Elderly women who have had five or more live births - grand multiparity - are significantly more likely to develop Type 2 diabetes than those with fewer or no births, report researchers.

They note, however, that the relationship was abolished after correcting for variation in body weight and sociodemographic factors.

Angela Fowler-Brown (Harvard Medical School, Boston, Massachusetts, USA) and colleagues analyzed parity data from 3211 women aged 65 years or above (mean 72.5 years) who were enrolled in the Cardiovascular Health Study.

Diabetes status, based on fasting levels of glucose and insulin and use of medication, was measured at baseline and after approximately 10 years in women without diabetes at baseline (n=2761).

The investigators found that there was a higher prevalence of Type 2 diabetes at baseline in women with grand multiparity, at 25%, compared with those with a lower number or no births, at 12% and 15%, respectively.

Following adjustment for age and ethnic background, women with grand multiparity had a significant 57% increased diabetes prevalence compared with other women. However, further adjustment for demographic, clinical, and body anthropometric factors caused the association to become nonsignificant.

In women without diabetes at baseline, parity was not associated with incident Type 2 diabetes over the follow-up period, although there was a small association between parity and higher fasting insulin levels and insulin resistance.

“Much of the higher prevalence of diabetes associated with past child-bearing seems to be mediated (or confounded) by the heavier body mass index associated with grand multiparity,” write the authors in the journal Diabetes Care.

“This finding presents an opportunity for education and intervention related to weight control among grand multiparous women to reduce diabetes prevalence.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Giving birth to many children may increase Type 2 diabetes risk

The increased spending on healthcare for Type 2 diabetes in recent years appears to be of value in terms of the adverse outcomes prevented, according to a study published in the Annals of Internal Medicine.

Joseph Newhouse (Harvard Medical School, Boston, Massachusetts, USA) and colleagues explain that chronic diseases account for a large share of total healthcare spending, but it is uncertain whether increases in spending always buy better outcomes for patients.

To address this issue, the researchers performed an economic analysis using data from an observational cohort of 613 Mayo Clinic patients with Type 2 diabetes to determine the net value of healthcare for this population.

The authors assessed changes in inflation-adjusted annual healthcare spending and in health status between 1997 and 2005. Two approaches were used to determine change in health status: 10-year risk for nonfatal and fatal coronary heart disease, and changes in each patient’s predicted remaining life expectancy and quality-adjusted life-years (QALY).

Spending data were obtained for all medical care, whether or not related to patients’ diagnosis of diabetes.

The authors defined net value as the present discounted monetary value of improved survival and avoided treatment spending for coronary heart disease minus the increase in annual spending per patient.

During the study period, control of coronary risk factors such as glycated hemoglobin, blood pressure, and serum lipids, improved with a consequent decrease in modifiable 10-year risk estimates.

Overall, there was a mean increase in predicted life expectancy and QALYs based on all diabetes-related complications of 0.123 years and 0.087 years, respectively.

Total spending during the study period more than doubled, with the greatest increases for inpatient services and pharmacy costs (142% for both).

Assuming that 1 life-year is worth $200,000 (€136,444) and accounting for changes in modifiable cardiovascular risk, the authors estimated the net value of changes in healthcare for patients with Type 2 diabetes as $10,911 (€7,444) per patient between 1997 and 2005.

“A positive dollar value that suggests the value of healthcare has improved despite increased spending,” explain the authors. Estimates remained positive when values of $100,000 (€68,222) and $300,000 (€204,666) were used.

A second approach based on diabetes complications yielded a net value of $6931 (€4,728) per patient.

“We estimate that the value of improved survival from lower cardiovascular risks exceeds or approximates the increased spending on care,” write the authors, although they caution that the estimates are based on a small group of patients and on many assumptions.

