N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes

NT-proBNP is a strong independent predictor of short-term CV mortality risk in elderly people with type 2 diabetes, including those without preexisting CVD. This association is evident even in people with slightly increased values, is not modified by CRP, and is additive to that provided by AER.

via N-Terminal Probrain Natriuretic Peptide Is a Stronger Predictor of Cardiovascular Mortality Than C-Reactive Protein and Albumin Excretion Rate in Elderly Patients With Type 2 Diabetes.

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Cardiovascular Biomarkers, Cardiac Dysfunction, and Outcomes in Patients With Type 2 Diabetes: A Prospective, Multicenter Study

We report a lack of association between echocardiographic variables and laboratory biomarkers in a large population of type 2 diabetes patients without overt cardiac disease and mild alterations in LV function. The only laboratory marker found to predict 2-year outcomes in these patients was HbA1c. Neither the other laboratory markers (NT-proBNP, hsCRP, and UACR) nor echocardiographic markers provided independent prognostic information. The role of HbA1c as a guide for the appropriateness of treatment of patients with type 2 diabetes is supported by these findings.

via Cardiovascular Biomarkers, Cardiac Dysfunction, and Outcomes in Patients With Type 2 Diabetes: A Prospective, Multicenter Study.

Notes from the Field: Acetyl Fentanyl Overdose Fatalities — Rhode Island, March–May 2013

The GC/MS toxicology results for 10 of the 12 decedents showed, in addition to acetyl fentanyl, various mixtures of other drugs, including cocaine (58%), other opioids (33%), ethanol (25%), and benzodiazepines (17%).

via Notes from the Field: Acetyl Fentanyl Overdose Fatalities — Rhode Island, March–May 2013.

So what do you do when you see a script for Naloxone prescribed by an EM specialist?

 

Low Glycemic Load Diet Lowers Diabetes Risk

Eating a low glycemic load diet that also follows the principles of the traditional Mediterranean diet can lower type 2 diabetes risk, new research suggested.

People in the study whose eating patterns most closely adhered to the principles of the Mediterranean diet and the low glycemic load diet were 20% less likely to develop diabetes than people who least closely followed the two diets, Carlo La Vecchia, MD, of the Mario Negri Institute of Pharmacological Research in Milan, and colleagues, wrote online in the journal Diabetologia.

via Low Glycemic Load Diet Lowers Diabetes Risk.

I have a very strong family history of diabetes.  A long time ago I told one of the leading endocrinologists in Dallas about my family history and asked what I could do to minimize my risk of developing the disease.

Stay as thin as you can for as long as you can.

Several years ago I adopted a Mediterranean style diet.  When I learned about the glycemic index I started avoiding most foods with a high glycemic index.

Sixty is on the horizon and I’m still not diabetic.

Office Derm: Can You Make the Diagnosis?

A previously healthy 27 year old male comes into your office complaining of headache, muscle pain, and a rash consisting of numerous non-blanching macules on his forearms, wrists, feet, and ankles. The patient tells you that just over a week ago he went on a camping trip in Oklahoma with some of his college buddies and thinks that he may have been bitten by something.

via Office Derm: Can You Make the Diagnosis?.

Take the test.  It’s fun.  Keyword – bitten.

You should be able to make the correct diagnosis.

Diabetes Prevention: Lifestyle Change – amednews.com

The national YMCA of the USA was awarded a three-year, $12 million grant from the federal Center for Medicare and Medicaid Innovation to make its diabetes-prevention program available to about 10,000 Medicare patients in 17 communities. Medicare fee-for-service patients pay no additional out-of-pocket cost for the YMCA class and 27 private health plans cover it. For other patients, the fee is charged on an income-based sliding scale that varies by facility and can reach $400, says Matt Longjohn, MD, MPH, the national health officer at YMCA of the USA.

26 million Americans have diabetes, more than 8% of the U.S. population. Researchers estimate that one in three U.S. patients — about 80 million — can be classified as prediabetic either because of their scores on diagnostic blood tests or a combination of age, family history of diabetes and other factors. Patients with prediabetes are two to five times likelier than patients with normal blood glucose to develop type 2 diabetes. Ten percent of prediabetics will become diabetics within seven years, says Ronald T. Ackermann, MD, MPH, associate professor of medicine at Northwestern University Feinberg School of Medicine in Chicago.

A randomized controlled trial of more than 3,000 patients with prediabetes found that patients exposed to an intensive lifestyle-modification program that aimed for 7% weight loss and 150 minutes in weekly physical activity were 58% less likely to develop diabetes than those who received standard lifestyle recommendations and took a placebo pill. During the study’s three-year period, the patients who got the comprehensive lifestyle support in the form of 16 lessons covering diet, exercise and behavior modification avoided diabetes at a rate nearly double that of patients who got the standard advice and took the diabetes drug metformin.

For every seven prediabetics who participated in the lifestyle-modification program, one case of diabetes was avoided, said the study in the Feb. 7, 2002 issue of The New England Journal of Medicine.

via Diabetes prevention: Set on a course for lifestyle change – amednews.com.