Health Rounds: Blood pressure drug helps pancreas function in type 1 diabetes

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By Nancy Lapid

March 2 (Reuters) -

Hello Health Rounds Readers! A new study suggests it might be possible to keep some pancreas cells working longer in children with type 1 diabetes, potentially delaying complications of the disease. Other research we're highlighting today adds to evidence showing that younger adults are increasingly vulnerable to colon cancer and suggests that structural racism may be contributing to worse surgery survival in older Black men.

In breaking news, see these stories from our Reuters journalists: By 2035, more than half of the world's population is likely to be overweight or obese; Computer chips in the brain? Getting past the FDA can take decades; President Biden says other pharmaceutical companies will have to follow suit after Eli Lilly slashes insulin prices.

Cheap drug preserves pancreas function in kids with diabetes

The inexpensive, commonly used blood pressure drug verapamil can keep the pancreas partially functioning in children with newly diagnosed type 1 diabetes, a small trial suggests.

"Not only is verapamil affordable, it's also a familiar medication that is well-tolerated with a favorable safety profile," Dr. Anna Neyman of the University of Indiana said in a statement. "I believe many families and children newly diagnosed with type 1 diabetes will benefit from what we discovered."

In type 1 diabetes, the pancreas progressively reduces its production of insulin until it stops completely. The longer the pancreas cells keep functioning to at least some degree, the lower the patients' risks for complications such as kidney and vision problems.

To assess pancreas cell function, doctors measure a marker called C-peptide secretion. In 47 children in the study who took one verapamil pill daily, C-peptide levels were 30% higher a year after diagnosis than in the 41 participants who got a placebo, researchers reported in JAMA and at the International Conference on Advanced Technologies and Treatments of Diabetes.

There were no significant differences between the groups at one year in levels of hemoglobin A1c, a commonly used measure of blood sugar levels, or in time spent with blood sugar levels in a target range.

The researchers could only test verapamil in children who weighed at least 66 pounds (30 kg), because dosages for smaller children are not commercially available.

Even the modest results demonstrated in this trial "are associated with a substantial reduction in the risk" of complications, Dr. Jennifer Couper of University of Adelaide, Australia, said in an accompanying editorial.

Everyone in the trial was already using insulin to control blood sugar, but the data support study of the drug in patients with presymptomatic type 1 diabetes before insulin dependence develops, Couper added

Late last year, the U.S. Food and Drug Administration approved teplizumab to delay the need for insulin in patients age 8 and older with presymptomatic type 1 diabetes. The drug, sold by Provention Bio Inc as Tzield, is priced at $193,900 for a 14-day course of treatment.

Surgery death risk highest for older Black men

Older Black men in the U.S. have a higher death rate in the month after surgery than similarly aged peers of any other subgroup of race and sex, researchers reported on Wednesday in The BMJ.

The largest inequality was seen after non-emergency surgeries, where the death rate for older Black men was 50% higher than in white men.

The researchers used Medicare data from 2016-2018 on more than 1.8 million patients age 65 and older who underwent one of eight operations: abdominal aortic aneurysm repair, appendectomy, gallbladder removal, colon surgery, coronary artery bypass, hip or knee replacement, or lung surgery.

Overall, 40.7% were white men, 53.4% were white women, 2.2% were Black men, and 3.7% were Black women. Roughly 70% of surgeries were scheduled in advance.

After accounting for factors that might affect postoperative death risks, such as other health conditions, the researchers found that 30-day post-operative mortality was 3.05% in Black men, 2.69% in white men, 2.38% in white women, and 2.18% in Black women.

After pre-planned surgery, 30-day death rates were 1.3% in Black men, 0.85% in white men, 0.82% in white women, and 0.79% in Black women.

After emergency surgery, Black and white men had similar death rates, at roughly 7%, while rates were lower in Black and white women, at 5.29% and 6.12%, respectively.

The researchers only had data on Black and white seniors. Outcomes might be different in other racial and ethnic groups.

The study was not designed to identify causes for disparities, but the researchers speculate that structural racial inequities in the healthcare system could explain their findings.

One-in-five colorectal cancers are in younger adults

The proportion of colorectal cancer (CRC) diagnoses in U.S. adults age 55 and under has doubled since the mid-'90s, despite an overall decline in new cases, the American Cancer Society (ACS) said on Wednesday.

In 2019, the last year with available data, 20% of new CRC diagnoses were in those 55 and younger, up from 11% in 1995, ACS researchers reported in CA-A Cancer Journal for Clinicians.

The proportion of cases diagnosed in Native Americans under age 65 has also been increasing, the researchers noted.

While CRC death rates declined by 2% annually from 2011–2020 overall, mortality from the disease rose by 3% annually in individuals younger than age 50.

Earlier detection with more widespread screening does not explain the increasing proportion of diagnoses in younger people, the researchers said. Risk factors such as obesity, diet, smoking, alcohol consumption, and physical inactivity could be contributing, they suggested.

This year, roughly 153,000 individuals will be diagnosed with colon cancer in the U.S., 52,550 of whom will die. About 19,550 cases and 3,750 deaths will occur in those aged 50 and younger, the researchers estimate.

As of 2021, more than 40% of those 45 and older were not up-to-date on CRC screenings, with rates particularly low in younger people and in those without health insurance, according to the report. (Reporting by Nancy Lapid; additional reporting by Shawana Alleyne-Morris; Editing by Bill Berkrot)

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