Men at greater risk of major health effects of diabetes than women, suggests study

Men are at greater risk than women of the major health effects of diabetes (types 1 and 2), suggests a long term study published online in the Journal of Epidemiology & Community Health.

Rates of cardiovascular disease, leg, foot, and kidney complications, and the sight-threatening eye disease diabetic retinopathy are all higher in men, regardless of whether they had diabetes for more or less than 10 years, the findings show.

The global prevalence of diabetes is similar in men and women, and is projected to rise to 783 million by 2045, note the researchers.

But while cardiovascular disease is more common in men, overall, it’s not clear if this sex difference is apparent in the incidence of the complications associated with diabetes, say the researchers. Nor is it clear whether the length of time lived with diabetes might be influential, they add.

To explore this further, the researchers drew on survey responses from the 45 and Up Study, Australia, a large prospective study of 267,357 people over the age of 45 living in New South Wales (NSW).

These responses were linked to medical records for a total of 25,713 people, all of whom had either type 1 or type 2 diabetes, to monitor the development of any of the major health issues associated with diabetes

These include cardiovascular disease-ischaemic heart disease, mini stroke or TIA, stroke, heart failure, diabetic cardiomyopathy; eye problems-cataract, diabetic retinopathy; leg/foot problems-peripheral neuropathy (nerve damage), ulcers, cellulitis, osteomyelitis (bone inflammation), peripheral vascular disease (poor circulation), and minor or major amputation; and kidney problems-acute kidney failure, chronic kidney disease, chronic kidney failure, dialysis, and kidney transplant.

Almost half of the group were aged 60 to 74, and over half (57%; 14,697) were men, a higher proportion of whom were overweight (39% vs 29% of women) and had a history of heart disease.

Although a similar proportion of men and women were current smokers, a higher proportion of men were ex-smokers: 51% vs 29% of the women.

Of the 19,277 (75%) people with diabetes whose age was recorded at their diagnosis, 58% had been living with the disease for less than a decade and 42% had lived with it for 10 or more years.

Men had higher rates, and were at greater risk, of the complications associated with diabetes.

Over an average monitoring period of 10 years, and after factoring in age, 44% of the men experienced a cardiovascular disease complication while 57% had eye complications. Similarly, 25% of the men had leg/foot complications, and 35% kidney complications. The equivalent figures for women were, respectively, 31%, 61%, 18% and 25%.

Overall, men were 51% more likely to develop cardiovascular disease than women, 47% more likely to have leg and foot complications, and 55% more likely to have kidney complications.

Although there was little difference in the overall risk of eye complications between the sexes, men were at slightly higher risk (14%) of diabetic retinopathy.

While complication rates rose in tandem with the number of years lived with diabetes for both men and women, the sex difference in complication rates persisted.

By way of an explanation, the researchers point out that the men in the study were more likely to have well known risk factors. Men may also be less likely to make lifestyle changes, take preventive meds, or get health checks to lower their risks, they suggest.

This is an observational study, and as such, no firm conclusions can be drawn about causal factors, added to which people with a history of complications were excluded from the study. And information on potentially influential factors, such as diabetes medications, and glucose, blood fat, and blood pressure control wasn’t available.

But based on their findings, the researchers suggest: “For every 1000 people with diabetes, our findings suggest that an average of 37, 52, 21, and 32 people will develop cardiovascular disease, eye, lower limb, and kidney complications every year.”

While the risks of complications are lower in women with diabetes, they are still high, emphasise the researchers.

And they conclude: “Although men with diabetes are at greater risk of developing complications, in particular [cardiovascular disease], kidney and lower-limb complications, the rates of complications are high in both sexes.

“The similar sex difference for those with shorter compared with longer diabetes duration highlights the need for targeted complication screening and prevention strategies from the time of diabetes diagnosis.

“Further investigation into the underlying mechanisms for the observed sex differences in diabetes complications are needed to inform targeted interventions.”

Reference:

Gibson AA, Cox E, Schneuer FJ, et alSex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetesJ Epidemiol Community Health Published Online First: 16 May 2024. doi: 10.1136/jech-2023-221759.

