Search

Purpose Incretin-based medications are a novel class of agents for the treatment of type-2 diabetes mellitus (DM2). The safety profile of these medications is not firmly established, and concerns have been raised about their potential carcinogenicity. The objective of our study was to produce new evidence on the effect of incretin-based medications on cancer risk in patients with DM2. Methods We conducted a "retrospective cohort" study with data from the Clinical Practice Research Datalink and the Hospital Episodes Statistics in the UK. New users of either an incretin-based medication (n = 18 885) or a sulfonylurea medication (n = 36 929) between 2007 and 2013 were identified and followed for up to 8 years. Cox proportional-hazards models were used to estimate the quasi-intention-to-treat and quasi-per-protocol hazard-ratios for the association between incretin-based medications with cancer while adjusting for potential confounders. Results The adjusted hazard ratio (95% confidence interval) for use of incretin-based medications versus use of sulfonylurea medications for the overall-cancer outcome was 0.97 (0.90, 1.05) in the quasi-intention-to-treat analysis and 0.90 (0.81, 1.00) in the quasi-per-protocol analysis. In both analyses, the hazard-ratio functions over the 8-year follow-up seemed fairly constant, and the 8-year cumulative-risk functions in the two subcohorts were similar. Conclusions Our study suggests that the use of incretin-based medications in patients with DM2 does not increase the risk of cancer relative to the use of sulfonylurea medications, at least in the first several years of the use. Further research is needed to assess long-term effects of the use of incretin-based medications on cancer risk.

Summary Objective The objective of the study was to test the hypothesis that greater fluctuations in physical activity lead to greater increases in body fat during adolescence. Methods Seven hundred fifty-six adolescents in Montreal, Canada, aged 12–13 years at baseline, completed a 7-d physical activity recall questionnaire every 3 months over 5 years. Body mass index (BMI), waist circumference, and triceps and subscapular skinfold thickness were measured at baseline and at the end of follow-up. Subject-specific linear regressions, expressing physical activity as a function of time, were fitted and physical activity fluctuation scores were obtained by averaging the absolute values of regression residuals. The association between body fat after 5 years and the physical activity fluctuation score was assessed in linear regressions adjusting for baseline body fat, average number of physical activity sessions per week, diet and sociodemographic variables. Results Among boys, there were statistically significant positive associations between physical activity fluctuation and BMI (β, 95% confidence interval: 0.12, 0.02–0.21) and triceps skinfold (0.40, 0.17–0.63). The associations with waist circumference or subscapular skinfold were not statistically significant (0.22, −0.04–0.49; 0.13, −0.05–0.32, respectively). In girls, there were statistically significant negative associations between physical activity fluctuation and BMI (−0.12, −0.20 to −0.03), waist circumference (−0.54, −0.91 to −0.17), subscapular skinfold (−0.41, −0.56 to −0.26) and triceps skinfold (−0.22, −0.38 to −0.05). Conclusion Physical activity fluctuations appear to affect body fat during adolescence. Sex-specific interventions may be needed given that greater physical activity fluctuations seem unfavourable for boys and beneficial for girls.

Objectives: To conduct a systematic review of the literature on the determinants of hospital emergency department (ED) visits by elders, using a modification of the Andersen behavioral model of health services, adapted to explain ED utilization. Methods: Relevant articles were identified through MEDLINE and a search of reference lists and personal files. Studies of populations aged 65 or older in which ED visits were a study outcome were included if they were: original, not restricted to a particular medical condition, written in English or French, and investigated one or more determinants. Data were abstracted and checked by two authors using a standard protocol. Results: Fourteen studies (reported in 15 articles) were reviewed, 10 community-based and four using clinical samples. Among ten studies that measured multiple determinants, determinants reported from multivariate analyses included measures of need (perceived and evaluated health status, prior utilization), predisposing factors (health beliefs and sociodemographic variables), and enabling factors (physician availability, regular source of care, family resources, geographical access to services). Conclusions: Need is usually the primary determinant of ED visits in older people. Controlling for need, predisposing and enabling factors that promote access to primary medical care are associated with reduced ED utilization.