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May 3, 2001
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Prevention of Type 2 Diabetes by Changes in Lifestyle
Modifiable risk factors for type 2 diabetes include obesity and a sedentary lifestyle. In this study, 522 overweight subjects with impaired glucose tolerance were randomly assigned to receive frequent individualized counseling or occasional general recommendations regarding diet and exercise. During a mean follow-up period of 3.2 years, there were 27 cases of diabetes in the intervention group and 59 cases in the control group, a reduction in risk of 58 percent.
That obesity and inactivity are risk factors for diabetes is not a new observation. However, that reducing weight and increasing activity have such a large effect in decreasing the incidence of diabetes has not previously been well documented in a prospective study. The widespread adoption of this regimen would have substantial effects.
Related Editorial
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Response to ACE-Inhibitor Therapy in Black Patients and White Patients
Data suggest that black patients may respond less well than white patients to therapy for heart failure. In this study of patients with left ventricular dysfunction who were randomly assigned to treatment with the angiotensin-converting-enzyme (ACE) inhibitor enalapril or placebo, there was no reduction in the risk of hospitalization for heart failure among black patients assigned to enalapril, whereas enalapril resulted in a 44 percent reduction in this risk among white patients.
Black patients with heart failure have a lesser response than white patients to therapy with ACE inhibitors. Although the reasons are not known, the findings are important for physicians to consider when selecting therapy for left ventricular dysfunction and heart failure in black patients.
Related Editorials, pages 1392 and 1393
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Race and the Response to Carvedilol in Patients with Heart Failure
In the treatment of heart failure, the efficacy of beta-blockers and angiotensin-converting-enzyme (ACE) inhibitors may be lower in black patients than in nonblack patients. It is unknown whether this observation applies to carvedilol, which blocks both b2- and a1-adrenergic receptors. In this study, carvedilol was found to be equally effective in black patients and nonblack patients.
Heart failure is more common in blacks than in nonblacks, and once established, it progresses more rapidly in blacks than in nonblacks. Medications commonly used to treat heart failure, such as ACE inhibitors and standard beta-blockers, appear to be less effective in blacks than in nonblacks, but this does not seem to apply to carvedilol.
Related Editorials, pages 1392 and 1393
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Intrauterine Transmission of Cytomegalovirus to Infants of Women with Preconceptional Immunity
Congenital cytomegalovirus (CMV) infections can occur in infants born to mothers with preexisting immunity against CMV, but whether the infections are caused by intrauterine transmission of the same strain or a different strain of CMV is not known. In this study of 46 women with preexisting immunity against CMV, 16 gave birth to infants with CMV infection. The majority of these 16 mothers had serum antibodies with specificity against different epitopes of the virus than were present during a previous pregnancy, and serum from several women had neutralizing activity against the CMV isolated from their infected infants. In contrast, few of the mothers whose infants were not infected had changes in the specificity of their serum antibodies against CMV.
This study, an attempt to understand why preconceptual immunity against CMV in pregnant women provides incomplete protection against congenital CMV infection, suggests that the infections are caused by intrauterine transmission of newly acquired, different strains of the virus. Thus, efforts to prevent congenital CMV infection in infants born to women who have previously been infected need to focus on the prevention of new infection.
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THE FIRST ARTICLE IN A NEW SERIES
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Clinical Practice: Prostate-Specific-Antigen Testing
A 65-year-old man with no risk factors for prostate cancer except age has a normal digital rectal examination. Should a prostate-specific-antigen (PSA) test be ordered?
This article marks the debut of "Clinical Practice," a new series of review articles that are targeted to practicing clinicians. The article discusses current approaches to prostate-cancer screening and evaluates the evidence to support the use of PSA testing. Guidelines from professional organizations are reviewed, and practical recommendations are provided.
Related Editorial
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NEXT: "Cervical-Cancer Screening" in the May 24 issue
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Medical Progress: Meningococcal Disease
Neisseria meningitidis is a major cause of bacterial meningitis and sepsis in the United States and is responsible for epidemic disease in sub-Saharan Africa. In the United States, the rates of infection are highest among infants, adolescents, and young adults. Smoking is an important risk factor that is modifiable, and vaccination of high-risk groups can provide protection against infection. This article is an up-to-date review of the pathogenesis, diagnosis, and treatment of meningococcal disease and of chemoprophylaxis against it.
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