05 January 2018
FRIDAY, Jan. 5, 2018 (HealthDay News) — This past year was a busy, productive one for diabetes research and care. “2017 was a year of progress in our understanding of diabetes and its complications, the tools available to help people manage their diabetes, and attention to the economic and accessibility challenges faced by people with diabetes,” said Dr. William Cefalu, chief scientific and medical officer for the American Diabetes Association (ADA). Strides were made in: Artificial pancreas technology Probably the biggest and most anticipated news of 2017 was the rollout of the so-called artificial pancreas. Created by Medtronic, the device combines an insulin pump, a continuous glucose monitor and a computer algorithm that measures blood sugar levels and then delivers insulin automatically when those levels rise. Insulin delivery is also temporarily suspended if blood sugar levels drop too low. The device isn’t completely automated yet. People with diabetes still need to know how to count the carbohydrates in their food and enter that information into their insulin pump. And the device still requires people with diabetes to check their blood sugar several times a day and enter that information into the machine — this is known as “calibrating.” The hope is that future versions of the device won’t require these steps. Aaron Kowalski, chief mission officer for JDRF (formerly the Juvenile Diabetes Research Foundation), said, “We’ve waited a long time to see these systems come to market, and while it’s not yet perfect, it has opened the door, and there’s definitely a benefit.” He added that a number of other insulin pump manufacturers and independent companies are working on their own artificial pancreas systems. “Competition is really important and helps drive innovation. The next few years will hold promise,” Kowalski added. Improving heart health Heart disease is a significant concern for people with diabetes. New research suggested that long-term use of metformin could reduce the risk of heart disease in people with type 1 diabetes. Other medications have been linked to a reduced risk of heart disease in people with type 2 diabetes. These include Jardiance, Invokana and Victoza. “Cardiovascular disease is the most deadly and expensive complication of diabetes, and a number of recent studies have shown that certain medications also have a strong protective effect against cardiovascular disease in people at high risk for it,” Cefalu said. Competition in the continuous glucose monitor (CGM) market The artificial pancreas wasn’t the only innovation in diabetes technology in 2017. Another continuous glucose monitoring device (CGM) was approved by the U.S. Food and Drug Administration (FDA). Made by Abbott and called the Libre, this device has been in use in Europe for several years. The major difference in the Libre is that you have to request the blood sugar information. Other devices on the market — from Dexcom and Medtronic — send blood sugar information collected by a tiny sensor wire inserted under the skin to a receiver every five minutes or so. The Libre also uses a tiny sensor wire inserted under the skin, but the person with diabetes has to request the information be sent to the receiver. In addition, the Libre also doesn’t require any fingerstick calibration as other devices on the market do. “Some people find the constant information provided by continuous glucose monitors to be stressful. With the Libre, you ask when you want the information. It’s also a little bit flatter than other CGMs, and it comes in at a much lower price point,” Kowalski explained. Improving blood sugar levels in pregnant women with type 1 diabetes One of the most promising uses of CGM technology became evident with the publication of the results of an international study of women with type 1 diabetes who wore the devices during pregnancy. Women with type 1 diabetes have to manage their blood sugar levels very tightly during pregnancy, because high blood sugar levels are associated with birth defects and other pregnancy complications. But this also puts them at risk of developing dangerously low blood sugar levels. Women using CGM spent more time in “target” range than women who didn’t. That means their blood sugar was neither too high nor too low for longer periods of time. “This study helped show that mothers and babies do better when the mother [with type 1 diabetes] has a CGM,” Kowalski said. The study was published in The Lancet. Insulin speed Novo Nordisk received FDA approval for a new insulin called Fiasp. This insulin starts working in about 2.5 minutes. Currently, Novolog, another product from Novo Nordisk, takes approximately five to 10 minutes to start working. That difference may not seem like much, but unless people with diabetes who are dependent on insulin inject at least five to 10 minutes before they eat, their blood sugar levels may spike too high after eating. It’s not always possible or even safe to pre-inject