For best viewing, click the bottom right corner for full screen.

 

20130717-3

By Charles Bankhead, Staff Writer, MedPage Today

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Take Posttest                                      

  • Note that this cohort study demonstrated that type 1 diabetics with “Type A” personalities had improved long-term survival.
  • Be aware that this is in contrast to studies in non-diabetic populations, which have tended to demonstrate associations between Type A personality and coronary artery disease.

 

Patients with type 1 diabetes and type A behaviors had a significantly lower mortality risk during 22 years of follow-up, investigators reported.

Every 1-point increase in the Bortner Rating Scale for type A behavior was associated with a 1% decrease in all-cause mortality. A significant association between Bortner score and mortality persisted in analyses that adjusted for sex, age, education, duration of diabetes, smoking status, body mass index (BMI), and physical activity.

But depression interacted significantly with type A behavior to diminish the mortality risk-reducing effects, Trevor J. Orchard, MD, of the University of Pittsburgh, and co-authors reported online in Diabetes Care.

In contrast to most previous studies, higher Bortner scores did not predict an increased risk of coronary artery disease (CAD) or associated mortality.

“Future research is needed to investigate the interaction between the BDI [Beck Depression Inventory] and type A behavior, as the latter was only protective in those with low depressive symptomatology,” the authors concluded. “Further research is also needed to explore the relationship between type A behavior and CAD death.

“Understanding these relationships is an important next step in exploring the effects of psychosocial factors on mortality in type 1 diabetes.”

The incidence of type 1 diabetes continues to rise, and the condition remains incurable. Because prevention is not an option, identification of potentially modifiable risk factors offers the most opportunity to reduce morbidity and mortality associated with the disease.

Type A behavior — associated with competitiveness, aggressiveness, and achievement-oriented personality traits — may represent a modifiable risk factor in type 1 diabetes. However, type A behavior has a complicated relationship with morbidity and mortality.

Several studies have found significant associations between type A behavior and CAD. Paradoxically, the association does not hold in patients at high risk for CAD because of a history of cardiac events.

“Therefore, it appears that type A behavior may have different effects on health depending on underlying chronic disease status,” the authors noted.

Little is known about the contributions of psychosocial factors to CAD risk in patients with type 1 diabetes. Data from the Pittsburgh Epidemiology of Diabetes Complications (EDC) have shown that participants with multiple diabetes-related complications are less likely to exhibit type A personality traits.

To explore the relationship, Orchard and colleagues analyzed data from the CDC, which has followed a cohort of patients with type 1 diabetes for 22 years.

Adult participants completed the Bortner Rate Scale at enrollment and provided information about a wide range of behaviors, habits, and activities. They also completed the BDI, a self-reported 21-item assessment of depressive symptoms. Higher scores are associated with increased depression. A score of 0 to 9 indicates minimal depression, and a score of 30 to 63 represents severe depression.

CAD was defined as myocardial infarction, coronary artery stenosis ≥50% or a history of revascularization, ischemia on an electrocardiogram, physician-diagnosed angina, or CAD death. To confirm deaths, the investigators used medical and hospital records, autopsy/coroner reports, and the Social Security Death Index and National Death Index.

Orchard and colleagues analyzed data for 506 EDC participants who had completed both the Bortner scale and the BDI. During follow-up, 128 EDC participants died.

Univariate analysis revealed a significant inverse association between Bortner scores and mortality (P=0.01). The relationship remained significant after adjustment for multiple confounders (P=0.03).

The addition of BDI scores to the analysis attenuated the relationship between Bortner scores and mortality (P=0.11), and the investigators found significant interaction between the BDI and Bortner scores.

The inverse association between Bortner scores and mortality existed only for patients who had low BDI scores. Bortner scores had no association with CAD mortality and only a nonsignificant association with CAD incidence (P=0.09).

The seemingly paradoxical association between type A behavior and mortality could have a logical explanation, according to Fernando Ovalle, MD, of the University of Alabama at Birmingham.

“That’s possibly related to the fact that people with type A personalty are very goal oriented,” he told MedPage Today. “They tend to want things done in a timely manner. They are high achievers in general.

“If a person with type A personality has type 1 diabetes, they are probably more likely to do what it takes to take care of the diabetes.”