In their conclusions, they acknowledge that it is unlikely that the current spending increases can be sustained. “It is still necessary to enhance value for money spent on care for patients with chronic conditions such as diabetes,” they write.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Quick-release (QR) bromocriptine is a well tolerated and effective therapy for Type 2 diabetes and is not associated with increased cardiovascular (CV) risk, report researchers.

Bromocriptine, a D2 dopamine receptor agonist, is used to treat conditions such as pituitary tumors and Parkinson’s disease. It has recently been shown to significantly reduce glycated hemoglobin (HbA1c) levels by around 0.5% and is now indicated for treatment of patients with Type 2 diabetes.

However, previous studies have been underpowered to assess cardiovascular safety of the drug. To test the overall safety and tolerability of bromocriptine for treatment of Type 2 diabetes, J Michael Gaziano (Harvard Medical School, Boston, Massachusetts, USA) and colleagues randomly assigned 3095 patients with Type 2 diabetes in a 2:1 fashion to take QR bromocriptine (titrated to a maximum of 4.8 mg/day) or placebo, both in addition to their usual diabetes therapy, for a period of 52 weeks.

All adverse events were assessed, with a particular focus on CV disease events - including a combined endpoint of myocardial infarction, stroke, coronary revascularization, and hospitalization for angina or congestive heart failure.

As reported in the journal Diabetes Care, 89% of the bromocriptine group and 83% of the placebo group reported some form of adverse events. In addition, 176 (8.6%) people in the bromocriptine group reported serious adverse events and 98 (9.6%) in the placebo group.

The combined CV disease endpoint was reported by 37 (1.8%) of the bromocriptine group compared with 32 (3.2%) of the placebo group.

The most commonly reported bromocriptine associated adverse event was nausea, reported in 7.6% of the bromocriptine treated patients compared with only 1.0% of the placebo group.

“Nausea was the chief limiting adverse event in this trial. For the majority of patients experiencing nausea, the symptoms occurred during the initial titration of the drug and lasted less than 2 weeks,” write the authors.

“Bromocriptine-QR represents a new treatment modality for Type 2 diabetes,” conclude Gaziono et al. “This first-in-class therapy may provide a new approach to addressing the comorbidities associated with Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Higher adiponectin levels are consistently associated with a lower risk for Type 2 diabetes in prospective studies of diverse populations, show results of a meta-analysis published in the Journal of the American Medical Association.

Adiponectin secretion is decreased in obesity and low levels of this anti-inflammatory and insulin-sensitizing cytokine are frequently implicated in the development of Type 2 diabetes.

To determine the strength and consistency of the relation between plasma adiponectin and risk for Type 2 diabetes, Rob van Dam (Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA) and colleagues conducted a systematic review and meta-analysis of prospective studies that evaluated adiponectin levels and incidence of Type 2 diabetes.

The authors searched the medical literature up to April 2009 for prospective studies in which adiponectin levels were measured in blood collected before the onset of Type 2 diabetes and which had a minimum follow-up of 1 year.

They identified 13 studies with a total of 14,598 participants and 2623 incident cases of Type 2 diabetes for inclusion in the meta-analysis.

A substantial inverse association between plasma adiponectin level and incidence of Type 2 diabetes was found, with a relative risk for Type 2 diabetes of 0.72 per 1 “log µg/ml increment in adiponectin levels.

This association was seen across diverse ethnic groups, including White, East “Asian, Asian “Indian, African “American, and Native “American populations.

The authors also found that the results did not differ substantially by adiponectin assay, method of diabetes ascertainment, study size, follow-up duration, body mass index, or proportions of men and women.

The research is important as adiponectin levels may be useful for identifying people most likely to benefit from interventions to treat dysfunctional adipose tissue and its metabolic complications, and may in the future be useful for prediction of Type 2 diabetes in addition to established risk factors.

“Although these epidemiologic studies cannot establish causality, the consistency of the association across diverse populations, the dose-response relationship, and the supportive findings in mechanistic studies indicate that adiponectin is a promising target for the reduction of risk for Type 2 diabetes,” conclude the authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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