insulin. For example, in a restaurant, you have no way of knowing when your food might arrive, and if you pre-inject and your food is late, you can have a dangerously low blood sugar level. The shorter time it takes Fiasp to work could help prevent spikes in blood sugar after eating, which ultimately leads to better diabetes control. Awareness of costs and increased coverage The cost of insulin has come under sharp scrutiny recently because the cost of some insulin has tripled in about a decade. Sen. Bernie Sanders (I-Vt.) first brought the issue up during the 2016 presidential campaign. The ADA started a campaign called “Make Insulin Affordable” and is working with members of Congress to bring more attention to the issue. This was also the first year that people on Medicare with diabetes could get coverage for all CGMs. Initially, Medicare only offered coverage for the Dexcom CGM, but on Jan. 4 the agency announced that it would also cover the Libre CGM. More information Learn more about diabetes from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
05 January 2018
FRIDAY, Jan. 5, 2018 (HealthDay News) — For people who’ve battled certain common forms of skin cancer, use of a generic cream called 5-FU may greatly reduce the odds that the disease will come back, new research shows. The study tracked outcomes for just over 930 U.S. veterans who averaged 70 years of age. All had already been diagnosed with a minimum of two basal cell carcinomas and/or squamous cell carcinomas. That meant their risk for a skin cancer recurrence was high, the researchers said. However, just a month’s application of 5-FU (fluorouracil 5 percent) appeared to have a lasting impact in preventing a recurrence — even after use of the cream was stopped. So concludes a study led by Dr. Martin Weinstock, professor of dermatology at Brown University in Providence. “The most remarkable thing about this study is that now we have something to use that doesn’t lose its effectiveness when you stop using it,” Weinstock said in a Brown news release. There was one drawback to the cream treatment, however: About one in every five of the men suffered “severe” skin side effects from using 5-FU, while 40 percent complained of moderate side effects. One skin cancer specialist who reviewed the findings said that while 5-FU can prevent skin cancers, side effects remain an issue. “5-FU has been used in the treatment of pre-cancers for decades and is a tried and true treatment, but it comes at a price in side effects and downtime from redness, scaling, irritation and even pain for those being treated,” said Dr. Doris Day. She’s a dermatologist at Lenox Hill Hospital in New York City. Adjustments can be made to minimize these effects, she said, but “it is very important to have a thorough and clear discussion to explain what the patient can expect during treatment and to consider treating one area of the face at a time, such as forehead, nose, cheek or chin.” The new four-year trial involved older male veterans, most of whom were white. They’d typically spent a great deal of time in the sun during their service and had already developed at least two cases of a non-melanoma skin cancer. The veterans were divided into two groups. For a month, one group applied the 5-FU cream twice per day on their face and ears, while the second group did the same with an inactive placebo cream that didn’t contain the active drug. All were also instructed to regularly use 30 SPF sunscreen. The result: For men who’d used the active cream, the odds of developing another squamous cell carcinoma — one bad enough to require surgery — fell by 75 percent over the following year. A similar but weaker trend was seen in terms of basal cell carcinomas, the researchers said. The benefit did seem to fade after a year, the Brown team noted. Side effects were also somewhat of a general concern, with about one-fifth of the vets reporting “severe” issues in terms of skin sensitivity, reddening and crustiness. All of the skin reactions cleared up, however, when cream use stopped, and nearly 90 percent of those who had used 5-FU said they would do it again if it helped prevent cancer. According to Weinstock, “This is the first study of its type. I’m hopeful there will be other studies that show other sorts of regimens that last longer and do a better job over time as science progresses. This is an important first step.” For her part, Day stressed that patients do have choices when it comes to skin cancer care. “There are also other treatment options that can help clear sun damage” and the odds for a skin cancer, she said, including photodynamic (“light”) therapy and a medicinal cream known as imiquimod. “Patients should know their treatment options and be able to select the one that would be most comfortable and easiest for them,” Day said. The new findings were published online Jan. 3 in JAMA Dermatology. More information There’s more on the prevention and treatment of skin cancers at the Skin Cancer Foundation.
