The sequencing of the Neanderthal genome has revealed that between 1-4% of the DNA in present-day non-African populations is derived from interbreeding with Neanderthals approximately 50,000-60,000 years ago. Subsequent analyses demonstrated that a significant proportion of these introgressed alleles localize to genes involved in immune regulation and pathogen defense, suggesting that archaic admixture exerted selective pressure on host-pathogen interactions.

During the Covid-19 pandemic, the relevance of this legacy became clinically apparent. Zeberg and Pääbo (2020) identified a Neanderthal-derived haplotype on chromosome 3 that confers a substantially increased risk of severe outcomes. Carriers of this haplotype demonstrated an odds ratio of ~2.0 for ICU admission and mechanical ventilation, with the highest allele frequency observed in South Asian populations (up to 50%). Conversely, subsequent work by the same group (Zeberg & Pääbo, 2021) identified a protective Neanderthal haplotype on chromosome 12, associated with a 22% reduced risk of progression to severe disease.

These findings illustrate the dual nature of archaic introgression. Certain variants provided adaptive advantages to ancient humans encountering novel Eurasian pathogens, enhancing antiviral defenses via toll-like receptor pathways and interferon responses. However, in contemporary settings, the same alleles predispose carriers to maladaptive hyper-inflammatory states, increasing susceptibility to acute respiratory distress in viral infections such as Covid-19.

The clinical implications extend beyond SARS-CoV-2. Genome-wide association studies (GWAS) have linked Neanderthal-derived alleles to a spectrum of immune-mediated disorders, including systemic lupus erythematosus, Crohn's disease, and type 2 diabetes (Dannemann & Kelso, 2017). This highlights an evolutionary trade-off: alleles advantageous in pathogen-rich Pleistocene environments may contribute to autoimmune dysregulation in modern, relatively sanitized conditions.

For clinicians, these discoveries underscore the heterogeneity of patient responses to infection beyond comorbidities and demographics. Ancestral genomic background may constitute an underappreciated risk modifier for disease severity. Although not yet integrated into clinical practice, the growing field of archaic genomics suggests that precision medicine could eventually stratify infection risk and therapeutic response according to both modern and archaic genetic variants.

References

• Green RE, Krause J, Briggs AW, et al. (2010). A Draft Sequence of the Neandertal Genome. Science, 328(5979):710-722. 
• Zeberg H, Pääbo S. (2020). The major genetic risk factor for severe Covid-19 is inherited from Neanderthals. Nature, 587:610-612. 
• Zeberg H, Pääbo S. (2021). A genomic region associated with protection against severe Covid-19 is inherited from Neanderthals. PNAS, 118(9): e2026309118.
• Dannemann M, Prüfer K, Kelso J. (2016). Functional implications of Neandertal introgression in modern humans. Genome Biology, 17:90.
• Dannemann M, Kelso J. (2017). The contribution of Neanderthals to phenotypic variation in modern humans. Am J Hum Genet, 101(4):578-589.

Both the World Health Organization and Eli Lilly warned Thursday that consumers should avoid fake versions of weight-loss drugs that are circulating in numerous countries.

The WHO warning said that the international health agency has fielded several reports of fake semaglutide -- the active ingredient in Novo Nordisk’s Wegovy and Ozempic -- in all geographic regions of the world since 2022.

“WHO advises healthcare professionals, regulatory authorities and the public be aware of these falsified batches of medicines,” Dr. Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products, said in the warning. “We call on stakeholders to stop any usage of suspicious medicines and report to relevant authorities.”

Meanwhile, Lilly said in an open letter that it was “deeply concerned” about phony or compounded versions of tirzepatide, the active ingredient in the Lilly weight-loss drugs Mounjaro and Zepbound.

"These [fake] products are often advertised and sold online, through social media or at certain med-spas," Lilly said in its letter. "They may contain no medicine, the wrong medicine, incorrect dosages or multiple medicines mixed together, which could result in serious harm. They are never safe to use."

Novo Nordisk has issued similar warnings in the past about its medications.

The WHO said patients can protect themselves by using prescriptions from licensed physicians to buy the medications. Consumers should also avoid buying the drugs from unfamiliar sources, the agency added.

For its part, Lilly noted any products marketed as tirzepatide and not Mounjaro or Zepbound were not made by the drugmaker and are not approved for use by the U.S. Food and Drug Administration.

