Clinical Briefs

By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville
Dr. Kuritzky is an advisor for Endo, Kowa, Pricara, and Takeda.

Coffee Might be One Less Thing We Have to Worry About

Source: Freedman ND, et al. N Engl J Med 2012;366:1891-1904.

IN THE UNITED STATES AND EUROPE, COFFEE is a staple of diet and social activities for most adults. Increased sympathetic tone — as generated by the autonomic nervous system, hyperthyroidism, cocaine, sympathetic amines, etc. — can be quite toxic. Caffeine also is a stimulant, albeit of short-lived duration. An association of coffee with higher LDL levels has also been noted. Could the commonplace life-long ingestion of coffee be toxic also?

The NIH-AARP Diet and Health Study solicited questionnaires from AARP members 50-71 years of age (n = 617,119) in 1995-96. Usable information for analysis was obtained from 402,263 of these. Many dietary aspects were addressed, but this communication was focused on coffee. Respondents grouped themselves into categories ranging from zero to more than six cups of coffee daily, subgrouped into caffeinated and decaffeinated.

By multivariate analysis (correcting for such confounders as smoking), there was an inverse relationship between coffee consumption and mortality for both men and women. For example, men who drank at least six cups of coffee daily had a 10% lower risk of death and women had a 15% lower risk. CV events, diabetes, and infectious disease causes of death were inversely associated with coffee drinking, and it did not appear to make a difference whether coffee was caffeinated or decaffeinated.

Given the observational nature of this trial, it is not possible to establish causation. Hence, while coffee consumption is associated with reduced mortality, we cannot yet say coffee consumption causes reduced mortality. Nonetheless, it is reassuring that a dietary habit so widespread among adults appears to be benign, and possibly even beneficial.

ED, Lower Urinary Tract Symptoms, and Ejaculatory Dysfunction

Source: Kwa JS, et al. Int J Impot Res 2012;24:101-105.

THAT ERECTILE DYSFUNCTION (ED) INcreases with age is not the least bit surprising. Nor, with but a moment’s consideration, is the correlation of age with lower urinary tract symptoms (LUTS) counterintuitive. After all, as men age, the prostate continues to enlarge, and nocturia, frequency, dribbling, difficulty starting/stopping stream commonly ensue. A curious observation within the last decade, however, is that there is an association between the presence of LUTS and ED that is independent of age. That is, at any age, men with LUTS have a higher frequency of ED, and the ED is correlated with the severity of LUTS. A mechanism interconnecting these two otherwise seemingly separate phenomenons has been elusive. However, a hypersensitivity to sympathetic tone has been noted both in ED and LUTS, and may be a central link. The common bond between ED and LUTS is further reflected by the recent approval of PDE5 inhibitors — which had heretofore been considered ED drugs — for management of benign prostatic hyperplasia (BPH).

In the data provided by Kwa et al on 250 mid-life men, it was again found that ED and LUTS increase with age. What they also note is that ejaculatory dysfunction (EjD) — which includes premature ejaculation, anejaculation, dry ejaculation, and decreased ejaculatory volume — also increases with age, although premature ejaculation alone was not associated with age.

EjD, ED, and LUTS have interrelatedness that is closely linked with age, but there may be other pathophysiologic correlates among them.

The Allure of Shared Medical Appointments in Diabetes Care

Sources: Ridge T. Diabetes Spectrum 2012;25:72-75. Miselli V, et al. Diabetes Spectrum 2012;25:79-84.

TWO ARTICLES IN THE SPRING EDITION OF the journal Diabetes Spectrum touch on the concept of shared medical appointments (e.g., group visits) to enhance management of type 2 diabetes. The appeal of group visits stems from several sources. First, in a busy clinical environment, the ability to share fundamental management concepts with multiple patients at the same time seems much more efficient. Second, group bonding and sharing experiences may foster team efforts that enhance knowledge, confidence, self-efficacy, and possibly even outcomes. The literature on this topic is generally favorable. The review article by Ridge describes various reports suggesting improved quality of life, knowledge, and (sometimes) diabetes control in persons who participate in group visits when compared with “usual care.”

Miselli et al provide the details of their structured Group Care Model and the results of a 4-year study of their model. Patients with type 2 diabetes were randomized into group care or usual care. At the end of 4 years, BMI, fasting glycemia, A1c, total cholesterol, and blood pressure had improved in the group care cohort, whereas they had either stayed the same or worsened in the control group. Similarly, quality of life, diabetes knowledge, and healthy behaviors improved comparatively in the group care subjects.

The idea of group visits is not new, but it has been slow to take hold in clinical settings in the United States. The group visit model may make sense both from an economic and health outcomes perspective.