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6 February 2001 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656. Full content of the issue is available on the Internet at on January 16, 2001.

Young Women at Greater Risk for Death After Heart Attacks than Men

Women younger than 60 had a higher mortality rate after heart attacks than men of the same age, a new study found (Article, p. 173). Women younger than 50 had an almost threefold higher risk for death after a heart attack than men. Researchers looked at medical records of 6,826 people who had been discharged from the hospital following a myocardial infarction. The interaction between sex, age and mortality after heart attack shifted until, among the oldest patients, women tended to have a lower two-year mortality than men of similar age. An editorial says that the study’s findings indicate that practicing physicians should make sure that both high-risk groups -- middle-aged women and men over 80 -- receive all proven effective treatments such as cardiac drugs, antidepressants, smoking cessation counseling and cardiac rehabilitation (Editorial, p. 239).

Inhaled Insulin Shows Some Promise for Treating Type 2 Diabetes

A three-month study of 26 adults with type 2 (adult-onset) diabetes found that inhaled insulin treatment improved blood sugar control without serious side effects (Brief Communication, p. 203). Currently, the most common method of administering insulin is by injection, and the most effective schedule for achieving normal blood sugar levels involves frequent injections. The frequent or intensive injection schedule has not gained widespread acceptance because, in addition to causing physical discomfort, it requires substantial time, effort, commitment and communication for both the patient and physician. Inhaling insulin could be a welcome alternative. An accompanying editorial says that this very preliminary study had no control group to determine if the inhaled therapy was as good as conventional injected therapy; used relatively large dosages of inhaled insulin since the lung does not absorb insulin efficiently; achieved only "modest" blood sugar control and did not address long-term safety issues (Editorial, p. 242).

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