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Vol. LXII, No. 6
March 19, 2010
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Digest

Diabetes and Depression Associated with Higher Risk for Major Complications

People with type 2 diabetes and coexisting major depression are more likely to experience life-threatening diabetes-related complications, according to a recent NIMH-funded study published in the February 2010 issue of Diabetes Care.

Research has shown that depression is commonly associated with diabetes. People who have both diabetes and depression tend to have more severe symptoms of both diseases, higher rates of work disability and use more medical services than those who only have diabetes alone.

Researchers from Group Health Research Institute in Seattle and colleagues from the University of Washington examined the association between type 2 diabetes and depression among 4,623 patients enrolled in Group Health, a health plan serving residents of Washington state. They first interviewed the participants between 2000 and 2002, and then conducted follow-up interviews between 2005 and 2007. They tracked the participantsí rates of microvascular complications (e.g., blindness, end-stage kidney disease, amputations and kidney failure deaths) and macrovascular complications (e.g., heart attack, stroke, cardiovascular procedures and deaths).

At the follow-up interview, 14 percent of the participants had developed a clinically advanced microvascular complication and 24 percent had developed a severe macrovascular complication. Over the 5-year follow-up period, those with major depression had a 36 percent higher risk of developing microvascular complications and a 25 percent higher risk of developing macrovascular complications compared with patients without major depression.

More research is needed to identify the underlying mechanisms for the association between depression and diabetes complications and to develop interventions that treat both diabetes and accompanying major depression.

Childhood Asthma Treatment: Not One-Size-Fits-All

An NHLBI-supported study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental,
treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids
alone.
An NHLBI-supported study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone.

A new study has found the addition of long-acting beta-agonist therapy to be the most effective of three step-up, or supplemental, treatments for children whose asthma is not well controlled on low doses of inhaled corticosteroids alone.

The study was designed to provide needed evidence for selecting step-up care for such children and was supported by the National Heart, Lung, and Blood Institute. Researchers also identified patient characteristics, such as race, that can help predict which step-up therapy is more likely to be the most effective for a child with persistent asthma.

The study found that almost all of its participants had a different response to the three different treatments. Although adding the long acting beta-agonist step-up was 1.5 times more likely to be the best treatment for most of the study group, many children responded best to the other two treatments instead.

The results were presented Mar. 2 at the American Academy of Asthma, Allergy and Immunology 2010 annual meeting and were published online in the New England Journal of Medicine.

Surgery, Stenting Equally Safe and Effective for Stroke Prevention

A major new study of people at risk for stroke showed that two medical procedures designed to prevent future strokes are safe and effective overall. Physicians will now have more options in tailoring treatments for their patients at risk for stroke. In the trial of 2,502 participants, carotid endarterectomy (CEA), a surgical procedure to clear blocked blood flow and considered the gold standard prevention treatment, was compared to carotid artery stenting (CAS), a newer and less invasive procedure that involves threading a stent and expanding a small protective device in the artery to widen the blocked area and capture any dislodged plaque.

One of the largest randomized stroke prevention trials ever, the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) took place at 117 centers in the United States and Canada over a 9-year period. CREST compared the safety and effectiveness of CEA and CAS in patients with or without a previous stroke. The trial was funded by the National Institute of Neurological Disorders and Stroke and led by investigators at Mayo Clinic, Jacksonville, Fla., and the University of Medicine and Dentistry of New Jersey in Newark. The overall safety and efficacy of the two procedures was largely the same with equal benefits for both men and for women, and for patients who had previously had a stroke and for those who had not.

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