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Treatment with selective aldose reductase inhibitor effective against diabetic cardiomyopathy? Study provides insights

USA: In a significant stride towards combating the complications of diabetes, a recent randomized trial has unveiled promising results regarding the efficacy of a selective aldose reductase inhibitor in managing diabetic cardiomyopathy. The trial, conducted by a team of researchers from renowned medical institutions, sheds light on a potential breakthrough in treating a severe complication associated with diabetes.

The researchers found that among individuals with diabetic cardiomyopathy (DbCM) and impaired exercise capacity, treatment with AT-001, a highly selective aldose reductase inhibitor, for 15 months did not significantly better exercise capacity compared with a placebo. However, several signals of benefit support a hypothesis that heart failure might be preventable if the polyol pathway, which features aldose reductase upregulation, is inhibited early.

The findings were published online in the Journal of the American College of Cardiology on April 8, 2024.

Progression to symptomatic heart failure is a complication of type 2 diabetes (T2D); heart failure onset in this setting is commonly preceded by deterioration in exercise capacity.

Diabetic cardiomyopathy, a condition characterized by structural and functional changes in the heart muscle, is a leading cause of morbidity and mortality among diabetic patients. Despite advancements in diabetes management, therapeutic options for diabetic cardiomyopathy remain limited, highlighting the urgent need for innovative treatments.

Against the above background, James L. Januzzi, Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA, and colleagues sought to determine whether AT-001 can stabilize exercise capacity among individuals with diabetic cardiomyopathy and reduced peak oxygen uptake (Vo2).

Six hundred and ninety-one individuals with DbCM meeting inclusion and exclusion criteria were randomized to twice daily placebo or ascending doses of AT-001. The mean age was 67.5 ± 7.2 years, and 50.4% of participants were women. Stratification at inclusion included region of enrollment, use of glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter 2 inhibitors, and cardiopulmonary exercise test results.

The primary endpoint was a proportional change from baseline to 15 months in peak Vo2. Subgroup analyses included measures of disease severity and stratification variables.

The study led to the following findings:

  • By 15 months, peak Vo2 fell in the placebo-treated patients by –0.31 mL/kg/min, whereas in those receiving high-dose AT-001, peak Vo2 fell by –0.01 mL/kg/min; the difference in peak Vo2 between placebo and high-dose AT-001 was 0.30.
  • In prespecified subgroup analyses among those not receiving glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter 2 inhibitors at baseline, the difference between peak Vo2 in placebo vs high-dose AT-001 at 15 months was 0.62 mL/kg/min.

While further research is warranted to validate these findings and explore long-term outcomes, the results of this randomized trial offer a beacon of hope for individuals living with diabetic cardiomyopathy. As researchers continue to unravel the complexities of this condition, the pursuit of innovative treatments remains paramount in improving the quality of life and prognosis for diabetic patients worldwide.

Reference:

Januzzi JL Jr, Butler J, Del Prato S, Ezekowitz JA, Ibrahim NE, Lam CSP, Lewis GD, Marwick TH, Perfetti R, Rosenstock J, Solomon SD, Tang WHW, Zannad F. Randomized Trial of a Selective Aldose Reductase Inhibitor in Patients With Diabetic Cardiomyopathy. J Am Coll Cardiol. 2024 Apr 3:S0735-1097(24)06613-0. doi: 10.1016/j.jacc.2024.03.380. Epub ahead of print. PMID: 38597864.

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World Health Assembly approves amendments to enhance International Health Regulations

Geneva: The World Health Organization said member countries on Saturday approved new steps to improve global preparedness for and response to pandemics like COVID-19 and mpox, and set a new deadline for agreeing on a broader treaty. 

Countries agreed by consensus to amend the International Health Regulations, which were last changed in 2005, such as by defining the term “pandemic emergency” and helping developing countries to gain better access to financing and medical products, WHO said.

The move came as the UN agency ended its six-day World Health Assembly this year, after plans to adopt a more sweeping pandemic “treaty” at the meeting was shelved largely over disagreements between developing countries and richer ones about better sharing of technology and the pathogens that trigger outbreaks.

Also Read:World Health Organization updates list of drug-resistant bacteria most threatening to human health

But countries agreed to complete negotiations on the pandemic accord with the year, “at the latest”, WHO said.

