News in brief - Sept. 6, 2004

Patients with type 2 diabetes may benefit from statins - Doctors may be overdoing colonoscopies - New tools approved against radiation contamination - Sedative abuse landing more people in ED

Patients with type 2 diabetes may benefit from statins

People who have type 2 diabetes may reduce their risk of cardiovascular events by taking statins, even if they do not have high cholesterol, according to a paper published in the Aug. 21 issue of The Lancet.

In a randomized study of 2,800 patients with type 2 diabetes, researchers in the United Kingdom gave participants either a placebo or 10 mg of atorvastatin daily. All had normal cholesterol levels and no history of heart disease at the start of the trial.

After nearly four years, the risk of death from heart disease was 27% lower among patients who received the drug. The number of strokes was reduced by 48%. The paper's authors suggested that there should no longer be any hesitation about prescribing a statin to this patient group, although an accompanying commentary expressed caution.

"It is still prudent to assess an individual's risk-benefit ratio before recommending long-term statin therapy," wrote Abhimanyu Garg, MD, chief of the division of nutrition and metabolic diseases at the University of Texas Southwestern in Dallas.

The American College of Physicians recommended in April that those with diabetes and one other heart disease risk factor should be prescribed a statin.

Doctors may be overdoing colonoscopies

About a quarter of gastroenterologists and more than half of general surgeons recommend surveillance colonoscopies in excess of guidelines for the procedure, according to a study published in the Aug. 17 Annals of Internal Medicine.

Researchers surveyed more than 600 physicians who perform screening colonoscopies. Twenty-four percent of gastroenterologists and 54% of surgeons said they recommended surveillance colonoscopies after a hyperplastic polyp. More than half of both groups also recommended the procedure more frequently than every three years after the discovery and removal of a small adenoma.

Guidelines currently do not recommend follow-up after a hyperplastic polyp but do recommend a surveillance colonoscopy every three to five years after a small adenoma.

The paper's authors suggested that overuse of the procedure is a burden on the health care system and puts patients at unnecessary risk. "We believe colonoscopy can be a life-saving procedure, but it shouldn't be done more often than necessary," said Pauline Mysliwiec, MD, MPH, lead author and assistant professor of gastroenterology at the University of California, Davis.

New tools approved against radiation contamination

The Food and Drug Administration recently approved two drugs that are used to treat certain kinds of radiation contamination.

Pentetate calcium trisodium injection, or Ca-DTPA, and pentetate zinc trisodium injection, or Zn-DTPA, have been used as investigational drugs for several decades to treat patients in radiation contamination emergencies that might occur in laboratory or industrial accidents. Both are used to treat internal contamination with plutonium, americium or curium, which could also result from terrorist attacks using a radiation dispersal device known as a "dirty bomb."

The FDA cautioned that both drugs should not be administered simultaneously. If both are available to a physician, Ca-DTPA should be given as the first dose and the treatment switched to Zn-DTPA if additional treatment is needed.

Both drugs are generally administered into the blood stream. However, in people whose contamination is only by inhalation, they can be administered by nebulized inhalation.

The two join potassium iodide, or KI, as tools used in the event of radiation exposure. Potassium iodide reduces the risk of thyroid cancer by flooding the thyroid with non-radioactive iodine, thus preventing the thyroid's uptake of radioactive molecules.

Sedative abuse landing more people in ED

The number of trips to hospital emergency departments related to abuse of benzodiazepine medications exceeded 100,000 in 2002, a 41% increase since 1995, according to the Substance Abuse and Mental Health Administration's Drug Abuse Warning Network.

Nearly half of ED visits concerning abuse of this medication class involved patients who tried to commit suicide using a benzodiazepine, had thoughts of suicide or who had made suicide gestures. Most of the patients were admitted to hospitals after emergency treatment.

Increases in ED visits were seen among young adults as well as adults older than 45. The most dramatic increase occurred among 18- to 19-year-olds, whose rate tripled from fewer than 20 per 100,000 in 1995 to nearly 60 per 100,000 in 2002.

Although benzodiazepines are useful medications and are widely prescribed for patients with anxiety, insomnia or seizures, their sophistication and frequent presence "in the nation's medicine cabinets" has increased the danger that they will be abused, said SAMHSA Administrator Charles Curie. The SAMHSA report is available online (www.oas.samhsa.gov/2k4benzodiazepines.cfm).