HEALTH

Low blood sugar events increase dementia risk in elderly patients with Type 2 diabetes, study finds

BY Allison Cerra

OAKLAND, Calif. Hypoglycemic episodes that require a visit to the hospital are associated with increased risk of dementia in elderly patients with Type 2 diabetes mellitus, according to a Kaiser Permanente Division of Research study in the Journal of the American Medical Association.

Though not a randomized clinical trial, this study provides additional information for the debate about how tightly blood sugar should be controlled in patients with Type 2 diabetes, particularly in elderly patients, the researchers reported. The study appears in the current diabetes mellitus themed issue of JAMA.

While several studies have shown low blood sugar to affect cognitive function in children with Type 1 diabetes, this is the first study to evaluate the association in older patients with diabetes.

“We know that the brain becomes more vulnerable with age, and we need a better understanding of how glycemic control can affect brain health over the long term,” said the study’s principal investigator, Rachel A. Whitmer, Ph.D., a research scientist with the Kaiser Permanente Division of Research. “This study adds to the evidence base that perhaps we should rethink the notion of very tight glycemic control for our elderly patients with diabetes mellitus.”

The study looked at 16,667 elderly patients with Type 2 diabetes from the Kaiser Permanente Northern California Diabetes Registry. The average age for the study population was 66 years; 55% were male and 60% were white. The researchers identified 1,465 patients in the cohort that were hospitalized or had emergency room admittance at least once for hypoglycemia from 1980 to the end of 2002.

Compared with those with no hypoglycemic episodes, patients with one hypoglycemic episode had a 45% increased risk of being diagnosed with dementia after 2003, the study revealed. Those with two episodes had a 115% increased risk, and those with three or more episodes had a 160% increased risk of dementia. Adjustments were made for age, body mass index, race, education, gender, and duration of diabetes. The effect remained after further adjustments for hypertension, stroke, cardiovascular disease, end-stage renal disease, glycosylated hemoglobin levels, and treatment for diabetes.

Compared with those with no hypoglycemic episodes, those with one or more episode had a 32% greater risk of dementia (adjusted for age, body mass index, education, gender, duration of diabetes, co-morbidities, glycosylated hemoglobin and treatment for diabetes).

“Our findings suggest that pursuit of ‘tight’ glycemic control (i.e. to hemoglobin A1c levels less than 7%) may be inadvisable in older patients with Type 2 diabetes if required treatment is causing hypoglycemia,” said Joe Selby, MD, MPH, a co-author on this study and the director of the Kaiser Permanente Division of Research.

In view of these three trials, recent recommendations from the American Heart Association and the American College of Cardiology have urged that treatment be individualized and that caution be exercised to prevent severe hypoglycemia. The guidelines further emphasize the critical importance of blood pressure control, lipid or cholesterol control, smoking cessation, and use of aspirin, Selby said.

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Food-borne illness frequency remains almost unchanged, CDC reports

BY Michael Johnsen

ATLANTA The incidence of the most common food-borne illnesses has changed very little over the past three years, according to a 10-state report released last week by the Centers for Disease Control and Prevention.

The findings are from 2008 data reported by the Foodborne Diseases Active Surveillance Network (FoodNet), a collaborative project of CDC, U.S. Department of Agriculture’s Food Safety and Inspection Service, Food and Drug Administration and 10 state sites.

Campylobacter, Cryptosporidium, Listeria, Shiga toxin-producing Escherichia coli (STEC) O157, Salmonella, Shigella, Vibrio, and Yersinia did not change significantly when compared to the previous three years (2005-2007), the latest data showed. Although there have been significant declines in the incidence of some foodborne infections since surveillance began in 1996, these declines all occurred before 2004. The incidence of Salmonella infections has remained between 14 and 16 cases per 100,000 persons since the first years of surveillance.

“This year’s report confirms a very important concern, especially with two high-profile Salmonella outbreaks in the last year,” stated Robert Tauxe, deputy director of CDC’s Division of Foodborne, Bacterial and Mycotic Diseases. “We recognize that we have reached a plateau in the prevention of foodborne disease and there must be new efforts to develop and evaluate food safety practices from the farm to the table. The foodborne division at CDC is planning to increase the capacity of several health departments so that outbreaks can be better detected and investigated.”

The USDA’s Salmonella Initiative Program, which began in 2006, has already significantly reduced the presence of Salmonellain raw meat and poultry products, according to David Goldman, assistant administrator of USDA’s Food Safety Inspection Service.

“We have worked hard to reduce contamination in FSIS-regulated products and have seen marked success in Salmonella and Listeria monocytogenes,” Goldman said. “We are concerned about the lack of progress in reducing the incidence of foodborne illness and believe this report points to the need for better information about sources of infection.”

The FDA is using new tools to help predict potential threats to foods and the best options for prevention to meet the many challenges of an increasingly complex food-supply chain, according to David Acheson, associate commissioner for foods.

“The FDA is embarking on an aggressive and proactive approach in protecting and enforcing the safety of the U.S. food supply,” he said. “The Agency is committed to make the necessary changes to keep unsafe products out of the marketplace before they reach consumers.”

Consumers can reduce their risk for food-borne illness by following safe food-handling and preparation recommendations and by avoiding consumption of unpasteurized milk, raw or undercooked oysters, or other raw or undercooked foods of animal origin such as eggs, ground beef, and poultry. Risk also can be decreased by choosing pasteurized eggs, high pressure-treated oysters, and irradiated produce. Everyone should wash hands before and after contact with raw meat, raw foods derived from animal products, and animals and their environments.

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Fat-rich diet may reduce epileptic seizures, according to study

BY Alaric DeArment

MILWAUKEE Most parents would not let their children eat a lot of whipping cream, vegetable oil and butter, but a new study shows that diet rich in those might benefit children with epilepsy.

The study, conducted by researchers at the Medical College of Wisconsin and appearing in the November issue of the journal Epileptica, indicates that a ketogenic diet might limit seizures.

According to a recent study of 43 patients at the Children’s Hospital of Wisconsin that has yet to be published, the approach has been effective. But, the researchers cautioned, the diet would require close supervision by healthcare professionals.

“This diet cannot be tried by parents without close medical management and follow-up,” lead study author and MWC professor of pediatrics Mary Zupanc said.

Of the children who started on the ketogenic diet between 2002 and 2006, half had a reduction in seizure frequency by more than 90% and had improved brain functioning. Most of the children who responded to the diet had either the most common form of epilepsy or a severe form called Lennox-Gastaut syndrome.

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