Type 2 Diabetes Takes Toll on Teens

(HealthDay News) -- With the incidence of type 2 diabetes and its complications among young people on the increase worldwide, aggressive measures are needed to treat and prevent the disease, two diabetes experts say.

Their article appears in the May 26 issue of The Lancet.

"The complications associated with adolescents' type 2 diabetes seems to behave differently than in children and adolescents with type 1 diabetes," said article co-author Dr. Orit Pinhas-Hamiel, of the Pediatric Endocrinology and Diabetes Department at Sheba Medical Center in Tel-Hashomer, Ramat-Gan, Israel.

These complications may be present at the time of diagnosis, and their rate of progression may be higher than in children and adolescents with type 1 diabetes, Pinhas-Hamiel said. "We need to develop improved approaches to awareness and early treatment of type 2 diabetes and associated abnormalities."

These complications, including high blood pressure, kidney disease, eye disease and problems with blood fat levels, may already be present when type 2 diabetes is diagnosed, while they rarely exist at the onset of type 1 diabetes, noted Pinhas-Hamiel and her colleague Dr. Philip Zietler, from the Department of Pediatrics at the University of Denver.

"In addition, studies to date suggest that early onset of type 2 diabetes is associated with a more rapid progression of these complications compared with adolescents with type 1 diabetes," Pinhas-Hamiel said.

Moreover, psychiatric problems are also associated with type 2 diabetes. In a study in Philadelphia, one in five such teens suffered from conditions such as depression, obsessive-compulsive disorder or other psychiatric conditions.

Another study found that the deaths of seven young black males, aged 13 to 21, with undiagnosed diabetes, met the criteria for high blood sugar and diabetic coma, the authors added.

Type 2 diabetes also puts unborn infants at risk. In a Canadian study of 51 pregnant adolescent girls with type 2 diabetes, only 35 had live births, and the pregnancy loss rate was 38 percent, the authors reported.

Pinhas-Hamiel thinks that adolescents with type 2 diabetes should be screened for signs of these complications when they are first diagnosed. "In addition, there is a need for well-established guidelines for the initiation of antihypertensive and anti-lipid treatments for adolescents with type 2 diabetes," she said. "Type 2 diabetes mellitus in children and adolescents is associated with significant morbidity and mortality."

One expert thinks this review confirms that type 2 diabetes in teens has become a serious public health problem.

"Recent studies have confirmed what most of us have long suspected, that the rate of what used to be called adult onset diabetes is rising rapidly in children and adolescents," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.

This study confirms another suspicion that even greater dangers are around the next corner should current trends persist, Katz said.

"In adults, type 2 diabetes is a potent risk factor for cardiovascular disease and other complications, from kidney failure to nerve damage," Katz said. "There is every reason to expect, and now findings to confirm, that these relationships hold in youth as well. When formerly adult onset diabetes develops in 7-year-olds, the threat of heart disease in 17-year-olds clearly looms," he said.

"Anyone who was waiting for an even more strident alarm before accepting that epidemic obesity and type 2 diabetes in our children is a public health crisis of the first order -- this is it," Katz said.

Another expert thinks that overweight adolescents who lead a sedentary life need to be tested for diabetes.

"Here we have a situation where we are not examining our youngsters for diabetes, and they already have complications present or developing," Dr. Stanley Mirsky, of Lenox Hill Hospital in New York City and a board member of the Juvenile Diabetes Foundation, said in a statement.

"We have to test these kids that spend all their time in front of the televisions or computers eating junk food instead of being outside exercising and eating right, especially when there already is a family history of diabetes," Mirsky said.

More information
For more information on diabetes, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

Female Urinary Incontinence Surgeries Go Head-to-Head

(HealthDay News) -- The results of a new head-to-head trial could help women with stress urinary incontinence decide between two surgeries -- called the Burch and the sling -- that are commonly used to correct the condition.

According to the study, "The sling was more effective in resolving urinary incontinence symptoms than the Burch, and it also showed significantly higher satisfaction rates," said study co-author Dr. Michael E. Albo, an associate professor of surgery at the University of California, San Diego. "The trade-off was that there were higher rates of complications with the sling."

The findings were presented Monday at the American Urological Association's annual meeting in Anaheim, Calif. They will also be published in the May 24 issue of The New England Journal of Medicine.

Doctors already have good evidence as to the benefits and risks of both of these procedures, Albo said, since more than 100,000 operations for urinary incontinence are performed in the United States each year. Based on that history, "we can now counsel our patients about what to expect from these procedures," he said.

