Obesity, not race, lies behind diabetes spikes
Type 2 diabetes is almost twice as common in African-Americans as it is in whites. Obesity, not racial factors, is to blame, a study in JAMA reports.
Researchers began with 4,251 black and white men and women ages 18 to 30 who were not diabetic. They then followed up with periodic interviews and health examinations over an average of 25 years. Compared to whites, black men were 67 percent more likely, and black women almost three times as likely, to develop diabetes.
When they controlled for a long list of modifiable risk factors — fasting glucose, body mass index, waist circumference, blood pressure, blood lipids, location of residence, socioeconomic status and more — the difference in diabetes incidence between the races disappeared. The key cause, the researchers determined, is obesity, which is tied to all of these risk factors.
“The benefit of capturing these behaviors over time is that we can study how the accumulation of unhealthy risk factors contributes to the development of diabetes,” said the senior author, Mercedes R. Carnethon, an associate professor of preventive medicine at Northwestern University. “Modifiable risk factors matter. The answer is simple, but the strategy to achieve change is complicated.”
— Nicholas Bakalar, The New York Times
Study on abortion pill shows in-home success
Ever since the abortion pill RU-486 began to hit the market in the 1980s, questions have lingered about its safety, especially for women who take it in countries where they cannot openly seek help from a medical professional if something goes wrong.
As reports of deaths and injuries grew in the early 2000s and the pill became a big political issue, studies were launched to try to get more data on the safety question.
The latest research, in PLOS One, focuses on the experience of 220 women in Peru. They had been evaluated by nurses, given information about how to use the drug misoprostol and encouraged to return to a clinic for follow-up. The rates of success and adverse events were similar to those in clinics, with 89 percent of women having a complete abortion. Only two had a major complication, which in both cases was an infection.
"Our findings corroborate those from a growing number of studies indicating that women can safely and effectively use medication abortion on their own with minimal clinical supervision," Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco, said in announcing the results.
"Worldwide, unsafe abortion is estimated to account for 8-18 percent of maternal deaths as well as a large number of medical complications," the authors write.
— Ariana Eunjung Cha, The Washington Post
Shingles vaccine more useful than previous version
The new shingles vaccine is expensive, but worth it, according to a new analysis in JAMA Internal Medicine.
Shingles is a painful and sometimes debilitating nerve inflammation and blistering skin rash caused by the same virus that causes chickenpox. Anyone who has had chickenpox is susceptible to it many years later.
The old vaccine, Zostavax, is about 50 percent effective. The new one, Shingrix, provides 90 percent protection. It is given in two shots at $140 each; it’s recommended for people older than 50. It may soon be covered by Medicare Part D and other insurers.
Using data from randomized trials, researchers calculated that using the new vaccine would save money over the long term, based on statistical measures that quantify the cost effectiveness of health care measures.
“Our findings are subject to the proposed price — $280,” said the lead author, Phuc Le, with the Cleveland Clinic. “Any price change in the future may change the calculation.”
The recipient’s age and failure to get the second shot could change the cost effectiveness.
— Nicholas Bakalar, The New York Times