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DATE: January 29, 2010

In previous research, consumption of coffee, both caffeinated and decaffeinated, and tea has been linked with a lower risk of type 2 diabetes. Now, according to a meta-analysis published in the December 2009 issue of Archives of Internal Medicine, a high intake of coffee is associated with a reduced risk of diabetes.

Investigators from the University of Sydney in Australia and their colleagues searched for relevant studies regarding the association between coffee, decaffeinated coffee, or tea and diabetes between 1966 and July 2009. They identified 18 studies reporting on the association between coffee consumption and diabetes, which included information on nearly 458,000 participants. They also found 6 studies on the link between decaffeinated coffee and diabetes and 7 studies on the association between tea and diabetes. The investigators found that increased coffee consumption was linked to decreased diabetes risk, with every additional cup of coffee contributing to a 7 percent reduction in the excess risk of diabetes. Similar significant inverse associations were observed with decaffeinated coffee and tea and risk of diabetes. While this meta-analysis suggests a protective effect of coffee, decaffeinated coffee, and tea against the risk of diabetes, these findings need to be validated in randomized clinical trials.

DATE: January 22, 2010

Over the next decade the health benefits achieved because fewer Americans are smoking will be more than overshadowed by the negative health effects of the unchecked rise in obesity, new research suggests. As a population, Americans are smoking less but weigh more than they have in many years. According to the CDC, about 34% of U.S. adults, or 72 million people, are obese today, compared to about 15% in 1980. But half as many adults smoke. About 1 in 5 American adults smoke today, compared to 2 in 5 in the 1970s. Although these competing trends have been obvious, the net impact on health has been less so. In an effort to forecast the effect of the rise in obesity and decline in smoking on health at the population level over the next decade, researchers from Harvard University and the University of Michigan examined data from national health surveys conducted from the early 1970s through 2006. Their study appears in a December issue of the New England Journal of Medicine. In every scenario tested, the researchers found that the negative health impact of not addressing the obesity epidemic outweighed the benefits derived from the decline in smoking.

If all adults in the United States stopped smoking and achieved a normal weight by 2020, the life expectancy of an 18-year-old would increase by nearly four years, according to the forecast. “The hypothetical scenario in which everyone is a nonsmoker of normal weight by 2020, though, perhaps not achievable, illustrates the dramatic toll these behavioral risk factors can take when combined,” lead researcher Susan T. Stewart, PhD, and colleagues wrote. If past trends continue, nearly half of adults in the U.S. will meet the World Health Organization criteria for obesity by 2020, the forecast projects. Better management of chronic conditions closely linked to obesity, including heart disease and diabetes, would also change the forecast, the researchers noted. They conclude that efforts to improve health in the United States at the population level must focus on reducing obesity, further reducing smoking rates, and improving the management of diseases caused by both. “Inadequate progress in these areas could result in an erosion of the pattern of steady gains in health observed in the United States since the early 20th century,” they wrote.

DATE: January 15, 2010

Researchers found that bugs were able to become resistant to disinfectants which were meant to kill them. Not only can they beat the disinfectants, the bugs can become immune from one of the commonly prescribed antibiotics, ciprofloxacin, without even being exposed to the drug. A team of researchers from the National University of Ireland in Galway found that bacteria exposed to small amounts of disinfectant adapted and were able to pump out antimicrobial agents which stopped both disinfectants and antibiotics from working. In practice in hospitals, this could mean a small amount of disinfectant remaining on the floor after it was mopped could help spread serious disease.

Dr Gerard Fleming, who led the study, said: "In principle this means that residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria. "What is more worrying is that bacteria seem to be able to adapt to resist antibiotics without even being exposed to them." Dr Fleming said there needed to be further studies into how disinfectants were used in hospital and how antibiotics were prescribed. "We need to investigate the effects of using more than one type of disinfectant on promoting antibiotic-resistant strains," he said. "This will increase the effectiveness of both our first and second lines of defence against hospital-acquired infections." The study showed that when very small non-lethal amounts of disinfectant were added to the bacteria in culture, the adapted bacteria were more likely to survive antibiotics and the disinfectant compared with the non-adapted bacteria. The adapted bacteria also had a mutation in their DNA that specifically allowed them to resist ciprofloxacin-type antibiotics. The researchers looked at P. aeruginosa - an opportunistic bacterium that causes a wide range of infections in people with weak immune systems and those with diseases such as cystic fibrosis and diabetes. The bug is an important cause of hospital-acquired infections, which kill thousands each year. Disinfectants are used to kill bacteria on surfaces to prevent their spread. But if the bacteria manage to survive the disinfectants and go on to infect patients, antibiotics are used to treat them. Bacteria such as P. aeruginosa that can resist both these control points may be a serious threat to hospital patients. Dr Gerard Flemings paper The effect of sub-inhibitory concentrations of benzalkonium chloride on the competitiveness of Pseudomonas aeruginosa grown in continuous culture will be published in the January issue of the Society for General Microbiologys journal Microbiology.

