ACE Inhibitors best for hypertension in diabetes
Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis | BMJ
Hon-Yen Wu et al
BMJ 2013;347:f6008
A meta-analysis of 63 trials with 36 917 participants, looking at survival and reno-protection, concluded that ACE inhibitors should be first line treatment in people with diabetes.
Read MoreConclusion:
Our analyses show the renoprotective effects and superiority of using ACE inhibitors in patients with diabetes, and available evidence is not able to show a better effect for ARBs compared with ACE inhibitors. Considering the cost of drugs, our findings support the use of ACE inhibitors as the first line antihypertensive agent in patients with diabetes. Calcium channel blockers might be the preferred treatment in combination with ACE inhibitors if adequate blood pressure control cannot be achieved by ACE inhibitors alone.
Top 20 POEMS for 2012
Mark Ebell is the editor of Essential Evidence Plus, a great source of POEMS, and to which I subscribe.
He has nominated the top POEMS of 2012. The list was published in The American Family Physician last November.
Top 20 research studies of 2012 for primary care physicians
Ebell MH, Grad R.
Am Fam Physician 2013 Sep 15;88(6):380-6.
A subscription is required, but Australia Doctor has replicated the list at
20 studies every GP should read (how can they do that?)
No pain no gain – Exercise is good for pain in hip and knee osteoarthritis
Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis
Paul S. Mueller, MD, MPH, FACP Reviewing Uthman OA et al., BMJ 2013 Sep 20; 347:f5555
There is good evidence that we should be prescribing exercise for people with osteoarthritic pain in the hip and knee.
Read MoreConclusion:
An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis.
Effect of vitamin D supplemention on depression – none
Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial
Kjærgaard M, Waterloo K, Wang CE, Almås B, Figenschau Y, Hutchinson MS, Svartberg J, Jorde R.
Reference : Br J Psychiatry. 2012 Nov;201(5):360-8. doi: 10.1192/bjp.bp.111.104349. Epub 2012 Jul 12.
I guess you wouldn’t be surprised if people in Norway had lower levels of Vitamin D than people in sunnier climates.
In this RCT, people with lowish Vit D levels (less than 55 nmol/L) were more likely to be depressed. Perhaps the depressive symptoms made them more likely to stay inside.
After six months, supplementation did improve Vit D scores to ‘normal’, but had no significant affect on depression when compared with a placebo group. Happily, both placebo and treatment arms improved.
Read MoreConclusion:
“Low levels of serum 25(OH)D are associated with depressive symptoms, but no effect was found with vitamin D supplementation”
Vitamin D – No benefit on bone density or fractures
Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis
A team of our colleagues from New Zealand have performed a meta analysis of the effects of Vit D supplementation on bone density. Didn’t work, apparently.
Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.
A previous meta-analysis has not shown benefit for Vit D in preventing fractures.
Why then is everybody taking it?
Read More