Metformin an option for pregnancy-related diabetes

NEW YORK (Reuters Health) - Use of metformin to treat pregnancy-related diabetes (i.e., gestational diabetes) does not increase the risk of pregnancy complications and most women prefer it to insulin, according to a study in this week's New England Journal of Medicine.

Metformin, sold under various trade names such as Glucophage, is primarily used to lower blood sugar in patients with type 2 diabetes.

Theoretically, metformin is a logical treatment for gestational diabetes, as it improves how the body responds to insulin and does not cause weight gain or low blood sugar, Dr. Janet A. Rowan, from Auckland City Hospital in New Zealand, and colleagues note. Its use in pregnant women, however, is controversial since one study tied the drug to fetal loss and preeclampsia, a dangerous condition in which a woman's blood pressure spikes during pregnancy.

To investigate further, Rowan's team randomly assigned 751 women with gestational diabetes who were 20 to 33 weeks pregnant to metformin or insulin. Supplemental insulin was given to metformin users if needed.

According to the researchers, the rate of the composite outcome - that is, low blood sugar, respiratory distress, need for phototherapy, birth trauma, low Apgar score and prematurity -- was nearly the same in each group (32 percent in the metformin group and 32 percent in the insulin group).

Metformin was not associated with any serious side effects and, overall, roughly 77 percent of women treated with metformin said they would prefer to receive it again if needed, compared with just 28 percent of insulin-treated women who said they would prefer to receive insulin again.

"The take home message, we believe, is that metformin is an appropriate alternative to insulin treatment for women with gestational diabetes who require additional therapy (beyond lifestyle intervention)," Rowan concluded.

SOURCE: The New England Journal of Medicine, May 8, 2008.

CORRECTION: Erectile dysfunction may precede Parkinson's onset

NEW YORK (Reuters Health) - Results of a study suggest an association between erectile dysfunction and an increased risk of developing Parkinson's disease.

The autonomic nervous system, which regulates involuntary bodily functions like heart rate and digestion, is often affected in Parkinson's disease, and erectile function, which is controlled by the autonomic system, is commonly compromised, the study team notes in a report.

"An important question," according to Dr. Xiang Gao, of Harvard School of Public Health, Boston, Massachusetts, and colleagues, "is whether erectile dysfunction precedes the onset of motor symptoms of Parkinson's disease."

They examined the question using data from the Health Professionals Follow-up Study. A total of 32,616 men free of Parkinson's disease in 1986 were included in the present study. In 2000, the men completed a questionnaire with questions on erectile dysfunction in different time periods. The relation between erectile dysfunction before 1986 and Parkinson's disease risk from 1986 to 2002 was analyzed.

During the 16 years' follow-up, 200 men were diagnosed with Parkinson's disease.

Compared to men who reported very good erectile function before 1986, those who reported erectile dysfunction had a significant 3.8-fold increased risk of developing Parkinson's disease, the investigators report.

"We further explored possible interactions of erectile function with age, body mass index, cigarette smoking, caffeine intake, and the presence of diabetes during follow-up," Gao's team explains. "None of these interactions was significant."

These findings, they conclude, support the hypothesis that the autonomic nervous system "may have been impaired years before Parkinson's disease is clinically recognizable."

SOURCE: American Journal of Epidemiology, December 2007.

Overactive Bladder at a Young Age? - Ask the Expert

Dear Dr. Motola,
I have had an overactive bladder for several years but for the most part it's been manageable. I am 42. Normally, I feel the urge to void about every 90 minutes. But it has started to interfere with important activities, like taking an intense admissions test for graduate school, when I need one or two extra restroom breaks. The other time I feel the urge to go more often is after ejaculating. Then, I feel the urge to go about every 30 minutes for the remainder of the day. I have finally sought treatment and my doctor gave me Vesicare which is supposed to be similar to Detrol LA but I can't see much improvement and I'm not sure if this is even what I need. I seems like it's a prostate problem, but it doesn't exactly fit any of the common problems that I've researched on the internet, like BPH. The ejaculation factor seems to be puzzling to my doctor and other experts I've consulted.

Urinary frequency occurs for many different reasons, one which may be an overactive bladder. Prior to being labeled as having an overactive bladder certain testing should occur in order to exclude other underlying conditions.

Drugs such as Detrol LA and Vesicare are used for the treatment of overactive bladder. Other drugs also exist within this category which may also be effective.

It is important for you to undergo testing to eliminate other disease processes that may be causing the urinary frequency which you are experiencing. Prostatic conditions can also occur in the early 40s, and should also be considered as a potential source of your problem.

SOURCE: www.healthcentral.com

Aspirin, Hormone Therapy Combo Can Shorten Lives of Prostate Cancer Patients

By Amanda Gardner

WEDNESDAY, Dec. 26 (HealthDay News) -- Men undergoing hormone therapy for prostate cancer who take baby aspirin to protect their heart run a significantly higher risk of dying, new research suggests.

Apparently, baby aspirin interacts with the hormone therapy to elevate liver-function test levels. The end result is the man must stop potentially lifesaving hormone therapy.

The findings are contained in a letter published in the Dec. 27 issue of the New England Journal of Medicine.

Hormonal therapy, which involves reducing levels of male hormones called androgens, is a common treatment for prostate cancer, but it can raise the risk of a heart attack. So men who are older or have known coronary risk factors such as diabetes or smoking usually take baby aspirin while undergoing hormone therapy because aspirin helps prevent blood clots.

"Aspirin is being prescribed more widely for these men so we looked to see if there was any effect of aspirin on prostate cancer outcomes," said lead researcher Dr. Anthony V. D'Amico, chief of the division of genitourinary radiation oncology at Brigham & Women's Hospital and the Dana-Farber Cancer Institute, both in Boston.

The authors analyzed data on 206 men with localized prostate cancers who were already enrolled in a trial to compare radiation therapy alone with radiation therapy plus hormone therapy. The hormone therapy included six months of the anti-androgen flutamide.

Flutamide had a tendency to elevate results of liver-function tests. Although these elevations were benign, they meant hormonal therapy had to be stopped, at least temporarily, D'Amico explained.

Men who didn't complete six months of hormone therapy were 3.5 times more likely to die compared to men who got the full course of hormone therapy.

"It was sort of a paradoxical finding," D'Amico said. "Men who were taking aspirin were more likely to die of prostate cancer than those who were not, which didn't make sense at first."

But when the researchers delved deeper, they realized that the men who were taking aspirin were more likely to have to stop hormone therapy.

"Liver function is something you monitor" when undergoing hormone therapy, D'Amico explained. "When the tests elevate, you take the patient off of hormone therapy till the tests normalize, then you restart the therapy."

An explanation for this interaction comes from previous animal studies, D'Amico said. For rabbits that take aspirin while undergoing hormone therapy, that aspirin is magnified 100-fold in terms of how much gets into the blood. "That makes it a toxic dose of aspirin," he explained.

Although such a study can't establish a cause-and-effect association, it does appear likely, D'Amico said.

"If a man is taking baby aspirin just to prevent heart disease, we would ask the oncologist to ask the primary-care physician if he could come off the baby aspirin for the months while he's getting cancer therapy. If the aspirin is just for prevention, this is probably the simplest thing to do," he said. "But if the patient is on aspirin because he absolutely needs it, then they'd have to treat the prostate cancer without hormone therapy. It really comes down to a trade-off: How much do they need the aspirin versus how much do they need hormonal therapy, and there are alternative treatments for prostate cancer."

SOURCE: www.healthcentral.com