More information

The Obesity Medicine Association has more on weight-loss drugs.

SOURCES: Eli Lilly, news release, June 2024; World Health Organization, news release, June 20, 2024

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For teens undergoing bariatric surgery, weight loss and remission of coexisting conditions are durable after 10 years, according to a research letter published online in the Oct. 30 issue of the New England Journal of Medicine.

Justin R. Ryder, Ph.D., of the Ann and Robert H. Lurie Children’s Hospital of Chicago, and colleagues reported the 10-year outcomes for the Teen Longitudinal Assessment of Bariatric Surgery study. The analysis included 161 adolescents who underwent gastric bypass and 99 who underwent sleeve gastrectomy at a mean age of 17 years (83 percent followed to 10 years).

The researchers found that at 10 years, body mass index (BMI) decreased significantly (mean change, −20.0 percent), with similar changes between gastric bypass (mean change, −20.6 percent) and sleeve gastrectomy (mean change, −19.2 percent). Four distinct trajectories of changes in BMI over time were identified through a latent class analysis. Greater early weight loss (change in BMI at six months) was associated with a more favorable long-term BMI trajectory (odds ratio, 1.16). Remission of coexisting conditions at 10 years postsurgery was 55 percent for type 2 diabetes, 57 percent for hypertension, and 54 percent for dyslipidemia, indicating durable responses for most participants.

"These findings show the long-term durability of weight loss and remission of coexisting conditions after bariatric surgery, as well as the greater health benefits and durability of the effects in adolescents than would be expected in similarly treated adults," the authors write.

Several authors disclosed ties to relevant organizations.

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The prevalence of diabetes was 15.8 percent among U.S. adults during August 2021 to August 2023, according to a November data brief published by the National Center for Health Statistics.

Jane A. Gwira, M.D., M.P.H., from the National Center for Health Statistics in Hyattsville, Maryland, and colleagues used data from the National Health and Nutrition Examination Survey to examine the prevalence of diagnosed, undiagnosed, and total diabetes (excluding gestational diabetes) among U.S. adults during August 2021 to August 2023.

The researchers found that the prevalence of total diabetes was 15.8 percent, and the prevalence rates of diagnosed and undiagnosed diabetes were 11.3 and 4.5 percent, respectively, among U.S. adults during August 2021 to August 2023. Men had a higher prevalence of total and diagnosed diabetes than women (18.0 and 12.9 percent versus 13.7 and 9.7 percent). With age and with increasing weight status, there was an increase in the prevalence of total, diagnosed, and undiagnosed diabetes. Between 1999-2002 and August 2021 to August 2023, there was an increase in the age-adjusted prevalence of total and diagnosed diabetes.

"Slightly more than one-quarter of adults with diabetes had undiagnosed diabetes," the authors write. "Continued monitoring of both diagnosed and undiagnosed diabetes will provide essential information about the prevalence of diabetes in adults in the United States."

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More than 45 percent of patients with type 2 diabetes (T2D) have micronutrient deficiencies, with the most prevalent deficiency being vitamin D, according to a meta-analysis published online Jan. 28 in BMJ Nutrition Prevention & Health.

Daya Krishan Mangal, Ph.D., from the Indian Institute of Health Management Research in Jaipur, and colleagues conducted a comprehensive assessment of the burden of multiple micronutrient deficiencies among patients with T2D. A total of 132 studies with 52,501 participants were included in the analysis.

The researchers found that the pooled prevalence of multiple micronutrient deficiencies was 45.30 percent among patients with T2D. The pooled prevalence was higher in women with T2D (48.62 percent) than in men (42.53 percent). The most prevalent micronutrient deficiency was vitamin D followed by magnesium (60.45 and 41.95 percent, respectively). The metformin-consuming group had higher B12 deficiency (28.72 percent). Across World Health Organization regions, there was variation seen in the prevalence of micronutrient deficiency.

"Micronutrient deficiencies may influence glucose metabolism and insulin signaling pathways, leading to the onset and progression of T2D," the authors write.

One author disclosed ties to Abbott, which funded the study.

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As people with diabetes age into Medicare, they face increased quarterly out-of-pocket costs for medication, according to a study published online July 9 in JAMA Network Open.

Douglas Barthold, Ph.D., from the University of Washington in Seattle, and colleagues examined whether reaching age 65 years is associated with changes in type 2 diabetes (T2D) medication out-of-pocket costs and utilization. The analysis included seven years of prescription drug claims data for 129,997 individuals with T2D identified from the TriNetX Diamond Network (before and after turning 65 years).

