Clinical Briefs By Louis Kuritzky, MD
Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.
Is There a Link between Coffee and Diabetes?
The relationship between coffee and diabetes is complex. For instance, even though cohort studies suggest less risk of diabetes in coffee drinkers, similar results have been seen in data evaluating decaffeinated coffee consumption, suggesting that some other component than caffeine might be responsible. Another limiting factor of previous studies is the inclusion of subjects based upon definition of diabetes by self report, rather than as confirmed by oral glucose tolerance testing (OGTT).
Smith, et al followed middle-aged adults (n = 910) for 8 years, comparing coffee drinkers with non-coffee drinkers. The population was also compartmentalized into persons with and without prediabetes as baseline. New development of diabetes was confirmed with OGTT.
The odds ratio for development of new-onset diabetes was 0.36 for coffee drinkers compared to non-drinkers. Similar risk reduction was seen in the population who were prediabetic at baseline. There was no relationship between the amount of coffee imbibed daily with outcomes. Coffee drinkers have about a 60% reduced risk of developing diabetes than non-drinkers. Persons with prediabetes enjoy similar reductions in risk as persons with normal glucose metabolism.
Smith B, et al. Diabetes Care. 2006;29:2385-2390.
Is it Time to Start Screening for Lung Cancer?
Trials of screening for lung cancer have not provided robust support, and major consensus groups do not endorse lung cancer screening. Because the burden of lung cancer is epidemiologically compelling, and the volume of at risk-individuals is equally prominent, investigators have sought to determine whether progressively more sensitive tools (ie, capable of detecting lung CA at smaller size) might provide advantage.
The Early Lung Cancer Action Program enrolled at-risk asymptomatic men and women over the age of 40 (n = 31,567). Participants were considered at increased risk for lung cancer due to cigarette smoking, occupational exposure (eg, asbestos), or second-hand smoke exposure. After a baseline low-dose spiral CT (and appropriate followup if suspicious lesions were discerned) 21,456 participants underwent annual low-dose spiral CT for up to 12 years.
Most of the cancers were detected at the initial baseline screen (over 80%). Utilizing combined strategies of a baseline screen and annual followup, most of the cancers were identified at Stage 1, where the 10 year survival rate was 88%. The authors suggest that the detection rate of lung cancer in this trial compares favorably with rates of breast cancer detected by mammography.
The International Early Lung Cancer Action Program Investigators. N Engl J Med. 2006;355:1763-1771.
Can Ramipril Prevent Progression from Pre-Diabetes to Diabetes?
Some cardiovascular trials, like the HOPE trial, have shown that ACE inhibitors such as ramipril (RAM) can reduce the incidence of new onset diabetes (DM). Whether similar effects might be seen in specifically in a population known to be at high risk for development of diabetes—persons with known prediabetes—has received little study. Prediabetes is defined as either a fasting glucose 110-125 mg/dL or glucose 2 hours post glucose-load of 140-199.
The DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) trial enrolled prediabetic adults (n = 5,269) and randomized them to ramipril (15 mg/d target dose) or placebo for 3 years. In contrast to the HOPE trial, subjects had to be free of CV disease and diabetes at entry. This same trial also examined the impact of rosiglitazone, reported in a separate publication.
After 3 years, there was no difference between ramipril and placebo in the incidence of diabetes among persons with prediabetes.
The DREAM Trial Investigators. N Engl J Med. 2006;355:1551-1562.
The relationship between coffee and diabetes is complex. For instance, even though cohort studies suggest less risk of diabetes in coffee drinkers, similar results have been seen in data evaluating decaffeinated coffee consumption, suggesting that some other component than caffeine might be responsible.Subscribe Now for Access
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