Changing jobs and locations frequently can often be a sign of incompetence and poor performance. Can this physician be restrained, or at least retrained?
Medscape Internal Medicine
Perinatal mortality is higher in women with type 2 diabetes than in women with type 1 diabetes, report researchers from Spain in the November issue of The Journal of Clinical Endocrinology & Metabolism.
Reuters Health Information
By 2034, nearly twice as many Americans will have diabetes and spending on the disease will triple, further straining the U.S. health system and testing the viability of Medicare and other government health insurance programs, U.S. researchers said on Friday.
Reuters Health Information
An easy-to-use, self-assessment diabetes screening score seems better than existing methods, but further research is needed in diverse populations.
Medscape Medical News
Obesity is the main risk factor for the development of left atrial enlargement during aging, according to a report in the November 17th Journal of the American College of Cardiology.
Reuters Health Information
Guaranteed issue, community rating, and individual mandate: What do these terms mean in the context of healthcare reform? What do they mean for you? David M. Brown, MD, explains in this video blog.
Medscape Ophthalmology
Gastric bypass surgery appears to have beneficial effect on inflammatory, functional, and structural markers of coronary artery disease, researchers report in the November 15 issue of the American Journal of Cardiology.
Reuters Health Information
 |
NEW YORK (Reuters Health) – An “important” relation exists between platelet reactivity and glycemic control in patients with type 2 diabetes and coronary artery disease who are on dual antiplatelet therapy, researchers report in the November issue of the American Heart Journal.
Dr. Paul A. Gurbel of the Sinai Center for Thrombosis Research in Baltimore, Maryland told Reuters Health, “The more poorly controlled the diabetes, the higher the platelet reactivity. These data suggest a rationale for glycemic control in the diabetic in order to reduce thrombotic risk.” Dr. Gurbel and his associates compared platelet aggregation in response to 5 and 20 µmol/L adenosine diphosphate (ADP) in 36 patients with type 2 diabetes and 35 non-diabetics undergoing elective stenting on aspirin and clopidogrel maintenance therapy. They found that diabetic patients had higher ADP-induced platelet aggregation than nondiabetic patients. At 5 µmol/L, platelet aggregation was 45 in diabetic subjects versus 33 in nondiabetic subjects (p = 0.009). At 20 µmol/L, it was 52 versus 40 (p = 0.004). The 20 diabetic patients with hemoglobin A1C at or above 7.0 g/dL had significantly higher 5 and 20 µmol/L ADP-induced platelet aggregation than the 16 diabetic patients with hemoglobin A1C < 7.0 g/dL (54 vs 34 and 62 vs 40, respectively; p < 0.001 for both). For the study, the researchers defined high platelet reactivity as platelet aggregation greater than 46% in response to 5 µmol/L ADP or greater than 59% in response to 20 µmol/L ADP. “These cut points were based on a previous study linking them to risk for post-stenting ischemic events,” the authors note. Using these predefined 5 and 20 µmol/L ADP-induced aggregation cut-points, 44% and 39% of diabetic patients had high platelet reactivity, respectively, compared to 11% and 3% of nondiabetic patients. Among diabetic patients with HbA1C 7.0 or higher, the prevalence of high platelet reactivity was 65% and 60% compared to 19% and 13% among those with HbA1C < 7. These findings “provide a pathophysiologic mechanism explaining increased cardiovascular risk in patients with diabetes,” the authors say. “It is interesting,” they add, “that when partitioning the diabetes mellitus group by HbA1C, the < 7% group numerically approximate(s) the results of the non-diabetes mellitus group." Dr. Gurbel and colleagues conclude: “Poorly controlled type 2 diabetic patients with the greatest platelet reactivity may benefit most from more potent antiplatelet strategies in addition to aggressive antihyperglycemic treatment.” Reference: Views: 1138 |
Researchers discover no change in triglycerides, high- or low-density lipoprotein levels, and lean/fat body mass ratios but find that calcium supplements can lower blood pressure slightly.
Medscape Medical News
Guidelines on darbepoetin treatment for renal anemia must be changed immediately.
Faculty of 1000 Medicine