Conversely, depression may “trump” the benefits of type A behavior in patients with type 1 diabetes by causing affected patients to be less adherent and less attentive to diabetes care, he said, adding that it’s purely speculation.

The EDC is supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

The authors reported no relevant disclosures.

Primary source: Diabetes Care
Source reference:
Fickley CE, et al “Type A behavior and risk of all-cause mortality, cAD, and CAD-related mortality in a type 1 diabetic population” Diabetes Care 2013; DOI: 10.2337/dc13-0266.

 

Pediatrics

Diabetes Tied to Timing of Baby’s First Solid Food

20130717-4

  • In children with an increased genetic risk of type 1 diabetes mellitus, both early and late first exposure to any      solid food predicted development of the disease.
  • The data suggest the safest age to introduce solid foods in children at increased genetic risk for type 1 diabetes is between 4 and 5 months of age.

20130717-5

By Todd Neale, Senior Staff Writer, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse

 

 

Take PosttestAmong children already at higher risk for type 1 diabetes, missing the sweet spot for introduction of solid foods may increase the risk even further, researchers found.

Compared with exposing children to solid food for the first time at ages 4 or 5 months, introducing solid food both earlier and later was associated with greater risks of developing the disease (hazard ratio 1.91 for early and HR 3.02 for later), according to Jill Norris, PhD, MPH, of the Colorado School of Public Health in Aurora, and colleagues.

The specific food category associated with the greatest risk was rice or oats when first exposure occurred at age 6 months or later (HR 2.88, 95% CI 1.36-6.11), the researchers reported online in JAMA Pediatrics.

“These results suggest the safest age to introduce solid foods in children at increased genetic risk for type 1 diabetes is between 4 and 5 months of age,” they wrote, noting that the findings are consistent with the American Academy of Pediatrics’ recommendation to start giving solid foods at 4 to 6 months of age, but should be confirmed in a larger study.

Previous studies looking at the association between the timing of the introduction of solid foods and risk of type 1 diabetes have yielded conflicting results, and Norris and colleagues further explored the issue using data from the Diabetes Autoimmunity Study in the Young (DAISY), a longitudinal investigation of risk factors for the disease.

The current analysis included 1,835 children who either underwent screening for diabetes-susceptibility alleles or had a first-degree relative with type 1 diabetes. Only those followed from birth with complete information about solid food exposure were included.

During the study, 53 of the children were diagnosed with type 1 diabetes.

Introducing solid foods in general too soon or too late was associated with a greater risk of developing type 1 diabetes after adjustment for human leukocyte antigen genotype, having a first-degree relative with the disease, maternal education, and type of delivery.

Early exposure to fruit — excluding fruit juice — was associated with a greater risk (HR 2.23, 95% CI 1.14-4.39), although the relationship became nonsignificant after accounting for other food exposures.

“The risk predicted by early exposure to solid foods might suggest a mechanism involving an abnormal immune response to solid food antigens in an immature gut immune system in susceptible individuals,” the authors wrote. “As the increased risk is not limited to a specific food, it is possible many solids, including cereals and fruits, contain a common component that triggers an immature response.”

On the other hand, the relationship between late exposure to solid foods and risk of type 1 diabetes “may be related to the larger amounts given at initial exposure to older children. Also, if solid foods are introduced too late, when breast milk alone no longer meets the infant’s energy and nutrient needs, nutrient deficiencies may occur, which may play a role in increasing … risk,” according to the researchers.

“Additionally, the increased risk predicted by late exposure to solid foods may be related to the cessation of breastfeeding before solid foods are introduced, resulting in a loss of the protective effects of breast milk at the introduction of foreign food antigens,” they wrote.

Although breastfeeding duration was not related to diabetes risk in the current study, breastfeeding at the time of the first exposure to wheat or barley was associated with a lower risk of developing the disease (HR 0.47, 95% CI 0.26-0.86), “suggesting that breast milk may protect against an abnormal immune response to new antigens in an immature gut,” according to Norris and colleagues.

The timing of exposure to meats, vegetables, and cow’s milk was not associated with the risk of type 1 diabetes.

