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Pharmacologic options for painful diabetic neuropathy reviewed

Good glycemic control is not sufficient to relieve painful diabetic neuropathy, necessitating investigation of other modalities to achieve analgesic efficacy. Dan Ziegler, MD, German Diabetes Clinic, German Diabetes Center, and professor of internal medicine, Leibniz Institute at the Heinrich Heine University, Düsseldorf, provided an overview of pharmacologic treatments that have been explored for painful diabetic neuropathy and the success achieved with each.

Progress is rapid in islet cell transplants

Islet cell transplants are effective in both the short- and long-term in freeing patients with diabetes from insulin injections and have proven to be safe, said Bernhard J. Hering, MD. The use of embryonic pig pancreatic precursor tissue as the source of islets appears promising and would expand the number of transplant recipients, which is currently limited by number of potential donors.

GLP-1 secretion: No acute affect on insulin

Take another look at the popular hypothesis that suggests type 2 diabetes has an acute effect on the secretion of GLP-1 and that lower GLP-1 secretion has an acute effect on insulin. It doesn't work that way, said Michael Nauck, MD, PhD, Diabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany. Decreased GLP-1 secretion is not part of the pathophysiology of type 2 diabetes.

Hepatic steatosis new worry in type 2 diabetes

Clinicians and type 2 diabetes patients have a new worry: hepatic steatosis, or nonalcoholic fatty liver disease. Liver disease is a less-obvious problem than kidney disease but may have equally grave consequences.

Reducing excess iron levels encourages diabetic wound healing

Researchers at Stanford University are reporting positive results in healing diabetic wounds with a pharmaceutical agent already approved by the FDA, but only in mice so far.

Exercise trumps fit and fat in diabetes

Forget the arguments over fit and fat in the development of diabetes and the resulting complications. Both fitness and fatness can be addressed by the same prescription: physical activity.

Endothelial dysfunction in diabetes is marker, cause of complications

Endothelial dysfunction is both a marker for and a cause of diabetic complications. Researchers are teasing out pathways that involve oxidative stress and endothelial dysfunction, said Per-Henrik Groop, MD, PhD, Helsinki University Central Hospital, Helsinki, Finland. The challenge is in finding drugs that show the same activity in vivo that they show in cell studies or animal models.

ADVANCE: Intensive blood glucose control has renal benefits

Intensive blood glucose control in patients with type 2 diabetes resulted in a significant reduction in the risk of microvascular complications compared with standard blood glucose control. This was driven by a reduction in the occurrence of nephropathy, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) study.

Evidence suggests that treating periodontal disease can improve glycemic control

Periodontal disease makes glycemic control more difficult in patients with type 2 diabetes, said George W. Taylor, DrPH, DMD, associate professor of dentistry, School of Dentistry and Public Health at the University of Michigan, Ann Arbor.

Greetings from the ADA in San Francisco

The editorial teams in the Modern Medicine Primary Care Content Group, with content from our legacy brands ? Medical Economics, Drug Topics, Geriatrics, Formulary and Contemporary OB/Gyn ? will cover key medical meetings, bringing you breaking news, the latest research findings and reports from the general sessions.

Reformers seek more comparative effectiveness information to control healthcare spending

Healthcare reform is a high-profile issue in the presidential election campaign, and drug access has become a central theme in the debate. Both Democratic and Republican candidates have rolled out healthcare reform plans that promise to cover the uninsured while also providing tax breaks and other incentives to help individuals obtain health insurance.

Formulary and Managed Healthcare Executive 2008 Media Kit

Formulary and Managed Healthcare Executive 2008 Media Kit

Formulary 2008 Rate Card

Formulary 2008 Rate Card

Prophylactic anticoagulation guidelines developed specifically for patients with cancer

Ambulatory patients with cancer who are undergoing chemotherapy should not receive prophylactic anticoagulation to prevent venous thromboembolism, according to new guidelines developed by ASCO. "It's not cost effective and we also do not recommend screening these patients for thrombophilia," said Mark Levine, MD, McMaster University, Hamilton, Ontario, Canada.

Paroxetine ineffective for insomnia treatment in patients with cancer

Physicians treating cancer-related depression with paroxetine should not expect patients' insomnia to also improve, according to a study presented by Oxana G. Palesh, PhD, University of Rochester Cancer Center, NY. "We know that insomnia and depression often occur together frequently in the general population, suggesting that there may be a common mechanism," she said.

Metformin may have antitumor effects

Metformin may represent a novel antitumor agent, say investigators from the University of Texas M.D. Anderson Cancer Center, Houston.

Disparities in cancer care addressed, solutions offered

Several factors contribute to a disparity of cancer care and outcomes between minority and majority populations in the United States.

Clinicians too cautious in use of chemotherapy for oldest patients with stage III colon cancer

Advanced age should not be a barrier to initiating adjuvant chemotherapy in patients with stage III colon cancer. In an observational study, the oldest patients suffered no more adverse events when treated with adjuvant chemotherapy than did younger patients but were much less likely than their younger counterparts to actually receive adjuvant chemotherapy for their colon cancer, said Katherine L. Khan, MD, professor of medicine at the University of California, Los Angeles.

