Treatment that includes surgery results in better blood flow to heart, study suggests

ScienceDaily (Nov. 16, 2010) ? Treatment that included early surgical procedures to open blocked arteries resulted in better blood flow to the heart than aggressive medical treatment alone in patients with both diabetes and heart disease, according to a study presented at the American Heart Association's Scientific Sessions 2010.

Previously, researchers in BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) found that over five years there were no fewer deaths and heart attacks in people who had medical treatment along with prompt vessel-opening surgery (revascularization) than in those who received only intensive treatment to manage blood sugar, blood pressure and cholesterol levels (with surgery performed later only if their condition worsened).

"Even though the main trial showed no difference in clinical outcomes, this study revealed that revascularization had a greater benefit in reducing the extent of ischemia (areas with reduced blood flow), which is often important in controlling symptoms," said Leslee J. Shaw, Ph.D., lead author of the study and professor of medicine at Emory University School of Medicine in Atlanta, Ga.

In the current sub-study of BARI 2D, 1,505 participants underwent an imaging procedure that located and measured areas of heart muscle receiving sufficient blood flow. One year into the trial, researchers found:

Fifty-nine percent of revascularization patients and 49 percent of medical patients had normal results with no drug-induced ischemia.Reductions in blood flow involved 3 percent of the heart tissue in revascularization patients and 9 percent of heart muscle in medical patients.More ischemia was associated with a greater risk of death or heart attack.

The results indicate the value of scanning patients with diabetes and heart disease who are being managed with medication and lifestyle interventions.

"The benefits of lifestyle and medication take several months, so scanning after a year can provide a barometer of how effective your treatment has been at reducing ischemia," Shaw said. "Because nerves can be damaged by high blood sugar levels, people with diabetes don't always get chest pain when blood flow is reduced. This test can show reductions in blood flow whether or not you have symptoms, and a normal test can be very reassuring."

The BARI 2D trial compared various treatment strategies for patients with both type 2 diabetes and heart disease.

More than 17 million adults in the United States have diabetes, which is one of the strongest risk factors for heart disease.

Co-authors are: Manuel Cerqueira, M.D.; Maria M. Brooks, Ph.D.; Veronica V. Sansing, M.S.; George A. Beller, M.D.; Rodica Pop-Busui, M.D.; Raymond Taillefer, M.D.; Bernard R. Chaitman, M.D.; Raymond J. Gibbons, M.D.; and Ami E. Iskandrian, M.D. Author disclosures are on the abstract. The National Heart, Lung, and Blood Institute funded the study.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

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Data Mining Method Helps Hospitals Better Identify Needs Of Their Sickest Pediatric Patients And Could Reduce Health Care Costs

Main Category: Pediatrics / Children's Health
Also Included In: Cystic Fibrosis;??Diabetes;??Blood / Hematology
Article Date: 17 Nov 2010 - 4:00 PST window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

Children with chronic health conditions such as cystic fibrosis, type 1 diabetes, sickle cell diseases and cerebral palsy represent less than two percent of the population but can consume more than 50 percent of resources at children's hospitals throughout the country. Coordinating care for these children has historically been difficult because hospitals have varying methods to identify them in their systems. In a new study led by John Neff, MD, of Seattle Children's Research Institute, researchers developed a unique method to identify children with serious lifelong chronic conditions using hospital discharge data that will enable children's hospitals to improve the quality of care for these patients and reduce costs. The study, "Identifying Children with Lifelong Chronic Conditions for Care Coordination Using Hospital Discharge Data," published online November 15 in Academic Pediatrics.

"In the long run, if we can identify these children, their cost patterns and needs, hospitals can then work with the state and health plans to provide support for the care coordination that they need. This should result in better quality of care and hopefully lower costs for these children," said Dr. Neff, clinical director at The Center for Children with Special Needs at Seattle Children's Hospital.