04 January 2018
THURSDAY, Jan. 4, 2018 (HealthDay News) — The mummified remains of an Italian boy who died 450 years ago suggest the hepatitis B virus has infected humans for centuries. The child died in the 16th century. And prior testing suggested smallpox killed him. But a new analysis evaluated DNA samples from the boy’s bone and skin. This second look led investigators to conclude the killer was actually hepatitis B. Hepatitis B is a serious liver infection. “These data emphasize the importance of molecular approaches to help identify the presence of key pathogens in the past, enabling us to better constrain the time they may have infected humans,” said study author Hendrik Poinar. Poinar is an evolutionary geneticist with the McMaster Ancient DNA Centre in Hamilton, Ontario, Canada. Hepatitis B is still a killer. It’s estimated that 350 million people have the virus, while one-third of the world’s population is thought to have been infected at some point. These numbers point to the importance of studying ancient viruses, Poinar said. “The more we understand about the behavior of past pandemics and outbreaks, the greater our understanding of how modern pathogens might work and spread,” Poinar said in a McMaster news release. “This information will ultimately help in their control,” he added. Poinar’s team said the genetic analysis further suggests this ancient strain of hepatitis has changed little over the last four centuries. The young child was buried within the Basilica of Saint Domenico Maggiore in Naples. The findings were published online Jan. 4 in PLOS Pathogens. More information The World Health Organization has more on hepatitis B.
04 January 2018
THURSDAY, Jan. 4, 2018 (HealthDay News) — Developers of a new patch hope to eliminate a big barrier in type 2 diabetes treatment — painful finger-sticks and injections. The new patch — which actually uses an array of tiny needles that researchers promise are pain-free — senses when blood sugar levels are rising and then releases medication to bring those elevated levels back down. That means the patch could end the need to draw blood from your fingertips to check your blood sugar level. It could also eliminate the needles used to administer insulin or other diabetes medications. “This type of disposable patch is expected to control blood glucose levels for a week,” said the study’s senior author, Xiaoyuan (Shawn) Chen, chief of the laboratory of molecular imaging and nanomedicine at the U.S. National Institute of Biomedical Imaging and Bioengineering in Bethesda, Md. “It will not complicate the routines of daily living,” Chen said. Though the patch looks promising, so far it’s been tested only on 21 mice with type 2 diabetes. Results from animal trials aren’t always equaled in human trials. The patch contains chemicals that sense rising blood sugar levels. When that happens, a medication called exendin-4 is released to trigger the body to produce insulin until blood sugar levels start to fall. Exendin-4 is part of a class of drugs called GLP-1 receptor agonists. It’s currently on the market in the United States as Byetta, a twice-daily injection. Other drugs in this class of injectable medications include Trulicity and Bydureon, which are weekly injections, and Victoza, which is a daily injection, according to the American Diabetes Association. For the patch, exendin-4 is combined with alginate, a gum-like material extracted from brown algae. This mixture is then poured into microneedle form and loaded onto the patch. The patch tested on the mice was about a half-inch square, according to the researchers. It contained enough medication for a week. “We achieved a smart, long-acting and glucose-responsive exendin-4 release,” Chen said. He noted that some of the mice had inflammation at the site of the patch. In humans, nausea and vomiting are known side effects of the drug, but the researchers believe that the release of exendin-4 is slow enough that it won’t cause those side effects. The next step is to make a larger patch with more needles, Chen explained. The researchers will also need to create longer needles to penetrate human skin. Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said it looked like the patch worked well in the study. “But it’s a big stretch from mice to even trying something like this in humans and getting approved by the [U.S. Food and Drug Administration],” said Zonszein, who wasn’t involved with the study. Still, he said, the patch itself is a very good idea, and the beauty of it would be that it wouldn’t require people with diabetes to spend a lot of time managing their disease. However, Zonszein pointed out that oral versions of GLP-1 drugs are in clinical trials and will compete with injections in the not-far-off future. Also, while the patch idea is interesting, “exendin-4 is the wrong medication,” Zonszein said. If researchers could figure out how to make the patch with insulin, he said, that would likely be a better option, though the required doses of insulin might be too large to fit in the patch. Results of the researchers’ study on the patch treatment on mice were published online recently in Nature Communications. More information The American Diabetes Association has more on treating type 2 diabetes.