Fatigue affects broad range of activities among patients with cancer

Cancer-related fatigue significantly interferes with patients' quality of life, and some areas often affected among these patients are not normally included on standard quality-of-life assessments, said Karen M. Mustian, PhD, University of Rochester School of Medicine, NY. More randomized, controlled trials are needed to identify these areas, she said.

MRI added to mammography identifies most ductal components of invasive breast cancer

Magnetic resonance imaging (MRI) is superior to mammography alone in diagnosing intraductal components of invasive breast cancer, allowing more accurate mapping before breast conservation surgery, said Simone Schrading, MD, Department of Radiology, University of Bonn, Germany.

Aerobic and strength exercise program improves several variables during chemotherapy treatment

An individualized exercise program may significantly reduce fatigue, increase strength, and improve psychosocial functioning during cancer treatment, according to results of a small study reported by Maike de Wit, University Clinic Hamburg, Germany.

Blood assay may detect early lung cancer

An RNA signature present in blood that is highly accurate for detecting prevalent lung cancer can accurately predict the development of lung cancer within the next 2 years 80% of the time, said Thomas Zander, MD, Department of Internal Medicine and the Center for Integrated Oncology, University Clinic Cologne, Germany. "Early detection of lung cancer is a major need, as most patients present for diagnosis at a late stage when there is no chance for cure," Dr Zander said. Two-year survival after a lung cancer diagnosis is approximately 15%. Early detection may therefore be a promising strategy to improve survival rates.

Acupuncture demonstrates promise in treating symptoms after neck dissection

A small study suggests that acupuncture has the potential to reduce pain and dysfunction in patients with head and neck cancer who have undergone neck dissection, said David G. Pfister, MD, chief, Head and Neck Medical Oncology, Memorial Sloan Kettering Cancer Center, New York.

High-dose vitamin D relieves pain and fatigue associated with aromatase inhibitor therapy

High-dose vitamin D supplementation can provide relief of symptoms related to vitamin D deficiency from aromatase inhibitor therapy in postmenopausal women with breast cancer, said Q.J. Khan, MD, Cancer Center of Kansas, Wichita.

Combined treatment benefits elderly patients with lung cancer

Most elderly patients do not receive combined modality treatment (CMT) with both chemotherapy and radiation for locally advanced, non-small cell lung cancer (NSCLC) despite trial data indicating that CMT enhances survival, decreases comorbidities, and is potentially curative. Data presented by Martin J. Edelman, MD, professor of medicine, University of Maryland Greenebaum Cancer Center, Baltimore, indicate that elderly patients receiving chemotherapy followed by concurrent chemotherapy and radiation derive the most significant survival benefit.

Use of ESAs should be restricted to indications, experts say

Strict evidence-based criteria should be used when prescribing erythropoiesis-stimulating agents (ESAs) for cancer, as ESAs appear to activate signaling pathways that are important in altering tumor behavior and treatment response, experts said.

Experts discuss rules for access to experimental drugs

The extent to which patients should have access to experimental therapies is a hotly contested issue, and courts and regulatory agencies have wrestled with the problems involved when an individual is willing to be treated with unapproved drugs at the potential expense of causing harm not only to the individual but to the clinical trial process itself.

Concomitant medications, aging-related changes in drug distribution may be predictors of chemotherapy adverse events in elderly patients with cancer

Drug-drug and disease-drug interactions in elderly patients with cancer are significant; 33% of elderly patients who are taking 3 or more medications are rehospitalized within 6 months of a hospital discharge. "A better index of predicting tolerance to chemotherapy in the elderly is crucial," said Mihaela Popa, MD, Moffitt Cancer Center, Tampa, Florida. Tolerance to chemotherapy among older patients with cancer may be affected by multiple chronic conditions requiring multiple medications and aging-related alterations that induce changes in drug distribution, she said.

KRAS gene status predicts response to initial biologic treatment for colorectal cancer

Patients with metastatic colorectal cancer are more likely to respond to initial treatment that includes cetuximab if they have nonmutated, wild-type KRAS gene status, reported Eric Van Cutsem, MD, University Hospital Gasthuisberg, Leuven, Belgium. "For the first time in colorectal cancer, we are able to predict which patients are likely to be helped by the new biologics," he said. "KRAS is the first molecular marker for the selection of a targeted therapy in combination with a standard chemotherapy regimen in first-line metastatic colorectal cancer. KRAS testing should be routinely conducted in all colorectal cancer patients immediately after diagnosis to ensure the best treatment strategies for the individual patient."

Review of inhaled corticosteroid/long-acting beta2-agonist combinations

In an effort to simplify therapy for patients with asthma or COPD, products have been designed that combine medications from 2 separate therapeutic classes.