20 Jan Antipsychotics Raise Risk of Diabetes in Youth
Posted at 22:02h
in Author Interviews, Diabetes, JAMA, Mental Health Research, Pediatrics, Pharmacology
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Dr. Christoph Correll[/caption]
More on Mental Health on MedicalResearch.com
MedicalResearch.com Interview with:
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
Hofstra Northwell School of Medicine
Hempstead, New York, USA
Investigator, Center for Psychiatric Neuroscience
Feinstein Institute for Medical Research
Manhasset, New York,
Medical Director, Recognition and Prevention
The Zucker Hillside Hospital,
Department of Psychiatry
Medical Research: What is the background for this study?
Dr. Correll: Antipsychotics have been used increasingly for psychotic, but also for many non-psychotic conditions, including for disorders and conditions for which they have not received regulatory approval. Moreover, antipsychotics have been associated with weight gain and abnormalities in blood fat and blood glucose levels. Although data in youth have been less available than in children and adolescents, youth appear to be more sensitive to the cardiometabolic adverse effects of antipsychotics than adults in whom significant weight gain might have already occurred due to long-term prior antipsychotic treatment. Nevertheless, type 2 diabetes, which is related to weight gain, overweight and obesity, seemed to be more common in adults than youth, likely due to the fact that it takes a long time for the body to develop diabetes. Recently, several individual epidemiologic or database studies with sufficient long-term follow-up durations suggested that the type 2 diabetes risk was higher in youth exposed to antipsychotics than healthy control youth and, possibly, even compared to psychiatrically ill patients treated with non-antipsychotic medications. However, a meta-analytic pooling of all available data has not been available to estimate the absolute and relative risk of type 2 diabetes in youth receiving antipsychotic treatment.
Medical Research: What are the main findings?
Dr. Correll: The main findings of the study that meta-analyzed data from 13 studies with 185,105 youth exposed to antipsychotics (average age 14.1 and 59.5 percent male) are that the absolute rates of type 2 diabetes are fortunately still relatively low, i.e. a cumulative type 2 diabetes risk of 5.7/1,000 patients and an exposure adjusted incidence rate of 3.1/1,000 patient-years. Nevertheless, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.6 times and three times higher compared with 298,803 healthy controls. Furthermore, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.1 times and 1.8 times higher compared with 1,342,121 psychiatric patients not exposed to antipsychotics. Main modifiable risk factors for type 2 diabetes development in antipsychotic-treated youth were treatment with the antipsychotic olanzapine and longer antipsychotic exposure time.
Pritesh Karia[/caption]
MedicalResearch.com Interview with:
Tanning Bed CDC Image[/caption]
MedicalResearch.com Interview with:
Myra Sendelweck M.Eng
M.D. Candidate 2018 and
Robert Dellavalle, MD, PhD, MSPH
Chief, Dermatology Service Denver VA Medical Center Denver, CO
University of Colorado School of Medicine
MedicalResearch: What is the background for this study? What are the main findings?
Response: Indoor tanning has increasingly been recognized amongst providers as a public health concern. Recent literature suggests an association between indoor tanning and other risky health behaviors in adolescents.
We were intrigued by this association. We analyzed a survey of Colorado high school students and found that those who tanned were also more likely to use various substances, such as steroids, alcohol, marijuana, and illicit drugs. Tanners were over five times as likely to report steroid use!
Dr. Brian Elbel[/caption]
Brian Elbel, PhD, MPH, Associate Professor, Department of Population Health, NYU Langone Medical Center
Amy Schwartz, PhD, Director, New York University Institute for Education and Social Policy, and the Daniel Patrick Moynihan Chair in Public Affairs, Syracuse University
Michele Leardo, MA, Assistant Director
New York University Institute for Education and Social Policy
Medical Research: What is the background for this study? What are the main findings?
Response: New York City, as well as other school districts, is making tap water available to students during lunch by placing water dispensers, called water jets, in schools. Surprisingly, drinking water was not always readily available in the lunchroom. Water jets are part of a larger effort to combat child obesity.
We find small, but statistically significant, decreases in weight for students in schools with water jets compared to students in schools without water jets. We see a .025 reduction in standardized body mass index for boys and .022 for girls. We also see a .9 percentage point reduction in the likelihood of being overweight for boys and a .6 percentage point reduction for girls. In other words, the intervention is working.