“The success of the IHR amendments demonstrates that in our divided and divisive world, countries can still come together to find common cause and common ground,” Director-General Tedros Adhanom Ghebreyesus said.

Lawrence Gostin, a public health law expert at Georgetown University, hailed a “big win for health security”, and posted on X that the move “will simplify negotiations for the pandemic agreement”.

WHO said countries have defined a pandemic emergency as a communicable disease that has a “wide geographical spread” or a high risk of one, and has exceeded or can exceed the ability of national health systems to respond.

It’s also defined as an outbreak that has or could cause “substantial” economic or social disruption and requires quick international action, the agency said.

WHO legal officer Steven Solomon said the move to revise the health regulations does not take effect immediately but will come into force a year after Tedros formally notifies countries of the decision.

Yuanqiong Hu, a senior legal and policy advisor at Doctors without Borders, said that the changes adopted on Saturday include “important provisions addressing equity in access to health products during global health emergencies”.

Also Read:World Health Organization prequalifies New Dengue Vaccine TAK-003 for containing dengue

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Systemic fluoroquinolone use not associated with uveitis or retinal detachment risk, reveals study

A recent research published in the Journal of American Medical Association investigated the potential link between systemic fluoroquinolone use and an elevated risk of eye conditions like uveitis and retinal detachment. Fluoroquinolones are a class of antibiotics which have been previously associated with these risks in noninterventional studies. And so, the team led by Jeremy Brown estimated the association between systemic fluoroquinolone use and the development of acute uveitis or retinal detachment. 

This comprehensive cohort study analyzed data from the Clinical Practice Research Datalink (CPRD) Aurum and GOLD UK primary care records databases which were linked to hospital admissions data. The study included adults who were prescribed either a fluoroquinolone or a comparator antibiotic, cephalosporin between April 1997 and December 2019. The extensive data analysis was conducted from May 2022 to May 2023. The participants were divided into two groups, where one group was prescribed fluoroquinolones and the other group was prescribed cephalosporins. The adults with uveitis or retinal detachment were separately analyzed in a self-controlled case series to further validate the findings.

The primary outcome was the diagnosis of acute uveitis or retinal detachment. This research estimated hazard ratios (HRs) in this study to determine the association between fluoroquinolone prescriptions and these eye conditions. The cohort study included a total of 30,01,256 individuals from the Aurum database and 4,34,754 individuals from the GOLD database.

The key findings of this study were as follows;

For uveitis, the pooled adjusted hazard ratios (aHRs) for fluoroquinolone use versus cephalosporin use were 0.91 at the first treatment episode and 1.07 over all treatment episodes. This indicated no significant increase in risk.

For retinal detachment, the pooled aHRs were 1.37 at the first treatment episode and 1.18 over all treatment episodes which suggests a potential but not statistically significant increased risk.

In the self-controlled case series, the adjusted rate ratios (aRRs) for uveitis during fluoroquinolone use versus nonuse were slightly increased during the initial 59 days but not significantly different for longer exposure periods. For retinal detachment, the aRRs showed no significant increase at any exposure duration. The findings of this study do not support a significant association between systemic fluoroquinolone use and a substantially increased risk of uveitis or retinal detachment. Overall, this study indicated that fluoroquinolone use does not pose a substantial threat to eye health when compared to other antibiotics.

Reference:

Brown, J. P., Wing, K., Evans, S. J., Leyrat, C., Mansfield, K. E., Smeeth, L., Wong, A. Y. S., Yorston, D., Galwey, N. W., & Douglas, I. J. (2024). Systemic Fluoroquinolone Use and Risk of Uveitis or Retinal Detachment. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2024.1712

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Innovative Lung Ultrasonography may Revolutionize Surfactant Therapy for Late Preterm and full-term neonates: JAMA

France: Neonatal care is a delicate field where even small advancements can significantly impact outcomes. One such advancement is quantitative lung ultrasonography, a promising tool reshaping the management of surfactant therapy in late preterm and neonatal populations.

The multicenter diagnostic study of 157 late preterm through full-term neonates with respiratory failure early after birth, published in JAMA Network Open, suggests that the lung ultrasonography score (LUS) can accurately guide surfactant administration.

“LUS accuracy in these neonates was comparable to that in early preterm neonates,” the researchers reported.

