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DART effective for weight loss in schizophrenia patients with Type 2 diabetes

By Jeremy Cockerill | August 18, 2010

Source: MedWire News

A 24-week dietary and lifestyle intervention program has been shown to result in significant reductions in body mass index (BMI) and weight and improve diabetes knowledge of schizophrenia patients with Type 2 diabetes.

Previous research has shown that people with schizophrenia are about twice as likely to develop diabetes as the general population, explain Christine McKibbin (University of Wyoming, Laramie, USA) and team.

They add: “The complexities of diabetes self-management (ie, careful balance between diet, physical activity, and in some cases, medication) may pose unique problems for patients with schizophrenia. Therefore it is important that diabetes management and education programs be tailored for this group.”

Writing in the journal Schizophrenia Research, the researchers report that that a group-based healthy lifestyle intervention - Diabetes Awareness and Rehabilitation Training [DART] - for patients with schizophrenia and diabetes significantly improves diabetes self-efficacy and leads to significant reductions in weight by the end of the 6-month intervention.

DART involves a 24-week intervention involving basic diabetes education, nutrition education, and lifestyle education and advice. Simple guidelines were provided such as switching from regular to diet soda and eating slowly.

In total, 62 participants with schizophrenia and diabetes, aged at least 40 years, were randomly assigned to receive DART or usual care with information (UCI), which consisted of brochures from the American Diabetes Association relevant to diabetes management.

To investigate the longer-term effects of DART, the researchers followed-up 52 participants 6 months after the end of the intervention.

They found that BMI had fallen by a mean of 1 point in the DART group, from 33.9 kg/m2 at randomization to 32.9 kg/m2 after 12 months, compared with a mean rise of 1.4 points in the UCI group, from 32.6 to 34.0 kg/m2, respectively.

Patients in the DART group also had a mean weight loss of 5 lbs after 12 months compared with a mean increase of 7 lbs in the UCI group.

The findings remained true after accounting for differences in antipsychotic or diabetes treatment.

DART participants also showed an increase in diabetes knowledge at 12 months, compared with no such improvement in the UCI patients.

McKibbin and team conclude: “The current follow-up study not only showed that participants retained some knowledge that they had gained over the course of treatment, but also that they experienced sustained improvements in anthropometric outcomes (i.e., weight/BMI and waist circumference).”

They add: “Future research should examine diabetes management interventions in larger samples of persons with schizophrenia and Type 2 diabetes.”

Osteoarthritis may protect against bone loss

By Jeremy Cockerill | August 17, 2010

Source: MedWire News

Increased severity of disc space narrowing (DSN), a feature of spinal osteoarthritis, is related to increased bone mineral density (BMD) and decreased bone resorption in postmenopausal women, Moroccan researchers report.

“Several studies have observed an inverse relationship between osteoporosis and spinal osteoarthritis, the latter being considered as possibly delaying the development of osteoporosis,” remark Linda Ichchou (El Ayachi University Hospital, Salé) and colleagues.

In the present study, Ichchou and team determined the association between individual radiographic features of spine degeneration, namely osteophytes and DSN, and bone mineral density (BMD) and bone-turn over markers.

They measured BMD at the spine and hip in 277 postmenopausal women using dual-energy X-ray absorptiometry. Lateral spinal radiographs were evaluated for the presence and severity of osteophytes and DSN at each vertebral level from L1/2 to L4/5, while serum osteocalcin and C-terminal cross-linking telopeptide of type I collagen (CTX-I) were measured from fasting morning blood samples.

Overall, 88.4% of the study participants had spine osteoarthritis and 31.2% were osteoporotic. The prevalence of osteophytes and lumbar DSN was 87.5% and 47.2%, respectively.

The researchers report that at all measured sites, BMD increased with increasing severity of DSN. In contrast, no association was found between BMD and the severity of osteophytes. However, this may be explained by the fact that the majority (78.8%) of the patients only had grade 1 osteophytes, which corresponds to a mild involvement of this radiographic feature, note the authors.

After adjustment for age and body mass index, decreased CTX-I was significantly associated with increased DSN. There was no significant correlation between CTX and osteophytes, or between osteocalcin, and either osteophytes, or DSN.

“These results are consistent with the hypothesis that osteoarthritis, through DSN, has a protective effect against bone loss, mediated by a lower rate of bone resorption,” conclude Ichchou et al in the open access journal BMC Women’s Health.

“However, spine BMD is not a relevant surrogate marker for the assessment of osteoporosis in the spine in patients with osteoarthritis, and debate as to the relationship between osteoarthritis and osteoporosis is still open because of the contradictory data in the literature,” they add.

Group C human rhinoviruses implicated in most childhood asthma attacks

By Jeremy Cockerill | August 16, 2010

Source: MedWire News

More than half of asthma attacks in children are associated with group C human rhinoviruses (HRVC), results from an Australian study suggest.

“Asthma exacerbations are a leading cause of hospitalization for children in developed countries and the majority of these exacerbations are associated with viral respiratory infections (VRI), particularly human rhinovirus (HRV),” explain Joelene Bizzintino (University Of Western Australia, Perth) and team.

However, they add that “a new and potentially more pathogenic group of HRV, group C, has recently been discovered,” which may be associated with more severe asthma attacks than HRV group A or B viruses or other viruses.

To investigate, the team studied 128 children, aged 2-16 years, from the Perth Childhood Acute Asthma Study who attended an emergency department suffering from asthma attacks.

