Exercise Improves Survival Rates for Diabetics with LVH

by U.S. Medicine

September 6, 2012

Achieving a certain level of physical fitness can improve survival rates of patients with diabetes who also have left ventricle hypertrophy (LVH), according to a new study.1

The research, presented at The Endocrine Society’s 94th Annual Meeting in Houston this past summer, found that diabetic patients who were not physically fit and had LVH were the most likely to die, with physically-fit patients — regardless of whether they had  LVH — having a significantly lower risk of death. Those differences remained even after investigators adjusted for high blood pressure, excess body weight, smoking and medication usage.

Compared to patients with low physical-fitness levels and no LVH, patients who were not physically fit and had LVH were at a 20% greater chance of dying. When patients were physically fit, however, those without LVH had a 41% reduced chance of dying, and those with LVH showed a 43% reduction, compared with the control group.

“Exercise fitness markedly improves survival in patients with type 2 diabetes and left ventricle hypertrophy,” said lead author Khaled A. Alswat, MBBS, endocrinology fellow at the Washington, DC, VAMC and George Washington University. “We also found that improvement in fitness improves survival significantly, regardless of the presence or absence of left ventricle wall thickness.”

The study looked at 866 male veterans with type 2 diabetes and an average age of 61 from 1986 to 2011 at the Washington, DC, VAMC.

When the study began, participants underwent a standard exercise assessment with a treadmill to determine fitness level and were then classified as either low fit or physically fit. In addition, all patients received an echocardiogram to diagnose LVH. Over the follow-up period, which was as long as 24 years with a median of nearly nine years, 346 deaths occurred at an annual rate of 4.3%.

1. Alswat, Khaled; Kokkinos, P, Khosla, S, et al. “The Prognostic Impact of Fitness on Mortality in Diabetics with and without Left Ventricular Hypertrophy.” The Endocrine Society, Houston June 23-26.

Diabetes Patients Quit Smoking at Higher Rates after Hospitalization

Patients with diabetes have a higher likelihood of successfully quitting smoking after hospitalization than some other groups, according to a new study that recommends more intensive tobacco cessation programs for this population.

The study, which looked at 496 patients who had acute-care hospitalization in three Midwestern VAMCs in VISN 11, looked at six-month post-hospitalization tobacco cessation rates among veterans with and without diabetes.1

For the research, patients with a mean age of 55.2 years, 62% white, were asked to complete a follow-up survey six months post-discharge. Of the study group, 29% had comorbid diabetes.

Bivariate- and multivariable-adjusted analyses were then conducted to determine differences in tobacco cessation rates between patients with and without a diagnosis of diabetes.

Researchers found that 18.8% of patients with diabetes reported tobacco cessation at six months, compared with 10.9% of those without diabetes (P = 0.02). Cotinine-verified cessation rates were 12.5 vs. 7.4% in the groups with and without diabetes, respectively (P = 0.07).

Controlling for psychiatric co-morbidities, depressive symptoms, age, self-rated health and nicotine dependence, the multivariable-adjusted logistic regression showed that patients with diabetes had three times higher odds of six-month cotinine-verified tobacco cessation as compared with those without diabetes (odds ratio 3.17, P = 0.005).

The study, conducted by the VA Center for Clinical Management Research at the VA Ann Arbor Healthcare System as well as the University of Michigan School of Nursing in Ann Arbor, was published this summer in the journal Diabetes Medicine.

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  1. Duffy SA, Munger A, Karvonen-Gutierrez CA, Piette JD, Kao TA; the Veterans Integrated Service Network (VISN) 11 Tobacco Tactics Team. Post-discharge tobacco cessation rates among hospitalized US veterans with and without diabetes. Diabet Med. 2012 Jul;29(7):e96-e101. doi: 10.11 1/j.1464-5491.2012.03635.x. PubMed PMID: 22435673.
Exercise Improves Survival Rates for Diabetics with LVH

Vitamin D Supplement OK in Hyperparathyroidism Patients

Vitamin D treatment can safely be used in patients with primary hyperparathyroidism who also have a vitamin D deficiency, according to a new study presented recently at The Endocrine Society’s 94th Annual Meeting in Houston.1

Concerns about raising calcium levels in patients with primary hyperparathyroidism have given physicians pause when they consider recommending vitamin D supplementation. Study authors suggest that the benefits of vitamin D, which helps the body absorb calcium and is vital for bone health, may merit the use of a supplement, if patients are carefully monitored.

“These patients need close monitoring every three to four months during vitamin D replacement therapy,” said Dima Abdelmannan, MD, an assistant professor at Case Western Reserve University in Cleveland and an endocrinologist at the Cleveland VAMC.

Abdelmannan, who presented the research findings, said doctors should measure blood levels of calcium and parathyroid hormone along with vitamin D levels throughout treatment.

“Measuring vitamin D levels alone may not be helpful in the management of vitamin D deficiency in patients with primary hyperparathyroidism,” she said. “The commercially available blood test for vitamin D level — the 25-hydroxyvitamin D — has limitations.”

For the study, researchers reviewed the medical records of 32 patients at the VAMC who had both primary hyperparathyroidism and vitamin D deficiency. All 10 women and 22 men had hypercalcemia, or high calcium in the blood, defined as a level greater than 10.1 milligrams per deciliter (mg/dL), and had vitamin D levels below the cutoff for normal of 30 nanograms per deciliter (ng/dL) on the 25-hydroxyvitamin D test for vitamin D.

Vitamin D2 (ergocalciferol) or vitamin D3 (cholecalciferol) was administered at an average daily dose of 3,630 IU. Most patients had their parathyroid hormone, calcium and vitamin D levels checked every three months for a year after commencing treatment.

Vitamin D levels returned to normal with treatment and remained normal at all intervals, Abdelmannan said, yet the average calcium blood level “remained virtually unchanged” from the pretreatment level of 10.7 mg/dL. The calcium level was 10.8 mg/dL at three months after treatment, 10.6 at six months and 10.7 at 12 months, the authors reported.

Despite the lack of increase in calcium levels, parathyroid hormone levels decreased from an average of 124 picograms per deciliter (pg/dL) before treatment to103 pg/dL one year after treatment. High calcium levels in hyperparathyroidism can cause bone aches, fatigue and kidney stones.

In its 2011 guideline on treating vitamin D deficiency, The Endocrine Society recommends that patients with primary hyperparathyroidism and vitamin D deficiency receive vitamin D treatment as needed and that serum (blood) calcium levels should be monitored.

1. Abdelmannan, D; Leciejewski, K, Ajlouni, H, et al. “Vitamin D Supplementation in Vitamin D Deficient Patients with Primary Hyperparathyroidism: Impact on Calcium and Parathyroid Hormone Levels.” The Endocrine Society, Houston June 23-26

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