medical records that compared outcomes of patients receiving high-dose olmesartan with those treated with high doses of other ARBs in over 58,000 patients. The study found an increased risk of overall death and of acute myocardial infarction associated with the use of high-dose olmesartan, which was not statistically significant (Pharmacoepidemiol. Drug Saf. 2014;23:340-7).

"Overall, these data raise concern of possible increased cardiovascular risk associated with the use of high-dose olmesartan in diabetic patients," the FDA concluded.

The FDA’s first safety communication on this issue was posted in June 2010, followed by an update in April 2011.

In 2013, about 1.8 million people received a dispensed prescription for olmesartan products from U.S. outpatient retail pharmacies, according to the FDA.

Serious adverse events in patients treated with olmesartan products should be reported to the FDA’s MedWatch program at 800-332-1088 or www.fda.gov/medwatch.

[email protected]

SAN FRANCISCO – The American Diabetes Association has unified the pediatric hemoglobin A_1c target values to less than 7.5% for all pediatric age groups, moving away from breaking down glycemic control targets by age. This will also harmonize the HbA_1c goals with those of international groups such as the International Society of Pediatric and Adolescent Diabetes (ISPAD).

The change is part of a new position statement released on June 16 during the annual scientific sessions of the American Diabetes Association (Diabetes Care 2014;37:2034-54). The document also for the first time brings together recommendations for care of individuals with type 1 diabetes across all age groups.

In a video interview, Dr. Lori M.B. Laffel, one of the statement’s coauthors and chief of the pediatric, adolescent, and young adult section at Joslin Diabetes Center, Boston, explains the rationale behind this decision. Dr. David Maahs of the University of Colorado, Aurora, discusses the potential concern regarding the risk of hypoglycemia.

[email protected]

On Twitter @naseemmiller

SAN FRANCISCO – The American Diabetes Association has unified the pediatric hemoglobin A_1c target values to less than 7.5% for all pediatric age groups, moving away from breaking down glycemic control targets by age. This will also harmonize the HbA_1c goals with those of international groups such as the International Society of Pediatric and Adolescent Diabetes (ISPAD).

The change is part of a new position statement released on June 16 during the annual scientific sessions of the American Diabetes Association (Diabetes Care 2014;37:2034-54). The document also for the first time brings together recommendations for care of individuals with type 1 diabetes across all age groups.

In a video interview, Dr. Lori M.B. Laffel, one of the statement’s coauthors and chief of the pediatric, adolescent, and young adult section at Joslin Diabetes Center, Boston, explains the rationale behind this decision. Dr. David Maahs of the University of Colorado, Aurora, discusses the potential concern regarding the risk of hypoglycemia.

[email protected]

On Twitter @naseemmiller

SAN FRANCISCO – The American Diabetes Association has unified the pediatric hemoglobin A_1c target values to less than 7.5% for all pediatric age groups, moving away from breaking down glycemic control targets by age. This will also harmonize the HbA_1c goals with those of international groups such as the International Society of Pediatric and Adolescent Diabetes (ISPAD).

The change is part of a new position statement released on June 16 during the annual scientific sessions of the American Diabetes Association (Diabetes Care 2014;37:2034-54). The document also for the first time brings together recommendations for care of individuals with type 1 diabetes across all age groups.

In a video interview, Dr. Lori M.B. Laffel, one of the statement’s coauthors and chief of the pediatric, adolescent, and young adult section at Joslin Diabetes Center, Boston, explains the rationale behind this decision. Dr. David Maahs of the University of Colorado, Aurora, discusses the potential concern regarding the risk of hypoglycemia.

[email protected]

On Twitter @naseemmiller

SAN FRANCISCO — When it comes to glucose ingestion, the adolescent brain reacts differently than the adult brain. That’s according to functional MRI scans comparing the cerebral blood flow of lean adolescents with lean adults, Dr. Ania M. Jastreboff reported June 15 at the annual scientific sessions of the American Diabetes Association. 

Researchers found that lean adolescents showed increased cerebral blood flow in several regions, including the reward-motivation region (striatum), the impulse control region (anterior cingulate cortex), and the prefrontal cortex, which is in charge of executive function regulation. All these regions undergo marked developmental changes during adolescence.

In a video interview, Dr. Jastreboff, assistant professor of internal medicine and pediatrics at Yale University, New Haven, Conn., further explains the study’s findings and its implications.