03 January 2018
WEDNESDAY, Jan. 3, 2018 (HealthDay News) — Stem cell transplants could offer new hope for people with a severe form of scleroderma — a debilitating and deadly condition that affects the immune system, a new study suggests. “Scleroderma hardens the skin and connective tissues and, in its severe form, leads to fatal organ failure, most often the lungs,” said the study’s lead author, Dr. Keith Sullivan. He is a professor of medicine and cellular therapy at Duke University Medical Center. “In these severe cases, conventional drug therapies are not very effective long-term, so new approaches are a priority,” Sullivan said in a hospital news release. Drugs to suppress the immune system are the standard of care in the United States for scleroderma with internal organ involvement, according to the researchers. Their study tested the effectiveness of stem cell transplant along with high-dose chemotherapy and whole-body radiation to treat the disease. The study was funded by the U.S. National Institutes of Health. For the study, 75 people with scleroderma were randomly assigned to receive one of two treatments. Roughly half of the group received a stem cell transplant designed to destroy their defective immune system and replace it with their own treated blood stem cells. The other half received 12 months of conventional immune-suppressing treatment. After 10 years, survival was better among those who underwent chemotherapy, whole-body radiation and a stem cell transplant, the study found. People in this group also had less need for immune-suppressing drugs after their transplant. “These results show that individuals with poor-prognosis scleroderma can improve and live longer and that these advances appear durable,” Sullivan said. The researchers noted, though, that stem cell transplant was riskier. It was associated with more serious side effects, such as low blood counts, infections and death, the study found. “Patients and their doctors should carefully weigh the pros and cons of intensive treatment with stem cell transplant, but this may hopefully set a new standard in this otherwise devastating autoimmune disease,” Sullivan said. “These advances show the value of medical research and clinical trials in finding better therapies to advance health,” he added. The study was scheduled for publication in the Jan. 4 issue of the New England Journal of Medicine. More information The American College of Rheumatology has more on scleroderma.
03 January 2018
WEDNESDAY, Jan. 3, 2018 (HealthDay News) — For people with tinnitus, the persistent sense of ringing in the ears is mildly annoying at best and disabling at worst. But a new device may help ease the phantom noises, researchers report. The experimental device uses precisely timed sound and skin stimulation to target nerve activity in the brain. It quelled the bothersome sounds in lab animals and improved quality of life in a test group of 20 humans, according to University of Michigan researchers. “Animal studies have identified specific nerve cells in the brain, called fusiform cells, that signal phantom sounds to the rest of the brain,” said lead researcher Susan Shore. In someone with tinnitus, fusiform cells increase activity as they normally would in the presence of a real sound, she explained. “These signals are transmitted to the auditory part of the brain and are interpreted as sound when there is no sound stimulus,” said Shore, a professor of otolaryngology, physiology and biomedical engineering. Some 15 percent of Americans suffer from tinnitus. About 2 million can’t work or carry out other daily activities because of the constant ringing or grinding in their ears or the resulting stress it causes, the researchers said in background notes. The problem often stems from exposure to loud noise, or head and neck trauma. The new study shows fusiform cell activity can be tamed using a combination of sounds and mild electrical stimulation of the skin. The home device tested in the study supplies the stimulation through electrodes and earphones, Shore said. Patients used the device 30 minutes a day for four weeks. After one week, the volume of the tinnitus returned, but the improvement in quality of life lasted up to several weeks, she noted. Patients who used a phony device had no improvement in their tinnitus, Shore said. A larger trial will try the treatment for longer. “We don’t know at this point whether they will need to continue to use it every day, or if they will just need to do it once a week or so. This will have to be determined,” she added. The cost of the device isn’t yet known because the treatment is still in development, Shore pointed out. There is no cure for tinnitus. But some people get emotional relief through cognitive behavioral therapy or sound therapy, according to the American Tinnitus Association. In severe cases, some patients try invasive treatments, such as deep brain stimulation and vagal nerve stimulation, Shore said. The new, non-invasive device relies on so-called stimulus timing-dependent plasticity, or STDP. It aims to correct the nerve malfunction at the root of tinnitus by directing sound into the ears and alternating mild electrical pulses to the cheek or neck. For the study, Shore and colleagues sought out tinnitus patients who could temporarily change their symptoms by clenching their jaws, sticking out their tongues, or turning or flexing their necks. These patients appear to benefit most from the combination of audio and electrical stimuli, the study authors noted. To determine the best timing of the impulses, Shore’s team tested the device on guinea pigs that had noise-induced tinnitus. In the human trial, half the patients received treatment for four weeks, while the other patients received sounds without electrical stimulation. After a one-month break, the study resumed, but patients switched to the other treatment. People who received STDP reported improvement in their symptoms and better quality of life. Some said the phantom sounds got less harsh or piercing or became easier to ignore. Dr. Harrison Lin is an assistant professor in the department of otolaryngology-head and neck surgery at the University of California, Irvine Medical Center. He said this new technique might be a breakthrough for some tinnitus patients. “This report of a non-invasive, well-tolerated method of reducing the volume of tinnitus for people suffering from bothersome and intolerable tinnitus is incredibly important,” said Lin, who wasn’t involved in the study. “This approach will hopefully mature into new, safe and effective treatment options, which are currently sorely lacking,” he added. The report was published Jan. 3 in the journal Science Translational Medicine. More information For more on tinnitus, visit the American Tinnitus Association.