"One of the big barriers in the past is that hospitals have not known who their patient population is and have not been able to systematically identify them," added Neff. "Categorizing children with complex or multiple chronic conditions is particularly difficult because of the general infrequency and variable nature of their conditions. Because hospitals haven't had a reliable method to identify these patients, they haven't been able to effectively coordinate their care or know the cost implications to their own hospital."

Findings suggest that children with lifelong chronic conditions require a disproportionate share of resources in children's hospitals and when measured over several years are likely to accrue a high percentage of health costs. The study reviewed one hospital's records from 2007; these children represented 41.1 percent of Seattle Children's Hospital total patients and 71.4 percent of patient days.

Neff and co-investigators combined the use of hospital discharge data from Seattle Children's Hospital and its primary care clinic, Odessa Brown Children's Clinic (OBCC) over seven years from 2001 through 2007. They selected patients whose primary care occurred at OBCC and hospitalization and emergency department care were likely to be at Children's. Using Clinical Risk Groups (CRGs) software to analyze the data - CRGs is a risk adjustment method that has been used with health plan data to identify and stratify individuals into condition and severity groups, but has not previously been used to analyze patients in hospital discharge data - patient information was classified according to complexity of diseases and primary chronic conditions. That data was merged with hospital discharge data to identify what hospital services those patients used.

As a result of this data and methodology, Seattle Children's Hospital is launching a study that will examine how to improve the coordination of care for patients with lifelong chronic conditions, decrease their need for hospitalization and improve their quality of life. The study will follow approximately 600 of these medically complex patients for two years in a clinic that will work with patients' primary care providers to develop care plans and other interventions to improve their care and reduce the need for hospitalization.

"This will be the most comprehensive study of its kind," said Mark Del Beccaro, MD, pediatrician-in-chief at Seattle Children's Hospital. "If we succeed in showing we can improve care and lower costs for the patients and their families, this will also have tremendous implications nationally as these most complex and fragile of patients utilize a significant portion of health care expenditures in every community and state."

Neff's study collaborators were Seattle Children's Holly Clifton, MPH, Kathleen J. Park, MD, MPH, Caren Goldenberg, MPH, Jean Popalisky, DNP, RN, James W. Stout MD, MPH, and Benjamin S. Danielson, MD.

Source:
Louise Maxwell
Seattle Children's

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Treatment That Includes Surgery Results In Better Blood Flow To Heart

Main Category: Heart Disease
Also Included In: Cardiovascular / Cardiology;??Vascular;??Diabetes
Article Date: 17 Nov 2010 - 3:00 PST window.fbAsyncInit = function() { FB.init({ appId: 'aa16a4bf93f23f07eb33109d5f1134d3', status: true, cookie: true, xfbml: true, channelUrl: 'http://www.medicalnewstoday.com/scripts/facebooklike.html'}); }; (function() { var e = document.createElement('script'); e.async = true; e.src = document.location.protocol + '//connect.facebook.net/en_US/all.js'; document.getElementById('fb-root').appendChild(e); }()); email to a friend ? printer friendly ? opinions ?

Treatment that included early surgical procedures to open blocked arteries resulted in better blood flow to the heart than aggressive medical treatment alone in patients with both diabetes and heart disease, according to a study presented at the American Heart Association's Scientific Sessions 2010.

Previously, researchers in BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) found that over five years there were no fewer deaths and heart attacks in people who had medical treatment along with prompt vessel-opening surgery (revascularization) than in those who received only intensive treatment to manage blood sugar, blood pressure and cholesterol levels (with surgery performed later only if their condition worsened).

"Even though the main trial showed no difference in clinical outcomes, this study revealed that revascularization had a greater benefit in reducing the extent of ischemia (areas with reduced blood flow), which is often important in controlling symptoms," said Leslee J. Shaw, Ph.D., lead author of the study and professor of medicine at Emory University School of Medicine in Atlanta, Ga.

