In brief

Patients underestimate waist size
Men in the UK are under the delusion that they are three inches thinner than they really are. Researchers from Leicester University asked 502 people to estimate their waist size and found that most underestimated it, by an average 2.7 inches. Men were the least accurate in their estimations (3.1 inches), while South Asian women were the most accurate. The study, which was presented at the Diabetes UK annual professional conference in Glasgow last month, found white Europeans were out by an average 2.9 inches, compared with an average overestimate of 1.6 inches among South Asians. The researchers highlighted that waist size can be a warning sign of increased type-2 diabetes risk.
Taub N, Khunti K, Webb D et al. Diabetes UK APC 2008, P376

Preventing falls in type-2 diabetes patients
Reducing diabetes complications among older people with type-2 diabetes may help to prevent falls. US researchers investigated the causes of falls among 446 patients with diabetes aged a mean 73.6 years over an average 4.9 years. Reduced peroneal nerve amplitude, poorer contrast, higher cystatin-C (a marker of reduced renal function) and low HbA1c levels (<6 compared with >8) among insulin users were associated with an increased risk of falling. Among those patients using oral hypoglycaemics but not insulin, low HbA1c was not associated with more frequent falls.
Schwartz AV, Vittinghoff E, Sellmeyer DE et al. Diabetes Care 2008; 31: 391-6

Letters can improve concordance
Sending information on the importance of beta-blockers to MI patients after they have been discharged can improve adherence to treatment. This randomised study involved 836 post-MI patients dispensed a beta-blocker prescription on discharge. Those in the intervention arm received two mailings, two months apart, on the importance of their treatment. Over the nine-month follow-up, patients sent information had 4.3 per cent more days covered with beta-blocker therapy than controls. Furthermore, the intervention group was 17 per cent more likely to have 80 per cent of days covered by treatment. For every 16 patients receiving the mailings, one additional patient would become adherent to therapy.
Smith DH, Kramer JM, Perrin N et al. Arch Intern Med 2008; 168: 477-83

Digoxin use in AF questioned
Patients with AF who are treated with digoxin may be at increased risk of death, an analysis of existing trial data suggests. Data were obtained from the SPORTIF III and V studies, which involved 7,329 AF patients at moderate-to-high risk, randomised to receive various treatments to prevent thromboembolism. This study investigated the survival of users (53.4 per cent of patients) and non-users of digitalis. Those taking digitalis had a 53 per cent greater risk of mortality than non-users, after adjustment for risk factors. The researchers say this suggests that digitalis, like other inotropic drugs, may increase mortality. This may be concealed in heart failure, but not in AF, which benefits from the rate-reducing effect but not the increased inotropy. Gjesdal K, Feyzi J, Olsson SB. Heart 2008; 94: 191-6

Search for the missing million
An examination of more than 3.6 million electronic patient records held at GP surgeries has unearthed thousands of cases of probable undiagnosed diabetes. Patient records from 480 surgeries that contribute anonymised data to the QRESEARCH database were examined for evidence of undiagnosed diabetes recorded in blood glucose measurements. After eliminating known diabetes and cases ruled out as diabetes in further tests, the researchers were left with 3,758 patients whose last blood glucose measurement indicated undiagnosed diabetes and 32,785 whose last level was borderline. If extended to all UK practices, the researchers estimate that 60,000 people would be identified with evidence of undiagnosed disease and more than half a million would require further testing to rule it out.
Holt TA, Stables D, Hippisley-Cox J et al. Br J Gen Pract 2008; 58: 192-6

Clopidogrel cessation in ACS patients
A rebound effect has been documented following cessation of clopidogrel treatment in patients with acute coronary syndromes (ACS). US researchers retrospectively analysed data on 3,137 ACS patients discharged after medical treatment or percutaneous coronary intervention (PCI), who were followed up for a mean 196 or 203 days, respectively. Death or acute MI occurred in 17.1 per cent of medically treated patients and 7.9 per cent of PCI treated patients. About 60 per cent of events in both groups occurred within 90 days of clopidogrel cessation. The researchers say studies are needed to confirm the clustering of events after stopping clopidogrel and to investigate it further.
Ho PM, Peterson ED, Wang L et al. JAMA 2008; 299: 532-9

Less intensive exercise for weight loss
Obese boys should exercise at a lower intensity than healthy boys to lose weight, according to researchers in France. They measured the rate of fat oxidation in 30 12-year-old boys, 17 of whom were obese, during graded leg cycling exercises. Exercise intensity increased every 3.5 minutes, with the aim of finding the level that burned off maximum fat. At low intensity (0-30 per cent of peak oxygen consumption), the fat oxidation rate was the same in both groups. At higher intensities (40, 50 and 60 per cent peak oxygen consumption), the fat oxidation rate was significantly higher in lean boys. The researchers suggest this is because obesity and the sedentary lifestyle it induces reduce muscle capacity and the requirement for, and ability to use, fat as a fuel.
Zunquin G, Theunynck D, Sesboue B et al. Br J Sports Med 2008; doi 10.1136/bjsm.2007.044529

CV event risk while watching football
Watching your favourite football team can be a 'heart-stopping' experience and researchers in Germany have shown that the emotional stress suffered at such times is no joke. They compared incidence of acute cardiovascular events in the greater Munich area during the last World Cup (9 June to 9 July 2006) with that during 'control' periods (1 May to 8 June and 10-31 July 2006; 1 May to 31 July 2003 and 2005). On days when the German team was playing, incidence of cardiac emergencies was 2.66 times that during control periods, and the highest average incidence occurred within the first two hours of the start of each match. Wilbert-Lampen U, Leistner D, Greven S et al. N Engl J Med 2008; 358: 475-83.

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