News in brief - Jan. 30, 2006

Lifestyle improvements can reverse type 2 diabetes, metabolic syndrome - Early symptoms of meningococcal disease are identified - Prostate cancer screening does little to prolong survival - Corticosteroid therapy should be paired with osteoporosis prevention - Low antibiotic use in first year of life reduces risk of allergies - Warning issued for diabetes drug - Alzheimer's drug safe and effective

Lifestyle improvements can reverse type 2 diabetes, metabolic syndrome

Overweight and obese individuals who have metabolic syndrome and type 2 diabetes showed significant health improvements after three weeks of a healthy diet and moderate exercise even though they remained overweight.

The study involved 31 men who ate a high-fiber, low-fat diet with no limit to the number of calories they consumed. The participants also performed 45-60 minutes of aerobic exercise per day on a treadmill.

The study was posted Dec. 15, 2005, in the online edition of the Journal of Applied Physiology.

The study shows, contrary to common belief, that type 2 diabetes or metabolic syndrome can be reversed solely through lifestyle changes," said lead author Christian Roberts, PhD, assistant researcher in the Dept. of Physiological Science at the University of California, Los Angeles.

Meanwhile, a second study that appeared in the Jan. 9 Archives of Internal Medicine shows that people who eat more protein from vegetables tend to have lower blood pressure. While unsure exactly how vegetable proteins might affect blood pressure, the researchers note that amino acids could play a role. Other dietary components of vegetables, such as magnesium, also might interact with amino acids to lower blood pressure.

Early symptoms of meningococcal disease are identified

British researchers have identified three early symptoms for meningococcal disease in children that could help speed diagnosis of this disease, which can progress from its initial symptoms to death within hours.

The researchers reported in the Jan. 11 online edition of The Lancet that 72% of 448 children who were studied had leg pain, cold hands and feet and abnormal skin color, symptoms that developed at an average of only 8 hours after the onset of the disease.

In contrast, the classic symptoms of meningococcal disease -- rash, headache, stiff neck, sensitivity to light and impaired consciousness -- develop 13 to 22 hours after onset.

The three early features of the disease often are present at the initial examination of an ill child, according to the researchers.

The presence of the three features suggests that vital signs, pulse, respiratory rate and capillary return might also be abnormal, they noted.

"Recognizing these early symptoms of sepsis could increase the proportion of children who are identified by primary care physicians and shorten the time to hospital admission," said lead author Dr. Matthew Thompson of the University of Oxford's Dept. of Primary Health Care in Oxford, England.

Prostate cancer screening does little to prolong survival

There is little evidence that measuring prostate-specific antigen levels in the blood and performing digital rectal exams are effective in reducing death from prostate cancer, says a study in the Jan. 9 Archives of Internal Medicine. While the screening tests could detect cancer at earlier stages, they did not necessarily prolong survival, researchers said.

They compared the treatment of 501 men age 50 and older who were diagnosed with prostate cancer between 1991 and 1995 and had died by 1999 with the treatment for 501 living men matched for age and treatment.

Medical records were reviewed to determine if the men in either group had been screened for prostate cancer. They found that 14% of the men who died of prostate cancer and 13% of the men in the control group had been screened with PSA, a similar rate. If prostate cancer screening prevented death, then fewer of the men who died would have received screening compared with the men who were living, the researchers concluded.

Thus far, evidence has led to varying recommendations. The American Cancer Society says physicians should offer the PSA blood test and digital rectal exam to men 50 and older. The U.S. Preventive Services Task Force has found insufficient evidence to recommend the screenings, and the American College of Physicians advises counseling men about the tests' benefits and risks.

Corticosteroid therapy should be paired with osteoporosis prevention

In a small study, most patients who were receiving prolonged oral corticosteroids for chronic skin diseases were not receiving therapies to prevent osteoporosis that may be caused by the drug, according to a study in the January Archives of Dermatology.

Research has demonstrated that medications known as bisphosphonates can boost bone mineral density and help reduce the risk of osteoporosis. While the American College of Rheumatology and the U.S. Dept. of Veterans Affairs have guidelines recommending their use with specific doses of glucocorticoids, no similar guidelines exist for dermatologists, said the researchers.

The researchers reviewed 35 patients with chronic skin conditions referred to the Hospital of the University of Pennsylvania. Each was taking glucocorticoids for at least one month before referral. They found that 28 of the patients were not taking bisphosphonates at the time they were referred.

"Unless there is a specific contraindication, bisphosphonates should be prescribed concomitantly with the initiation of corticosteroid therapy in diseases for which long-term glucocorticoid use is anticipated as part of the standard of care," they concluded.

Low antibiotic use in first year of life reduces risk of allergies

Children prescribed antibiotics or given drugs to reduce a fever in the first year of life are more likely to develop allergic diseases such as asthma or eczema, according to a study published in the January issue of the Journal of Allergy and Clinical Immunology.

Researchers studied more than 4,000 children attending Steiner schools in five European countries and compared them with more than 2,000 regular school children.

Steiner schools are run by anthroposophic principles which defines health as a combination of mind, body and spiritual balance, and children who attend them are less likely to have taken these medications.

Previous studies had found that Steiner children had a lower rate of allergic disease. This study attempted to determine exactly what factors play a role in that phenomenon.

Kids who took antibiotics in the first year of life were 97% more likely as to develop nasal congestion as result of an allergic reaction as those who did not. The risk of asthma increased 179% and the risk of eczema increased 63%.

The link was less severe for anti-inflammatories, although it was still there. These drugs were linked to a 54% increased risk of asthma and a 32% increase in the chance of developing eczema. There was no increased risk of nasal allergies.

Researchers suggest that because the intestinal flora is vital to the development of a normal immune system, antibiotics in the first year of life might disrupt this process. They also suggested that additional research is needed to confirm causation and look for other lifestyle differences between these two groups of children that could lead to increased risk of immune system issues.

Warning issued for diabetes drug

GlaxoSmithKline, in conjunction with the Food and Drug Administration, is warning physicians that rosiglitazone (Avandia) has, in a small number of patients, been linked to the onset or worsening of macular edema. A majority of the patients who developed this reaction already had peripheral edema, and, for many, the situation was resolved by reducing the dose or discontinuing the drug.

The label already advises physicians to use caution with this drug in patients who retain water, and the company plans to add information about macular edema in the future.

This condition tends to occur in conjunction with diabetic retinopathy and can lead to blurred vision and decreased color sensitivity.

The drug was approved for use in the United States in May, 1999. More than 5 million people with type 2 diabetes have taken it.

Alzheimer's drug safe and effective

Memantine, a drug approved for the treatment of Alzheimer's disease, appears safe and effective in patients with moderate to severe cases of the condition, according to a study in the January Archives of Neurology.

For an open-label extension trial, 175 patients with moderate to severe Alzheimer's who had completed an earlier double-blind study of memantine received 20 mg of the drug daily for 24 weeks.

Cognitive tests, reports from caregivers and observations by clinicians all indicated that memantine was beneficial to the patients.

The data "provide additional assurance to prescribing physicians that long-term use of memantine is safe, continues to have a low rate of adverse effects and may have continuing beneficial clinical effects," wrote Jeffrey L. Cummings, MD, director of the Alzheimer's Disease Research Center at the University of California, Los Angeles, in an accompanying editorial.