The researchers found that reaching age 65 years was associated with an increase of $23.04 in mean quarterly out-of-pocket costs for T2D drugs, including an increase of $56.36 at the 95th percentile of spending, after utilization adjustment. At age 65 years, utilization decreased by 5.3 percent (3.40 claims per quarter to 3.22 claims per quarter). A shift in utilization composition showed increased insulin use, which was associated with additional increases in patient costs.

"The increased patient cost burden at age 65 years and a modest reduction in overall T2D drug utilization suggest that as people with T2D age into Medicare, there is potentially an increase in nonadherence and diabetes complications," the authors write.

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Adults screened for inactivity at well visits have lower rates of comorbid conditions, according to a study published online Jan. 2 in Preventing Chronic Disease.

Cole G. Chapman, Ph.D., from the University of Iowa in Iowa City, and colleagues examined the value of screening patients for physical activity in a study involving adults treated for a well visit between Nov. 1, 2017, and Dec. 1, 2022, at a large Midwestern university hospital. A total of 7,261 patients screened for inactivity were compared to 33,445 unscreened patients. Further comparisons were conducted between screened patients who were inactive, insufficiently active, or active (0, 1 to 149, and 150+ minutes/week of moderate-to-vigorous physical activity).

The researchers found that patients screened for inactivity presented with lower rates of several comorbid conditions, including obesity, diabetes, and hypertension, compared with unscreened patients. Significantly healthier cardiometabolic profiles and a lower risk for up to 19 inactivity-related comorbid conditions were seen for active versus insufficiently active and inactive patients.

"We believe this finding is a result of those patients who take the time to come in for annual wellness exams also are taking more time to engage in healthy behaviors, such as being physically active," coauthor Lucas J. Carr, Ph.D., from the University of Iowa Health Care Medical Center, said in a statement.

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FRIDAY, Jan. 26, 2024 (HealthDay News) -- Individuals with evidence of remission of type 2 diabetes have a considerably reduced risk for chronic kidney disease (CKD) and cardiovascular disease (CVD), according to a study published online Jan. 18 in Diabetologia.

Edward W. Gregg, Ph.D., from the Royal College of Surgeons of Ireland in Dublin, and colleagues conducted a multicenter randomized controlled trial comparing the effect of a 12-year intensive lifestyle intervention with that of diabetes support and education on CVD and other long-term outcomes. Based on achievement and duration of diabetes remission, the incidence of CVD and CKD was compared among 4,402 and 4,132 participants, respectively. CVD incidence was defined as any occurrence of nonfatal acute myocardial infarction, stroke, admission for angina, or CVD death; high-risk or very high-risk CKD were defined based on the Kidney Disease Improving Global Outcomes criteria.

The researchers found that in multivariate analyses adjusting for hemoglobin A1c, blood pressure, lipid levels, CVD history, diabetes duration, and intervention arm, the risks for CKD and the composite CVD measure were significantly reduced for participants with evidence of any remission during follow-up (hazard ratios, 0.67 and 0.60, respectively). Participants with evidence of longer-term remission had the greatest magnitude of risk reduction.

"As the first intervention study to associate remission with reduction of diabetes-related complications, this is encouraging news for those who can achieve remission from type 2 diabetes," Gregg said in a statement. "While our study is also a reminder that maintenance of weight loss and remission is difficult, our findings suggest any success with remission is associated with later health benefits."

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TUESDAY, May 7, 2024 (HealthDay News) -- Patients younger than 65 years with atrial fibrillation (AF) have a significant burden of risk factors and comorbidities, as well as heightened risk for hospitalization for cardiovascular events, according to a study published online April 22 in Circulation: Arrhythmia and Electrophysiology.

Aditya Bhonsale, M.D., from the University of Pittsburgh Medical Center, and colleagues examined the association between AF and all-cause mortality among 918,073 individuals aged younger than 65 years without AF.

