Thursday, 31 March 2016
More obese than underweight, says study
There are now more adults in the world classified as obese than underweight, a major study suggests. via BBC News - Health Read More Here..
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Diabetes drug linked to increased bladder cancer risk
"The anti-diabetic drug pioglitazone raises the risk of bladder cancer by 63 per cent," The Daily Telegraph reports.
While the actual increased risk in real-world terms is small, the results may help to inform prescription decisions for both doctors and patients. Pioglitazone is a drug that helps people with type 2 diabetes by making their cells more sensitive to insulin.
Some previous studies have linked pioglitazone with a raised chance of bladder cancer, although the results of previous research have been inconclusive.
The new study looked at what happened to 145,806 people who took pioglitazone compared to other oral diabetes drugs (not insulin) over a 14-year period (2000 to 2014).
Researchers found that people who had taken pioglitazone, as opposed to other diabetes drugs, were 63% more likely to have been diagnosed with bladder cancer, and that the risk increased the longer they had taken it.
It is important to note that the overall risk of bladder cancer was low. There were 121 cases of bladder cancer for every 10,000 people taking pioglitazone for 10 years, compared to 89 cases for people taking other diabetes drugs.
For people who respond well to this drug, the benefits in terms of diabetes control are thought to outweigh the risks.
Anyone taking pioglitazone should continue the drug as prescribed, but discuss any concerns they have with their doctor, and immediately report any symptoms such as blood in urine, frequent urination, or pain when passing urine.
Where did the story come from?
The study was carried out by researchers from the Jewish General Hospital and McGill University, both in Montreal, Canada, and was funded by the Canadian Institutes of Health Research.
The study was published in the peer-reviewed British Medical Journal (BMJ) on an open-access basis, making it free to read online.
The Daily Mail and the Telegraph covered the study accurately, for the most part.
The Mail claimed that pioglitazone "remains popular with doctors even though newer and better diabetes drugs exist, because it is so cheap," although they did not explain where this claim came from.
This appears to be a fairly flippant remark, with no hard evidence to support it.
Pioglitzone may be considered as an additional treatment for diabetes if a person's blood sugar is not controlled with one oral tablet alone. It is not used without careful consideration of the potential risks – which include cardiovascular, as well as bladder cancer, risk, and people's response is carefully monitored. It is withdrawn if it is not working.
What kind of research was this?
This was a population-based cohort study, which aimed to examine whether the type 2 diabetes drug pioglitazone is associated with increased risk of bladder cancer. This is a link that has previously been observed, but as the researchers say is "controversial".
Cohort studies are useful to compare what happens to big groups of people in different situations. They cannot prove that one factor (in this case, pioglitazone) definitely causes another (bladder cancer). However, the researchers who did this study carried out a lot of additional work to rule out other possible causes (confounders) such as occupation, for the increased risk of bladder cancer.
What did the research involve?
Researchers used the records of 145,806 people who started taking a diabetes drug for the first time from January 1 2000 to July 31 2013. They followed them up until July 31 2014. After adjusting their figures to take account of other factors that could influence the results, the researchers compared the chances of getting bladder cancer for people who took pioglitazone with people who took any other diabetes drug.
The researchers also directly compared pioglitazone to rosiglitazone. This was a similar drug also introduced in 2000, but this was withdrawn in 2010 because of concerns about the risk of heart attacks and strokes. They examined whether the risk of bladder cancer increased with the length of time that people took either drug, or with the total amount they took.
To make sure they were looking at effects of pioglitazone and not any other factor, the researchers did many sensitivity tests of their figures. This included using different cut-off time periods to avoid counting people who might already have had bladder cancer before they started taking a diabetes drug, only including people who had at least four prescriptions a year, and excluding anyone who had any sort of bladder condition. They also adjusted the figures to take account of a range of confounding factors (such as age, sex and whether they smoked) that could be linked to risk of bladder cancer.
What were the basic results?
Overall, 622 people were diagnosed with bladder cancer during the study’s follow-up period.
