(This is an excerpt of the Health Rounds newsletter, where we present latest medical studies on Tuesdays and Thursdays.)
By Nancy Lapid
May 22 (Reuters) – We also report on a large analysis that found little clinical anti-fracture benefit from vitamin D or calcium supplements, and a study that suggests insurers may be cutting off sleep apnea patients from their CPAP machines prematurely.
SCREEN ALL CHILDREN FOR TYPE 1 DIABETES, STUDY SUGGESTS
Type 1 diabetes can be detected in children with a blood test by the family pediatrician long before symptoms develop or an emergency occurs, researchers reported, suggesting more widespread early screening may be in order.
Most children who developed full-blown type 1 diabetes in this study had no family history of the disease, which means screening should not be limited to those with a family history, the researchers said in a report in JAMA.
“The ability to detect type 1 diabetes early through screening and monitoring is a significant breakthrough with vast potential to reach a broad population and change the course of the disease for those who will develop it,” Esther Latres of Breakthrough T1D, which helped fund the research, said in a statement.
Families often don’t recognize the early-warning symptoms of diabetes such as excessive thirst, weight loss, or fatigue, leading to development of diabetic ketoacidosis, a severe medical emergency, the researchers noted.
In the study in Germany, more than 220,000 children were tested for early stages of type 1 diabetes during routine pediatric care. A small blood sample is analyzed for the presence of at least two different types of islet autoantibodies, which are immune cells that mistakenly attack the pancreas.
Children with islet autoantibodies but normal blood glucose levels are considered to be in stage 1. Families receive information, education, and access to specialized diabetes centers where regular follow-up examinations then take place.
In stage 2, the first signs of impaired glucose metabolism appear. In stage 3, insulin is required.
At the first screening, 590 children, or roughly 0.3%, were found to have early-stage type 1 diabetes. Eventually, 212 of them progressed to stage 3.
After five years, the probability of progressing from an early stage to clinical type 1 diabetes was 36.2%, researchers reported.
Once an early stage was diagnosed, there was no difference in disease progression in children with and without a family history, they noted.
“The long-standing argument that early-stage disease cannot be readily identified – and therefore cannot efficiently or effectively be studied or targeted – no longer holds,” Dr. Jamie Felton and Dr. Emily Sims of the Indiana University School of Medicine, who were not involved in the study, wrote in an editorial.
“The findings suggest that the time to seriously consider general population screening has arrived,” they concluded.
STUDY QUESTIONS VALUE OF CALCIUM AND VITAMIN D SUPPLEMENTS
Daily use of calcium and vitamin D supplements offers older people little meaningful protection against falls and fractures, according to a large analysis of recently published studies.
Previous studies have come to similar conclusions, yet clinicians and guidelines continue to recommend that patients use them for prevention, the researchers said.
For the new analysis published in The BMJ, they reviewed data from 69 randomized trials that compared calcium or vitamin D supplements – or both – with placebo for reducing fractures and falls.
Study participants got little to no “clinically meaningful” benefit from use of calcium supplements, vitamin D supplements or combined supplementation regardless of age, sex, history of falls, or dietary habits, the researchers said.
The 153,902 study participants were mostly healthy seniors living independently who were not at high risk of falls or fractures. The conclusions might not apply to individuals with certain medical conditions, including those receiving drug treatment for osteoporosis, the researchers acknowledged.
They say general recommendations for calcium and vitamin D supplementation should be reevaluated “in light of current evidence.”
An editorial published with the study calls for increased funding of interventions that have been shown to offer meaningful prevention of falls and fall-related injuries, such as balance and resistance exercise and hazard assessments.
Experts not involved in the analysis said the researchers’ definition of a meaningful benefit as being at least a 50% reduction in risk might have been excessive.
Given that in the UK alone, there are more than 70,000 hip fractures annually costing approximately £2 billion ($2.7 billion), “some might consider a much smaller reduction a meaningful benefit,” Dr. Donal McNally of the University of Nottingham said in a statement.
INSURERS MAY LABEL CPAP AS HAVING FAILED PREMATURELY
Sleeping with CPAP machines that push air into the throat can be difficult, and insurance companies often stop paying for the obstructive sleep apnea treatment without waiting to see whether patients eventually adapt to using the devices, a study found.
Many insurers stop covering rental charges for continuous positive airway pressure, or CPAP, devices if patients aren’t using them for at least four hours per night on 70% of nights during a 30-day window within the first 90 days, the researchers said.
In a study of more than 132,000 CPAP users whose insurance plans didn’t have such limits, 51% of patients did not meet the 90-day criteria for continued use. But one year later, 36% of those patients were still using CPAP, study leader Dr. Dennis Hwang of Kaiser Permanente Southern California reported in Orlando at the American Thoracic Society annual meeting.
Even those who weren’t meeting the four-hour threshold were still using the devices for at least two hours a night, which is known to improve symptoms of sleep apnea. This suggests that early non-adherence doesn’t equate to treatment failure, Hwang said.
“Extending support and coverage beyond the first 90 days could help more patients achieve meaningful benefit,” he said.
($1 = 0.7439 pounds)
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(Reporting by Nancy Lapid; Editing by Bill Berkrot)
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