Dr. Yitschak Biton[/caption]
MedicalResearch.com Interview with:
Yitschak (Yitsik) Biton, MD
Postdoctoral Research Fellow
University of Rochester Medical Center
Saunders Research Building
Heart Research Follow-Up Program
Rochester, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Biton: Patients with heart failure and reduced ejection fraction have increased risk for sudden cardiac death due to ventricular arrhythmias. The causes of these arrhythmias are thought to be adverse left ventricular remodeling and scarring. Cardiac resynchronization therapy has been previously shown to reverse the adverse process of remodeling and induce reduction in cardiac chamber volumes. Relative wall thickness is a measure of the remodeling process, and it could be classified into normal, eccentric and concentric. In our study we showed that the degree relative wall thickness in patients with dilated cardiomyopathy and eccentric hypertrophy is inversely associated with the risk of ventricular arrhythmias. Furthermore we showed the CRT treated patients who had increase in relative wall thickness (became less eccentric) had lower risk for ventricular arrhythmias.
Prof. De Caterina[/caption]
Prof. Raffaele De Caterina M.D., Ph.D
University Cardiology Division G. d'Annunzio University
Medical Research: What is the background for this study? What are the main findings?
Dr. De Caterina: There is uncertainty on how to predict bleeding upon treatment with anticoagulants, because bleeding risk scores and thromboembolic risk score fare very similarly in predicting bleeding, making the net clinical benefit difficult to assess in the single patient. Here we find that a history of bleeding – even minor bleeding – has an important prognostic value on the risk of future bleeding – virtually all sorts of future bleeding, with the notable exception of intracranial hemorrhage. Some novel oral anticoagulants (NOACs), such as apixaban, studied here, reduce the risk of major bleeding, and appear to benefit independent of the bleeding history.
Dr. Ajay Dharod[/caption]
Dr. Marie St-Onge[/caption]
Marie-Pierre St-Onge, Ph.D, FAHA
Assistant Professor, Department of Medicine
New York Obesity Nutrition Research Center
Institute of Human Nutrition
College of Physicians & Surgeons, Columbia University
New York, NY 10032
Medical Research: What is the background for this study? What are the main findings?
Dr. St-Onge: We have shown that sleep affects food intake: restricting sleep increases energy intake, particularly from fat (others also find increased sugar intake). We wanted to know if the reverse was also true: does diet affect sleep at night?
Medical Research: What should clinicians and patients take away from your report?
Dr. St-Onge: Diet quality can play an important role in sleep quality. Sleep can be affect after only a single day of poor dietary intakes (high saturated fat and low fiber intakes). It is possible that improving one’s diet can also improve their sleep.
Dr. Andrew Lim[/caption]
Dr. Lindsey Taillie[/caption]
Dr. Benjamin Bakondi[/caption]
MedicalResearch.com Interview with:
Benjamin Bakondi, Ph.D. Postdoctoral Scientist
Laboratory of: Shaomei Wang, M.D., Ph.D.
Institute Director: Clive N. Svendsen, Ph.D.
Board of Governors Regenerative Medicine Institute
Cedars-Sinai Medical Center;
Dept. of Biomedical Sciences
Los Angeles, CA 90048
Medical Research: What is the background for this study? What are the main findings?
Dr. Bakondi: Retinitis Pigmentosa (RP) is an inherited disease that causes progressive retinal degeneration and continual vision loss. Over 130 mutations have been identified in over 60 genes that cause RP. Gene replacement therapy is being evaluated for the recessive form of RP, in which both inherited alleles are dysfunctional. 
Dr. Jung Min Bae[/caption]
MedicalResearch.com Interview with:
Jung Min Bae, MD, PhD
Department of Dermatology, St. Vincent's Hospital,
College of Medicine
The Catholic University of Korea,
Suwon Korea
Medical Research: What is the background for this study?
Response: Vitiligo is one of the major challenging skin diseases. Although a number of interventions have been done in the treatment of vitiligo, no definitive curative treatment exists. Narrowband ultraviolet B phototherapy is considered the mainstay of vitiligo treatment, and 308-nm excimer laser/light therapy has gained popularity for localized vitiligo. However, they are not effective in all patients with vitiligo, and the combination therapies with topical agents are widely applied to increase the response rates of these treatment modalities in clinical practice. We sought to compare the efficacy of excimer laser/light and topical agent combination therapy versus excimer laser/light monotherapy for vitiligo. We performed a systematic review and meta-analyses of randomized controlled trials in this subject.
Medical Research: What are the main findings?
Response: According to our study, the combination therapy of excimer laser/light and topical calcineurin inhibitors showed almost a two-fold increase in treatment success rate (≥75% repigmentation) compared to excimer laser/light monotherapy (relative risk 1.93). The combination therapy also reduced the treatment failure rate (<25% repigmentation) by almost half (relative risk 0.43). Addition of topical vitamin-D3 analogs or topical corticosteroids on excimer laser/light showed insufficient evidence to support their use in combination therapies yet. Considering the difficulites in complete recovery of vitiligo, the combination therapies enhancing the treatment response are promising.
Dr. Erin Hahn[/caption]
MedicalResearch.com Interview with:
Erin E. Hahn, PhD, MPH
Research Scientist
Southern California Permanente Medical Group
Kaiser Permanente Research
Department of Research & Evaluation
Pasadena, CA 91101
Medical Research: What is the background for this study?