People who took pioglitazone were more likely to have been diagnosed with bladder cancer than people who took any other drug. The longer people took pioglitazone, the higher the chances of getting bladder cancer.
The risk of getting bladder cancer was 63% higher for people taking pioglitazone (hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.22 to 2.19). Absolute risk of bladder cancer was still low, at 121 cases for every 10,000 people taking pioglitazone over one decade, compared to 89 cases for people taking other diabetes drugs.
Most people in the study were followed up for four to five years. Bladder cancer risk was only significantly increased after about two years of taking pioglitazone (HR 1.78, 95% CI 1.21 to 2.64). There was no clear picture in relation to dose.
The sensitivity checks on the results did not change them in any significant way.
How did the researchers interpret the results?
The researchers say their figures show that taking pioglitazone "is associated with an increased risk of bladder cancer" and the results suggest that the increased risk is "drug specific" to pioglitazone.
They say that, although they cannot rule out some confounding of the results from factors they could not measure, such as family history of cancer, their checks on the results mean they "do not believe that residual confounding is a likely explanation" for the link between pioglitazone and increased risk of bladder cancer.
Conclusion
It seems likely from this research that pioglitazone is linked to an increased risk of bladder cancer, although the overall chances of getting bladder cancer remain very low. While this type of research cannot prove that pioglitazone is the cause of the increased risk of bladder cancer, it is not easy to find a convincing alternative explanation for these results.
Previous research has already shown unexpectedly higher levels of bladder cancer among people taking pioglitazone, although other studies had found no such link. However, the size and the care with which this new study was carried out makes it convincing. Even so, we don’t know how the drug might cause bladder cancer. More work needs to be done to find out what action of the drug might trigger this specific type of cancer.
Doctors have already warned of a "small increased risk" of bladder cancer with this drug (PFD, 59kb). The European medicines regulator (the European Medicines Agency) advises that doctors do not use pioglitazone for people who have any history of bladder cancer, and that the risk of bladder cancer is checked before they start using the drug. Cautious use is advised for people with risk factors, such as increasing age, smoking, or history of chemotherapy or radiotherapy to the pelvic area.
For all people prescribed pioglitazone, the drug is stopped if blood sugar control does not improve within three to six months of use. However, for people who respond adequately to treatment, the benefits of pioglitazone are believed to outweigh the risks.
Anyone taking pioglitazone should continue the drug as prescribed. If you have any concerns about the link to bladder cancer, see your doctor to talk about whether the benefit you get from the drug outweighs the risks. You should always report any signs and symptoms of bladder problems immediately, such as blood in your urine, pain while urinating, or a feeling of needing to pass water urgently, to your doctor.
Links To The Headlines
Common diabetes drug raises risk of developing cancer. The Daily Telegraph, March 30 2016
Common diabetes drug taken by one million patients 'raises the risk of bladder cancer by two-thirds'. Daily Mail, March 30 2016
Links To Science
Tuccori M, Filion KB, Yin H, et al. Pioglitazone use and risk of bladder cancer: population based cohort study. BMJ. Published online March 30 2016
More Evidence Diabetes Drug Actos Raises Bladder Cancer Risk a Bit
But odds are small, and experts want it to remain on market, although newer drugs are available
Source: HealthDay
Related MedlinePlus Pages: Bladder Cancer, Diabetes Medicines, Drug Reactions via MedlinePlus Health News Read More Here..
Anti-Addiction Drug May Help Curb Painkiller, Heroin Dependence
Study finds lower relapse rate associated with naltrexone, but long-term use recommended
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Related MedlinePlus Pages: Heroin, Prescription Drug Abuse via MedlinePlus Health News Read More Here..
Study: Longer-Term Antibiotics Won't Ease 'Chronic Lyme Disease'
Dutch trial is latest to show no benefit from extended treatment, but finding unlikely to end the controversy
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Related MedlinePlus Pages: Antibiotics, Lyme Disease via MedlinePlus Health News Read More Here..
Doctors Report Groundbreaking HIV-To-HIV Organ Transplants
One donor supplied a kidney to one patient and a liver to another patient
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Related MedlinePlus Pages: HIV/AIDS, Organ Transplantation via MedlinePlus Health News Read More Here..
