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.
Does Glucose Monitoring Really Help Type 2 Diabetics?
Tight glucose control has been shown to provide improved outcomes in both Type 1 and Type 2 diabetes (DM2). Although intuitively one would assume that self-monitoring of blood glucose (SMBG) in DM2 would improve glucose control, 5 randomized controlled trials have failed to conclusively confirm this notion. Since SMBG requires substantial time, energy and resources, we would like to have an evidence base which confirms benefits to the patient.
Study subjects (n = 1,286) comprised participants in the Fremantle Diabetes Study of western Australia. At baseline, 70% of subjects utilized SMBG, allowing a substantial comparison group of 'non-users.' The median frequency of SMBG was 4 tests weekly. Data were compiled based upon 5 years of observation.
A1c control was not found to be superior in persons utilizing SMBG versus persons who did not perform SMBG. In Australia, SMBG per patient costs an average of $123/yr (United States dollars), without considering the actual price of the glucometer. Although SMBG can be useful for confirming hypoglycemia, convincing evidence of meaningful benefit in improving A1c control remains to be presented.
Davis WA, et al. Is self-monitoring of blood glucose appropriate for all type 2 diabetic patients? The Fremantle Diabetes Study. Diabetes Care. 2006;29:1764-1770.
CV Risk in Migraineurs
Several studies have suggested that migraine (MIG), particularly MIG with aura (MIG/a), is associated with increased risk of ischemic stroke. Less data have accrued to study the relationship between MIG and other ischemic vascular end points, such as myocardial infarction (MI). Since the prevalence of MIG in women is three times that of men (18% vs 6%), the Women's Health Study (WHS) provides an appropriate population of healthy women (n = 27,840) in whom we may observe the cardiovascular outcomes of migraineurs over time.
In concordance with established prevalence data, 18.4% of WHS participants reported MIG, of which 40% had MIG/a. In an earlier report from the WHS, a six-year followup did not detect any relationship between MI and migraine. The 10-year followup looks distinctly different.
The hazard ratio for major cardiovascular disease among women with MIG/a was more than double that of women without MIG. Specifically looking at MI, the hazard ratio was also doubled (HR = 2.08; P = .002).
The population of women with MIG but no aura was not demonstrated to be at increased cardiovascular risk in this population. The factors that place persons with MIG/a (as opposed to simple MIG) at greater ischemic CV risk remain to be elucidated.
Kurth T, et al. Migraine and risk of cardiovascular disease in women.JAMA. 2006;296:283-291. Erratum in: JAMA. 2006;296:654; JAMA. 2006;296:1 p following 291.
Motorcycling and ED
Numerous reports have indicated a relationship between bicycling and erectile dysfunction (ED). Even when overt sexual dysfunction is not apparent, bicycling has been shown to alter penile sensation in some subjects. Such findings have been attributed to ischemic neuropathy secondary to mechanical compression. Motorcycling involves similar postural events, albeit with different saddle design; additional vibration forces occur with motorcycling that are not seen with bicycling, which could also impact development of neuropathic sequelae. There have not been any studies previously of the relationship between motorcycling and ED.
Members of an amateur motorcycle club in Japan (n = 244) form the data base for this study. Erectile function was measured by means of the IIEF, a 5-item questionnaire validated for identification and monitoring of ED. On the IIEF, a normal point score ≥ 26; in this trial, ED was defined as a score < 22.
Compared to prevalence data generated by the Massachusetts Male Aging Study, the prevalence of ED in the motorcycle club was surprising: 58% (age, 20-29), 63% (age, 30-39), 76% (age, 40-49), and 93% (age, 50-59). The majority of ED was mild-moderate degree. For men with ED, clinicians may wish to inquire about motorcycling activity.
Ochiai A, et al. Do motorcyclists have erectile dysfunction? A preliminary study. Int J Impot Research. 2006;18:396-399.
Tight glucose control has been shown to provide improved outcomes in both Type 1 and Type 2 diabetes (DM2).Subscribe Now for Access
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