Glucosamine, URTIs and diabetes

Too busy to read the journals? Let Dr Simon Hunter guide you through the latest research.

Research of the week
Decline in SIDS - Arch Dis Child 2007; 92: 625-6

Compared with the early 1990s, there is little reported about sudden infant death syndrome (SIDs). This could be because the press has lost interest, but it is probably because of the dramatic decline in deaths (by 63 per cent in New Zealand between 1993 and 2004) following the 'Back to Sleep' campaign urging parents to put their babies to sleep on their backs.

A postal survey carried out in NZ, asking what position they put their baby to sleep in found 72 per cent on their back, 14 per cent on their side and 1.5 per cent on their front (and 12 per cent on side and back).

This shows the message has got through but it is still worth us reinforcing it so this improvement is maintained.

Predicting response to glucosamine
Br J Sports Med 2007; 41: 415-9

Glucosamine is one of the ingredients required to build cartilage, so it was mooted that ingestion would help rebuild cartilage in osteoarthritis.

Studies have lent some weight to this hypothesis.

This particular study tried to ascertain which patients with chronic knee pain in the community would benefit from glucosamine.

It found that glucosamine at 1.5g/day reduced pain and improve mobility at 12 weeks by 77 per cent and 69 per cent respectively. Those more likely to be helped were those with a lower BMI, those with patello-femoral joint osteophytes and those who self-reported more uncertainty about performing tasks.

Portion control
Arch Intern Med 2007; 167: 1,277-83

This caught my eye, because our local professor is very keen on food portion size control as a way to lose weight. This Canadian study used a commercially available plate (the Diet Plate) that has portion sizes marked. Subjects were all obese patients with diabetes.

Over six months those using the plate lost on average 1.8 per cent of their weight, whereas those who did not lost 0.1 per cent of their weight.

Interestingly much greater weight loss was seen in those patients who needed insulin. More importantly, those who used the plate were able to reduce diabetic medication.

More than just a cold
Arch Dis Child 2007; 92: 594-7

The amount of antibiotics prescribed for childhood URTIs has fallen, but has now plateaued. This trial from Oxford took viral swabs from children whose GP had considered prescribing an antibiotic as their presentation seemed to be 'more than a simple cold'.

A viral cause was identified in 77 per cent of cases. The use of antibiotics did not alter the parents' perceived resolution of the illness and the type of virus did not have an impact on the length of illness.

The exception was influenza, where antibiotics did seem to help, presumably because of secondary infection. Symptoms the child presented with were poor indicators of whether a virus could be identified.

Rostiglitazone combined with insulin
Arch Intern Med 2007; 167: 1,284-90

A good proportion of patients with type-2 diabetes end up on insulin because of poor control, but this often is not an ideal solution because the primary problem is insulin resistance, not hyposecretion and so there is a risk of ratcheting up the dose with little effect.

In this study, researchers compared insulin plus low dose rosiglitazone (2mg/day or 4mg/day) against insulin plus a placebo. This decreased HbA1c by 0.3 and 0.4 per cent respectively, compared with the placebo group.

The rosiglitazone group also had lower CRP and fibrinogen levels. Adverse effects were similar in both groups, hypoglycaemic events. Some 13-14 per cent more patients were able to get their HbA1c under 7 per cent than the placebo group.

It stands to reason that this combination should work, but it is handy to have evidence to back it up.

Dr Hunter is a GP in Bishop's Waltham, Hampshire, and a member of our team who regularly reviews the journals

The quick study
Glucosamine is more effective in patients with a lower BMI or patello-femoral osteophytes and those reporting uncertainty about performing tasks.

Weight loss is helped with a plate designed to control portion size.

Antibiotic prescribing for URTI in children has declined, but antibiotics are still prescribed in many cases with a viral cause.

Rosiglitazone in combination with insulin gives better glycaemic control than insulin alone in patients with type-2 diabetes.

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