PHARMACY

Study suggests link between blood-sugar and birth defects

BY Drew Buono

BOSTON According to a new study, lower blood-sugar levels than originally thought in pregnancy increase the chances of such problems as high-birth-weight babies and increase the need for Caesarean sections, as reported by The Wall Street Journal.

But study authors stopped short of recommending insulin or other treatments for pregnant women with moderately elevated blood-glucose levels. They said further study was needed to decide what level of blood sugar might dictate medication.

The study involved 23,000 women in nine countries. Nearly all had blood-sugar levels below the threshold for gestational diabetes, a condition that usually starts in pregnancy and resolves itself after birth. Gestational diabetes affects about 4 percent of pregnant women, with about 135,000 cases in the U.S. each year, according to the American Diabetes Association.

Untreated gestational diabetes can give babies high blood-glucose levels and lead to excessive birth weight, or macrosomia, a condition that can lead to health problems, including damage to a baby’s shoulders during birth and, later, obesity and diabetes.

The study found that the odds of having a baby with a high birth weight—that is, one higher than 90 percent of all births—rose consistently along with the level of blood sugar. So did the chances of having a first-time C-section.

But based on the study’s findings, researchers couldn’t determine a level at which it made sense to start treatment, such as insulin injections, says Donald Coustan, chair of obstetrics and gynecology at Brown Alpert Medical School. Coustan said the implications of the study are “about the future, not about the present” adding it won’t “affect clinical practice this week or this month.”

Researchers are scheduled to meet next month to discuss the data to determine whether doctors may one day have to treat women whose blood-sugar levels do not meet the current definition of gestational diabetes.

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Anthem BC/BS allows doctors to access EMRs via cell phone

BY Drew Buono

MANCHESTER, N.H. Anthem Blue Cross and Blue Shield in New Hampshire has unveiled new technology that will enable physicians to have secure access to online patient medical records and claims information from their mobile phones.

“Now all licensed New Hampshire practitioners who are part of our e-prescribing program are also able to access both medical records and claims data on Anthem members, anytime, anywhere by using their web-enabled cell phone,” said Richard Lafleur, medical director, Anthem Blue Cross and Blue Shield in New Hampshire, who added that participants could also access the new program from their office or home computer.

The addition of the new technology, known as Member Medical History, further enhances the e-prescribing tool by delivering an unprecedented amount of clinical information to the physician wherever he or she may be. Now the doctor looking to generate an electronic prescription is able to quickly access their Anthem patient’s medical history, getting valuable information on medical conditions and the patient’s most recent care, test results, or diagnoses by other clinicians.

“Putting even more comprehensive information in the physician’s hands at the time care decisions are being made improves quality and efficiency,” said Charles Kennedy, vice president of health information technology for Anthem. “E-prescribing and MMH are good examples of how Anthem can use technology to create a community benefit for all patients while still delivering unique value for our members.”

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Study shows metformin as effective as insulin injections during pregnancy

BY Drew Buono

BOSTON According to a new study, metformin, the generic version of Bristol-Myers Squibb’s diabetes drug Glucophage, is just as effective as insulin injections in treating women who develop diabetes during pregnancy, researchers in New Zealand and Australia reported yesterday.

Gestational diabetes appears in 1-in-20 pregnant women, and there has been concern that metformin might affect a fetus because the drug can cross the placenta.

But the study, led by Janet Rowan of the Auckland City Hospital in New Zealand, found that the risk of complications such as respiratory distress, birth trauma and newborn hypoglycemia, or low blood sugar, was no different for the 363 women who received metformin and the 370 given conventional insulin shots.

After delivery, nearly 77 percent of the metformin recipients said they would want to stay with the pill if they developed diabetes during pregnancy again, even though 46 percent still needed supplemental insulin injections at some point. On the other hand, only 27 percent of those who got insulin shots felt the same way.

But doctors may still be cautious, the researchers said. “Clinicians may remain circumspect about using metformin until follow-up data for offspring are available,” they wrote. The children born during the study are being tested when they reach their second birthday.

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