All about the regnancy diabetes

Pregnant women with pregnancy-related diabetes are less likely to achieve blood sugar control if they rely on food stamps or have a generally chaotic lifestyle, according to a U.S. study.

These kinds of factors may be modifiable, the authors write in Obstetrics and Gynecology.

“Many social factors have a major impact on overall pregnancy health,” said Dr. Laura Colicchia, who led the study at the University of Pittsburgh and is currently in Maternal-Fetal Medicine at Abbott Northwestern Hospital in Minneapolis.

About 200,000 U.S. women develop diabetes during pregnancy each year, Colicchia said, and they must follow a strict diet, prick their fingers four times daily to check blood sugar, report their blood sugars to the doctor weekly, have frequent office visits and ultrasounds, and in many cases take insulin or medications several times daily to control their sugars.

“Gestational diabetes impacts every aspect of a woman’s life including eating with and cooking for her family, scheduling her blood sugar checks and meals at work, where she obtains the food to follow the diet and how she creates time for everything,” she said.

“Because of this, barriers to management of diabetes can come from any part of her life including her family, her neighborhood, her daily routine or her employer,” she told Reuters Health by email.

Women who are obese, have limited access to food or are from marginalized communities are at higher risk for gestational diabetes and often have higher blood sugar levels when diabetes is diagnosed making it harder to control, Colicchia noted.

The researchers surveyed 111 women with gestational diabetes at clinical visits, using questionnaires designed to measure social support and degree of life “chaos,” which includes organization, stability and the ability to plan and prepare for the future.

They later analyzed medical records for blood sugar control and pregnancy outcomes, including infant size, maternal weight gain, cesarean delivery and newborn health.

Women were rated as having good blood sugar control if at least 70 percent of their blood sugar assessments were at goal level or better.

Overall, 86 of the 111 women achieved good glycemic control, either by diet changes alone or with the help of medication and insulin treatment. These women were more likely to be married, have higher household income and exercise three times a week, and less likely to have public insurance or a history of depression or anxiety.

Heart failure drug

The cost of generic drugs that treat heart failure can vary so wildly, even among pharmacies within one area, that uninsured patients may not be able to afford them, according to research reported at the American Heart Association medical meeting in New Orleans on Tuesday.

Researchers found that the combined cost for a month’s supply of three commonly prescribed generic heart failure drugs ranged from $12 to $400, with an average price of about $70 in the greater St. Louis area, putting them out of reach for some patients who desperately need them.

About 5.7 million Americans are living with heart failure, according to the AHA. The condition, in which the heart no longer pumps efficiently enough to supply the body’s blood and oxygen needs, is one of the most common causes of hospitalization in people aged 65 and older and often requires treatment with multiple medications.

Prompted by a 25-year-old patient who said he could not afford to fill his prescription for digoxin at $100 for a 30-day supply, Dr. Paul Hauptman decided to look into the variable cost of supposedly cheaper generic heart failure medicines.

“I think a lot of doctors assume that if you’re writing a prescription for a generic drug, that it will be affordable,” said Hauptman, a heart failure specialist at St. Louis University School of Medicine.

Researchers surveyed 175 pharmacies in the St. Louis area to see how much they charged uninsured customers for digoxin, lisinopril and carvedilol. The researchers found no apparent link between price and type of pharmacy or the average income in a particular neighborhood. They even found that two major pharmacy chains did not have consistent pricing between their stores.

“We do not know where the major pricing problem lies in the journey that a generic drug for heart failure takes from generic company to distributor to retail pharmacy and then to patient. There is no transparency here,” Hauptman said.

Uninsured patients typically do not shop around for lower prices, Hauptman said, adding that if a patient finds a drug too expensive, “they don’t fill the prescription.”

He suggested this type of study be replicated in other parts of the country and for other medical conditions.

Former AHA President Dr. Clyde Yancy, who was not involved with this research, said the issue affects everyday life of patients he treats who are on fixed incomes.

Worse breast cancer survival odds

Women with a history of depression may have lower survival odds with breast cancer than patients without past mental health problems, research in Denmark suggests.

In the study of more than 45,000 women with early-stage breast malignancies, 13 percent of patients previously treated with antidepressants died within five years of their cancer diagnosis, compared with 11 percent of women who hadn’t ever taken medication for depression.

“We did not find that women with depression were diagnosed at later stages,” said lead study author Dr. Nis Palm Suppli of the Danish Cancer Society Research Center in Copenhagen.

Instead, women with depression may be less likely to start or continue recommended treatments based on individual factors including a patient’s age, tumor size, the type of cancer and how far it has spread in the body, Suppli added by email.

Many people develop depression as a result of a cancer diagnosis, but to identify the possible effect of depression on cancer prognosis, rather than the other way around, researchers focused on women with a history of depression before their cancer diagnosis, the study team writes in the Journal of Clinical Oncology.

