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Anchor lead: Electronic cigarettes outperform other smoking cessation aids, Elizabeth Tracey reports

Smokers who were attempting to quit who used e-cigarettes to assist them were successful more often and remained nonsmokers in greater numbers than those who used other nicotine replacement aids, a recent study found. Michael Blaha, a cardiologist at Johns Hopkins, describes the findings.

Blaha: More smokers quit smoking in the electronic cigarette arm than in the traditional nicotine replacement therapy arm. About 18% quitting in the e-cigarette group and about 10% with the nicotine replacement group. Now there’s some good and some bad in this study. The good is that more people quit using electronic cigarettes.  The bad is of course that 80% or more people still remained smoking at the end of the trial. And unfortunately, of those people that were randomized to electronic cigarettes, that remained smokers, 20% of them continued using electronic cigarettes as well, and are now so called duel users. :30

Blaha notes that there is clearly still a lot of room to develop effective aids to help people stop smoking, but that the best strategy remain avoidance of all nicotine products. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What can patients who need insulin do when it comes to pricing? Elizabeth Tracey reports

If you’re a person who takes insulin for diabetes and you can’t afford your medication, tell your healthcare provider. That’s the advice of Rita Kalyani, a diabetes expert at Johns Hopkins, who says that while Congress is wrestling with out of sight insulin prices, you and your doctor can work together to craft a solution that works for you.

Kalyani:  What this has really brought to mind for me as a healthcare provider is that when I see patients in clinic to really think about the cost of the therapies that we’re prescribing. To look at the insurance coverage that they have and to ask patients if they’re having any difficulty filling their prescriptions. We take it for granted that when we write a prescription patients will be able to fill it but that might not be the case and we do have other options for patients that can’t do that. There are many low cost options.  :26

Kalyani says older insulins may not offer the convenience of the newer types but are substantially less expensive. She notes that a slight rise in blood sugar may occur when a switch is made but then it normalizes. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the alternatives to sky high insulin prices? Elizabeth Tracey reports

Insulin, the injectable drug that brings blood sugar down in millions of people with diabetes, has been around for decades. Why then is the price of insulin front and center when it comes to Congressional investigation of drug prices? Rita Kalyani, a diabetes expert at Johns Hopkins, says insulin comes in many types, and it’s the newer forms that are so very expensive.

Kalyani: The newer insulins often can be better for patients in terms of quality of life. Many patients prefer to take them because they don’t have as much low blood glucose or hypoglycemia, you can take them with your meal, you don’t have to wait necessarily a long period of time before eating and they tend to have a longer duration of action so some of them can reduce the frequency of injection, so for this reason we tend to prefer them clinically, but when you look at the cost of these insulins and how much some of our patients have to pay they may not be the preferred insulin.  :30

Kalyani notes that many people with diabetes can switch to the older, cheaper forms of insulin with no lasting compromise of controlling blood sugar. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The poster child for out of control drug prices is insulin, Elizabeth Tracey reports

Congress is looking closely at skyrocketing drug prices, with one obvious example the drug insulin. This life-preserving medicine is required by millions of people with diabetes, yet prices for many types of insulin just keep going up. Rita Kalyani, a diabetes expert at Johns Hopkins, says to get insulin pricing under control, understanding the entire supply chain is critical.

Kalyani: There are multiple parts of the chain that determine insulin pricing and I think part of what the spotlight on this issue has been has been to better understand where in that chain that prices are really being driven up, how we can contain these prices, and what other options we have for patients who can’t afford the insulin until these prices come down. But it’s been phenomenal how much insulin prices have increased particularly for these newer insulins.  :27

Kalyani says price increases are out of step with inflation and need to be scrutinized closely. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: People with diabetes visit the emergency department a lot, Elizabeth Tracey reports

Diabetes tops the list for medical conditions among older frequent users of emergency departments, a recent national study revealed. Rita Kalyani, a diabetes expert at Johns Hopkins, isn’t surprised by the results.

Kalyani: What I think the study indicates is that we need to better understand why people with diabetes account for such a great proportion of these high frequency users to the emergency room. I would be interested to know what treatments they’re on which wasn’t recorded in this study. We do know that people who use insulin for instance are more likely to visit the emergency room and if that is indeed the case then that is something that we could explore further in other studies, particularly as it relates to low blood glucose or hypoglycemia in older adults.  :29

The study notes that adults 65 and older represent about 15% of all emergency department visits nationally, and that such patients stay longer, and typically require more interventions and resources than other groups.  Kalyani says one-fourth of adults over 65 have diabetes, so understanding why they end up in the ED is crucial. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How are obesity and asthma related? Elizabeth Tracey reports

Asthma, a condition where the airways in the lungs constrict, can be life-threatening, and is known to be worse in obese people than in those who are not. One question that isn’t understood is whether it’s the diet overweight people consume or presence of too much adipose tissue that’s the culprit. Now a Johns Hopkins study led by Seva Polotsky, a pulmonary and critical care expert, seems to point to the extra fat rather than the type of calories consumed.

Polotsky: It’s already well known that obesity is associated with asthma. What is not known is what component of obesity or whether its obesity itself or a particular diet. A premise of our study was to differentiate the effects of obesity from the effects of different types of diet. The bottom line is it doesn’t matter what you eat, it really matters how much.    :22

Polotsky examined the impact of high fat, high sugar and what he calls typical bad Western diet consumption in overweight mice, and found that the type of calories were irrelevant in asthma attacks. The research also showed a drug called anakinra helped. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Does keeping blood pressure in control reduce your risk of dementia? Elizabeth Tracey reports

Keeping blood pressure in check didn’t reduce the development of dementia in older people, a recent study found, although the condition known as ‘mild cognitive impairment’ did decrease in those whose blood pressure was controlled. Constantine Lyketsos, an Alzheimer’s disease expert at Johns Hopkins, comments.

Lyketsos: I don’t think this is disappointing. I think this is a step in the process of understanding the relationship between blood pressure and cognitive outcomes. My bet would be that if they did this aggressive blood pressure control in fifty to sixty five year olds that it would be impactful.  :18

Lyketsos notes that blood pressures that are too low can be harmful.

Lyketsos: What’s the right blood pressure for an older person? Over 75, in that age group aggressive blood pressure management is probably harmful, because people need a higher blood pressure to perfuse their brain.  :11

At Johns Hopkins, I’m Elizabeth Tracey.

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