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Bhardwaj S.,Griffin Hospital | Selvarajah S.,Yale University | Schneider E.B.,The Surgical Center
Clinical Interventions in Aging | Year: 2013

Statins have demonstrated substantial benefits in supporting cardiovascular health. Older individuals are more likely to experience the well-known muscle-related side effects of statins compared with younger individuals. Elderly females may be especially vulnerable to statin-related muscle disorder. This review will collate and discuss statin-related muscular effects, examine their molecular and genetic basis, and how these apply specifically to elderly women. Developing strategies to reduce the incidence of statin-induced myopathy in older adult women could contribute to a significant reduction in the overall incidence of statin-induced muscle disorder in this vulnerable group of patients. Reducing statin-related muscle disorder would likely improve overall patient compliance, thereby leading to an increase in improved short- and long-term outcomes associated with appropriate use of statins.

Mahmood S.,Griffin Hospital | Booker I.,University of Connecticut | Huang J.,University of Connecticut | Coleman C.I.,University of Connecticut
Journal of Clinical Psychopharmacology | Year: 2013

BACKGROUND: Clinical Antipsychotic Trials of Intervention Effectiveness showed that atypical antipsychotics (AAPs) were associated with significant weight gain and glucose intolerance. A few trials have shown topiramate to reduce weight gain in patients receiving AAPs, although this benefit has not been present in all trials. OBJECTIVE: This study aimed to determine topiramate therapy's impact on weight gain in patients receiving AAPs. DATA SOURCE: A systematic literature search of MEDLINE (1948 to July 8, 2011) and Cochrane CENTRAL (4th Quarter 2011) was conducted. STUDY SELECTION: Eight trials (n = 336 participants) met our inclusion criteria: randomized controlled trial, evaluated topiramate in patients taking AAPs, and reported weight change during the treatment course. DATA EXTRACTION: Two investigators (S.M. and C.I.C.) used a standardized data abstraction tool to independently collect data, with disagreement resolved through discussion. The difference between the mean weight in the topiramate and control groups was calculated as the weighted mean difference with accompanying 95% confidence interval. A random effect model was used for all analyses. DATA SYNTHESIS: Upon meta-analysis, we found that patients receiving topiramate lost weight or had attenuated weight gain compared to control patients (weighted mean difference,-2.83 kg; 95% confidence interval,-4.62 to-1.03). CONCLUSIONS: Our meta-analysis shows that using topiramate can prevent or reduce weight gain associated with AAPs. Copyright © 2013 Lippincott Williams &Wilkins.

Monica Reddy R.P.,Griffin Hospital | Inzucchi S.E.,Yale University
Endocrine | Year: 2016

The glucose-lowering pharmacopeia continues to grow for patients with type 2 diabetes. The latest drug category, the SGLT2 inhibitors reduce glycated hemoglobin concentrations by increasing urinary excretion of glucose. They are used mainly in combination with metformin and other antihyperglycemic agents, including insulin. Their glucose-lowering potency is modest. Advantages include lack of hypoglycemia as a side effect, and mild reduction in blood pressure and body weight. Side effects include increased urinary frequency, owing to their mild diuretic action, symptoms of hypovolemia, genitourinary infections. There are also recent reports of rare cases of diabetic ketoacidosis occurring in insulin-treated patients. Recently, a large cardiovascular outcome trial reported that a specific SGLT2 inhibitor, empagliflozin, led to a reduction in the primary endpoint of major cardiovascular events. This effect was mainly the result of a surprising 38 % reduction in cardiovascular death, and the drug was also associated with nearly as large a reduction in heart failure hospitalization. These findings were notable because most drugs used in type 2 diabetes have not been shown to improve cardiovascular outcomes. Accordingly, there is growing interest in empagliflozin and the entire SGLT2 inhibitor class as drugs that could potentially change the manner in which we approach the management of hyperglycemia in patients with type 2 diabetes. © 2016, Springer Science+Business Media New York.

Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase I | Award Amount: 154.36K | Year: 2005

The burden of chronic disease in the United States is formidable, with 70% of all deaths attributable to some form of chronic illness. As the majority of chronic diseases arise from, and vary in severity with, modifiable behaviors, self-care has enormous potential to ameliorate their course; however, adherence to self-care plans is often poor. Advances in technology can empower patients in novel ways to adhere to self-care management plans. The Palaistra System is a breakthrough wireless remote patient monitoring and response system that collects and transmits patient data and provides daily interactive, individually tailored informative messages, based on patient data, via cellular phones. Adoption and maintenance of recommended lifestyle changes and disease monitoring/management practices are thus facilitated. Proposed, therefore, is Novel Interactive Cell-phone technology for Health Enhancement (NICHE), a controlled clinical trial evaluating the feasibility and efficacy of the Palaistra System in the management of type 2 diabetes in adults. Feasibility outcomes of this Phase I STTR trial are success of implementation in a clinical setting and validated measures of patient and clinician satisfaction. Clinical and disease-specific outcomes include: HbA1c levels, BMI, physical activity levels, diabetes self-care knowledge and self-efficacy.

Shetty S.,Griffin Hospital | Inzucchi S.E.,Yale University | Goldberg P.A.,Yale University | Cooper D.,Pulmonary and Critical Care Medicine | And 2 more authors.
Endocrine Practice | Year: 2012

Objective: To report our preliminary experience with the revised, more conservative Yale insulin infusion protocol (IIP) that targets blood glucose concentrations of 120 to 160 mg/dL.Methods: We prospectively tracked clinical responses to the new IIP in our medical intensive care unit (ICU) by recording data on the first 115 consecutive insulin infusions that were initiated. All blood glucose values; insulin doses; nutritional support including intravenous dextrose infusions; caloric values for enteral and parenteral nutrition; and use of vasopressors, corticosteroids, and hemodialysis or continuous venovenous hemodialysis were collected from the hospital record.Results: The IIP was used 115 times in 90 patients (mean age, 62 [±14 years]; 51% male; 35% ethnic minorities; 66.1% with history of diabetes). The mean admission Acute Physiology and Chronic Health Evaluation II score was 24.4 (±7.5). The median duration of insulin infusion was 59 hours. The mean baseline blood glucose concentration was 306.1 (±89.8) mg/dL, with the blood glucose target achieved after a median of 7 hours. Once the target was reached, the mean IIP blood glucose concentration was 155.9 (±22.9) mg/dL (median, 150 mg/dL). The median insulin infusion rate required to reach and maintain the target range was 3.5 units/h. Hypoglycemia was rare, with 0.3% of blood glucose values recorded being less than 70 mg/dL and only 0.02% being less than 40 mg/dL. In all cases, hypoglycemia was rapidly corrected using intravenous dextrose with no evident untoward outcomes.Conclusions: The updated Yale IIP provides effective and safe targeted blood glucose control in critically ill patients, in compliance with recent national guidelines. It can be easily implemented by hospitals now using the original Yale IIP. Copyright © 2012 AACE.

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