 

 

The study was supported by NIH grants and a Diabetes Endocrine Research Center Clinical Investigation and Bioinformatics Core grant.

The authors reported no conflicts of interest.

Primary source: JAMA Pediatrics
Source reference:
Frederiksen B, et al “Infant exposures and development of type 1 diabetes mellitus: the Diabetes Autoimmunity Study in the Young (DAISY)” JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.317.

Editor’s note: From time to time, we post news about the Big Apple (where we are located), that will affect many people, including those living in other parts of the country.

 

20130716-1

July 16, 2013

Photo: AP/Seth Wenig
Former New York Gov. Eliot Spitzer is surrounded by media as he tries to collect signatures for his run for New York City comptroller, which he did get enough of; in fact, over 27,000 signatures, in less than a week..

By Thomas Hedges, Center for Study of Responsive Law

Corporations have revved their engines back up for round two of the smear campaign against Eliot Spitzer, the former governor of New York who has announced that he will run for New York City comptroller. With headlines such as “Here We Ho Again” and “Lust for Power,” news outlets are already pigeonholing Spitzer as a depraved sex addict, more loathsome than the average politician gone wrong.
In the last couple of decades, there have been many scandals in politics, often sex-related. Remember Anthony Weiner, Mark Sanford, Chuck Robb, Newt Gingrich, Barney Frank, David Vitter, Ted Kennedy, Ken Calvert, Bill Clinton and so on? But not every politician faces the same kind of criticism that continues to follow Spitzer. Indeed, the careers of Frank, Calvert and Vitter, all of whom had sex with prostitutes, were largely uninterrupted.
Spitzer had enemies not because of his sex life, but because of the hard-line approach he took toward financial institutions beginning in 1998 as New York’s attorney general. He turned a position that, for years, was not particularly forceful into one that frightened Wall Street and held companies accountable for corruption that had been largely ignored or settled with meager plea deals.
In 2002, Spitzer sued several investment banks alleging they had inflated stock prices. When executives tried to sweep the issue aside and keep the information secret—their common practices at the time—the attorney general refused.
“I said no,” Spitzer recounted in Alex Gibney’s 2010 film “Client 9: The Rise and Fall of Eliot Spitzer,” “because my job as attorney general is to change the system so that it’s fair and honest. And if we seal the evidence and you pay with a check and we don’t change the system, I’m basically being bought off.”
In a state of amnesia, New York City Council Speaker Christine C. Quinn, a Democrat, was quoted July 8 by The New York Times saying, “the question with both Anthony Weiner and Eliot Spitzer is, what have they been doing to earn a second chance?”
Quinn, like most Americans, has eaten up the story that the corporate media fed to the public. She forgets about the other politicians listed above, some of whom are still serving as senators and House members. And she has also conveniently forgotten that Spitzer continued to rail against big banks that, months after his resignation, would bring the economy close to a halt.
It was this unwavering conviction that prompted Wall Street to scrutinize every aspect of Spitzer’s life. When a prostitution ring called the Emperors Club was suddenly uncovered, it was outsiders who pushed for an investigation of “client 9,” even though johns, the New York Police Department acknowledged, are usually not prosecuted in such cases.
Many people contend that “Eliot Spitzer brought himself down,” Gibney said in an interview about his documentary. “Actually, there were other forces at work that, though he was the one who made himself vulnerable, were there very much to use their power to make sure he went down as hard as possible, so that his fall was a kind of freefall. And he would never be able to be picked up again.”
Gibney’s “Client 9” cleverly uses the scandal to entice Wall Street players such as ex-New York Stock Exchange Director Ken Langone and former AIG Chief Executive Maurice Greenberg to sit down and talk about—not the scandal itself—but what led up to it. The film becomes a kind of mystery-thriller and exposes the lies and tricks that top executives use to destroy people like Spitzer. The film suggests that it was Roger Stone, a wealthy Wall Street playboy with a tattoo of Richard Nixon on his back, who got the scoop on Spitzer’s sexual affairs and relayed the news, probably to Langone.
“You know we all have our private hells,” an ecstatic Langone told a reporter after the Spitzer scandal broke in 2008. “I hope his private hell is hotter than anybody else’s.”

This article was made possible by the Center for Study of Responsive Law.