The researchers found that during a mean follow-up of more than five years, the proportion of patients with one or more hospitalization for myocardial infarction, heart failure, and stroke was 1.3, 4.8, and 1.1 percent, respectively, for those aged younger than 50 years and 2.2, 7.4, and 1.1 percent, respectively, for those ages 50 to 65 years. Increased mortality in younger patients with AF with heart failure and hypertension was associated with multiple cardiac and noncardiac risk factors, illustrating a significant age-related interaction. Significantly worse survival was seen among patients with AF aged younger than 65 years compared with comorbidity-adjusted patients without AF (men aged younger than 50 years: hazard ratio [HR], 1.5; men aged 50 to 65 years: HR, 1.3; women aged younger than 50 years: HR, 2.4; women aged 50 to 65 years: HR, 1.7). Cardiovascular risk factors among individuals younger than 65 years with AF included current smoker status (16 percent), high body mass index (mean, 33.0), hypertension (55 percent), diabetes (21 percent), heart failure (20 percent), coronary artery disease (19 percent), and prior ischemic stroke (6 percent), while comorbidities included chronic obstructive pulmonary disease (11 percent), obstructive sleep apnea (18 percent), and chronic kidney disease (1.3 percent).

"These patients warrant an aggressive focus on risk factor and comorbidity evaluation and management," the authors write. 

Several authors disclosed ties to the medical technology industry.

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The absolute risk for thyroid cancer is low among patients receiving glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, but risk is elevated in the first year of treatment, according to a study published online Jan. 23 in JAMA Otolaryngology-Head & Neck Surgery.

Juan P. Brito, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues estimated the risk for incident thyroid cancer among adults with type 2 diabetes being treated with GLP-1 RAs versus other common glucose-lowering medications. The analysis included 41,112 patients starting treatment with GLP-1 RAs; 76,093 starting a dipeptidyl peptidase-4 inhibitor (DPP4i); 43,499 starting a sodium-glucose cotransporter 2 inhibitor (SGLT2i); and 191,209 starting sulfonylurea therapy.

The researchers found that the numbers of patients diagnosed with thyroid cancer were 0.17 percent in the GLP-1 RA group, 0.23 percent in the DPP4i group, 0.17 percent in the SGLT2i group, and 0.20 percent in the sulfonylurea group. GLP-1 RA initiation was not significantly associated with an increased overall risk for thyroid cancer versus the other diabetes drugs in the modified intention-to-treat analysis (hazard ratio [HR], 1.24; 95 percent confidence interval [CI], 0.88 to 1.76). In the first year after GLP-1 RA initiation, thyroid cancer risk was elevated (HR, 1.85; 95 percent CI, 1.11 to 3.08) and was amplified in the overall as-treated analysis that restricted patients from analysis when therapy was discontinued or another medication was added (HR, 2.07; 95 percent CI, 1.10 to 3.95).

"These findings indicate that GLP-1 RA initiation was associated with new diagnosis of thyroid cancer only in the short term, likely due to increased vigilance and case detection rather than de novo pathogenesis," the authors write.

Several authors disclosed ties to relevant organizations.

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MONDAY, June 26, 2023 (HealthDay News) -- Bempedoic acid is associated with a reduction in major adverse cardiovascular events among statin-intolerant primary prevention patients, according to a study published online June 24 in the Journal of the American Medical Association to coincide with the annual meeting of the American Diabetes Association, held from June 23 to 26 in San Diego.

Steven E. Nissen, M.D., from the Cleveland Clinic, and colleagues conducted a masked, randomized trial involving 13,970 statin-intolerant patients, including 4,206 primary prevention patients to determine the effects of bempedoic acid on cardiovascular outcomes. Participants were randomly assigned to oral bempedoic acid or matching placebo (2,100 and 2,106 patients, respectively).

The researchers found that bempedoic acid reduced low-density lipoprotein cholesterol levels by 30.2 mg/dL and high-sensitivity C-reactive protein levels by 0.56 mg/L compared with placebo (reductions of 21.3 and 21.5 percent, respectively). A significant risk reduction was seen in the primary end point of first occurrence of any component of a composite of cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, or coronary revascularization (111 versus 161 events [5.3 versus 7.6 percent; adjusted hazard ratio, 0.70]) during follow-up for a median of 39.9 months. Significant risk reductions were also seen in key secondary end points, including the composite of cardiovascular death, MI, or stroke; MI; cardiovascular death; and all-cause mortality (hazard ratios, 0.64, 0.61, 0.61, and 0.73, respectively).

"Administration of bempedoic acid in patients unable or unwilling to take guideline recommended doses of a statin was associated with a significant reduction in the primary end point, four-component major adverse cardiovascular events," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Esperion Therapeutics, which manufactures bempedoic acid and funded the study.