In the current sub-study of BARI 2D, 1,505 participants underwent an imaging procedure that located and measured areas of heart muscle receiving sufficient blood flow. One year into the trial, researchers found:

- Fifty-nine percent of revascularization patients and 49 percent of medical patients had normal results with no drug-induced ischemia.

- Reductions in blood flow involved 3 percent of the heart tissue in revascularization patients and 9 percent of heart muscle in medical patients.

- More ischemia was associated with a greater risk of death or heart attack. The results indicate the value of scanning patients with diabetes and heart disease who are being managed with medication and lifestyle interventions.

"The benefits of lifestyle and medication take several months, so scanning after a year can provide a barometer of how effective your treatment has been at reducing ischemia," Shaw said. "Because nerves can be damaged by high blood sugar levels, people with diabetes don't always get chest pain when blood flow is reduced. This test can show reductions in blood flow whether or not you have symptoms, and a normal test can be very reassuring."

The BARI 2D trial compared various treatment strategies for patients with both type 2 diabetes and heart disease.

More than 17 million adults in the United States have diabetes, which is one of the strongest risk factors for heart disease.

Co-authors are: Manuel Cerqueira, M.D.; Maria M. Brooks, Ph.D.; Veronica V. Sansing, M.S.; George A. Beller, M.D.; Rodica Pop-Busui, M.D.; Raymond Taillefer, M.D.; Bernard R. Chaitman, M.D.; Raymond J. Gibbons, M.D.; and Ami E. Iskandrian, M.D. Author disclosures are on the abstract.

The National Heart, Lung, and Blood Institute funded the study.

Source:
American Heart Association

Please rate this article:
(Hover over the stars
then click to rate)

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

All opinions are moderated before being added.

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

View the original article here

Insulin-creating cell research may lead to better diabetes treatment

ScienceDaily (Oct. 29, 2010) ? Beta cells, which make insulin in the human body, do not replicate after the age of 30, indicating that clinicians may be closer to better treating diabetes.

Type 1 diabetes is caused by a loss of beta cells by auto-immunity while type 2 is due to a relative insufficiency of beta cells. Whether beta cells replicate after birth has remained an open issue, and is critically important for designing therapies for diabetes.

By using radioactive carbon-14 produced by above-ground nuclear testing in the 1950s and '60s, researchers have determined that the number of beta cells remains static after age 30.

Lawrence Livermore National Laboratory scientist Bruce Buchholz, with collaborators from the National Institutes of Health, used two methods to examine adult human beta cell turnover and longevity.

Using LLNL's Center for Accelerator Mass Spectrometry, Buchholz measured the amount of carbon 14 in DNA in beta cells and discovered that after age 30, the body does not create any new beta cells, thus decreasing the capacity to produce insulin as a person ages.

Carbon 14 atmospheric concentration levels remained relatively stable until the Cold War, when above-ground nuclear bomb tests caused a sharp increase, or peak, which decreased slowly after the end of above-ground testing in 1963. This spike in carbon 14 in the atmosphere serves as a chronometer of the past 57 years.

Because DNA is stable after a cell has gone through its last cell division, the concentration of carbon 14 in DNA serves as a date mark for when a cell was born and can be used to date cells in humans.

"We found that beta cells turnover up to about age 30, and there they remain throughout life," Buchholz said. "The findings have implications for both type 1 and type 2 diabetes."

Type 1 diabetes is an auto-immune disease in which the body attacks beta cells. Both genetic predisposition and environmental triggers that are poorly understood have been implicated in the disease development. Disease onset is frequent during childhood but can occur throughout life and requires lifelong insulin injections/pump delivery. The body simply lacks the ability to make insulin. Type 2 diabetes (often called adult onset diabetes) is common in older people whose ability to secrete sufficient insulin to regulate blood sugar deteriorates as they age and is often due to increased demand in obese people.

