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Blood test in early pregnancy could determine a woman’s later risk for gestational diabetes

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A blood test conducted as early as the 10th week of pregnancy may help identify women at risk for gestational diabetes, a pregnancy-related condition that poses potentially serious health risks for mothers and infants, according to researchers at the National Institutes of Health and other institutions. The study appears in Scientific Reports.

Gestational diabetes occurs only in pregnancy and results when the level of blood sugar, or glucose, rises too high. Gestational diabetes increases the mother’s chances for high blood pressure disorders of pregnancy and the need for cesarean delivery, and the risk for cardiovascular disease and type 2 diabetes later in life. For infants, gestational diabetes increases the risk for large birth size. Unless they have a known risk factor, such as obesity, women typically are screened for gestational diabetes between 24 and 28 weeks of pregnancy.

In the current study, researchers evaluated whether the HbA1c test (also called the A1C test), commonly used to diagnose type 2 diabetes, could identify signs of gestational diabetes in the first trimester of pregnancy. The test approximates the average blood glucose levels over the previous 2 or 3 months, based on the amount of glucose that has accumulated on the surface of red blood cells. According to the authors, comparatively few studies have examined whether the HbA1c test could help identify the risk for gestational diabetes, and these studies have been limited to women already at high risk for the condition. The test is not currently recommended to diagnose gestational diabetes at any point in pregnancy.

The researchers analyzed records from the NICHD Fetal Growth Study, a large observational study that recruited more than 2,000 low-risk pregnant women from 12 U.S. clinical sites between 2009 and 2013. The researchers compared HbA1c test results from 107 women who later developed gestational diabetes to test results from 214 women who did not develop the condition. Most of the women had tests at four intervals during pregnancy: early (weeks 8-13), middle (weeks 16-22 and 24-29) and late (weeks 34-37).

Women who went on to develop gestational diabetes had higher HbA1c levels (an average of 5.3 percent), compared to those without gestational diabetes (an average HbA1c level of 5.1 percent). Each .1 percent increase in HbA1c above 5.1 percent in early pregnancy was associated with a 22-percent higher risk for gestational diabetes.

In middle pregnancy, HbA1c levels declined for both groups. However, HbA1c levels increased in the final third of pregnancy, which is consistent with the decrease in sensitivity to insulin that often occurs during this time period.

“Our results suggest that the HbA1C test potentially could help identify women at risk for gestational diabetes early in pregnancy, when lifestyle changes may be more effective in reducing their risk,” said the study’s senior author, Cuilin Zhang, Ph.D., of the Epidemiology Branch at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Exercise and a healthy diet may lower blood glucose levels during pregnancy. If these measures are not successful, physicians may prescribe insulin to bring blood glucose under control.

The authors noted that further studies are needed to confirm whether measuring HbA1c levels in early pregnancy could determine a woman’s later risk for gestational diabetes. Similarly, research is needed to determine whether lowering HbA1c with lifestyle changes, either in early pregnancy or before pregnancy, could reduce the risk for the condition.

Source:https://www.nichd.nih.gov/news/releases/081618-gestational-diabetes

clinical

Muscle relaxants increase risk of respiratory complications

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Muscle relaxants are a necessary part of anesthesia during certain major operations. However, studies have hinted at respiratory risks connected with these drugs. POPULAR, a major prospective observational European study has confirmed the association between the use of muscle relaxants and respiratory complications, and assessed the chances of the current avoidance strategies.

Anesthetics make patients unconscious during an operation and prevent them from feeling pain. Muscles, however, are not paralyzed by these drugs and may still move. “To prevent this, we also use muscle relaxants or, more precisely, neuromuscular blocking agents,” says Professor Manfred Blobner, an anesthesiologist at TUM’s Clinic for Anesthesiology and Intensive Care.

“These drugs are particularly important when operating on a patient’s chest or abdomen. They are also used to protect the vocal cords from injury when a tube is placed in the airway to allow artificial ventilation,” says Blobner who is the chair of the POPULAR steering committee, a multinational group of researchers. The prospective observational POPULAR study collected data from 22,803 patients of 211 hospitals in 28 European countries.

