Studies Say Diabetes Abounds In Obese Children But Awareness Is Lacking

By Brian McCurdy, Associate Editor

With the increasing prevalence of type 2 diabetes in children, are parents and children getting the message that being overweight can lead to the disease? Several new studies suggest otherwise, finding rising health problems in obese children and concluding that childhood obesity can go unnoticed by both parents and children. Although Eric Espensen, DPM, has not seen an increased number of children who have type 2 diabetes, he notes that Minh Mach, MD, an endocrinologist colleague, has seen such an increase and lectures on the rising incidence of type 2 diabetes in youth. Dr. Espensen urges parents to be aware of health complications that can occur in their children. “The most important thing to emphasize to parents is both awareness, which includes signs and symptoms such as ketoacidosis and hyperglycemia, and complications that result from poor control,” advises Dr. Espensen, the Director of the Providence Diabetic Foot Center at the Providence St. Joseph Medical Center in Burbank, Calif. Which complications are being discovered in overweight children? One study, presented at the Annual Scientific Sessions of the American Diabetes Association (ADA), observed 1,700 eighth-graders in Texas, California and North Carolina, and found 40.2 percent had pre-diabetes. In addition, 49.3 percent of the children had body mass indexes (BMI) above the 85th percentile of their ages and some had diabetes, hypertension and raised levels of cholesterol and lipids, according to the trial, sponsored by the Studies to Treat or Prevent Pediatric Type 2 Diabetes Study Group (STOPPT2D). Researchers note that being overweight and having problems with cholesterol, blood pressure or blood glucose can also place children at risk for cardiovascular disease if the children do not improve nutrition and become more physically active. Many parents and children may be unaware of problems with their weight, according to the British Early Bird Study, which was also presented at the ADA meeting. The study is in the fourth year of a 12-year observance of a randomly selected group of 300 children, starting at an average age of 4.9. These children visit a hospital every six months and are tested via a battery of parameters, including BMI, metabolic rate, physical activity and fasting blood sugar, according to the ADA. This study revealed that 51 percent of children underestimated their weight while just 17 percent overestimated it. An ADA report on the study noted that some parents also underestimated their children’s weight as well as their own. According to the study, one-third of the parents of obese girls and one-half of the parents of obese boys rated their children’s weight as “about right.” The study adds that one-third of the mothers and one-half of the fathers who were either overweight or obese also rated their own weight as “about right.” Another study, which was recently published in The New England Journal of Medicine, assessed 439 obese, 31 overweight and 20 non-obese children and adolescents. Researchers discovered that half of the severely obese children had metabolic syndrome and found an increased risk of cardiovascular disease in such children, according to the study. How Can You Encourage Compliance? With the health risks of obesity becoming more documented, how can one facilitate compliance to a good nutrition regimen to prevent complications such as diabetes? Educating children is the key, according to Dr. Espensen, who says DPMs can encourage compliance by increasing children’s awareness of the potential complications of being overweight. Dr. Espensen also recommends encouraging patients to take advantage of the diabetes support groups and educational programs at local hospitals. One group at his facility is open to those newly diagnosed with diabetes meeting those who have had the disease for a long period of time. He notes the ADA also has similar educational chapters. “It also allows youths to hear firsthand about some of the devastating complications of diabetes,” says Dr. Espensen of the meetings. Francine Kaufman, MD, a co-author of the aforementioned study involving 1,700 eighth-grade children, says she will be implementing a three-year program to assess the benefits of improving nutrition and physical activity in school environments. Dr. Kaufman, Chairwoman of STOPPT2D, says the program will attempt to change children’s perceptions of health norms. Are Instant TCCs A Cheaper, Faster Alternative To Total Contact Casts? By Brian McCurdy, Associate Editor Although offloading with the instant total contact cast (iTCC) has been proposed as an alternative to the gold standard of the total contact cast (TCC), there had been no previous studies comparing the iTCC to the TCC. However, a new study presented at the ADA meeting concludes iTCCs not only have a similar rate of healing but are also cheaper and quicker to apply. The randomized study compared 38 patients, half of whom wore a standard TCC and the rest of whom wore a removable cast walker (Active Offloading Walker, Royce Medical), which study authors converted to an iTCC by wrapping it with a strip of cohesive bandage or casting material. The patients suffered from plantar neuropathic foot ulcers that were non-infected and non-ischemic. The study notes a Kaplan-Meier analysis detected no differences in healing times and no differences in all complications between groups. Recalling a previous study that concluded patients wearing removable casts wore them for only 28 percent of their day, study co-author David G. Armstrong, DPM, MSc, PhD, has touted the efficacy of the iTCC. “(The iTCC) is such a simple sounding thing but it has the potential to help people,” notes Dr. Armstrong, a Professor of Surgery, Chair of Research and Assistant Dean at the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine in Chicago. As for application times, the study found the TCC was applied on average in 12 minutes and 30 seconds while the iTCC was applied on average in seven minutes and 47 seconds. The average removal time for the TCC was three minutes and 39 seconds whereas the average removal time for the iTCC was two minutes and 17 seconds, according to the study. The study also notes the iTCC is cheaper, with a total cost of $148.75 versus a total cost of $191.18 for a TCC. Accounting for the salary of an orthopedic technician increases the cost for a TCC to $210.67 while raising the cost for an iTCC to $158.47. “We are excited about the potential of technologies like this,” notes Dr. Armstrong. “Often, it’s