Effects of 1,25-Dihydroxycholecalciferol on Recovery and Resolution of Late Transient Neonatal Hypocalcemia

Background. Late transient neonatal hypocalcemia with hyperphosphatemia is potentially life-threatening. The use of 1.25 dihydroxycholecalciferol in the management of neonatal hypocalcemia is unexplored. Objective. We hypothesized adding 1.25 dihydroxycholecalciferol to intravenous continuous calcium infusion (CaI) will achieve accelerated correction of hypocalcemia. Design/Methods. A controlled double-blind randomized placebo group was organized to compare the addition of 1.25 dihydroxycholecalciferol to CaI in 3–14 day old neonates presenting with hypocalcemia, hyperphosphatemia and seizures. Ionized calcium and phosphorus were measured to adjust CaI and maintain eucalcemia. Time to resolution of hypocalcemia was defined as time from starting CaI to the first ionized calcium of ≥1.1 mmol/L. CaI was discontinued when ionized calcium levels were ≥1.1 mmol/L on two measurements and the infant tolerated feeds. Results. Fourteen neonates were studied without statistical difference between groups. Time to correction of hypocalcemia for 1,25 dihydroxycholecalciferol versus placebo was 7.2  ±  1.9 versus 11.5  ±  3.4 hours respectively (p = .26). The duration of CaI was 15.0  ±  1.5 versus 24.8  ±  4.4 hours respectively (p = .012). Conclusions. The addition of 1.25 dihydroxycholecalciferol to standard CaI therapy reduced the duration of CaI, but did not reduce the time to correct hypocalcemia in neonates with late transient hypocalcemia

Is cost a barrier to screening mammography for low-income women receiving Medicare benefits? A randomized trial

BACKGROUND: In 1991, Medicare began covering screening mammograms subject to copayment and deductible. This study evaluated the effectiveness of Medicare in removing financial barriers to screening mammography among low-income older women. METHODS: In an inner-city public hospital\u27s General Medicine Clinic, 119 consecutive, eligible, and consenting Medicare-enrolled women without known risk factors for breast cancer other than age, and no mammogram in the previous 2 years, were entered into a randomized controlled trial with follow-up after 2 months. The mean age was 71 years; 77% were black, 92% had an annual income below $10,000, and 52% had had a previous mammogram. All patients were counseled concerning indications for screening mammograms and Medicare coverage, and all were referred to a low-cost mammography facility. Sixty-one subjects were randomly assigned a voucher for a free screening mammogram at the referral facility. Obtaining a mammogram within 60 days of study entry was the main outcome measure. RESULTS: Of the women given vouchers, 27 (44%) obtained screening mammograms, compared with six (10%) of those without vouchers (P \u3c .001). Adjustment by multiple logistic regression confirmed this association, yielding an adjusted odds ratio of 7.4 (95% confidence interval, 2.5 to 21.4). Knowledge concerning mammography and breast cancer increased significantly overall (and within randomization groups) between initial interview and follow-up; fear did not change. For women without the voucher, the main reason for not obtaining a mammogram was financial; the main reason for women with the voucher was transportation. CONCLUSION: In a low-income, inner-city population of older women, financial barriers to screening mammography persist despite Medicare coverage

Correlates of Medication Adherence in the TODAY Cohort of Youth With Type 2 Diabetes.

OBJECTIVE: To identify factors that predict medication adherence and to examine relationships among adherence, glycemic control, and indices of insulin action in TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth). RESEARCH DESIGN AND METHODS: A total of 699 youth 10–17 years old with recent-onset type 2 diabetes and ≥80% adherence to metformin therapy for ≥8 weeks during a run-in period were randomized to receive one of three treatments. Participants took two study pills twice daily. Adherence was calculated by pill count from blister packs returned at visits. High adherence was defined as taking ≥80% of medication; low adherence was defined as taking <80% of medication. Depressive symptoms, insulin sensitivity (1/fasting insulin), insulinogenic index, and oral disposition index (oDI) were measured. Survival analysis examined the relationship between medication adherence and loss of glycemic control. Generalized linear mixed models analyzed trends in adherence over time. RESULTS: In this low socioeconomic cohort, high and low adherence did not differ by sex, age, family income, parental education, or treatment group. Adherence declined over time (72% high adherence at 2 months, 56% adherence at 48 months, P < 0.0001). A greater percentage of participants with low adherence had clinically significant depressive symptoms at baseline (18% vs. 12%, P = 0.0415). No adherence threshold predicted the loss of glycemic control. Longitudinally, participants with high adherence had significantly greater insulin sensitivity and oDI than those with low adherence. CONCLUSIONS: In the cohort, the presence of baseline clinically significant depressive symptoms was associated with subsequent lower adherence. Medication adherence was positively associated with insulin sensitivity and oDI, but, because of disease progression, adherence did not predict long-term treatment success

CGM Metrics Identify Dysglycemic States in Subjects from the TrialNet Pathway to Prevention Study

   OBJECTIVE  Continuous glucose monitoring (CGM) parameters may identify subjects at risk of progressing to overt type 1 diabetes. We aimed to determine whether CGM metrics provides additional insights into progression to clinical Stage 3 type 1 diabetes.  RESEARCH DESIGN AND METHODS  One hundred and five relatives of type 1 diabetes probands (median age 16.8 years; 89% non-Hispanic White; 43.8% female) from the TrialNet Pathway to Prevention Study underwent 7-day CGM assessments and oral glucose tolerance tests (OGTTs) at 6-month intervals, the baseline data is reported here. Three groups were evaluated: individuals with 1) Stage 2 type 1 diabetes (n=42) with ≥2 diabetes-related autoantibodies and abnormal OGTT; 2) Stage 1 type 1 diabetes (n=53) with ≥2 diabetes-related autoantibodies and normal OGTT; and 3) negative test for all diabetes-related autoantibodies and normal OGTT (n=10).  RESULTS  Multiple CGM metrics were associated with progression to Stage 3 type 1 diabetes. Specifically, spending ≥5% time with glucose levels ≥140 mg/dL (p = 0.01), ≥8% time ≥140 mg/dL (p=0.02), ≥5% time ≥160 mg/dL (p = 0.0001) and ≥8% of the time spent at glucose levels ≥160 mg/dL (p=0.02) were all associated with progression to Stage 3 disease. Stage 2 participants and those who progressed to Stage 3 also exhibited higher mean day-glucose values, spent more time with glucose values over 120, 140 and 160 mg/dL, and had greater variability. CONCLUSIONS  CGM could aid in the identification of subjects, including those with a normal OGTT, who are likely to rapidly progress to Stage 3 type 1 diabetes. </p