The Burch and sling procedures are aimed at correcting "stress urinary incontinence" -- leakage that can result from coughing, laughing, sneezing, running or lifting heavy objects. Both of the surgeries are designed to provide support to the bladder neck and urethra during increases in abdominal pressure that happen with these kinds of activities.

In the sling procedure, a sling made from the patient's own tissue is placed around the urethra for additional support. With the Burch method, sutures are attached to a pelvic ligament to support the urethra. Both procedures require an abdominal incision and an overnight hospital stay.

In the study, 655 women with stress urinary incontinence received either the sling procedure or the Burch.

The researchers found that two years after the procedures, 47 percent of the women who had the sling were dry overall compared with 38 percent on the women who had the Burch. For women who suffered stress incontinence, 66 percent who had the sling procedure remained dry compared with 49 percent who had the Burch.

Most women in the study said they were satisfied with the results of their treatment, whichever surgery they had received. However, 86 percent women with the sling surgery were satisfied compared with 78 percent of women who had the Burch.

On the other hand, there were more side effects noted among women who received the sling, the researchers found. The most common were urinary tract infections, which affected 63 percent of women with a sling and 47 percent of women with a Burch. The sling also had more voiding problems associated with it (14 percent vs. 2 percent) and "persistent urge incontinence" -- the loss of urine just before feeling a strong, sudden urge to empty the bladder (27 percent vs. 20 percent).

Moreover, 19 women with slings had difficulty voiding after treatment, requiring additional surgery to correct the problem. None of the women who underwent the Burch needed corrective surgery for voiding problems.

There are also new procedures that are variations on the sling, Albo noted. In these procedures a synthetic mesh is used to secure the urethra into position. The advantages of these new techniques are that they require a smaller incision, and usually the patient can go home the same day as the procedure is done. For doctors, the mesh is easier to place than making a sling from the patients own flesh, he said.

Albo said studies are under way comparing these newer procedures to both the standard Burch and sling.

"We are in the middle of trials looking at new procedures," added co-author Dr. Linda Brubaker, a professor of obstetrics/gynecology and urology at Loyola University. "These newer procedures are becoming more common," she said.

Another issue surrounding these procedures is sexual function. While data on which procedure is best in terms of sexual function has not been released, Brubaker said that, typically, "When incontinence improves, sexual function responds as well."

Incontinence is more than just an annoyance, she added. "Incontinence is not painful or life-threatening," Brubaker said. "But, it dramatically decreases the quality of life for women," she said.

One expert believes the study will help doctors and patients in choosing which procedure is best for them.

"Incontinence is fixable," said Dr. John Lavelle, the director of urophysiology at the University of North Carolina. "At least half the patients will be symptom-free after treatment," he said.
Based on this study, patients will most likely opt for the sling, Lavelle said. "There is no answer about whether the mesh sling is better or worse than the tissue sling, although more women seem to be opting for the mesh sling," he said.

Lavelle agreed that treating incontinence can improve sexual function. "A lot of women will tend not to have intercourse with their partner, because they are afraid of being wet," he said. "So, when they are fixed and they are dry, they probably resume sexual activity," he added.
In another presentation scheduled for the same meeting, researchers at the University of Pittsburgh School of Medicine used stem cells to treat women with stress urinary incontinence. The procedure strengthened patients' sphincter muscles, providing them with long-term improvement.

Of the eight women in the trial, five reported improvement in bladder control and quality of life with no serious short- or long-term adverse effects one year after treatment.

"This clinical trial is extremely encouraging, given that 13 million people in the United States, most of them women, cope with stress urinary incontinence," lead researcher Dr. Michael B. Chancellor, a professor of urology and gynecology, said in a prepared statement. "We're demonstrating for the first time that we may be able to offer people with stress urinary incontinence a long-term and minimally invasive treatment option."

More information
Learn more about urinary incontinence at the American Academy of Family Physicians.

Health Tip: Healing Hemorrhoids

(HealthDay News) -- Hemorrhoids occur when veins in the rectum become swollen and painful.

Symptoms may include tender bumps near the anus, or blood found on toilet paper after a bowel movement.

Here are suggestions on how to help them heal and ease the pain, courtesy of the American Academy of Family Physicians:
Sit in a warm bath.
Use baby wipes or moist toilet paper after each bowel movement.
Use ice packs on the area to reduce swelling.
Take an over-the-counter pain reliever to ease pain.
Apply a cream that contains witch hazel, or a hydrocortisone cream to relieve pain and itch.
The academy says you should talk with your doctor before using any hemorrhoid medication.