An LUS greater than 8 and 4 or less had the highest global accuracy (replacement test) and highest sensitivity (triage test), respectively.

Surfactant therapy, the administration of a natural substance that helps keep the lungs open, is crucial for the respiratory health of preterm infants. However, determining the optimal timing for surfactant therapy in late preterm and neonatal babies can be challenging, as traditional methods rely on clinical assessment and subjective criteria.

Enter quantitative lung ultrasonography, a non-invasive imaging technique that provides real-time information about lung aeration and function. By using ultrasound to assess lung aeration and the response to mechanical ventilation, clinicians can make more informed decisions about when to initiate surfactant therapy and how to optimize ventilator settings.

The lung ultrasonography score is accurate in guiding surfactant replacement in early preterm neonates, but it has not been studied yet in the late preterm through full-term neonatal population. Considering this, Daniele De Luca, AP-HP–Paris Saclay University, Paris, France, and colleagues aimed to assess whether LUS is equally accurate in predicting surfactant need in late preterm through full-term neonates as in early preterm neonates.

For this purpose, the researchers performed a prospective, international, multicenter diagnostic study between 2022 and 2023 in tertiary academic neonatal intensive care units in Italy, France, the US, and Spain. It enrolled late preterm through full-term neonates (≥34 weeks gestation) with respiratory failure early after birth.

Point-of-care lung ultrasonography to calculate the neonatal LUS (range, 0-18, with higher scores signaling worse aeration), registered in dedicated research databases and unavailable for clinical decision-making.

The outcome was the area under the curve (AUC) in receiver operating characteristic analysis and derived accuracy variables, considering LUS as a replacement for other tests (i.e., highest global accuracy) and as a triage test (i.e., highest sensitivity).

The sample size was calculated to evaluate LUS noninferiority to predict surfactant need in the study population compared with neonates born prematurely. The research team assessed correlations of LUS with the ratio of hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) to fraction of inspired oxygen (FiO2) and with the oxygen saturation index (OSI).

The following were the key findings of the study:

  • One hundred fifty-seven neonates (61.1% male) were enrolled and underwent lung ultrasonography at a median of 3 hours of life; 20.4% needed surfactant administration (pretest probability, 20%).
  • The AUC was 0.87. The highest global accuracy and sensitivity were reached for LUS values higher than 8 or 4, or lower, respectively.
  • Subgroup analysis gave similar diagnostic accuracy in neonates born late preterm (AUC, 0.89; n = 111) and early term and later (AUC, 0.84; n = 46).
  • After adjusting for gestational age, LUS significantly correlated with SpO2:FiO2 (adjusted β, −10.4) and OSI (adjusted β, 0.2).

LUS accuracy to predict surfactant need was not inferior to that observed in earlier preterm neonates in the diagnostic study of late preterm through full-term neonates with respiratory failure early after birth.

“An LUS greater than eight is associated with the highest global accuracy (replacement test), suggesting that it’s usefulness to guide surfactant administration,” the researchers wrote. “An LUS value of 4 or lower was linked with the highest sensitivity (triage test), indicating it is unlikely for this population to need surfactant.”

Reference:

De Luca D, Bonadies L, Alonso-Ojembarrena A, et al. Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later. JAMA Netw Open. 2024;7(5):e2413446. doi:10.1001/jamanetworkopen.2024.13446

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Study predicts clinical entrance location for thoracic epidural catheter insertion in paramedian route

Recent research paper investigates the preferred skin puncture point for mid-thoracic epidural insertion. The primary objective of the study was to find the skin puncture point with the highest success rate for epidural catheterization, and the secondary objectives were to study the number of attempts, passes, and failure rates.

Approach and Anatomical Landmarks –

The study was conducted with 155 patients undergoing general anesthesia with epidural analgesia in the mid-thoracic region (T5-T8). A paramedian approach was used for epidural insertion in all patients. The researchers recorded the anatomical landmark used (superior or inferior tip of spinous process or interspinous cleft), the paramedian distance of the puncture point, and the number of passes required to locate the epidural space.