[email protected]

On Twitter @naseemmiller

SAN FRANCISCO — When it comes to glucose ingestion, the adolescent brain reacts differently than the adult brain. That’s according to functional MRI scans comparing the cerebral blood flow of lean adolescents with lean adults, Dr. Ania M. Jastreboff reported June 15 at the annual scientific sessions of the American Diabetes Association. 

Researchers found that lean adolescents showed increased cerebral blood flow in several regions, including the reward-motivation region (striatum), the impulse control region (anterior cingulate cortex), and the prefrontal cortex, which is in charge of executive function regulation. All these regions undergo marked developmental changes during adolescence.

In a video interview, Dr. Jastreboff, assistant professor of internal medicine and pediatrics at Yale University, New Haven, Conn., further explains the study’s findings and its implications.

[email protected]

On Twitter @naseemmiller

SAN FRANCISCO — When it comes to glucose ingestion, the adolescent brain reacts differently than the adult brain. That’s according to functional MRI scans comparing the cerebral blood flow of lean adolescents with lean adults, Dr. Ania M. Jastreboff reported June 15 at the annual scientific sessions of the American Diabetes Association. 

Researchers found that lean adolescents showed increased cerebral blood flow in several regions, including the reward-motivation region (striatum), the impulse control region (anterior cingulate cortex), and the prefrontal cortex, which is in charge of executive function regulation. All these regions undergo marked developmental changes during adolescence.

In a video interview, Dr. Jastreboff, assistant professor of internal medicine and pediatrics at Yale University, New Haven, Conn., further explains the study’s findings and its implications.

[email protected]

On Twitter @naseemmiller

VANCOUVER, B.C. – Many overweight and obese children don’t outgrow their risk as they get older – and if they do, it’s usually between kindergarten and first grade, according to a longitudinal study that followed kindergartners to fifth grade.

But how should physicians open up the conversation with parents about their children’s obesity risks?

In this video interview at the annual meeting of the Pediatric Academic Societies, Dr. Raquel G. Hernandez, the study’s lead investigator who is with the department of pediatrics at the Johns Hopkins University School and is the associate director of medical education at All Children’s Hospital Johns Hopkins Medicine, St. Petersburg, Fla., shares her practice tips for talking with parents.

[email protected]

On Twitter @naseemmiller

VANCOUVER, B.C. – Many overweight and obese children don’t outgrow their risk as they get older – and if they do, it’s usually between kindergarten and first grade, according to a longitudinal study that followed kindergartners to fifth grade.

But how should physicians open up the conversation with parents about their children’s obesity risks?

In this video interview at the annual meeting of the Pediatric Academic Societies, Dr. Raquel G. Hernandez, the study’s lead investigator who is with the department of pediatrics at the Johns Hopkins University School and is the associate director of medical education at All Children’s Hospital Johns Hopkins Medicine, St. Petersburg, Fla., shares her practice tips for talking with parents.

[email protected]

On Twitter @naseemmiller

VANCOUVER, B.C. – Many overweight and obese children don’t outgrow their risk as they get older – and if they do, it’s usually between kindergarten and first grade, according to a longitudinal study that followed kindergartners to fifth grade.

But how should physicians open up the conversation with parents about their children’s obesity risks?

In this video interview at the annual meeting of the Pediatric Academic Societies, Dr. Raquel G. Hernandez, the study’s lead investigator who is with the department of pediatrics at the Johns Hopkins University School and is the associate director of medical education at All Children’s Hospital Johns Hopkins Medicine, St. Petersburg, Fla., shares her practice tips for talking with parents.

[email protected]

On Twitter @naseemmiller

LAS VEGAS – Anorexia nervosa in men may present in unusual ways, confounding the diagnosis and leading to inappropriate treatment, according to a case series reported at the annual meeting of the American Association of Clinical Endocrinologists.

In a video interview, Dr. Aren H. Skolnick, an endocrinology fellow at Hofstra University, Hempstead, N.Y., Jewish Medical Center, explains the signs of anorexia in men, how the condition presents itself, and what clinicians should do.

[email protected]

On Twitter @naseemmiller

LAS VEGAS – Anorexia nervosa in men may present in unusual ways, confounding the diagnosis and leading to inappropriate treatment, according to a case series reported at the annual meeting of the American Association of Clinical Endocrinologists.

In a video interview, Dr. Aren H. Skolnick, an endocrinology fellow at Hofstra University, Hempstead, N.Y., Jewish Medical Center, explains the signs of anorexia in men, how the condition presents itself, and what clinicians should do.