The severity of the children’s asthma exacerbations was assessed and nasal secretions were collected for analysis of respiratory viruses.

Most of the children (85.2%) had moderate-to-severe asthma and 98.9% were admitted to hospital, the researchers note in the European Respiratory Journal.

Overall, 87.5% of the children showed evidence of HRV infection, including most of the 14.8% of children that showed evidence of infection with other viruses.

Furthermore, more than half (59.4%) the children were infected with HRVC, which was associated with increased asthma severity.

Indeed, children with HRVC had significantly higher mean asthma exacerbation severity scores than those infected with HRV A or B only (n=34), at 10.4 versus 9.5, and all other children who were not infected with an HRVC strain (n=50), at 9.4.

These differences in severity remained significant after adjustment for age and gender.

Bizzintino and team conclude: “The current study has shown that the newly identified HRVC group of viruses is responsible for not only the majority of acute asthma attacks in children, but also that this group causes more severe attacks than previously-known viruses.”

They add: “These findings suggest that HRVC is by far the most important virus group in acute asthma.

“Further studies are needed to investigate the epidemiology and the pathogenicity of the different HRV strains and host susceptibility to these strains with a view to developing new therapeutic strategies.”

Retinopathy prevalence high in US adults with diabetes

By Jeremy Cockerill | August 12, 2010

Source: MedWire News

Over a quarter of US diabetics aged 40 years or older have retinopath, with a particularly high prevalence seen in non-Hispanic Black individuals, show study results published in the Journal of the American Medical Association.

“Investigating the prevalence of diabetic retinopathy (DR) is important because it is a key indicator of systemic diabetic microvascular complications, and as such, a sentinel indicator of the impact of diabetes,” write Xinzhi Zhang (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues.

They carried out a cross-sectional, nationally representative study of the prevalence of DR in 1006 diabetic adults who participated in the National Health and Nutrition Examination Survey 2005-2008 and were aged 40 years or older.

The researchers defined diabetes as a self-reported previous diagnosis or a glycated hemoglobin (HbA1c) level of 6.5% or more, and DR was identified using fundus photographs graded according to the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale.

Predicted population values for the prevalence of DR and vision-threatening DR were 28.5% and 4.4%, respectively.

The overall recorded prevalence of DR was 31.6% in men and 25.7% in women with diabetes. Male gender increased the risk for having DR 2.07 fold. Vision-threatening DR prevalence was not influenced by gender and was 4.2% overall.

Non-Hispanic Black and Mexican-American diabetics had a higher prevalence of DR than non-Hispanic White diabetics, at 38.8% and 34.0% versus 26.4%, respectively. The former two ethnic groups also had a higher prevalence of vision-threatening DR, at 9.3% and 7.3% versus 3.2% in non-Hispanic White diabetics.

Individuals with DR had higher mean HbA1c (7.9% vs 7.0%), longer diabetes duration (15.0 vs 7.3 years), and higher systolic blood pressure (134.2 vs 130.1 mmHg) than those without DR. They were also 3.23 times more likely to be taking insulin than those without DR.

“These estimates provide policy makers updated information for use in planning eye care services and rehabilitation. With the aging of the population and the increasing proportion of the population with diverse racial/ethnic heritage, the number of cases of diabetic retinopathy and vision-threatening diabetic retinopathy will likely increase,” conclude the authors.

“Furthermore, the need for eye care and for culturally appropriate interventions that can reduce disparity and improve access to eye care among diverse populations is also likely to increase,” they add.

Obesity in childhood increases risk for GERD

By Jeremy Cockerill | August 4, 2010

Source: MedWire News

Obese children have significantly increased risk for developing gastroesophageal reflux disease (GERD) compared with those of normal weight, report researchers.

“Childhood obesity, especially extreme childhood obesity, comes with a high risk for many serious health consequences such as diabetes, cardiovascular disease, and cancer,” said lead study author Corinna Koebnick, from Kaiser Permanente Southern California’s Department of Research and Evaluation in Pasadena, USA.

“The takeaway message of our study is that GERD now also is one of the conditions associated with childhood obesity,” she said.

Koebnick and colleagues report the results of their study in the International Journal of Pediatric Obesity. They analyzed cross-sectional data from 690,321 children aged 2-19 years enrolled in an integrated, prepaid health plan from 2007-2008.

The children were stratified by weight according to gender-specific body mass index (BMI) for their age. They were classified as being underweight (below 5th BMI percentile), normal weight (BMI between 5th and 85th percentile), overweight (BMI at or above 85th percentile or 25 kg/m2), moderately obese (BMI at or above 95th percentile or 30 kg/m2), and extremely obese (BMI at or above 1.2 x 95th percentile or 35 kg/m2).

The researchers also assessed the frequency of GERD, which was diagnosed in 1.5% of boys and 1.8% of girls in total.

Compared with normal-weight children aged 6-11 and 12-19 years, those in these age groups who were moderately or extremely obese were a significant 16% and 16% more likely to have GERD, respectively. This association was not seen in children aged 5 years or younger, however.

The increased risk for GERD in obese patients was greatest among those who were extremely obese, with the risk increased 32% among those aged 6-11 years, compared with normal-weight children, and 40% among participants aged 12-19 years.

“Even though some health conditions associated with extreme childhood obesity may not seem important early in life, they can be a significant burden for the patient and a link to other serious conditions later in life,” said Koebnick.

“We need to be aware of these links, search for obesity-related conditions and address childhood obesity as a family issue as early as possible,” she added.