Success Rate and Factors –

The results showed that the success rate at different skin puncture sites was not statistically significant. The overall success rate for epidural catheter insertion in the mid-thoracic space was 84.5%, with a failure rate of 12.9%. The first attempt success rate was 49%. The success rate was not significantly different based on the distance from the midline (0.5-1 cm, 1-2 cm, or more than 2 cm) or the anatomical landmark used.

Age and Other Factors –

The study found that failed epidural catheterization was significantly higher in the age group above 56 years. However, the effect of factors such as sex, BMI, and quality of anatomical landmarks on epidural outcome was not statistically significant.

Conclusion –

The authors conclude that there is no single preferred skin puncture point or paramedian distance that is associated with a significantly higher success rate for mid-thoracic epidural insertion using the paramedian approach. They suggest that the use of ultrasound or other imaging modalities may improve the success rates, and they have initiated a randomized trial to evaluate the role of ultrasound in this context.

Key Points

Here are the 3 key points from the research paper:

1. The study found that the success rate of epidural catheter insertion in the mid-thoracic region (T5-T8) using a paramedian approach was 84.5%, with a failure rate of 12.9%. The first attempt success rate was 49%.

2. The success rate was not significantly different based on the skin puncture site or the anatomical landmark used (superior or inferior tip of spinous process, or interspinous cleft). The distance from the midline (0.5-1 cm, 1-2 cm, or more than 2 cm) also did not affect the success rate.

3. The study found that failed epidural catheterization was significantly higher in patients over 56 years of age, but factors such as sex, BMI, and quality of anatomical landmarks did not have a statistically significant effect on the epidural outcome.

Reference –

Deshmukh BY, Shetmahajan MG, Bakshi SG, Jain P.

Predicting clinical entry point for thoracic epidural catheter insertion during paramedian approach: A prospective observational study. J Anaesthesiol Clin Pharmacol 2024;40:248‑52.

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1 in 8 pregnant females have a disability, but significant gaps exist in the provision of accessible care, claims study

People with disabilities account for 13% of all pregnancies in Ontario, but a new report shows that this population was more likely to experience pregnancy complications such as emergency department visits, hospitalizations, and preterm birth.

Researchers from ICES, the University of Toronto Scarborough, and the Centre for Addiction and Mental Health (CAMH) have released a landmark report detailing findings from one of the largest studies to date on disability and pregnancy.

Funded by the US National Institutes of Health, the Disability and Pregnancy Study used healthcare data on nearly 150,000 births to people with disabilities and interview data to examine the preconception, pregnancy, labour and birth, and postpartum and newborn health outcomes and health care experiences of people with physical, sensory, developmental and multiple disabilities in Ontario, Canada.

“In our in-depth interviews with over sixty people with disabilities, service-providers, and policymakers, we certainly found examples of positive pregnancy care experiences,” says lead author Hilary Brown, Adjunct Scientist at ICES and Associate Professor in the Department of Health and Society at the University of Toronto Scarborough. “But we also heard just how inaccessible pregnancy care can be for people with disabilities.”

Pregnancy care experiences

Interviews with people with disabilities revealed challenges that many face in the pregnancy care system, including barriers to accessibility, fragmented care, poor healthcare provider knowledge about disability, and disrespectful and ableist assumptions.

One participant shared: “I met [the doctor] for the first time when I went in to confirm the pregnancy. He was like ‘What brings you here?’ ‘Oh, I just found out that I’m pregnant.’ And he looked down at my wheelchair for a second, and he looked at me, and he said, ‘Are you here to get an abortion?’ And I was absolutely stunned. ‘No, we’ve been trying for a year and we’re really excited,’ and that was a really weird and terrible experience.”

Other participants reported difficulties in using equipment such as exam tables, communication challenges, judgment from healthcare providers, and a lack of coordinated care from social services and the health system.

Service-providers and policymakers shared their thoughts on structural barriers to accessible pregnancy care, including a lack of time during appointments to address patients’ needs-often cited as a consequence of Ontario’s fee-for-service remuneration system. Other barriers included insufficient funding for accessible equipment, inadequate disability-related training, and few clinical guidelines to support the delivery of care.

