News in brief - May 17, 2004

More Americans at risk for diabetes - ACP recommends that more diabetics take statins - Fish oil found to be heart healthy - More gonorrhea cases resistant to oral antibiotics

More Americans at risk for diabetes

A new estimate of a condition defined as "pre-diabetes" places about 40% of U.S. adults ages 40 to 74 -- or 41 million people -- at heightened risk of developing type 2 diabetes, heart disease and stroke. That estimate was announced by Health and Human Services Secretary Tommy Thompson on April 29 and is based on a revised definition of pre-diabetes released last fall by the American Diabetes Assn.

Previous criteria put estimates of those with pre-diabetes at some 20.1 million Americans in that age group. The condition, marked by blood glucose levels that are higher than normal but not yet diabetic, places people at greater risk of developing type 2 diabetes within 10 years.

Thompson announced the new estimate at HHS' second annual Steps to a HealthierUS Summit in Baltimore, where he espoused lifestyle changes to achieve better health. Those changes include losing weight, becoming physically active and eating a healthy diet to help keep diabetes and other serious health problems at bay.

Plans were also announced through the HHS National Diabetes Education Program to produce education materials tailored to African-Americans, Hispanic and Latino Americans, American Indians and Alaska Natives, Asian-Americans and Pacific Islanders and all adults ages 60 and older.

ACP recommends that more diabetics take statins

Patients with type 2 diabetes and at least one other factor that makes them more susceptible to cardiovascular disease should be prescribed moderate doses of statin drugs regardless of their cholesterol levels, according to guidelines issued by the American College of Physicians last month.

The guidelines, which were published in the Annals of Internal Medicine, also noted that all type 2 diabetics who had already had a cardiovascular event should be on the drugs, but that routine monitoring of liver function or muscle enzymes was unnecessary because of the medication's long safety record. Monitoring was needed only if patients: experienced symptoms that suggested possible side effects; already had liver problems; or were taking other medications that might increase the possibility of complications.

These recommendations are the second set of ACP guidelines attempting to address cardiovascular disease among those with type 2 diabetes. In April 2003, the group recommended that this patient group tightly control blood pressure.

Fish oil found to be heart healthy

The evidence is in that fish oil can help reduce deaths from heart disease, according to new evidence reported on April 22 by the Agency for Healthcare Research and Quality.

A systematic review by the agency of the available literature found that long chain omega-3 fatty acids, the beneficial component of fish or a fish oil supplement, reduces heart attacks and other problems related to heart and blood vessel disease in people who already have the conditions, as well as their overall risk of death.

Although omega-3 fatty acids do not alter total cholesterol, HDL cholesterol, or LDL cholesterol, evidence suggests that they can reduce levels of triglycerides, a fat in the blood that may contribute to heart disease.

The review also found evidence that fish oil can help lower high blood pressure slightly, might reduce risk of coronary artery re-blockage after angioplasty, could increase exercise capability among patients with clogged arteries and might reduce the risk of irregular heart beats, particularly in individuals who have had a recent heart attack.

More gonorrhea cases resistant to oral antibiotics

The Centers for Disease Control and Prevention is recommending that ceftriaxone and spectinomycin become the first-line choice for treating cases of gonorrhea among gay and bisexual men. Both are only available by injection.

The agency took this action because of findings published in the Morbidity and Mortality Weekly Report last month that concluded the fluoroquinolones were losing their effectiveness against the bacteria in this population. Nearly 5% of specimens collected from men who have sex with men were resistant in 2003 -- an amount more than double the rate of nearly 2% in 2002.

Fluoroquinolones have been the preferred treatment since 1993 because they are cheap, effective and available in pill form. The new recommendation may make treatment trickier for clinicians, noted the CDC. Additionally, physicians and other health care professionals are asked to be vigilant for possible treatment failures.

The inclusion of cases acquired by men who have sex with men is the latest addition to the growing list of drug-resistant versions of the bug. Cases acquired in Asia, the Pacific Islands, England, Wales, Hawaii and California have shown high levels of resistance for several years.