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Take Note – December 2008


Reducing homocysteine with B vitamins doesn’t slow cognitive decline in Alzheimer’s disease
Homocysteine levels may be increased in Alzheimer’s disease (AD), possibly contributing to disease pathophysiology. High-dose supplements of folic acid and vitamins B6 and B12 can lower these levels. In previous studies of B vitamins to reduce homocysteine in AD patients, sample size was too small or therapy duration too short to assess the influence on cognitive decline.
In a new controlled trial, about 400 adults with mild to moderate AD who had normal homocysteine, folic acid, and vitamin B12 levels were randomized to receive either high-dose folate, vitamin B6, and vitamin B12 supplements or placebos for 18 months. Although vitamin and homocysteine levels decreased in subjects who received vitamin supplements, the rate of cognitive decline was the same in both groups. The vitamin group experienced more depression-related adverse events. (For more information on AD, see “Easing the anguish of Alzheimer’s disease” in the Alzheimer’s CE.)

Update on hyperglycemia management in type 2 diabetes
In a revision of their 2006 consensus statement, the American Diabetes Association and the European Association for the Study of Diabetes provide the following guidance:
•  Exenatide or pioglitazone may be considered when hypoglycemia is especially undesirable, such as in patients with hazardous jobs.
•  Rosiglitazone is no longer recommended because of its link to an increased risk of myocardial infarction.
The groups continue to recommend that patients try to achieve and maintain hemoglobin A1c levels under 7%. Also, treatment should start with lifestyle intervention and metformin at the time of diagnosis; if that regimen doesn’t attain or sustain glycemic goals, additional drugs should be added within 2 to 3 months. If those therapies don’t work, insulin should be started or intensified.

“You may have an STD” email service on the rise
An increasingly popular online service lets people send e-cards to sex partners informing them they may have been infected with sy­philis, gonorrhea, human immuno­-deficiency virus, or other sexually transmitted diseases (STDs). According to a recent report, more than 30,000 people have sent nearly 50,000 e-cards to sex partners through the service, called inSPOT, since it launched in 2004. Proponents say it’s an easy, convenient, and (if desired) anonymous way to inform sex partners of possible disease exposure. On the website, users submit the e-mail addresses of sex partners and identify which disease or diseases that person may have been exposed to. The recipient then gets an e-mail with the subject line, “E-card from a concerned friend re: your health via inSPOT.”

New guidelines on GERD management
The American Gastroenterological Association (AGA) Institute has released evidence-based guidelines for managing and treating suspected gastroesophageal reflux disease (GERD). Here are the highlights:
•  For esophageal GERD syndromes (healing esophagitis and symptomatic relief), proton pump inhibitors (PPIs) are more effective than histamine2–receptor antagonists.
•  Twice-daily PPI doses should be used if the patient doesn’t respond adequately to once-daily doses.
•  Patients with reflux chest pain should receive PPIs after careful consideration of possible cardiac causes.
•  Long-term PPI therapy should be titrated downward to the lowest effective dosage.
•  Except in PPI-intolerant patients, PPIs are preferred over antireflux surgery.

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