FDA Approves Experimental Zika Test for Blood Donations
But agency still asks those who've possibly been exposed to the virus to forgo giving blood right now
Source: HealthDay
Related MedlinePlus Pages: Blood Transfusion and Donation, Zika Virus via MedlinePlus Health News Read More Here..
Beans, Chickpeas May Help with Weight Loss
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Related MedlinePlus Pages: Diets, Nutrition, Weight Control via MedlinePlus Health News Read More Here..
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Inserting new DNA into cardiac cells may help strengthen the heart, study finds
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Related MedlinePlus Pages: Genes and Gene Therapy, Heart Failure via MedlinePlus Health News Read More Here..
Caregivers Often Give Up Necessities to Cover Alzheimer's Costs
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Study Asks, What Is a 'Good Death'?
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Study Explores Mechanism Between Zika Virus, Birth Defects
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Related MedlinePlus Pages: Birth Defects, Brain Malformations, Zika Virus via MedlinePlus Health News Read More Here..
GSK to 'drop patents in poor countries'
UK pharmaceutical giant GlaxoSmithKline says it wants to make it easier for manufacturers in the world's poorest countries to copy its medicines so more people can have access to them. via BBC News - Health Read More Here..
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Urban health: major opportunities for improving global health outcomes, despite persistent health inequities
The new report emphasizes the urgency of addressing health disparities and their determinants in cities as countries strive to achieve the Sustainable Development Goals. via WHO news Read More Here..
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End-of-life care ‘improving’
| But round-the-clock palliative care services come in for criticism Related items from OnMedica Palliative care Only half of clinicians feel patients’ end of life needs are met RCGP admits end-of-life care needs to improve Doctors call for better training in end-of-life care First guideline on end-of-life care launched by NICE |
Nurse recruitment struggling to meet demand
| Analysts say NHS needs major overhaul of workforce planning and deployment Related items from OnMedica 1,600 more full time senior doctors working in NHS than a year ago Workforce shortages threaten delivery of NHS Five Year Forward View Staff burnout could derail the NHS’s drive for efficiency NHS pressures could cause staff ‘burnout’ Government clamps down on ‘rip-off’ agency staff |
Diabetic foot ulcer care needs to improve
| Audit reveals need for more referrals to experts in under two weeks Related items from OnMedica Care of the diabetic foot Annual diabetes checks still being missed NICE recommends tighter blood sugar control in diabetes NHS must hold CCGs accountable for poor diabetes care Still too many ‘unacceptable’ variations in diabetes care, say MPs |
CQC inspection fees set to rise
| Single GP practice with up to 10,000 patients faces £1,849-a-year increase Related items from OnMedica GP practice inspections behind schedule Planned CQC fee hikes for NHS bodies ‘exhorbitant’, fumes BMA CQC regime is ‘damaging’ patient care, says survey CQC fee hike slammed by GPs and health providers The CQC - a suitable case for treatment |
New genetic testing for childhood cancers
| Doctors hope to deliver more personalised treatments and access to new medicines Related items from OnMedica Genetic research finds 15 new breast cancer ‘hotspots’ Breakthrough in myeloma diagnosis ‘Molecular scissors’ provide miracle cure Researchers develop single blood test for all known inherited heart conditions Rare diseases in children identified by DNA project |
Wednesday, 30 March 2016
Exercise and the Elderly - Benefits and Recommendations
30 March 2016 Everyone benefits from physical activity: young, old, fat, skinny, healthy and sick. While younger individuals tend to ignore health benefits in favor of the aesthetic nature of exercise, physical activity has the potential to greatly improve the quality of life for the elderly population. From increased mobility and independence to decreased depression, physical activity and exercise are crucial in maintaining normal function as we age.
via Straight Health RSS Feed More READ
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Dear Google, please help us use our data to beat dengue and Zika
A worried dad wants the tech giant to allow its users to share access to their location history to help protect families from mosquito-borne diseases
via New Scientist - – New Scientist Read More Here..
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