Diabetes clinics not screening for disordered eating
Lack of screening tool use for disordered eating in young patients with type 1 diabetes (T1D) could be preventing early diagnosis and management and putting patients at increased risk of complications, an Australian study suggests.
A survey of 10 Australian and New Zealand paediatric T1D clinics found only one used screening tools for eating disorders, though not routinely and not diabetes-specific.
All clinics used the routine clinical interview as the main method of screening for disordered eating, however, low reported rates suggest that it may be under-detected, the study authors said. Eight clinics reported eating disorder rates of less than 5%, yet two had rates over 20%.
“The focus on food as part of management and the increased burden associated with daily diabetes cares may contribute to the increased risk. Additionally, there is opportunity to engage in insulin restriction or omission to manage weight or achieve weight loss,” the researchers wrote in Nutrients.
While anorexia nervosa was most commonly diagnosed in the study, bulimia nervosa and eating disorders not otherwise specified make up the majority of literature-reported cases in T1D patients.
“Having both T1D and an eating disorder is associated with poorer glycaemic control and higher risk of diabetes-related complications, including diabetic ketoacidosis, retinopathy, neuropathy and nephropathy, all of which contribute to increased morbidity and mortality,” the authors wrote.
Overcoming barriers to tool-use, such as lack of time and staff training could help improve implementation and detection, allowing for earlier intervention and complication prevention, they concluded.
SGLT-2 inhibitor listed on PBS for heart failure
The SGLT-2 inhibitor dapagliflozin (Forxiga) is listed on the PBS from 1 January 2022 for the treatment of symptomatic heart failure with reduced ejection fraction (HFrEF) in adults, as an adjunct to the standard of care therapy.
Reimbursement of the oral glucose lowering therapy for heart failure is based on evidence of cardiorenal benefits beyond its current indication for glycaemic control in people with type 2 diabetes.
Cardiologist Professor Andrew Coats, Director of the Monash Warwick Alliance and Academic Vice-President, Monash and Warwick Universities, said the PBS listing of dapagliflozin reflected the inclusion of additional treatment options for patients with HFrEF within the 2021 ESC clinical guidelines.
“We are seeing a global shift in the way we are managing heart failure. The much-awaited update to the clinical management of heart failure at a global level may catalyse an update in heart failure guidelines worldwide, including Australia, and may deliver the improved patient outcomes we need to see,” he said in a statement released on behalf of AstraZeneca Australia.
“I’m thrilled that there is now broader access to another treatment option that may help to reduce hospitalisation and improve symptom management,” he added
Fracture risks differ with osteoporosis drug holidays
The ‘drug holiday’ recommended for patients after several years of osteoporosis therapy is associated with a slightly higher risk with risedronate compared to alendronate, a Canadian study shows.
Data from more than 25,000 elderly patients taking either drug showed little difference in the association between drug holidays and hip fractures until about two years of not receiving therapy. Over three years, drug holidays after risedronate therapy were associated with an 18% relative and 0.6–percentage point absolute increased risk for hip fracture compared with alendronate drug holidays.
The difference may be due to risedronate having a shorter half-life than alendronate, and thus the residual length of fracture protection may be shorter, said researchers in Annals of Internal Medicine.