The first results from this study are now being published in The Lancet Respiratory Medicine. They confirm what earlier studies based on pre-existing data had hinted at: The use of neuromuscular blockers during general anesthesia is associated with a significantly increased risk of several respiratory complications after surgery.

The most common complications involving the respiratory system were a reduced capacity of the lungs to absorb oxygen transiently (5.2 percent), and infections of the lung and respiratory tract (2.5 percent). Roughly three quarters of all patients (17150 people) were treated with neuromuscular blocking agents. They were shown to have a significantly higher risk (+4.4 percent) of developing any type of respiratory complication.

Neither monitoring nor drugs lower the risk

The study did not look into how the use of muscle relaxants might cause the negative effects. Earlier studies have shown that even small amounts of muscle relaxants remaining in the bodies of patients could be responsible for some of the complications. The data from POPULAR, however, show that established techniques used to avoid residual neuromuscular block do not lower the patients’ risk of pulmonary complications.

The respiratory outcome was not changed by drugs reversing the effects of the muscle relaxants, or monitoring the neuromuscular function during anesthesia to ensure complete recovery of muscle function. The researchers point out that this does not mean that these measures are unable to reduce residual paralysis, but they must be used correctly. There may be flaws in the way these measures are implemented as well as other unknown causes for the complications.

“It’s important to note that neuromuscular blocking agents have made surgery considerably safer and more effective since their introduction several decades ago,” says Professor Blobner. “We have constantly refined both the drugs and the techniques used. Many operations would not be possible without them. Still, the results from POPULAR raise important questions.”

Blobner and co-authors are planning to implement more targeted studies to identify the underlying mechanisms behind their findings. “Based on our results, we believe that patients undergoing minor surgical procedures that do not necessarily require neuromuscular blocking drugs might benefit from avoiding them. Using devices like laryngeal masks for anesthesia instead of tracheal tubes that go past the vocal cords could prove helpful as well,” says Blobner.

More information: Kirmeier E, Eriksson LI, Lewald H, Jonsson Fagerlund M, Hoeft A, Hollmann M, Meistelman C, Hunter JM, Ulm K, Blobner M. “Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study”. Published online September 14, 2018. DOI: 10.1016/S2213-2600(18)30294-7

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Diabetes

Beer’s bitter delight is tasted in the gut

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Hoppy beers are famous as a driver of craft brewing. But the challenging taste of hops goes far beyond the palate. According to a new study from Scripps Research scientists, the bitter flavor literally reaches into your gut.

Moreover, chemicals in hops called isohumulones may help control obesity, type 2 diabetes and other diseases.

Intestinal taste receptors detect isohumulones, according to the study. While the work was performed in mice and needs to be confirmed in humans, it’s already known that people also have taste receptors in their gut.

Previous research indicates that intestinal taste receptors influence the production of hormones as well as appetite, said Enrique Saez, a Scripps Research associate professor. And hops extracts have been shown to reduce weight gain and decrease insulin resistance.

So the study fills a gap in research between the observed effects of hops extracts and the chemicals and molecular mechanism causing the effects, Saez said.

The study was recently published in the journal Molecular Metabolism.

Isohumulones are being studied by Seattle’s KinDex Pharmaceuticals as therapy for metabolic diseases such as Type 2 diabetes and polycystic ovary syndrome. The company is studying the compounds in people under the name KDT501.

KinDex asked Saez and associates to study isohumulones to better characterize what they do. With that knowledge, KinDex could optimize the drugs, said Saez. He is on the KinDex advisory board with colleagues Paul Schimmel and Ben Cravatt.

“We were quite surprised when reviewing the literature,” Saez said. “It turned out that these taste receptors are expressed not only in the mouth, but also in the gut, the airway epithelia, the liver, and some other organs.”

These receptors appeared to have evolved as protection against eating bitter substances, which are often poisonous, Saez said.