They analyzed data on Danish women diagnosed with breast cancer from 1998 to 2011.

Overall, 6,068 women, or 13 percent, had been treated with antidepressants, and another 744, or 2 percent, had previously been hospitalized for depression.

When women had a history of depression, they were 14 percent more likely to receive breast cancer care that didn’t follow recommended treatment guidelines, the study found.

With depression history, women were also 21 percent more likely to die of any cause during the study and 11 percent more likely to die of breast cancer.

The study doesn’t prove depression causes worse outcomes for women with breast cancer.

Even so, the findings suggest that doctors should take extra care with women who have a history of depression to make sure these patients start all recommended treatments and continue with therapy that can sometimes be needed for several years, Suppli said.

Medicine for weeks after swallowing

Scientists have developed a new drug capsule that stays in the stomach for up to two weeks after being swallowed, gradually releasing its payload.

The capsule, developed by researchers in the United States, could be a powerful weapon in fighting malaria, HIV and other diseases where successful treatment depends on repeated doses of medicine.

In a study published in the Science Translational Medicine journal on Wednesday, the researchers used the new capsule to deliver an anti-parasitic drug called ivermectin, which they believe could help fight malaria.

The long-acting pill technology could also have a range of other applications, the scientists said – from use in treating Alzheimer’s disease and mental illnesses to HIV and tuberculosis.

Although long-acting drug delivery systems already exist, they are either injectable or implantable, or involve an invasive procedure and are not suitable for many situations.

“Until now, oral drugs would almost never last for more than a day,” said Robert Langer, a professor at MIT who worked on the study.

“This really opens the door to ultra-long-lasting oral systems … There are a lot of exciting things this could someday enable.”

Drugs taken orally tend to work for a limited time because they pass quickly through the body and are exposed to harsh environments in the stomach and intestines.

Langer said he and his team have been working for several years to overcome this problem, initially focusing on malaria and ivermectin, which kills any mosquito that bites someone who is taking the drug.

The new long-acting pill has a star-shaped structure with six arms that can be folded inwards and are encased in a smooth capsule. Drug doses are loaded into the arms, and each arm is attached to a core by a linker that is designed eventually to break down.

After the capsule is swallowed, acid in the stomach dissolves the outer capsule layer, allowing the arms to unfold. Once the star expands it stays in the stomach. It is big enough to resist the forces that would normally push something down the digestive tract, but too small to cause a blockage.

“When the star opens up inside the stomach, it stays inside the stomach for the duration that you need,” said Tyler Grant, another researcher on the project.

In tests in pigs, the researchers found that drug doses were gradually released over two weeks, and the linkers that join the arms to the core then dissolved, allowing the arms to break off and pass through the digestive system.

The researchers ran mathematical models to analyze the potential impact of the long-acting capsule with ivermectin.

Heart pumping device

St. Jude Medical Inc’s new, smaller HeartMate 3 heart pumping assist device proved superior to its older HeartMate II in advanced heart failure patients, according to the first data from a large trial presented on Wednesday.

Six months after implantation, 86 percent of patients who received HeartMate 3 were still alive without a disabling stroke or need for reoperation to repair or replace the device. That compared with 77 percent for those who received the older device.

HeartMate 3 was designed to prevent blood from clogging in the mechanism, a complication known as pump thrombosis that can lead to major surgery to replace the device.

While survival and stroke rates were similar, there was no pump thrombosis with HeartMate 3 versus 18 cases in the older device, based on data from the first 294 patients in a study that intends to enroll more than 1,000.

HeartMate 3 is approved in Europe. This trial aims to make the case for U.S. approval.

The trial was designed to demonstrate that the new device is at least as safe as HeartMate II.

“We met not only non-inferiority, but also superiority. We’re ecstatic with this,” said Dr. Mandeep Mehra, the lead researcher who presented the data at the American Heart Association scientific meeting in New Orleans.

“We are always looking for something that reduces the limitations of these devices,” he said. “We now have the HeartMate 3 that virtually eliminates one major complication that we see with left ventricular assistance.”

Analysts have said if the data proves very positive it could pressure a rival product from Medtronic Plc.

The study included both patients who needed a short-term option while awaiting a heart transplant or long-term support because they were not candidates for transplantation.

Nearly 6 million Americans are living with heart failure, a leading cause of hospitalization, and a condition that causes shortness of breath and difficulty performing daily activities. These devices do the work of the left ventricle by pumping blood into the aorta.

HeartMate 3 has wider blood passages and its rotor is suspended by magnetic forces to prevent damage to red blood cells. It also fits entirely inside the chest cavity, while the larger model must be placed below the diaphragm.