Public Release:  Carrying a little extra weight decreases mortality from type 2 diabetes

American College of Physicians

1. Carrying a little extra weight decreases mortality from type 2 diabetes

Free summary for patients: http://www.annals.org/article.aspx?doi=10.7326/P15-9015

Patients with type 2 diabetes who are overweight but not obese live longer than those who are underweight or normal-weight, according to a study is published in Annals of Internal Medicine. Researchers call this effect the "obesity paradox."

Obesity is a known risk factor for cardiovascular disease and type 2 diabetes. Studies show that overweight patients with cardiovascular disease live longer than normal-weight patients with cardiovascular disease. To determine if the same could be true about patients with diabetes, researchers followed more than 10,500 patients with type 2 diabetes and no known cardiovascular disease for a median of 10.6 years and collected information about cardiovascular events and all-cause mortality. The overweight and obese patients had an increased risk for cardiovascular events, but those who were overweight had better survival rates compared to those who were underweight or normal-weight.

The authors offer a few possible reasons for the obesity paradox in type 2 diabetes. First, type 2 diabetes induced by the metabolic stress of obesity may fundamentally differ from that which develops in the absence of obesity. Second, patients with type 2 diabetes and a low BMI might have higher tobacco and alcohol consumption, contributing to both the development of diabetes and a lower BMI. Finally, obese patients may be more likely to be checked for diabetes, leading to earlier diagnosis. The researchers caution that these results do not suggest an ideal BMI and should not discourage patients from adopting a healthy lifestyle.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Angela Collom acollom@acponline.org. The lead author, Dr. Pierluigi Costanzo, can be reached directly at pierluigicostanzo83@gmail.com.


2. Daily low-molecular-weight heparin injections not recommended for reducing recurrent miscarriage

Free summary for patients: http://www.annals.org/article.aspx?doi=10.7326/P15-9014

A daily injection of low-molecular-weight heparin (LMWH) does not increase ongoing pregnancy or live-birth rates in women with unexplained recurrent pregnancy loss, according to an article in Annals of Internal Medicine. Given the burden of injections, LMWH is not recommended for preventing miscarriage.

Recurrent loss of pregnancy before 24 weeks' gestation causes emotional stress to women and their families and impedes family planning. For women with recurrent pregnancy loss caused by thrombophilic disorders, LMWH injections can increase live-birth rates. However, it is unclear if these injections can also help women without thrombophilic disorders for whom recurrent pregnancy loss is unexplained.

In this randomized, controlled, open-label, multicenter trial, 449 women with at least two consecutive early miscarriages or one late miscarriage were given either multivitamin pills or multivitamins plus a daily injection of dalteparin-sodium for up to 24 weeks' gestation. At 24 weeks, 86.8 percent of pregnancies in the intervention group and 87.9 percent of pregnancies in the control group were intact. The live-birth rates were nearly identical in both groups, as well. These results suggest that LMWH does not increase ongoing pregnancy or live-birth rates in women with unexplained recurrent pregnancy loss.

Note: The URL will be live when the embargo lifts. For an embargoed PDF and author contact information, please contact Angela Collom acollom@acponline.org.


3. Fecal transplant safe and effective for recurrent Clostridium difficile infection

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2693

A systematic review of published evidence suggests that fecal microbiota transplantation resolves symptoms in patients with recurrent Clostridium difficile infection (CDI) with few short-term adverse events. The results are published in Annals of Internal Medicine.

Clostridium difficile is a bacterium that releases toxins into the intestines causing infectious diarrhea. While the condition was previously linked to health care exposure, it now also affects persons with no or limited contact with the health care system. A key challenge with CDI is its high rate of recurrence and subsequent limited response to antimicrobial treatment. These suboptimal response rates have spurred investigation of additional treatment options, including fecal transplant.

Researchers reviewed published evidence about the benefits and harms of fecal transplant for recurrent, refractory, and initial CDI and looked for evidence that the effectiveness varied by method of transplantation. While the researchers noted a shortage of research (2 RCTs and 28 case-series studies), they saw a large positive effect with fecal transplant for CDI, both in the RCTs and case-series studies. Overall success was 85 percent for recurrent disease and 55 percent for refractory disease - rates that are substantially higher than the 30 percent to 80 percent typically reported with various medical therapies. The researchers found insufficient evidence to determine whether treatment effects vary by donor, preparation, or delivery method.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Angela Collom acollom@acponline.org. The lead author, Dr. Dimitri Drekonja, can be reached directly at drek0002@umn.edu or 952-681-0319 (mobile).

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