[email protected]

On Twitter @naseemmiller

LAS VEGAS – Anorexia nervosa in men may present in unusual ways, confounding the diagnosis and leading to inappropriate treatment, according to a case series reported at the annual meeting of the American Association of Clinical Endocrinologists.

In a video interview, Dr. Aren H. Skolnick, an endocrinology fellow at Hofstra University, Hempstead, N.Y., Jewish Medical Center, explains the signs of anorexia in men, how the condition presents itself, and what clinicians should do.

[email protected]

On Twitter @naseemmiller

VANCOUVER, B.C. – Recently, it’s become clear that milder forms of glycogen storage disease (GSD) – a genetic aberration in sugar metabolism – can cause problems with attention, mood, and growth that are easy to mistake for something else. GSD type 9 is a particularly potent imposter that occurs in boys and men only.

Once recognized, the solution is easy – cornstarch doses about every 4 hours. At the annual meeting of the Pediatric Academic Societies, a team lead by Dr. David A. Weinstein, a professor of pediatric endocrinology and the director of the glycogen storage disease program at the University of Florida, Gainesville, reported that a new, slow-release form of cornstarch called Glycosade lets patients skip their night dose so they can get a full 8 hours of sleep.

At the meeting, Dr. Weinstein told us how to recognize, diagnose, and treat glycogen storage disease, and a little bit about how effective intervention can change the lives of people who have it.

[email protected]

VANCOUVER, B.C. – Recently, it’s become clear that milder forms of glycogen storage disease (GSD) – a genetic aberration in sugar metabolism – can cause problems with attention, mood, and growth that are easy to mistake for something else. GSD type 9 is a particularly potent imposter that occurs in boys and men only.

Once recognized, the solution is easy – cornstarch doses about every 4 hours. At the annual meeting of the Pediatric Academic Societies, a team lead by Dr. David A. Weinstein, a professor of pediatric endocrinology and the director of the glycogen storage disease program at the University of Florida, Gainesville, reported that a new, slow-release form of cornstarch called Glycosade lets patients skip their night dose so they can get a full 8 hours of sleep.

At the meeting, Dr. Weinstein told us how to recognize, diagnose, and treat glycogen storage disease, and a little bit about how effective intervention can change the lives of people who have it.

[email protected]

VANCOUVER, B.C. – Recently, it’s become clear that milder forms of glycogen storage disease (GSD) – a genetic aberration in sugar metabolism – can cause problems with attention, mood, and growth that are easy to mistake for something else. GSD type 9 is a particularly potent imposter that occurs in boys and men only.

Once recognized, the solution is easy – cornstarch doses about every 4 hours. At the annual meeting of the Pediatric Academic Societies, a team lead by Dr. David A. Weinstein, a professor of pediatric endocrinology and the director of the glycogen storage disease program at the University of Florida, Gainesville, reported that a new, slow-release form of cornstarch called Glycosade lets patients skip their night dose so they can get a full 8 hours of sleep.

At the meeting, Dr. Weinstein told us how to recognize, diagnose, and treat glycogen storage disease, and a little bit about how effective intervention can change the lives of people who have it.

[email protected]

LAS VEGAS – When it comes to treating Hispanic patients, one size doesn’t fit all, according to results from the ongoing Hispanic Community Health Study/Study of Latinos.

In a video interview, Dr. Larissa Avilés-Santa, a medical officer at the National Heart, Lung, and Blood Institute in Bethesda, Md., talks about the study’s findings and provides advice to physicians at the annual meeting of the American Association of Clinical Endocrinologists.

[email protected]

On Twitter @naseemmiller

LAS VEGAS – When it comes to treating Hispanic patients, one size doesn’t fit all, according to results from the ongoing Hispanic Community Health Study/Study of Latinos.

In a video interview, Dr. Larissa Avilés-Santa, a medical officer at the National Heart, Lung, and Blood Institute in Bethesda, Md., talks about the study’s findings and provides advice to physicians at the annual meeting of the American Association of Clinical Endocrinologists.

[email protected]

On Twitter @naseemmiller

LAS VEGAS – When it comes to treating Hispanic patients, one size doesn’t fit all, according to results from the ongoing Hispanic Community Health Study/Study of Latinos.

In a video interview, Dr. Larissa Avilés-Santa, a medical officer at the National Heart, Lung, and Blood Institute in Bethesda, Md., talks about the study’s findings and provides advice to physicians at the annual meeting of the American Association of Clinical Endocrinologists.

[email protected]

On Twitter @naseemmiller