Showing posts with label Significant. Show all posts
Showing posts with label Significant. Show all posts

Friday, November 26, 2010

Diabetes Research Made Significant Strides in Past Year

Type 2 Diabetes: Manage Your Symptoms By Serena Gordon
HealthDay Reporter

FRIDAY, Nov. 12 (HealthDay News) -- Even as the threat of diabetes continues to grow, scientists have made significant discoveries in the past year that might one day lead to ways to stop the blood sugar disease in its tracks.

That's some good news as World Diabetes Day is observed this Sunday. Created in 1991 as a joint project between the International Diabetes Federation and the World Health Organization to bring more attention to the public health threat of diabetes, World Diabetes Day was officially recognized by the United Nations in 2007.

One of the more exciting findings in type 1 diabetes research this year came from the lab of Dr. Pere Santamaria at University of Calgary, where researchers developed a vaccine that successfully reversed diabetes in mice. What's more, the vaccine was able to target only those immune cells that were responsible for destroying the insulin-producing beta cells in the pancreas.

"The hope is that this work will translate to humans," said Dr. Richard Insel, chief scientific officer for the Juvenile Diabetes Research Foundation. "And what's exciting is that they've opened up some pathways we didn't even know were there."

The other avenue of type 1 research that Insel said has progressed significantly this year is in beta cell function.

Pedro Herrera, at the University of Geneva Medical School, and his team found that the adult pancreas can actually regenerate alpha cells into functioning beta cells. Other researchers, according to Insel, have been able to reprogram other cells in the body into beta cells, such as the acinar cells in the pancreas and cells in the liver. This type of cell manipulation is called reprogramming, a different and less complex process than creating induced pluripotent stem cells, so there are fewer potential problems with the process, he said.

Another exciting development that came to fruition this past year was in type 1 diabetes management. The first closed loop artificial pancreas system was officially tested, and while there's still a long way to go in the regulatory process, Insel said there have been "very promising results."

Unfortunately, not all diabetes news this past year was good news.

One of the biggest stories in type 2 diabetes was the U.S. Food and Drug Administration's decision to restrict the sale of the type 2 diabetes medication rosiglitazone (Avandia) amid concerns that the drug might increase the risk of cardiovascular complications. The manufacturer of Avandia, GlaxoSmithKline, was also ordered to get an independent review of clinical trials run by the company.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at the Montefiore Medical Center in New York City, said one of the biggest problems he's seen stem from the Avandia debate is that many people don't want to be on any diabetes medications now. Unfortunately, he noted, unless people can really make lifestyle changes and stick with them for the long term, they may need medication to get their diabetes under control.

Perhaps the most disheartening diabetes news came just last week when the U.S. Centers for Disease Control and Prevention announced that if America stays on its current path, one in three Americans will have diabetes by 2050. Currently, the number of new diabetes cases annually is about 8 per 1,000 people, and that number is predicted to jump to 15 per 1,000 in 2050, according to CDC estimates.

One bright note in type 2 research was the most recent finding from the Look AHEAD study, a 10-year prospective study to chart the effects of aggressive weight loss efforts and compare those to standard care. This year, the four-year results came in, finding that "weight loss is clearly beneficial," said Dr. Sue Kirkman, senior vice president of medical affairs and community information for the American Diabetes Association.

"That message tends to get lost, but the effects of weight loss look as good as the results would for a drug that would end up getting approved. And, you don't have to lose huge amounts of weight to make a difference. In terms of diabetes prevention, losing 5 to 7% of your weight will help," she said.

Another piece of good news was continued research that showed that for patients who are morbidly obese, bariatric weight-loss surgery can help stop type 2 diabetes almost immediately.

"For the right patient, bariatric surgery is a good surgery. But it has risks and it has side effects, and really it's just putting a big band-aid on the problem," said Zonszein.

"The magic bullet is prevention," said Zonszein. "We have to give the message that prevention helps. If you're at risk of diabetes, or you're early in the disease, you need a plan to lose weight and exercise. Ask your doctor for help. With the right treatment plan, you may be able to delay diabetes for years," he said.

MedicalNewsCopyright ⓒ 2010 HealthDay. All rights reserved. SOURCES: M. Sue Kirkman, M.D., senior vice president, Medical Affairs & Community Information, American Diabetes Association; Joel Zonszein, M.D., professor, clinical medicine, and director, Clinical Diabetes Center, Montefiore Medical Center and Albert Einstein College of Medicine, New York City; Richard Insel, M.D., chief scientific officer, Juvenile Diabetes Research Foundation; April 4, 2010, Nature, online; April 14, 2010, Science Translational Medicine; April 23, 2010, Immunity; U.S. Centers for Disease Control and Prevention, news release, Oct. 22, 2010; Sept. 27, 2010 Archives of Internal Medicine



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Wednesday, November 3, 2010

Therapeutic Benefits Of Bariatric Surgery On Diabetes Translate Into Significant Economic Benefits


Main Category: Diabetes
Also Included In: Cosmetic Medicine / Plastic Surgery;??Obesity / Weight Loss / Fitness
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New data presented at Obesity 2010, the 28th annual scientific meeting of The Obesity Society, find that bariatric surgery is associated with reduced healthcare costs for diabetes patients who are morbidly obese. The study, conducted by Washington University School of Medicine in St. Louis, Universite du Quebec a Montreal (UQAM), and Analysis Group, Inc., shows that costs associated with bariatric surgery are fully recovered in two to three years post-surgery, and a significant reduction in diabetes diagnostics claims and diabetes medication claims occurs post-surgery. The study, Economic Impact of the Clinical Benefits of Bariatric Surgery in Diabetes Patients With BMI ≥35 kg/m2, also was published in last month's online edition of Obesity (link to abstract of study in Obesity).