Isohumulones work indirectly. They stimulate release of a hormone called glucagon-like peptide-1, or GLP-1, that works with insulin to decrease blood sugar levels, he said. The chemicals also promotes satiety.

“It makes you feel fuller, and other hormones that this bitter taste receptor also regulates limit the absorption of nutrients in the gut,” he said. “So in effect it probably limits absorbing these potentially poisonous compounds.”

A mimic of GLP-1 was developed by San Diego’s Amylin Pharmaceuticals as a diabetes medication, exenatide. It was discovered in an unlikely place, the saliva of the Gila monster.

The drug is sold as Byetta and in extended release form as Bydureon. It was attractive enough that Amylin was purchased for $7 billion by Bristol-Myers Squibb in 2012.

However, exenatide must be injected, limiting its usefulness, Saez said.

“Isohumulones are small molecules that you can eat,” he said.

More information: Bernard P. Kok et al. Intestinal bitter taste receptor activation alters hormone secretion and imparts metabolic benefits, Molecular Metabolism (2018). DOI: 10.1016/j.molmet.2018.07.013

©2018 The San Diego Union-Tribune
Distributed by Tribune Content Agency, LLC.

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Cardiology

Aspirin could play valuable role as additional treatment for cancer

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Regular use of aspirin could help in the treatment of some cancers, finds a new review of 71 medical studies.

The systematic review, which looked at the survival of 120,000 patients with cancer who took aspirin, compared with 400,000 patients who did not, showed that at any time following the diagnosis of some cancers the proportion of patients who were still alive was 20-30% greater in those taking the drug. The spread of cancer to other parts of the body was also substantially reduced in patients using aspirin.

Peter Elwood, Honorary Professor at Cardiff University, who directed the study said: “The use of low-dose aspirin as a preventive in heart disease, stroke and cancer is well established but evidence is now emerging that the drug may have a valuable role as an additional treatment for cancer too.”

One of the colon cancer studies the researchers looked at suggested that a non-diabetic man of about 65 years who takes aspirin would have a prognosis similar to that of a man five years his junior who takes none. For a woman of similar age with colon cancer the addition of aspirin could lead to a similar prognosis of a woman four years younger.

Almost half the studies included in the review were of patients with bowel cancer, and most of the other studies were of patients with breast or prostate cancer. There were very few studies of patients with other less common cancers, but on the whole the pooled evidence for all the cancers is suggestive of benefit from aspirin.

All this evidence of benefit is however limited. First, it comes from observational studies of patients who took aspirin for reasons other than the treatment of cancer, and not from appropriate randomised trials designed to test aspirin and cancer.

Furthermore, the evidence is not entirely consistent and a few of the studies failed to detect benefit attributable to aspirin. More evidence is therefore urgently needed. A number of new randomised trials have been set up, but these are unlikely to report for quite a few years.

The issue of bleeding was examined carefully in the review. Information on bleeding was requested from an author of each of the 71 reports and replies were received from 31 authors.

Very few patients had serious bleeding. Amongst those who had, the proportion of patients taking aspirin who had a ‘serious’ bleed was no greater than the proportion of patients not taking aspirin who had experienced a ‘spontaneous’ stomach bleed due to causes other than aspirin. In two studies a very small number of fatal stomach bleeds had occurred, but again the proportion was no greater in the patients on aspirin than in those not taking aspirin.

Peter Elwood, Honorary Professor at Cardiff University, who directed the study says: “Patients with cancer should be given the evidence now available and be helped to make their own judgement of the balance between the risks and the benefits of daily low dose. Evidence from further studies is urgently required, and patients should be strongly encouraged to participate in appropriate research studies.

“All patients should consult their GP before starting new medication.”

The research “Systematic review update of observational studies further supports aspirin role in cancer treatment: time to share evidence and decision-making with patients?” is published in Plos One Medicine.

More information: Peter C. Elwood et al. Systematic review update of observational studies further supports aspirin role in cancer treatment: Time to share evidence and decision-making with patients?, PLOS ONE (2018). DOI: 10.1371/journal.pone.0203957

 

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