Dr. Hahn: Adolescent and young adults, or AYAs, who are diagnosed and treated for Hodgkin lymphoma have very high overall survival rates. However, these patients are at high risk for short and long term health issues related to their cancer treatment, including cancer recurrence, cardiac and pulmonary problems, and developing new primary cancers. Some of these issues arise during treatment and persist over time, called long-term effects, and some develop years later, called late effects.
Evidence and consensus based guidelines are available from organizations like the National Comprehensive Cancer Network and the Children’s Oncology Group to help manage the post treatment care of Adolescent and young adults Hodgkin lymphoma survivors. Examining adherence to guidelines is an important part of high quality care, and can help us find and address gaps in care.
Guideline recommended care for these patients includes: oncology visits, imaging and labs, preventive care, counseling and education, risk based screening for late effects. Risk-based screening is based on a patient’s treatment. The type of health screening a patient needs is determined by the treatment exposure they had, such as certain types of chemotherapy or high-dose radiation that have known late effects
Medical Research: What are the main findings?
Dr. Hahn: For this pilot study, I was interested to see if post-treatment Adolescent and young adults 
Dr. Noriko Osumi[/caption]
Dr. Joanne Cranwell[/caption]
Dr. Srivas Chennu[/caption]
Dr. Benjamin Neel[/caption]
Dr. Elena Batrakova[/caption]
Dr. Mia T. Minen[/caption]
Dr. Dai Fukumura[/caption]
MedicalResearch.com Interview with:
Dai Fukumura, M.D., Ph.D.
Joao Incio, M.D.
and Rakesh K. Jain, Ph.D
Edwin L. Steele Laboratory
Department of Radiation Oncology
Massachusetts General Hospital
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Fukumura: This study focused on pancreatic ductal adenocarcinoma, the most common form of pancreatic cancer, which accounts for almost 40,000 cancer death in the U.S. ever year. Half of those diagnosed with this form of pancreatic cancer are overweight or obese, and up to 80 percent have type 2 diabetes or are insulin resistant. Diabetic patients taking metformin – a commonly used generic medication for type 2 diabetes – are known to have a reduced risk of developing pancreatic cancer; and among patients who develop the tumor, those taking the drug may have a reduced risk of death. But prior to the current study the mechanism of metformin’s action against pancreatic cancer was unclear, and no potential biomarkers of response to metformin had been reported.
We have uncovered a novel mechanism behind the ability of the diabetes drug metformin to inhibit the progression of pancreatic cancer. Metformin decreases the inflammation and fibrosis characteristic of the most common form of pancreatic cancer. We found that metformin alleviates desmoplasia – an accumulation of dense connective tissue and tumor-associated immune cells that is a hallmark of pancreatic cancer – by inhibiting the activation of the pancreatic stellate cells that produce the extracellular matrix and by reprogramming immune cells to reduce inflammation. Our findings in cellular and animal models and in patient tumor samples also indicate that this beneficial effect may be most prevalent in overweight and obese patients, who appear to have tumors with increased fibrosis.
Dr. Emily DeFranco[/caption]
MedicalResearch.com Interview with:
Emily A. DeFranco, D.O., M.S.
Associate Professor Maternal-Fetal Medicine
Center for Prevention of Preterm Birth, Perinatal Institute
Cincinnati Children's Hospital Medical Center
University of Cincinnati College of Medicine
Department of Obstetrics and Gynecology
Medical Sciences Building, Room 4553B
Cincinnati, OH
Medical Research: What is the background for this study?
Dr. DeFranco: The Infant Mortality Rate in the state of Ohio is higher than many other states. Additionally, there is a large disparity in the IMR with black infants impacted to a higher degree compared to white infants. For this reason, we are particularly interested in identifying factors that contribute to this disparity in order to identify potential areas where public health efforts can be focused.
We know that preterm birth is a major contributor to infant mortality, and that all babies born alive prior to 23 weeks of gestational age, i.e. "previable", die after birth and contribute to the infant mortality rate. In this study, we wanted to assess whether black women are more likely to have early preterm births at less than 23 weeks, and if so whether that may be part of the explanation of why black mothers are at higher risk of experiencing an infant mortality.
Medical Research: What are the main findings?
Dr. DeFranco: In this study, we found that black mothers were more likely to deliver than white mothers at very early preterm gestational ages, less than 23 weeks. We also found that the earlier the delivery, the larger the disparity with black mothers being at higher risk for the earliest deliveries compared to white mothers. From this data, we estimated that in Ohio, 44% of all infant mortality in black mothers is caused by previable preterm birth, whereas only 28% of infant mortality in white mothers is attributed to the same cause. We concluded that very early