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MONDAY, June 26, 2023 (HealthDay News) -- The nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist orforglipron as a once-daily oral therapy is associated with clinically significant weight reduction, according to a study published online June 23 in the New England Journal of Medicine to coincide with the annual meeting of the American Diabetes Association, held from June 23 to 26 in San Diego.

Sean Wharton, M.D., from McMaster University in Toronto, and colleagues conducted a randomized trial enrolling adults with obesity or with overweight plus at least one weight-related coexisting condition, without diabetes. A total of 272 participants were randomly assigned to 36 weeks of orforglipron at 12, 24, 36, or 45 mg or placebo once daily.

The researchers found that the mean body weight was 108.7 kg at baseline and mean body mass index was 37.9 kg/m2. The mean change from baseline in body weight ranked from −8.6 to −12.6 percent across the orforglipron dose cohorts at week 26, and was −2.0 percent with placebo. The mean change ranged from −9.4 to −14.7 percent with orforglipron and was −2.3 percent with placebo at 36 weeks. By week 36, a weight reduction of at least 10 percent occurred in 46 to 75 percent receiving orforglipron and 9 percent receiving placebo; a weight reduction of at least 15 percent occurred in 48 and 1 percent of those receiving orforglipron 45 mg and placebo, respectively. The safety profile was consistent with that of the GLP-1 receptor agonist class.

"Further studies are needed to establish whether the health benefits seen with injectable GLP-1 receptor agonists are shared by orforglipron," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Eli Lilly, which manufactures orforglipron and funded the study.

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For patients undergoing nonemergent cardiopulmonary bypass (CPB), use of an extracorporeal blood purification (EBP) device is associated with a lower rate of cardiac surgery-associated acute kidney injury (CSA-AKI), according to a study published online Oct. 9 in the Journal of the American Medical Association to coincide with the annual congress of the European Society of Intensive Care Medicine, held from Oct. 5 to 9 in Barcelona, Spain.

Xosé Pérez-Fernández, Ph.D., from L'Hospitalet de Llobregat in Barcelona, Spain, and colleagues conducted a double-blind, randomized clinical trial in two tertiary hospitals to examine whether use of an EBP device reduces CSA-AKI after CPB. Adults undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were randomly assigned to receive EBP or standard care (169 and 174 patients, respectively).

The researchers found that the rate of CSA-AKI was 28.4 and 39.7 percent in the EBP and standard-care groups, respectively. In most of the predefined clinical secondary end points or post hoc exploratory end points, there were no significant differences observed. In terms of CSA-AKI reduction, EBP was more effective for patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (<40 percent), and lower body mass index (<30 kg/m2) in a sensitivity analysis. The groups did not differ in adverse events.

"The use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first seven days after the surgical procedure," the authors write.

One author disclosed ties to Exthera and SphingoTec.

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THURSDAY, May 18, 2023 (HealthDay News) -- Risk models for type 2 diabetes overestimate risk for non-Hispanic Whites, according to a study published online May 17 in PLOS Global Public Health.

Héléne T. Cronjé, M.S.P.H., from the University of Copenhagen in Denmark, and colleagues used National Health and Nutrition Examination Survey data between 1999 and 2010 to examine whether the Prediabetes Risk Test, (PRT) issued by the National Diabetes Prevention Program, and two prognostic models, the Framingham Offspring Risk Score and the Atherosclerosis Risk in Communities (ARIC) Model, demonstrate racial bias between non-Hispanic Whites and non-Hispanic Blacks. Data were included for 9,987 adults without a prior diagnosis of diabetes and with fasting blood samples available.

The researchers found that across the survey years, all investigated models were found to be miscalibrated with respect to race. The Framingham Offspring Risk Score overestimated and underestimated the risk for type 2 diabetes for non-Hispanic Whites and non-Hispanic Blacks, respectively. For both races, the PRT and ARIC models overestimated risk, more so for non-Hispanic Whites.

"Our study shows that the PRT currently adopted by U.S. health care, and prognostic type 2 diabetes prediction models available for adoption in U.S. health care, are likely attached with some degree of racial bias, which in turn is likely to perpetuate inequalities by providing fewer benefits to minorities, who already demonstrate higher risk for metabolic diseases," the authors write.

