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.

Hair Growth With Finasteride: Not Just More, but More Better!

Male pattern baldness is a result of the impact of dihydrotestosterone (DHT) upon scalp hair follicles which results in a progressive miniaturization of follicles leading to thinner, shorter hairs in genetically susceptible men. Scalp biopsy has shown that susceptible men have higher levels of cutaneous DHT, more cutaneous 5-alpha-reductase (the hormone responsible for converting testosterone to DHT), and more androgen receptors than comparator groups.

Finasteride is a 5-alpha-reductase inhibitor (5ARI), which prevents production of DHT from testosterone. In this trial, subjects were given standard oral doses of finasteride (1 mg/d) or placebo for 4 years.

Active treatment produced a significant effect upon hair weight and hair count. For instance, by week #192, hair weight had increased by 21.6% in the treatment group, but had decreased by 24.5% in the placebo group, for a net increase of 46% compared to placebo. Finasteride has a favorable impact both upon the number of scalp hairs and their size.

Price VH, et al. J Am Acad Derm 2006;55:71-74.

Prevalence of Diabetic Neuropathy

The relevance of diabetic peripheral neuropathy (DPN), and its commonplace sequela of diabetic peripheral neuropathic pain (DPNP) has recently been highlighted by an American Diabetes Association survey that indicates a distressingly low level of patient awareness of this disorder or its importance. Since diabetes remains the number 1 cause of non-traumatic limb loss in the United States, and DPN is the most common antecedent, it is critical to heighten clinician attention to identification and management of persons with DPN or DPNP. Epidemiologic prevalence data may help to drive clinician awareness.

This cross-sectional survey of a population in South Wales, United Kingdom incorporated both a postal survey and neurologic examination to define the presence of DPN and DPNP. Of 326 diabetic persons who responded to the postal survey that they had "burning, aching, or tenderness in your legs or feet," evaluation by a neurologist indicated that DPNP was the etiology in 19% of the cases. In persons with DPNP, the vast majority (80%) reported the degree of pain as moderate to severe. Persons with DPNP demonstrated a poorer quality of life than persons with non-neuropathic pain.

The authors comment that extrapolating these data to the diabetic population of the United Kingdom, as many as a half million persons suffer DPNP, most of whom endure pain of moderate or greater intensity. To date, in this population only approximately half of DPNP sufferers have sought treatment.

Davies M, et al. Diabetes Care 2006;29:1518-1522

What is the Best Way to 'Predict' Diabetes: IFG, IGT, or A1c?

The american diabetes association (ADA) does not advocate use of the A1c for diagnosing diabetes. Rather, they suggest use of fasting or random glucose, or oral glucose tolerance testing (GTT). Most commonly, the diagnosis is made by means of the fasting or random measurement, since GTT is more cumbersome, expensive, and less convenient. Other authors have suggested that A1c might be a reasonable way to diagnose diabetes, since we only intervene with treatment when the A1c is above a particular threshold (> 7.0, according to the ADA). The ADA points out that although there is a national standard test for A1c, laboratories are not required to use it; we are in a similar state with A1c to where we used to be with the Pro-time for Coumadin monitoring: it varied from hospital to hospital. Then came the INR, so that now the results are standardized across all hospitals. We do not yet enjoy a similar universal standardization of A1c. Additionally, the A1c appears to be less sensitive to very early abnormalities of glucose as detected by IFG or IGT.

The DESIR study provided data on 2,720 men and women who were defined as being 'at-risk' on the basis of an elevated fasting glucose. These individuals also had A1c measured and were followed for 6 years.

A1c was less sensitive and less specific than fasting glucose for predicting diabetes. If some circumstance prevents patients from obtaining a fasting glucose measurement, A1c provides a second-best predictive value.

Droumaguet C, et al. Diabetes Care. 2006;29:1619-1625.