Acanthosis Nigricans Severity Helps Predict Diabetes Risk

 Patients with a high grade of acanthosis nigricans should be screened for insulin resistance, according to Dr. Sandhya Venkatswami.

His cross-sectional study found that 47 of 150 acanthosis nigricans patients (31%) were insulin resistant, with an acanthosis nigricans grade of 3 or 4 being more predictive of the condition.

We suggest that all patients with severe AN [acanthosis nigricans] grades should be evaluated for IR [insulin resistance] and thereby prevent further complications," wrote Dr. Venkatswami, who presented his findings during a poster session at the American Academy of Dermatology’s Summer Academy Meeting.

While previous studies have found acanthosis nigricans to be a marker for prediabetes, Dr. Venkatswami’s study found that taking severity into account helps to further identify patients who may be at risk.

He and his fellow investigators enrolled 150 consecutive patients with acanthosis nigricans of the neck (25 males), aged 18-64 years. The patients were graded according to acanthosis nigricans severity on a scale of I-IV.

Grade I was defined as acanthosis nigricans that was only visible on close inspection (21 patients); grade II was defined as acanthosis nigricans confined to the base of the skull (58 patients); grade III was defined as acanthosis nigricans that extended laterally to the posterior border of the sternocleidomastoid but was not visible when the patient was facing forward (48 patients); and grade IV was defined as acanthosis nigricans that was visible when the patient was facing forward, as the acanthosis nigricans encircled the neck (23 patients), said Dr. Venkatswami of the department of dermatology, Sri Ramachandra University, Chennai, India.

One patient with grade I acanthosis nigricans was found to be insulin resistant; 10 patients with grade II acanthosis nigricans were found to be insulin resistance; 20 patients with grade III acanthosis nigricans were insulin resistant; and 16 patients with grade IV showed a resistance to insulin.

Secondary study findings showed that patients with higher grades of texture of acanthosis nigricans were also more likely to be insulin resistant. That is, those with visible and extremely coarse "hills and valleys."

"AN lesions are asymptomatic and usually ignored by the patients unless they are of cosmetic concern. However, this is of clinical importance in diagnosing prediabetes," he noted in his poster.

Further studies will look to see if behavior modifications will help lower the risk for diabetes in patients with the condition.

Dr. Venkatswami did not disclose having any conflicts of interest.

Tomado de internalmedicinenews.com

Low HDL Cholesterol Ups Risk of Diabetic Nephropathy

In type 2 diabetes, HDL-C independent risk factor for diabetic nephropathy but not retinopathy

High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for the development of diabetic nephropathy, but not retinopathy, in patients with type 2 diabetes, according to research published online Aug. 13 in Diabetes Care.

Jamie Morton, M.B.B.S., of The Heart Research Institute in Sydney, and colleagues followed 11,140 patients in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study, the participants of which had type 2 diabetes and at least one additional vascular risk factor. The ADVANCE study was designed to evaluate the association between HDL-C and microvascular disease (composite of renal and retinal events).

     Over a median follow-up of five years, the researchers found that 28 percent of patients experienced a renal event and 6 percent experienced a retinal event. Compared with those in the highest third, patients in the lowest third of HDL-C levels had a 19 percent higher risk of renal events (17 percent higher risk of combined renal and retinal microvascular events). There was no association between HDL-C and retinal events (P = 0.9).

     

     "In conclusion, in a large population of patients with type 2 diabetes and after adjustment for a wide variety of confounders, low HDL-C level was shown to be an independent risk factor for the development and progression of diabetic nephropathy," the authors write. "Measurement of this lipid fraction may be useful in tailoring screening and therapeutic strategies."

Several authors disclosed financial ties to Servier, which partially funded the study.

Tomado de physiciansbriefing.com

Smokers may have more sleep problems

 Smokers may get fewer hours of sleep and have a less restful slumber than non-smokers, a new study suggests.

German researchers found that of nearly 1,100 smokers they surveyed, 17 percent got less than six hours of sleep each night and 28 percent reported "disturbed" sleep quality.

