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Intensive lifestyle intervention in type 2 diabetes Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short term studies. These benefits include improvements in glycaemic control, risk factors for cardiovascular disease, quality of life, and other obesity-related coexisting illnesses. This study examines the long-term effects of such an intervention in terms of cardiovascular morbidity and mortality. The researchers randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The trial was stopped early (9.6 years median follow-up) as there was no difference between the groups with respect to the primary outcomes. They conclude that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. Disappointing, but the trial did confirm the short-term benefits. N Engl J Med 2013;369:145-54. Blood pressure targets in patients with recent lacunar stroke Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. This report concerns the effects of different blood-pressure targets on the rate of recurrent stroke in patients with small subcortical infarcts (i.e. lacunar strokes). 3020 patients with an MRI proven lacunar stroke were randomised to a systolic-blood-pressure target of 130-149 mmHg or less than 130 mmHg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). After 1 year the mean systolic blood pressure was 138 mmHg in the higher target group and 127 mmHg in the lower target group. There were non-significant rate reductions for all strokes within the lower target group. The rate of intracerebral haemorrhage was significantly reduced in the lower target group. The conclusion reached was that although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of systolic-blood-pressure target of less than 130 mmHg is likely to be beneficial. Lancet 2013;382:507-15. Is maternal obesity associated with an increased risk of premature death and cardiovascular disease in adult offspring? This interesting possibility is addressed in this cohort analysis of children born in Aberdeen between 1950 and 1976. All women who delivered a live singleton birth at term (>37 weeks gestation) between 1950 and 1976 and were overweight or obese according to BMI at first antenatal visit were included. Follow-up to 2012 revealed that all cause premature mortality was increased in offspring of obese mothers (BMI>30) compared with offspring or mothers of normal BMI. After adjustment for other factors maternal age, economic status, birth weight and length of gestation the hazard ratio was 1.35. The researchers note that only 4% of mothers in the cohort were obese, whereas currently 20% of women in the UK are obese at their antenatal booking. A clear message. BMJ 2013;347:f4539.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
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Intensive lifestyle intervention in type 2 diabetes Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short term studies. These benefits include improvements in glycaemic control, risk factors for cardiovascular disease, quality of life, and other obesity-related coexisting illnesses. This study examines the long-term effects of such an intervention in terms of cardiovascular morbidity and mortality. The researchers randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The trial was stopped early (9.6 years median follow-up) as there was no difference between the groups with respect to the primary outcomes. They conclude that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. Disappointing, but the trial did confirm the short-term benefits. N Engl J Med 2013;369:145-54. Blood pressure targets in patients with recent lacunar stroke Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. This report concerns the effects of different blood-pressure targets on the rate of recurrent stroke in patients with small subcortical infarcts (i.e. lacunar strokes). 3020 patients with an MRI proven lacunar stroke were randomised to a systolic-blood-pressure target of 130-149 mmHg or less than 130 mmHg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). After 1 year the mean systolic blood pressure was 138 mmHg in the higher target group and 127 mmHg in the lower target group. There were non-significant rate reductions for all strokes within the lower target group. The rate of intracerebral haemorrhage was significantly reduced in the lower target group. The conclusion reached was that although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of systolic-blood-pressure target of less than 130 mmHg is likely to be beneficial. Lancet 2013;382:507-15. Is maternal obesity associated with an increased risk of premature death and cardiovascular disease in adult offspring? This interesting possibility is addressed in this cohort analysis of children born in Aberdeen between 1950 and 1976. All women who delivered a live singleton birth at term (>37 weeks gestation) between 1950 and 1976 and were overweight or obese according to BMI at first antenatal visit were included. Follow-up to 2012 revealed that all cause premature mortality was increased in offspring of obese mothers (BMI>30) compared with offspring or mothers of normal BMI. After adjustment for other factors maternal age, economic status, birth weight and length of gestation the hazard ratio was 1.35. The researchers note that only 4% of mothers in the cohort were obese, whereas currently 20% of women in the UK are obese at their antenatal booking. A clear message. BMJ 2013;347:f4539.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Intensive lifestyle intervention in type 2 diabetes Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short term studies. These benefits include improvements in glycaemic control, risk factors for cardiovascular disease, quality of life, and other obesity-related coexisting illnesses. This study examines the long-term effects of such an intervention in terms of cardiovascular morbidity and mortality. The researchers randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The trial was stopped early (9.6 years median follow-up) as there was no difference between the groups with respect to the primary outcomes. They conclude that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. Disappointing, but the trial did confirm the short-term benefits. N Engl J Med 2013;369:145-54. Blood pressure targets in patients with recent lacunar stroke Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. This report concerns the effects of different blood-pressure targets on the rate of recurrent stroke in patients with small subcortical infarcts (i.e. lacunar strokes). 3020 patients with an MRI proven lacunar stroke were randomised to a systolic-blood-pressure target of 130-149 mmHg or less than 130 mmHg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). After 1 year the mean systolic blood pressure was 138 mmHg in the higher target group and 127 mmHg in the lower target group. There were non-significant rate reductions for all strokes within the lower target group. The rate of intracerebral haemorrhage was significantly reduced in the lower target group. The conclusion reached was that although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of systolic-blood-pressure target of less than 130 mmHg is likely to be beneficial. Lancet 2013;382:507-15. Is maternal obesity associated with an increased risk of premature death and cardiovascular disease in adult offspring? This interesting possibility is addressed in this cohort analysis of children born in Aberdeen between 1950 and 1976. All women who delivered a live singleton birth at term (>37 weeks gestation) between 1950 and 1976 and were overweight or obese according to BMI at first antenatal visit were included. Follow-up to 2012 revealed that all cause premature mortality was increased in offspring of obese mothers (BMI>30) compared with offspring or mothers of normal BMI. After adjustment for other factors maternal age, economic status, birth weight and length of gestation the hazard ratio was 1.35. The researchers note that only 4% of mothers in the cohort were obese, whereas currently 20% of women in the UK are obese at their antenatal booking. A clear message. BMJ 2013;347:f4539.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Correspondence Email

Competing Interests

Contact diana@nzma.org.nz
for the PDF of this article

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