“There is a lot of evidence showing that higher rates of mental health concerns and mental health service utilization are seen in disabled people than non-disabled people accessing pregnancy care. Inaccessible care has significant impacts on mental health during pregnancy as well as postpartum,” says Yona Lunsky, report co-lead, Adjunct Scientist at ICES and Scientific Director of the Azrieli Adult Neurodevelopmental Centre at CAMH. “We learned from our study that the experience can be isolating, frightening, and challenging when supports are not in place. When we think about how to make our pregnancy care as good as possible, we need a mental health lens to fully support people.”

Key Data Findings:

• Overall, 16.3% of 15 to 49-year-old females in Ontario had a recorded disability. The most common disabilities were physical disabilities (11%), followed by sensory (4%), multiple (1%) and developmental (0.4%) disabilities.

• Emergency department visits for obstetric reasons in pregnancy were more common in females with physical (20%), developmental (27%), and multiple disabilities (25%) than in those without a disability (15%). Hospital admissions and mental health conditions were also more common for these groups.

• Newborns of females with developmental (9%) and multiple (10%) disabilities were more likely than newborns of females without a disability (6%) to be born premature (less than 37 weeks’ gestation).

Time for change

“The time to act is now,” says Brown. “We need to put a greater focus on accessibility, and this includes modifying the structures and processes of pregnancy care, so that we’re meeting the full range of needs of people with disabilities.”

The authors recommend that all pregnancy care spaces should be adapted for the mobility, communication, sensory and learning needs of people with disabilities. Further, healthcare provider renumeration policies should be flexible to allow for longer and more frequent appointments. Healthcare providers themselves need better training related to disability and accessibility. A holistic approach needs to attend to both physical and mental health needs.

“Most importantly, we need to be offering person-centered care,” Brown adds. “This means we need to listen to and affirm what people with disabilities are telling us they need-without this, we risk making changes that cause further harm.”

The report, “Equity and Inclusion in Pregnancy Care: Report on the Pregnancy Outcomes and Health Care Experiences of People with Disabilities in Ontario,” was published by ICES.

Reference:

Brown HK, Saeed G, Tarasoff LA, Proulx L, Welsh K, Fung K, Qureshi S, Guttmann A, Havercamp SM, Parish SL, Ray JG, Vigod SN, Lunsky Y. Toronto, ON: ICES; 2024.

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Breath-holding test may help assess risk of severe pain after laparoscopic gynecological surgery, suggests study

The issue of managing pain after surgery remains important, even with advancements like laparoscopy. Research shows that many patients still experience moderate to severe pain post-surgery. Recently, experts have been looking at how baroreflex sensitivity affects pain perception and relief. They found that a simple test, where patients hold their breath as long as possible during an inhale, can non-invasively and accurately assess the health of the cardiorespiratory system. This test helps identify patients who have reduced baroreflex sensitivity.

The study aimed to see how the breath-holding test is related to postoperative pain and to create a model for predicting pain after laparoscopic gynecological surgery.

Data from 489 patients who had gynecological laparoscopy at the Kuban State Medical University Clinic between August 2019 and September 2023 were analyzed.

Severe postoperative pain was reported by 146 patients (29.9%). The length of time patients could hold their breath was significantly correlated with their pain scores (NRS) upon admission to the PACU at all times during the study (ranging from -0.15 to -0.21). Logistic regression analysis showed that scores on the Generalized Anxiety Disorder scale, the Pain Catastrophizing Scale, the duration of surgery, breath-holding time, and whether the surgery was for endometriosis affected the risk of severe postoperative pain (NRS 7-10), with an AUROC of 0.809.

The breath-holding test, combined with other factors, may help assess the risk of severe postoperative pain after laparoscopic gynecological surgery.

Reference:

Alexey Dmitriev, Nikita Trembach, Breath-holding Test in the Prognosis of Postoperative Pain in Laparoscopic Gynecology: Observational Cohort Study, The Open Anesthesia Journal, DOI: 10.2174/0125896458296522240404043901.

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Asian patients more prone to type 2 diabetes 1 year after prediabetes diagnosis compared to white and Black patients: Study

One year after a prediabetes diagnosis, Asians were more likely to develop diabetes mellitus whereas Black patients were more likely to remain in prediabetes range, highlighting racial disparities in diabetes prevention, according to data presented at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass.