01 January 2018
MONDAY, Jan. 1, 2018 (HealthDay News) — If resolutions are on your New Year’s to-do list, consider adopting a more positive opinion about your body, an expert suggests. “Consider what is really going to make you happier and healthier in 2018: losing 10 pounds or losing harmful attitudes about your body,” said Pamela Keel, a professor and body image researcher at Florida State University. Body dissatisfaction is a major problem in the United States, especially among young women, Keel noted. Much of that has to do with media images. “There’s a big gap between what we’re shown as being ideal and what to aspire to and where we actually are as a population,” she said in a university news release. “That leaves people feeling bad about themselves, and, unfortunately, feeling bad about your body does not actually motivate a person to pursue healthy behavior.” What to do? Certain steps can help improve body satisfaction, Keel said. For instance, she suggests standing in front of a full-length mirror in little or no clothing and pinpointing positive body traits. This can include specific functions of body parts. “You would say, ‘I really appreciate the way my legs take me wherever I need to go,’ ” Keel said. ” ‘Every day without fail, they get me out of bed, to the car, up the stairs and into the office. I don’t have to worry about walking.’ “It can be that kind of functional appreciation of what your body does for you,” she said. Or, you might focus on appreciating a body feature — such as your skin or the shape of your shoulders or neck. “You can even go for higher-risk body parts,” Keel said. “Rather than looking at yourself and saying, ‘I hate my gut,’ you could say, ‘I really like the shape of my legs.’ “ “If there is something about you that you like, the idea is to spend time focusing on it,” she said. Another approach is to think about specific activities you avoid because of body issues — wearing a bathing suit or not wearing shorts, for instance — and then deciding to do them. “Most people experience a sense of freedom when they realize that nothing bad will happen if they wear a swimsuit or shorts in public — everyone is completely fine with it,” Keel said. “This reinforces body acceptance through experience.” More information The National Eating Disorders Association has more on body image.
28 December 2017
THURSDAY, Dec. 28, 2017 (HealthDay News) — Among people with the skin disease psoriasis, could skin color play a role in whether or not they visit a dermatologist? An analysis of federal government health survey data from 2001 to 2013 found that black, Asian and other minorities are less likely than white people in the United States to see a doctor for treatment of the chronic inflammatory disease. The researchers found that among 842 people with psoriasis included in the study, nearly 51 percent of whites saw a dermatologist versus about 47 percent of Hispanics. In comparison, only 38 percent of blacks, Asians, native Hawaiians/Pacific Islanders and other non-Hispanic minorities saw a dermatologist for their psoriasis. White patients also visited a dermatologist more often, the study found. They averaged 2.69 visits a year, compared with 1.87 for Hispanics and 1.30 for non-Hispanic minorities. Nationwide, this would translate into more than 3 million fewer visits a year for psoriasis among non-Hispanic racial minorities than among whites. “While psoriasis is less common among minorities, previous research has shown their disease can be more severe,” senior author Dr. Junko Takeshita, an assistant professor of dermatology and epidemiology at the University of Pennsylvania, said in a university news release. “Despite that, this study shows minorities are less likely to see a dermatologist for treatment,” Takeshita added. Psoriasis affects about 7.5 million Americans, according to the National Psoriasis Foundation. Along with affecting the skin, causing raised red patches with silvery scales, psoriasis has been linked with an increased risk for heart attack, stroke and premature death. “When you combine the results of our study with the knowledge that psoriasis severity and quality-of-life impact suggest a larger burden of psoriasis among minorities, it brings into focus the racial gaps that exist in psoriasis care,” Takeshita said. Further research is needed to learn more about the reasons for these disparities, the study authors said. “Ultimately, increasing awareness of these disparities is the first step in trying to provide equitable care and improve outcomes for all individuals with psoriasis,” Takeshita concluded. The findings were published recently in the Journal of the American Academy of Dermatology. More information The American Academy of Family Physicians has more on psoriasis.