Diabetes mellitus is a major public health concern in the United States and other parts of the world because of its prevalence, considerable morbidity and mortality and economic burden. Diabetes is associated with serious complications, including coronary heart disease, kidney failure, neuropathy, blindness and amputation, and was the seventh leading cause of death in 2006, accounting for more than 72,000 deaths.[i]

Type 2 diabetes accounts for 90 to 95 percent of all diagnosed cases.1 Obesity is a major risk factor for Type 2 diabetes,[ii] and the risk of diabetes increases directly with body mass index (BMI).[iii] Results of a 2004 meta-analysis of more than 20,000 patients who had bariatric surgery showed that diabetes was completely resolved in 76.8 percent of patients, and resolved or improved in 86 percent, following surgery.[iv]

"Weight loss is an important therapeutic goal in obese patients with type 2 diabetes, because even moderate weight loss 5 percent improves hepatic insulin sensitivity and reduces glucose production by the liver[v]," says Samuel Klein, M.D., director, Center for Human Nutrition, Washington University School of Medicine, St. Louis. "Bariatric surgery is the most effective available weight-loss therapy and has considerable beneficial effects on diabetes and other obesity-related comorbidities."

Diabetes-related costs represent a disproportionate share of healthcare costs among the obese.[vi] The estimated yearly costs of managing a patient with diabetes ($13,243) are more than five times that of a patient without diabetes ($2,560), and this number is expected to reach $350 billion total by 2025. With the addition of productivity lost, this number increases to $2.6 trillion in the next 15 years.[vii]

"The purpose of this study was to estimate the economic impact of the clinical benefits of bariatric surgery on medical costs and return on investment of the surgery in patients with diabetes who are morbidly obese (BMI ≥35 kg/m2)," says Pierre Cremieux, Ph.D., a health economics expert and Managing Principal at Analysis Group. "We identified obese patients with diabetes who were treated with bariatric surgery and compared their post-surgery healthcare costs, diabetes diagnosis claims, and diabetes medication claims with matched non-surgery control patients. The data show surgical therapy to be clinically effective, and ultimately less expensive, than leaving these patients on standard therapy."

Using an administrative claims database of privately insured patients covering 8.5 million lives 1999 - 2007 at 40 large nationwide companies, the researchers identified obese patients with diabetes, 18 to 65 years old who were treated with bariatric surgery, using Healthcare Common Procedure Coding System codes. These patients were matched with non-surgery control patients on demographic factors, comorbidities and healthcare costs. The overall return on investment associated with bariatric surgery was calculated using multivariate analysis, and surgery and control patients were compared post-index with respect to diagnostic claims for diabetes, diabetes medication claims, and adjusted diabetes medication and supply costs. Specific findings of the study include:

-- At six months post-surgery, 28 percent of surgery patients had a diabetes diagnosis, compared to 74 percent of control patients (P < 0.001).

-- At three months post-surgery, insulin use (among pre-index insulin users) dropped to 43 percent for surgery patients vs. 84 percent for controls (P < 0.001).

-- At one month post-surgery, medication and supply costs were significantly lower for surgery patients (P < 0.001).

This research comes in the wake of Analysis Group's 2008 research, "A Study on the Economic Impact of Bariatric Surgery," which also demonstrated that healthcare costs for morbidly obese patients receiving bariatric surgery dropped while costs for morbidly obese patients who did not have surgery continued to rise. That study also provided evidence that insurers recover their costs for bariatric surgery in two to four years, depending on the type of surgery performed.

The study was co-authored by Samuel Klein, M.D., (Wash. U), Pierre Cremieux, Ph.D., (UQAM and Analysis Group), Arindam Ghosh, Ph.D., Sara Eapen, Ph.D. and Tamara J. McGavock (all of Analysis Group). The study was funded by Ethicon Endo-Surgery, Inc., a manufacturer of minimally invasive and traditional surgical devices and instruments for bariatric surgery.

Analysis Group provides economic, financial, and business strategy consulting to leading law firms, corporations, and government agencies. The firm has more than 500 professionals, with offices in Boston, Chicago, Dallas, Denver, Los Angeles, Menlo Park, New York, San Francisco, Washington and Montreal

References

[i] National Diabetes Fact Sheet: United States, 2007. CDC Diabetes, 2007.

[ii] Ford ES, Williamson DF, Liu S. Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol 1997;146:214 - 222.

[iii] Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481 - 486.

[iv] Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724-37.

[v] Wing RR, Koeske R, Epstein LH et al. Long-term effects of modest weight loss in type II diabetic patients. Arch Intern Med 1987;147:1749 - 1753.

[vi] Cawley J, Rizzo J, Gunnarsson C, Haas K. The health care cost effects of diabetes among obese and morbidly obese adults in the United States. Poster presented at International Society of Pharmacoeconomic Outcomes Research (ISPOR) 13th Annual International meeting, Toronto, ON, Canada.

Source: Jonhnson and Johnson

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