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This Week in JAMA
June 18, 2008

This Week in JAMA

JAMA. 2008;299(23):2715. doi:10.1001/jama.299.23.2715

In an analysis of data from a longitudinal cohort study of men and women aged 45 to 84 years, Golden and colleagues examined the bidirectional association between depressive symptoms and type 2 diabetes. The authors report that a modestly increased risk of incident diabetes among persons who had depressive symptoms at baseline was partially explained by lifestyle factors. They also found that baseline impaired glucose tolerance and untreated diabetes were inversely associated with incident depressive symptoms, whereas persons with treated diabetes were at increased risk of developing elevated depressive symptoms during follow-up.

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Patients with a biochemical recurrence after radical prostatectomy often have salvage radiotherapy, but it is not known whether this treatment improves survival. In a retrospective analysis of 635 men who developed recurrent disease following radical prostatectomy for clinically localized prostate cancer, Trock and colleagues assessed prostate cancer–specific survival following a biochemical recurrence, local recurrence, or both in men who had salvage radiotherapy alone or combined with hormonal therapy vs no therapy. The authors report that 116 men died of prostate cancer during a median follow-up of 6 years following recurrence. The authors found that compared with no salvage treatment, salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer–specific survival in a subgroup of men whose prostate-specific antigen doubling time was less than 6 months.

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An atypical form of type 2 diabetes mellitus (“ketosis prone”) has recently emerged in persons who are black and of African origin. In a cross-sectional study of adult patients living in France who were born in sub-Saharan African, where human herpesvirus 8 (HHV-8) is endemic, Sobngwi and colleagues investigated the association of HHV-8 infection with ketosis-prone type 2 diabetes. The authors found a significantly higher prevalence of HHV-8 antibodies and the presence of HHV-8 viremia at disease onset in patients with ketosis-prone type 2 diabetes compared with patients with nonketotic type 2 diabetes or nondiabetic controls.

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Cholesteryl ester transfer protein (CETP), which is involved in the exchange of cholesteryl esters for triglycerides, has been a target in new drug development for prevention of coronary disease. However, the safety of CETP inhibitors has been called into question, and whether these agents warrant further study is uncertain. Thompson and colleagues Article report the results of meta-analyses to assess the associations of 6 CETP genotypes with CETP activity, lipid levels, and coronary risk. Among the authors' findings is that several common CETP genotypes associated with moderate inhibition of CETP activity—and thereby modestly increased high-density lipoprotein cholesterol levels—have weakly inverse associations with coronary risk. In an editorial, Wilson Article discusses how summary analyses of genotypes, metabolic information, and clinical outcomes enhance understanding of environment and gene interactions in disease causation.

“Fear is palpable when disease is present, always percolating beneath a veneer of illusory calm.” From “Wanting.”

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Companies using the Internet to speed recruiting of patients for clinical trials may open clinical research to more patients, but critics worry that inadequate regulation of the approach may put patients' interests at risk.

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“Perfect storm” in health care

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Illegal use of growth hormone

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Join Sherita Hill Golden, MD, MHS, July 16 from 2 to 3 PM eastern time to discuss the bidirectional association between depressive symptoms and diabetes. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

How would you manage a 70-year-old man with severe coronary and peripheral artery disease who presents with acute-onset slurred speech and left facial droop? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is June 25.

For your patients: Information about weight and diabetes.

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