In brief

Walking while you work
Vertical workstations with built-in treadmills may be the way forward in the fight against obesity, according to a small US study. Fifteen obese volunteers had their energy expenditure measured while seated at a conventional desk and while using a 'walk and work' desk. An average 72kcal per hour were burned while seated, compared with 191kcal per hour while walking one mile per hour at the vertical workstation. The authors estimate that this could translate into a weight loss of 20-30kg over a period of one year.
- Levine JA, Miller J. Br J Sports Med 2007 May 15 (Epub ahead of print).

Rosiglitazone hits the headlines
A meta-analysis of 42 trials concluded that rosiglitazone was associated with a 43 per cent increased risk of MI. The reviewers advised clinicians to take the potential for serious adverse events into consideration when prescribing the drug.

However, a subsequent interim analysis of data on 4,447 patients with type-2 diabetes (3.75 years' follow-up) was inconclusive with respect to any associated potential risk of hospitalisation or death due to cardiovascular disease. But the drug was associated with an increased risk of heart failure.

An MHRA statement in May highlighted that the product information for rosiglitazone had been updated in September 2006 to reflect more fully the risk of heart failure and to include a warning about the potential increased risk of MI.
- Home PD, Pocock SJ, Beck-Nielsen H et al. N Engl J Med 2007 June 5 (Epub ahead of print). Nissen SE, Wolski K. N Engl J Med 2007 May 21 (Epub ahead of print).

Selecting patients for exercise referral
Physical activity referral schemes may not suit everybody, according to researchers from Staffordshire University. They identified the characteristics associated with uptake and completion of an exercise programme among 3,568 people referred across the county over a period of three years. Referral uptake was most likely in the 60-69 year age group and least likely among those in rural villages or deprived areas. Completion was most likely among men and the over-seventies. The researchers say schemes should be targeted towards adults of middle to old age who are more likely to require supervision.
- Gidlow C, Johnston LH, Crone D et al. J Public Health 2007;29:107-13.

Stay with a generic statin first-line
The relative merits of different statins have been assessed in a review. It concludes that generic simvastatin remains the most cost-effective option and should be used first-line in most patients. The reviewers suggest pravastatin as an alternative for patients in whom drug interactions are a problem and say that atorvastatin should be reserved for second-line use or for those intolerant of simvastatin. They also note that there are limited clinical trial data for fluvastatin or rosuvastatin and that these drugs are much more expensive than simvastatin; consequently, the reviewers see no reason for using them in routine management.
- Drug Ther Bull 2007;45(5):33-7.

Consensus on diabetes prevention
A consensus statement on type-2 diabetes prevention has been issued by the International Diabetes Federation (IDF). It recommends opportunistic screening to identify those at high risk and lifestyle modification as the first-line intervention. If this does not reduce weight or improve glucose tolerance, the IDF recommends metformin (250-850mg twice daily) as a preventive strategy. It says acarbose may be worth considering, but does not recommend routine use of thiazolidinediones. Orlistat is suggested as a further option for obese patients.
- Alberti KG, Zimmet P, Shaw J. Diabet Med 2007;24(5):451-63.

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