DATE: January 08, 2010

Researchers led by specialists at the Johns Hopkins Wilmer Eye Institute have found that injecting a corticosteroid, triamcinolone, directly into the eye may slow the progression of proliferative diabetic retinopathy, a complication of diabetes that frequently leads to blindness. Authors of the study caution, however, that because use of steroids in the eye may increase the risk of glaucoma and cataract, laser photocoagulation remains the treatment of choice until further development of drugs that may reproduce the good effects of steroids, without the damage.

"Steroid treatment worked, but because of safety issues, cannot be recommended routinely at this time," says Neil M. Bressler, the James P. Gills Professor of Ophthalmology and chief of the Retina Division of the Johns Hopkins Wilmer Eye Institute, chair of the government-sponsored Diabetic Retinopathy Clinical Research Network. "It is a condition that can be treated safely and effectively with lasers." The study, published in the December issue of the Archives of Ophthalmology, described and compared one of two treatments on 840 eyes from 693 men and women between July 2004 and May 2006. The subjects, about evenly divided between men and women with an average age of 63, had diabetic retinopathy with macular edema, a swelling of the central portion of the retina that's caused by leakage of fluid. Proliferative diabetic retinopathy is marked by the growth of new and unwanted blood vessels on the optic nerve in the back of the eye (which communicates information from the retina to the brain) or another area of the retina, the light-sensitive part of the eye. Despite advances in treating both diabetes and its complications, about 700,000 Americans have proliferative diabetic retinopathy and 63,000 new cases develop each year.

In the study, each patient's eyes were randomly assigned to receive either a laser treatment (photocoagulation) for diabetic macular edema or an injection (1 or 4 milligrams) of triamcinolone acetonide directly into the eye as often as every four months. According to Bressler, lead author of the study, there was some evidence that steroids could improve vision outcomes from diabetic macular edema (DME), swelling of the center of the retina, the part of the retina used for reading or driving. Study results showed that steroids were not superior to laser treatments for DME. "The primary objective of the study was to determine if steroids were superior to laser for DME, and if so, to balance that superiority with steroids' side effects. A secondary objective was to determine if the steroids affected the progression of diabetic retinopathy," adds Bressler. "Steroid treatments did reduce the risk of progression of diabetic retinopathy, but, not DME, which can also cause vision loss from proliferative diabetic retinopathy, bleeding in the middle cavity of the eye or scarring of the retina, which can detach the retina from the back wall of the eye."

The steroid injections were not superior to laser with respect to increasing the chance of improved vision and decreasing the chance of vision loss, the primary objective of a study reported in 2008. "However, there was evidence that steroids can affect the pathways that lead to the development of new blood vessels on the surface of the retina in diabetes, a secondary objective of the study" says Bressler. "Controlling blood glucose levels can help prevent the development of retinopathy and laser treatments can reduce the risk of vision loss, but the identification of other treatments remains important." Bressler and colleagues, in the Diabetic Retinopathy Clinical Research (DRCR) Network, discovered that after two years, retinopathy had progressed in 31 percent of 330 eyes treated with laser treatment, 29 percent of 256 eyes treated with 1-milligram doses of triamcinolone acetonide, and 21 percent of 254 eyes treated with 4-milligram doses. The differences appeared to be sustained at three years, even though most eyes in the triamcinolone groups did not receive injections every four months during the second year and less than half received any injections in the third year because there no longer was macular edema, or less commonly, because side effects from the injections precluded applying additional steroids when following the study's treatment protocol.

Bressler says the study suggests that corticosteroids interfere with the creation of new blood vessels by reducing the production of compounds that spur their growth and cautions that steroids are also associated with other eye diseases. "Researchers now need to find ways of using the steroid effect on these blood vessels for treatment, but, not at the expense of causing glaucoma and the side effects of cataract formation or worsening of cataracts which could lead to the need for a patient to undergo cataract surgery." Other investigators who authored the study for the Diabetic Retinopathy Clinical Research Network include Allison R. Edwards, M.S., Roy W. Beck, M.D., Ph.D., Christina J. Flaxel, M.D., Adam R. Glassman, M.S., Michael S. Ip, M.D., Craig Kollman, Ph.D., Baruch D. Kuppermann, M.D., and Thomas W. Stone, M.D. The study was supported through a cooperative agreement from the National Eye Institute and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, part of the Department of Health and Human Services. Allergan Inc. provided the preservative-free triamcinolone acetonide and topical antibiotics as requested by the DRCR Network and unrestricted funds to the DRCR Network. Following the Network's Industry Collaboration Guidelines to maintain academic integrity, the DRCR Network had complete control over the design of the protocol, ownership of the data and all editorial content of presentation and publications related to the protocol.