CLINICAL
NEWS JOURNAL WRAP
class and those secondary end points.
The authors concluded that among
adults with type 2 diabetes, there
were no significant differences in
the associations between any of the
classes of glucose-lowering drugs
(alone or in combination) and the risk
of cardiovascular or all-cause mortality. All drugs were estimated to be
effective when added to metformin.
Palmer, et al., stated that “these findings are consistent with American
Diabetes Association (ADA) recommendations for using metformin
monotherapy as initial treatment for
patients with type 2 diabetes and
selection of additional therapies based
on patient-specific considerations.”
Many adolescents who have diabetes are unaware of their condition,
according to “Prevalence of Diabetes
in Adolescents Aged 12 to 19 Years
in the United States, 2005-2014,”
a research letter authored by Andy
Menke, PhD, et al. Using data from
the National Health and Nutrition
Examination Survey (NHANES) from
2005 to 2014, the authors looked at
responses from adolescents 12 to 19
years old. In addition to being asked
if they had ever been diagnosed with
diabetes, patients’ hemoglobin A1C
and fasting plasma glucose were measured, and an oral glucose tolerance
test was administered.
Of the 2606 patients included, 62
had diabetes, 20 were undiagnosed
and 512 had prediabetes. Prediabetes
was more common in males than females; the percentage of undiagnosed
patients and the prediabetes prevalence were higher in non-Hispanic
black participants.
“To our knowledge, these are
the first estimates of diabetes in a
nationally representative sample of
US adolescents using all three ADA
recommended biomarkers,” stated
Menke, et al. “The estimates are
higher than previously reported.” The
fact that a relatively large proportion
of patients were unaware of the condition indicates a need for an improved
diabetes screening process among
adolescents.
Palmer SC, Mavridis D, Nicolucci A, et al.
JAMA. 2016;316(3):313-24.
Menke A, Casagrande S, Cowie CC. JAMA.
2016;316(3):344-5.
16
CardioSource WorldNews
programs like this work, funding
them must become a priority. “The
United Nation’s goals for non-communicable disease reduction and the
World Health Organization targets for
physical activity have led to improvements in adoption of national policies. But political commitment and
resources are lacking to implement
those policies,” they explain. “We
hope this Series will encourage policy
makers to take physical activity more
seriously and for people to take it
regularly. We must continue to strive
towards the longer term goal: the
integration of physical activity into
our daily lives,” they add.
Ekelund U, Steene-Johannessen J,
Brown WJ, Fagerland MW, et al. Lancet.
2016;doi:10.1016/S0140-6736(16)30370-1
Ding D, Lawson KD, Kolbe-Alexander
TL, Finkelstein EA, et al. Lancet.
2016;doi:10.1016/S0140-6736(16)30383-X
Sallis JF, Bull F, Guthold R, Heath GW,
et al. Lancet. 2016;doi:10.1016/S01406736(16)30581-5
Physical Activity
Series Looks at
Global Progress
and Challenges
Just one hour of physical activity per
day may help offset the harmful effects of eight hours of sitting, according to findings from a study of over 1
million individuals published July 27
as part of a four-part physical activity
series in The Lancet.
The study, by Ulf Ekelund, PhD,
et al., was a meta-analysis of 16 studies, and found that “the magnitude of
increased risk with increased sitting
time is mitigated in physically active
people.” Patients who were most active (reporting 60-75 minutes per day
of moderate-intensity physical activity) appear to have no increased risk
of mortality despite sitting more than
eight hours per day.
In order to assess the global economic burden of physical inactivity, a
separate study in the series found that
the costs associated with coronary
heart disease, stroke, type 2 diabetes,
breast cancer, and colon cancer worldwide was equivalent to $67.5 billion
in 2013. While the majority of these
costs are borne by high-income countries, lead author Melody Ding, MD,
of the University of Sydney notes that
as lower-income countries develop,
the economic burden of inactivity
will affect them as well. “Our study
makes the economic case for a global
response to promote physical activity
to tackle diseases such as diabetes,
heart disease and some cancers, with
the aim of reducing health inequalities,” she explains.
Another study in the series looked at
the effectiveness of programs and campaigns that encourage physical activity
in a number of countries. Since the 2012
Olympics, “more countries have been
monitoring progress in physical activity,
but evidence of any improvements is
scarce,” stated lead author Jim Sallis,
PhD, of the University of California San
Diego. In 2015, over 90% of countries
studied had a policy in place, and 71%
reported the policy being operational,
but this has had little effect on the physical activity level of citizens.
Increased collaboration and monitoring may increase physical activity,
according to a final study in the series
by Rodrigo S. Reis, PhD, et al. Successful programs cited included those that
put bus stops further apart to encourage walking and school-based campaigns that promote physical activity,
nutrition and healthy lifestyle choices.
However, as stated by Pam Das,
MD, and Richard Horton, MD, in an
editorial comment, in order to make
Reis RS, Salvo D, Ogilvie D, Lambert EV,
et al. Lancet. 2016;doi:10.1016/S01406736(16)30728-0
Does Liraglutide
Have an Effect on
Post-Hospitalization Stability of HF
Patients?
In patients with advanced heart
failure (HF), the drug liraglutide – a
glucagon-like peptide 1 (GLP-1)
agonists – does not lead to greater
post-hospitalization clinical stability,
according to the results of a study
published Aug. 2 in JAMA.
In the Functional Impact of GLP-1
for HF Treatment (FIGHT) study,
Kenneth B. Margulies, MD, and colleagues looked at 300 patients with
established HF and reduced left ventricular ejection fraction (LVEF) who
were randomized to receive either
liraglutide (n = 154) or a placebo (n =
146). All patients were ranked across
three hierarchical tiers: time to death,
time to rehospitalization for HF, and
time-averaged proportional change in
N-terminal pro-B type natriuretic pep-
September 2016