Evidence-Based Medicine by ProQuest


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									           Evidence-Based Medicine
  This department uses the best available scientific findings to offer practice guidance on a wide range of
  conditions seen in primary care.The author, Alan Ehrlich, MD, is a deputy editor for DynaMed, Ipswich,
  Mass., and assistant clinical professor in Family Medicine, University of Massachusetts Medical School, in
  Worcester. DynaMed (www.ebscohost.com/dynamed/) is a database that provides evidence-based infor-
  mation on more than 3,000 clinical topics and is updated daily through systematic surveillance covering
  more than 500 journals.The most important evidence identified is summarized here.

STATINS SLIGHTLY INCREASE                                                         levels compared with placebo (-2.2 µmol/L vs.
RISK OF DIABETES                                                                  +2.6 µmol/L, P <0.001), it was associated with an
A recent systematic review assessed the relation-                                 increase in the composite outcome of myocardial
ship between statin use and diabetes with data                                    infarction, stroke, revascularization, and all-cause
on 91,140 patients from 13 randomized trials.                                     mortality (23.5% vs. 14.4%, P=0.04, NNH 11).
Over mean follow-up of four years, statin use                                     The trial was inadequately powered to show dif-
was associated with a small increase in new-onset                                 ferences in individual cardiovascular outcomes.
diabetes (4.89% vs. 4.5%, odds ratio 1.09, 95%                                    Treatment with B vitamins also had a detrimental
CI 1.02-1.17). The number needed to harm                                          effect on kidney function, significantly reducing
(NNH) was 255 patients treated with statins for                                   the mean glomerular filtration rate (16.5 mL/
four years to result in one additional diabetes                                   minute/1.73 m2 vs. 10.7 mL/minute/1.73 m2,
case. Diabetes risk with statins was highest in                                   P=0.02). Due to these adverse outcomes, the
trials with older patients. Because the risk of                                   authors recommend that B vitamins not be used
diabetes is low in comparison to the beneficial                                    to lower homocysteine levels ( JAMA. 2010;303:
effects of statins on cardiovascular events, the        B vitamin                 1603-1609).
authors do not recommend changing statin treat-         formulations
ment in patients with or at risk of cardiovascular                                LACTOBACILLUS GG MAY
disease (Lancet. 2010;375:735-742).
                                                        with B12 and              DECREASE RISK OF
                                                        high doses of             NOSOCOMIAL RESPIRATORY
TREATMENT WITH HIGH-DOSE                                folate and B6             AND GI INFECTIONS IN
FOLIC ACID, VITAMIN B6,                                                           HOSPITALIZED CHILDREN
                                                        have been used            Level 2: Mid-level evidence
ADVERSE OUTCOMES IN                                     to reduce                 Children can be at high risk of infections during
PATIENTS WITH DIABETIC                                  homocysteine              hospital stays, and measures commonly used to
NEPHROPATHY                                             levels.                   prevent nosocomial infections (e.g., hand hygiene)
Level 2: Mid-level evidence                                                       are not completely effective. A randomized
Nephropathy is a common complication of dia-                                      trial with 742 children evaluated the efficacy
betes and has been associated with high plasma                                    of Lactobacillus GG for preventing hospital-
homocysteine levels. Because B vitamin formu-                                     acquired infections (Pediatrics. 2010;125
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