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MONDAY, June 26, 2023 (HealthDay News) -- For adults with type 2 diabetes, glycemic control is significantly better with once-weekly icodec than once-daily insulin glargine U100, according to a study published online June 24 in the New England Journal of Medicine to coincide with the annual meeting of the American Diabetes Association, held from June 23 to 26 in San Diego.

Julio Rosenstock, M.D., from Velocity Clinical Research at Medical City in Dallas, and colleagues conducted a 78-week phase 3a trial involving adults with type 2 diabetes who had not previously received insulin. Participants were randomly assigned to receive once-weekly insulin icodec or once-daily insulin glargine U100 (492 in each group).

The researchers found that at 52 weeks, the mean reduction in glycated hemoglobin level was greater with icodec than with glargine U100 (from 8.50 to 6.93 percent and from 8.44 to 7.12 percent, respectively); the estimated between-group difference of −0.19 percentage points (95 percent confidence interval, −0.36 to −0.03) confirmed the noninferiority and superiority of icodec. Compared with glargine U100, the percentage of time spent in the glycemic range of 70 to 180 mg/dL was significantly higher with icodec (71.9 versus 66.9 percent), which confirmed superiority. The rates of combined clinically significant or severe hypoglycemia were 0.30 and 0.16 events per person-year of exposure with icodec and glargine U100, respectively, at week 52, and 0.30 and 0.16 per person-year of exposure, respectively, at week 83 (estimated rate ratios, 1.64 [95 percent confidence interval 0.98 to 2.75] and 1.63 [95 percent confidence interval, 1.02 to 2.61], respectively).

"The findings of the current trial highlight the totality of evidence for glycemic control with icodec," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Novo Nordisk, which manufactures once-weekly insulin icodec and funded the study.

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WEDNESDAY, Feb. 21, 2024 (HealthDay News) -- In an Endocrine Society position statement published online Feb. 21 in the Journal of Clinical Endocrinology and Metabolism, guidelines are presented to help health care providers (HCPs) recognize the perspectives of people with diabetes (PWD) in order to achieve optimal disease management.

Rita R. Kalyani, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues examined gaps in the management of diabetes and its complications and identified tools needed for HCPs and PWD to address these challenges.

Priority targets for addressing challenges for PWD include effective communication during clinical interactions at diagnosis and through the disease course; addressing the emotional and psychosocial needs of PWD; navigating available therapeutic options and explaining complex regimens to support medication taking; and the use of telehealth in the appropriate clinical setting. The authors describe tools that are available to help HCPs, including guided communication styles for facilitating effective communication; guidance on preferred and nonpreferred language; clinical screening tools for assessing psychosocial conditions and directories to assist in referrals for mental health providers; patient education resources to help navigate aspects of living with diabetes, including pharmacotherapies; and checklists to determine the appropriateness of telehealth use for individual patients.

"In the ever-changing landscape of diabetes and its management, both health care providers and people with diabetes will continue to need new and evolving tools to help address the common challenges they face," Kalyani said in a statement.

Several authors disclosed ties to the biopharmaceutical and other industries.

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There is a consistent, bidirectional association between chronic diabetes complications (CDCs) and mental health disorders (MHDs), according to a study published online July 15 in Diabetes Care.

Maya Watanabe, from the University of Michigan in Ann Arbor, and colleagues examined bidirectional associations between the timing of CDCs and MHDs in individuals with type 1 or type 2 diabetes. The analysis included 553,552 individuals (44,735 with type 1 diabetes, 152,187 with type 2 diabetes, and 356,630 without diabetes).

The researchers found that having a CDC increased the risk for developing an MHD (hazard ratio, 1.9 to 2.9), with a higher risk observed in older age strata. Furthermore, having an MHD increased the risk for developing a CDC (hazard ratio, 1.4 to 2.5), with a higher risk observed among those ages 0 to 19 years. In younger individuals (younger than 60 years), those with type 1 diabetes were more likely to have CDCs, while those with type 2 diabetes were more likely to have MHDs. However, the bidirectional relationship between CDCs and MHDs was not affected by diabetes type.

"Most likely, a combination of direct and indirect effects and shared risk factors drive the association we are seeing," Watanabe said in a statement. "Diabetes care providers may be able to simultaneously prevent the risk of multiple complications by providing interventions to treat these shared risk factors."

Several authors disclosed ties to the pharmaceutical and medical device industries.

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