That compared with rates of seven percent and 19 percent, respectively, among more than 1,200 non-smokers. The findings cannot prove that smoking directly impairs sleep. Smokers may have other habits that could affect their shut-eye - such as staying up late to watch TV or getting little exercise, said lead researcher Dr. Stefan Cohrs, of Charite Berlin medical school in Germany.

But there is also reason to believe smoking is to blame - namely, the stimulating effects of nicotine, Cohrs told Reuters Health in an email.

There have also been studies showing that smokers' sleep improves after they quit the habit, according to Cohrs. "If you smoke and you do suffer from sleep problems, it is another good reason to quit smoking," Cohrs said.

Poor sleep quality may not only make your waking hours tougher: Some studies have also linked habitually poor sleep to health problems like obesity, diabetes and heart disease.

The new study, which appears in the journal Addiction Biology, included 1,071 smokers and 1,243 non-smokers who were free of mental health disorders - since those conditions may make a person both more likely to smoke and more vulnerable to sleep problems.

The researchers used a standard questionnaire that gauges sleep quality. Overall, more than one-quarter of smokers had a score that landed them in the category of "disturbed" sleep.

That means they had a "high probability" of having insomnia, according to Cohrs.

Many things can affect sleep quality. Cohrs' team was able to account for some of those factors, like age, weight and alcohol abuse. And smoking was still linked to poorer sleep quality.

It's still possible there are other things about smokers that impair their sleep. But Cohrs thinks the most likely culprit is nicotine.

Of course, there are already plenty of established reasons to kick the smoking habit. But the prospect of better sleep could offer people more motivation, Cohrs noted.

SOURCE: bit.ly/TOrYx0 Addiction Biology, online August 23, 2012.

Tomado de Reuters health

Reducing the Side Effects of Treatment for Prostate Cancer

New research published in BioMed Central's open access journalBMC Medicine reassessing clinical data from trials, which investigate ways of treating side effects of therapy for prostate cancer, finds that tamoxifen, an anti-estrogen used to treat breast cancer, is also able to suppress gynecomastia and breast pain in men.

Prostate cancer is one of the most common cancers in men and early treatment is usually very successful. Androgen-suppression therapy is often used to slow down progression of advanced disease. However, unwanted side effects of anti-androgen treatment, such as breast enlargement, can stop men from seeking treatment for their cancer.

Testosterone can drive the growth of prostate cancer and anti-androgens are used to inhibit prostate cancer growth by preventing testosterone from binding to androgen receptors. But receptors in cells within the testes are also blocked and start to make more testosterone to compensate. Some of this extra testosterone is converted into estrogen which is responsible for development of breast tissue and other breast events. Anti-estrogens work by jamming the estrogen receptor, while aromatase inhibitors prevent the conversion of testosterone into estrogen.

A collaboration between the German Cochrane Center and University Clinic Erlangen combined data from four independent clinical trials each looking at the management of breast events (during treatment for prostate cancer) with tamoxifen.

A meta-analysis of all four trials showed that tamoxifen reduced the risk of both gynecomastia and breast pain at 3, 6, 9, and 12 months of treatment compared to men who received no treatment. Overall, treatment with tamoxifen was more successful in reducing breast symptoms than treatment with an aromatase inhibitor (anastrazole) or radiotherapy.

Although there is no long term data available, few of the men treated with tamoxifen, either as preventative or therapeutic treatment, stopped taking their medication during their year of treatment. There were also no significant adverse effects.

Dr Frank Kunath, who led this study explained, "Not all men will suffer gynecomastia during anti-androgen therapy. However, if men know that there is a successful option for reducing the breast symptoms associated with treatment for prostate cancer they may be more likely to see their doctor when symptoms of cancer first appear, and consequently reduce the number of unnecessary deaths."

BioMed Central Limited. "Reducing the side effects of treatment for prostate cancer."ScienceDaily, 24 Aug. 2012. Web. 6 Sep. 2012.