27 December 2017
WEDNESDAY, Dec. 27, 2017 (HealthDay News) — Holiday parties and gatherings mean more trips to nail and hair salons for some. But if you’re not careful, you might end up picking up more than you bargained for. In a recent small survey of nail and hair salon clients, more than two-thirds said they’d had one or more health issues after visiting a salon. These included skin problems, fungal infections and respiratory symptoms. “When it comes to safety, the most important thing is being aware of the dangers present in salons,” said Lindsey Milich, lead author of a study based on the survey. She’s a research analyst at the Rutgers School of Public Health in Piscataway, N.J. Nail and hair salons generally offer a wide range of services. Manicures, pedicures, applying artificial nails, removing hair with wax, hair styling and hair coloring are common offerings. However, many of these services involve exposure to chemicals that can be hazardous for the client or for the nail technician or stylist, the researchers said. These products can cause allergic reactions and skin irritation. In addition, because many of the tools are reused from one client to another, it’s possible to pick up bacterial and fungal infections if proper sterilization techniques aren’t used. The survey included 90 patrons of nail and hair salons from three counties in New Jersey. Nearly all (94 percent) were women. Survey participants were asked about health symptoms, as well as their knowledge of potential hazards and safety practices in salons. About 42 percent they’d developed skin issues and 10 percent reported fungal infections after salon visits. These problems included itchiness to the hands or face, cuts, burning or tingling sensations, pain or redness around the nail area, athlete’s foot, finger or toenail fungus, and nail discoloration. One in 6 survey participants reported respiratory symptoms, including runny nose, itching or watery eyes, trouble breathing and headache. Across the board, the percentages for reported problems were higher for nail salons than hair salons. Though the salon clients reported experiencing these problems after a salon visit, Milich noted that the study did not prove that these issues were caused by the salon. Milich was also involved in a second study, which looked at the health of nail salon technicians. That study — led by Derek Shendell from the Rutgers School of Public Health — included 68 workers from 40 nail salons whose owners agreed to their participation. Most of the nail salon workers were Asian women who said they’d had eye, nose, throat or skin symptoms they believed were related to their jobs. The study found that most workers had received training only in English, not in their primary language. The researchers suggested that salon workers needed “comprehensive chemical use training,” and urged that more research be done on the extent of salon workers’ exposure to hazardous materials. For those who frequent salons, what can you do to safeguard your health? First, check that the salon appears clean and is licensed by your state’s cosmetology board, Milich advised. Also check that the salon properly sanitizes any hair or nail tools that are reused from client to client. Dr. Debra Spicehandler, co-chief of infectious diseases at Northern Westchester Hospital in Mount Kisco, N.Y., agreed — adding that you also should make sure the equipment is sterilized in an “autoclave.” That’s a device that heats the tools to kill bacteria and looks like a small oven. “If they’re just putting the tools in chemicals, that’s not enough,” said Spicehandler, who was not involved with the studies. She also recommended going to a nail salon that uses a disposable plastic liner in the footbath used for pedicures. Spicehandler said it’s better to have your cuticles pushed back than cut, but if sterile equipment is used, it’s OK to have cuticles cut. If you do get an injury when they’re cutting, be sure to clean it well and apply an antibiotic ointment to the cut. “If you see any swelling or redness at the site of the cut, or you get an injury on the nail bed, see your doctor,” she said. Spicehandler also said that people with diabetes need to be extra careful when getting pedicures. “It’s best to go to a podiatrist to get your nails cut, but you can get your nail color at the salon,” she said. The study involving salon clients was published in the November/December issue of the Journal of Chemical Health and Safety. The study on nail salon workers was published last month in the Journal of Occupational and Environmental Medicine. More information The U.S. Department of Labor has more about staying safe at a nail salon.