the simple stuff that saves legs.” Tort Reform Relief On The Way In Three States By Brian McCurdy, Associate Editor New Jersey, Oklahoma and Ohio are joining the ranks of states that have passed new measures of tort reform relief. While the reform signed by New Jersey Gov. James McGreevey does not include a cap on noneconomic damages, it allows judges to reduce awards they deem excessive. Although New Jersey-based Kenneth Malkin, DPM, acknowledges patients who are injured by practitioner negligence should be compensated, he argues lawsuits most often result from poor outcomes rather than negligence. “In my opinion, the key to tort reform is only allowing cases with merit to be tried in the courts,” says Dr. Malkin, a Fellow of the American Board of Quality Assurance and Utilization Review Physicians. He says there should be a panel that oversees these cases. The New Jersey law establishes a $78 million fund, which would offset liability premiums with state regulators deciding who will receive the funds and in which amount. To create the fund, doctors, health professionals and lawyers will pay $75 a year and hospitals and other healthcare businesses will pay $3 per employee. The state law also provides stricter requirements for expert witnesses and will permit physicians named in a suit to sign an affidavit to be removed from the case if they were not involved in a patient’s care, according to the American Medical Association (AMA). While Dr. Malkin says his Caldwell, N.J. practice has not been adversely affected by malpractice issues, he notes that issues with Medicare and third-party payer reimbursement make paying premiums more difficult. He believes the New Jersey Podiatric Medical Society has done its best to educate its members about malpractice carriers. However, he notes the society cannot control premium increases raises from the Podiatry Insurance Company of America (PICA) because PICA does not share its claims experience with the state society. “In the long run, a practical monopoly is never a good thing, now matter how well run, in most industries,” contends Dr. Malkin. Oklahoma Gov. Brad Henry signed a bill that imposes a noneconomic damages cap of $300,000. This amount was previously only applied to obstetricians and emergency physicians but the new law extends this damages cap to all physicians, according to the AMA. In Ohio, where a $350,000 cap on economic damages has been in place since 2002, Gov. Bob Taft signed a bill that tightens requirements for witnesses in malpractice lawsuits and is geared toward reducing the number of lawsuits without merit filed against physicians, according to the AMA. Reforms failed in New Hampshire, as the Senate rejected a $250,000 cap, and in Missouri, where the governor vetoed a bill that would have capped noneconomic damages at $400,000, down from the current $565,000 cap, the AMA reports. As this issue went to press, the Senate Judiciary Committee in Pennsylvania tabled its consideration of amending the state Constitution to cap noneconomic damages in malpractice lawsuits. Emerging Clinical Trials Emphasize Healing Potential Of Oasis By Brian McCurdy, Associate Editor Three recent clinical trials have demonstrated the efficacy of Oasis® Wound Matrix (Healthpoint) in comparison with other healing modalities. These studies were presented at the recent Symposium on Advanced Wound Care and the 36th Annual Conference of the Wound, Ostomy and Continence Nurses Society. Robert G. Frykberg, DPM, the Associate Chairman of the Podiatry Section at the Carl T. Hayden VA Medical Center in Phoenix, Ariz., was involved in the clinical trials and finds Oasis a useful adjunct to wound management. He says the product is a collagen matrix that helps expedite wound repair and enhances the development of granulation tissue. Citing the advantages of the product, Dr. Frykberg says Oasis is available in several sizes, has a longer shelf life, does not require special storage and is less costly than many other advanced biological dressings. He notes the matrix has shown superiority in venous ulcer trials as well as equivalence with growth factor therapy in a diabetic foot ulcer trial. In the first of the aforementioned clinical trials, a study of 120 patients who had venous ulcers, researchers found the incidence of healing within a 12-week period was 53 percent greater with Oasis as opposed to the standard care group. Another study of 130 patients with pressure ulcers found that at the 90 percent-healed endpoint, Oasis showed a 41 percent improvement over the standard care group. The third study tracked 98 patients who had ulcers resulting from diabetes-related circulation problems. Researchers found the incidence of healing within the group treated with Oasis was 75 percent greater than the incidence of healing within the group treated with a gel containing human platelet-derived growth factor (PDGF). Dr. Frykberg, a Fellow and Past President of the American College of Foot and Ankle Surgeons, says he also uses Oasis for post-traumatic wounds, dehiscences, lacerations and abrasions. In Brief The American Podiatric Medical Association (APMA) has awarded Gris-PEG® (griseofulvin ultramicrosize) Tablets its Seal of Approval, according to the manufacturer Pedinol Pharmacal, Inc. The APMA also gave Seals of Approval to Pedinol products Lazerformalyde® Solution, Lactinol-E® Crème and Lotion, and Fungoid® Tincture. Stratus Pharmaceuticals, Inc., recently announced that its enzymatic debriding ointments Kovia and Ziox are now also available in unit dose packets. The company says the unique single use packets will help prevent cross contamination. It also notes the packets are included in all the GPO contracts. The Orthotic Group has established a rental program for its GaitScan pressure analysis system. Qualified practitioners can use the GaitScan technology in conjunction with pre-existing examination processes for free, according to the company. For more information, contact (800) 551-3008. AMICAS, Inc., the Web-based picture archiving and communications systems (PACS) company, has received top rating for PACS in the KLAS Top 20: 2004 Mid-Year Report Card. The company is a VitalWorks subsidiary. MediNotes’ CEO and President Don Schoen has received the Entrepreneur of the Year Award as a regional winner for Iowa/Nebraska in the “Realizing Business Potential” category. Schoen co-founded the medical software company. Langer, Inc. has appointed Charles A. Berhang its Vice President of Clinical Sales. Berhang was previously a National Sales Manager with Coloplast Corp.

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