“Every year a small proportion of patients with prediabetes will progress to diabetes mellitus with some proportion of patients reverting to normal glucose levels,” said Ewelina Niedzialkowska, M.D., an internal medicine resident at Corewell Health William Beaumont University Hospital, in Royal Oak, Mich. “While diet, lifestyle and genetics play a large role in the progression of prediabetes to diabetes, a better understanding is needed of the role that age, gender and race play in this progression.”

The retrospective observational study included 12,509 people (57% female, 53% white, 28% Black, and 7% Asian) ages 18-65 with prediabetes, based on having two consecutive years of HbA1c between 5.7% and 6.5%. The researchers compared the demographic characteristics of individuals who progressed to type 2 diabetes or regressed to normoglycemia within one year.

“The findings revealed that 17.9% of patients returned to normal glucose levels, while 7.21% developed diabetes within the follow-up period,” Niedzialkowska said.

Most of the patients remained in the prediabetes range, she added.

“We observed that patients who progressed to diabetes were more likely to be male and have a higher BMI,” Niedzialkowska said.

The data revealed BMI was not linked to their return to normal blood glucose.

Of note, younger patients were more likely to return to normal blood glucose levels than the older patients. However, Asian and Black patients were less likely to rebound to normal glucose levels compared to white patients. The study also showed that Asian patients had a higher risk for developing diabetes, while Black patients showed a lower risk than white patients.

“Our study results highlight important characteristics in patients with prediabetes who could be at risk of progressing to diabetes. By identifying these risk factors, we will be able to develop better tools that will allow us to intervene earlier and more effectively to prevent diabetes and provide better care for our patients, especially in specific populations that may be at higher risk of developing diabetes” Niedzialkowska said.

Reference:

Asian patients more likely to develop type 2 diabetes 1 year after prediabetes diagnosis compared to white and Black patients, The Endocrine Society, Meeting: ENDO 2024.

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Preoperative washing with chlorhexidine gluconate and postoperative occlusion reduces postoperative wound infections: Study

A recent study found promising results in preventing infections in lower extremity surgical sites after Mohs micrographic surgery. The research focused on the effects of a 14-day regimen involving preoperative rinses with 4% chlorhexidine gluconate (CHG) and stringent postoperative wound care. The major findings of this study were published in the recent edition of Dermatologic Surgery journal.

Mohs micrographic surgery is renowned for its precision in removing skin cancers and often involves high stakes due to the complexity and location of the surgeries. Lower extremity sites are highly prone to infections due to various factors including poor blood supply and constant exposure to contaminants.

The study was conducted from January 2022 to June 2023 and meticulously gathered retrospective data from 100 cases that strictly adhered to the rigorous pre- and postoperative protocol. The criteria for inclusion in the study required patients to undertake a comprehensive waist-down soak and rinse with CHG for 14 days prior surgery to until the day before the operation. Also, the patients were instructed to keep the surgical dressing clean, dry and undisturbed until their follow-up appointment two weeks later.

These results revealed that none of the patients who followed this protocol developed any surgical site infections by indicating a potential breakthrough in postoperative care for Mohs surgery patients. These findings are particularly compelling given the current challenges in managing postoperative infections, which can complicate recovery processes, extend hospital stays and increase medical costs. The use of CHG which is a broad antiseptic that reduces bacteria significantly, could be a critical component in improving the patient outcomes following dermatological surgeries.

While the results of this study are encouraging, further research is necessary to fully ascertain the efficacy and safety of CHG in routine clinical practice. They advocate for additional studies to confirm these findings and potentially establish new standards of care that could be executed in outpatient dermatology settings nationwide.

This study paves the way for potentially integrating CHG rinses and meticulous wound care into standard pre- and postoperative routines but also highlights the importance of proactive infection control measures in surgical practices, specially in procedures that involved high-risk areas like the lower extremities. Overall, this research offers a promising perspective on preventing the complications through simple, yet effective, preoperative and postoperative care strategies.

Reference:

Dempsey, M. P., Riopelle, A. M., West, M., Kumar, A., & Schanbacher, C. F. (2024). The Effect of Preoperative Chlorhexidine Gluconate Cleanse on Lower Extremity Surgical Site Infections: A Retrospective Cohort Study. In Dermatologic Surgery. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/dss.0000000000004169

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