Winners and losers at the rosiglitazone gamble A meta-analytical approach at the definition of the cardiovascular risk profile of rosiglitazone

The treatment with rosiglitazone could be associated with increased risk for myocardial infarction (MI). This meta-analysis is aimed at identifying moderators of the effect of rosiglitazone on the risk of MI and chronic heart failure (CHF) in type 2 diabetic patients. The risk ratio (RR) of MI and CHF was calculated for each trial as the ratio of incidence density in rosiglitazone and comparator groups. A total of 86 trials were included. After adjusting for trial duration, RR for MI showed a significant inverse correlation with mean baseline HbA1c, triglycerides, and LDL-cholesterol (r=-0.24, -0.45, and -0.33, respectively; all p<0.05). Conversely, rosiglitazone-associated risk of MI was increased in trials with higher mean BMI or greater proportion of insulin-treated patients (r=0.26 and 0.42, respectively; p<0.05). Lower triglyceride levels were also associated with a higher rosiglitazone-induced risk of CHF (r=-0.23, p<0.05). Treatment with rosiglitazone could have divergent effects on cardiovascular risk, depending on the characteristics of the patients. Benefits could outweigh harms in patients with poor glycemic control and worse lipid profile; conversely, the drug could increase the risk of MI in obese or insulin-treated patients.     

Telemonitoring for infants at risk of apnoea, bradycardia and hypoxaemia: transmission of data improves the family compliance during home monitoring

We evaluated the compliance of families using telemonitoring and families using conventional home monitoring in infants at risk of apnoea, bradycardia and hypoxaemia. Families who used the telemedicine system could perform the remote data transmission from their home. Families who used the conventional system had to come to the regional centre to download the cardiorespiratory traces captured by the monitor. A total of 175 patients examined at the Regional Centre for Sudden Infant Death Syndrome (SIDS) in Florence were included in the 5-year study. Good compliance was defined as an average daily use of 10 hours or more; insufficient compliance was defined as an average daily use of less than 10 hours. The Centre analysed 612 data downloads, 339 from the telemedicine system and 273 from the conventional system. This represented a total of 105,061 hours of data during 12,862 days of home monitoring. The compliance of families who used the telemedicine system was significantly higher than that of families who used the conventional system. Of the 105 families who used the conventional system, 50 (48%) were good compliers. Of the 70 families who used the telemedicine system, 49 (70%) were good compliers. Telemedicine was associated with a significant improvement in the compliance of families using cardiorespiratory monitors.     

Ambulatory Blood Pressure Monitoring in Older Nursing Home Residents: Diagnostic and Prognostic Role

BackgroundOlder subjects living in nursing homes (NHs) show a high prevalence of multimorbidity, disability, and cognitive impairment. The clinical meaning of arterial hypertension (AH) in this population is unclear, and few studies have adopted ambulatory blood pressure monitoring (ABPM) with this purpose.The aims of the study were to evaluate the concordance between office and monitored blood pressure in a sample of NH residents and to assess the prognostic meaning of ABPM parameters after 1 year.MethodsNH residents underwent a comprehensive geriatric assessment and 24-hour ABPM (Spacelabs 90207). White-coat hypertension (WCH) was defined as office blood pressure of 140/90 or higher and ABPM lower than 135/85 mm Hg. Vital status was assessed after 1 year.ResultsA total of 100 residents (mean age 83, 51% affected by AH) showed WCH in 33% of cases and in 70% of cases elevated office blood pressure. Correlation between monitored and office blood pressure was limited for systolic (R = 0.30) and nonsignificant for diastolic blood pressure (R = 0.11). Disability and behavioral disorders were independently associated with 1-year mortality. No ABPM parameter, except low nighttime systolic blood pressure variability, was associated with 1-year mortality.ConclusionsConcordance between office and ABPM values is limited, and WCH prevalence is high among NH residents. Survival at 1-year follow-up is predicted by disability and behavioral disorders, but is not associated with blood pressure values.     

Metformin and cancer occurrence in insulin-treated type 2 diabetic patients

OBJECTIVE

Metformin is associated with reduced cancer-related morbidity and mortality. The aim of this study was to assess the effect of metformin on cancer incidence in a consecutive series of insulin-treated patients.

RESEARCH DESIGN AND METHODS

A nested case-control study was performed in a cohort of 1,340 patients by sampling, for each case subject, age-, sex-, and BMI-matched control subjects from the same cohort.

RESULTS

During a median follow-up of 75.9 months, 112 case patients who developed incident cancer and were compared with 370 control subjects. A significantly lower proportion of case subjects were exposed to metformin and sulfonylureas. After adjustment for comorbidity, glargine, and total insulin doses, exposure to metformin, but not to sulfonylureas, was associated with reduced incidence of cancer (odds ratio 0.46 [95% CI 0.25–0.85], P = 0.014 and 0.75 [0.39–1.45], P = 0.40, respectively).

CONCLUSIONS

The reduction of cancer risk could be a further relevant reason for maintaining use of metformin in insulin-treated patients.Several studies have shown that metformin is associated with reduced cancer-related morbidity and mortality (1–4), due to improvement in insulin sensitivity (5) or to the activation of AMP-activated protein kinase (6). In insulin-treated patients, the reduction in insulin doses determined by metformin (7) could theoretically produce a decrease in cancer incidence.