diabetes

AF + DM = 61% Greater Risk of All-Cause Mortality

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Medical News: Atrial Fibrillation Predicts Poor Outcome in Diabetes – in Cardiovascular, Diabetes from MedPage Today

Among the findings:

  • Over 4.3 years of follow-up, 879 patients died and 53% of those deaths were from cardiovascular causes
  • 15% of the deaths occurred in patients with atrial fibrillation
  • Atrial fibrillation was associated with a 77% risk of cardiovascular death (P<0.0001) and a 68% increase in risk of death from heart failure (P=0.0002) over the course of the study
  • Atrial fibrillation was associated with an increased risk of ischemic stroke (P=0.0006)
  • 26% of patients with atrial fibrillation at baseline were on anticoagulant therapy
  • Among patients taking oral anticoagulant therapy at baseline, the “adjusted HRs associated with [atrial fibrillation] were 2.16 (95% CI 1.15 to 4.07; P=0.02) and 2.32 (95% CI 1.06 to 5.12, P=0.04) for all-cause mortality and cardiovascular death, respectively.”

CKD Risk and High HgbA1c

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Arch Intern Med — Abstract: Poor Glycemic Control in Diabetes and the Risk of Incident Chronic Kidney Disease Even in the Absence of Albuminuria and Retinopathy: Atherosclerosis Risk in Communities (ARIC) Study, Dec 8/22, 2008, Bash et al. 168 (22): 2440

The more we know, the less we know.  The study population is small, but the findings merit our collective attention.  Think about these things the next time you are considering credits for the absence of retinopathy and/or albuminuria in a diabetic applicant.

One Sweet Idea

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According to the CDC, the incidence of diabetes increased 90% during the 10-year period ending in 2007. So is any company working in the brokerage market surprised to hear that some competitors are now offering Preferred rates to applicants who have IGT?

“He doesn’t have diabetes. He has IGT, not diabetes.”

This is one slippery slope. I strongly caution underwriters to be extremely selective when offering the best mortality rate for future diabetics. Take a hard look at the applicant’s health behaviors trend. Whether or not an individual goes on to develop full-blown diabetes from an impaired glucose tolerance state is strongly dependent upon current and future behaviors.

Last century when I was President of the Texas HOLUA I had the opportunity to ask one of the leading diabetes specialists some questions about my personal situation. Dr. Norman Kaplan at Southwestern Medical Center, University of Texas, Dallas addressed the group and I talked family history with him. I mentioned my strong family history for diabetes and asked Dr. Kaplan how I could avoid diabetes in the future. His reply was simple and eloquent:

“Stay as thin as you possibly can.”

Good advice for a lot of what ails you.

Bye Bye Byetta?

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The FDA just updated their safety information on Byetta to reflect the reports of 6 cases of hemorrhagic necrotizing pancreatitis in people taking the drug. All six required hospitalization and two have died. If you know any diabetics taking this drug, please advise them of this information. Sooner, not later. I’ve added a link to the FDA MedWatch page on the sidebar under drug abuse.

Read a Book a Week – On the Shelf

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I’ve just finished reading the best book on the prevention and management of Type 2 diabetes. The recommendations in Beating Diabetes are based on evidence from a randomized controlled clinical study called the Diabetes Prevention Program.. This book needs to be in your underwriting library and would make an excellent text for training purposes. But for those of you who may not have the time to find and read the entire book, I’ll summarize the key points:

  • Eat less
  • Move more

The book focuses on weight loss strategies and lifestyle modification. Get it, read it, live it.