"It could be due to loss of beta cells with age," Buchholz said. "The body doesn't make new ones in adulthood and there might not be enough cells to control blood sugar."

In addition, as the obesity rate increases, the incidence of type 2 diabetes increases and it is now starting to be found in obese children.

Buchholz said there is active research in stem cell therapies to replace lost beta cells for both types of diabetes. "But with these new findings, it isn't clear how easy it will be to get the body to make more beta cells in adulthood, when it is not a natural process," he said. "At the surface, it seems like coaxing the body to do what it does naturally will be easier to accomplish."

The research was funded by the National Institute of Diabetes, Digestive and Kidney Diseases at the National Institutes of Health (NIH) and NIH/National Center for Research Resources. It appears in the October issue of The Journal of Clinical Endocrinology & Metabolism.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by DOE/Lawrence Livermore National Laboratory.

Journal Reference:

S. Perl, J. A. Kushner, B. A. Buchholz, A. K. Meeker, G. M. Stein, M. Hsieh, M. Kirby, S. Pechhold, E. H. Liu, D. M. Harlan, J. F. Tisdale. Significant Human β-Cell Turnover Is Limited to the First Three Decades of Life as Determined by in Vivo Thymidine Analog Incorporation and Radiocarbon Dating. Journal of Clinical Endocrinology & Metabolism, 2010; 95 (10): E234 DOI: 10.1210/jc.2010-0932

Note: If no author is given, the source is cited instead.

View the original article here

Sensor and insulin pump results in better blood-sugar control in all age groups with diabetes, study finds

ScienceDaily (Sep. 26, 2010) ? Adding a continuous blood sugar level sensor to an insulin pump helps patients with type 1 diabetes achieve better blood sugar control compared to the common standard of care, multiple daily insulin injections, concludes a study published online in the New England Journal of Medicine.

The paper is entitled, Effectiveness of Sensor-Augmented Insulin-Pump therapy in Type 1 Diabetes.

"Combining the best technologies for insulin delivery and blood sugar monitoring really pays off for diabetes control," says Dr. Bruce Perkins, one of the co-authors of the study, endocrinologist at Toronto General Hospital and Assistant Professor at the University of Toronto. "Being aware of continuous blood sugar trends and having the tools to do something about them can help committed patients of all ages self-manage their diabetes very well."

Research conducted at 30 centres across North America, including Toronto General Hospital, found a significant decrease in average blood sugar levels (or A1c levels, which measure the average blood sugar levels over the past two or three months) from a baseline of 8.3% to 7.5% in the group using sensors and insulin pumps, compared to 8.3% to 8.1% in the multiple daily injection group, at one year. The decrease in A1c levels in both adults and children occurred without an increase in the rate of severe hypoglycemia, or low blood sugar, a common problem among patients who are trying to achieve better control of their blood sugar. Symptoms include shakiness, rapid heart beat, confusion and even unconsciousness.

Moreover, the proportion of participants who reached the A1c target of 7% or less was greater in the pump-therapy group than in the injection-therapy group. Adults with diabetes try and maintain A1c levels of seven percent or below in order to reduce the risk of complications from diabetes, such as kidney failure, heart disease and blindness.

The 485 study participants with inadequately controlled type 1 diabetes ranged in ages from seven to 70, and were treated for at least one year, in a randomized, controlled trial.

In the study, patients in the sensor-augmented pump therapy arm used an integrated system which incorporates an insulin pump, continuous glucose monitor and self-management software. A glucose (sugar) sensor reveals fluctuations in glucose levels in real-time, and transmits electric signals wirelessly to the insulin pump, which is about the size and shape of a small cell phone. The pump displays the blood sugar levels, allowing patients to react to either high or low levels before they become dangerous.

The study was sponsored by Medtronic, Inc.; and supported by Novo Nordisk; Lifescan; Bayer Heathcare; and Becton Dickinson.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University Health Network, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

View the original article here