Study finds diabetes drug may prevent, slow kidney disease

In this Sept. 24, 2018 file photo, a patient undergoes dialysis at a clinic in Sacramento, California. Results of a study released on April 14, 2019 show that the diabetes drug Invokana has been shown to help prevent or delay worsening of kidney disease, which causes millions of deaths each year and requires hundreds of thousands of people to use dialysis to stay alive. (AP Photo/Rich Pedroncelli)
Updated 15 April 2019
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Study finds diabetes drug may prevent, slow kidney disease

WASHINGTON: A drug that’s used to help control blood sugar in people with diabetes has now been shown to help prevent or slow kidney disease, which causes millions of deaths each year and requires hundreds of thousands of people to use dialysis to stay alive.
Doctors say it’s hard to overstate the importance of this study, and what it means for curbing this problem, which is growing because of the obesity epidemic.
The study tested Janssen Pharmaceuticals’ drug Invokana. Results were discussed Sunday at a medical meeting in Australia and published by the New England Journal of Medicine.
About 30 million Americans and more than 420 million people worldwide have diabetes , and most cases are Type 2, the kind tied to obesity. It occurs when the body can’t make enough or properly use insulin, which turns food into energy.
This can damage the kidneys over time, causing disease and ultimately, failure. In the US, it’s responsible for nearly half a million people needing dialysis, and for thousands of kidney transplants each year.
Some blood pressure drugs lower this risk but they’re only partially effective. The new study tested Invokana, a daily pill sold now to help control blood sugar, to see if it also could help prevent kidney disease when added to standard treatments.
For the study, about 13,000 people with Type 2 diabetes and chronic kidney disease from around the world were to be given Invokana or dummy pills. Independent monitors stopped the study early, after 4,400 people had been treated for about 2.5 years on average, when it was clear the drug was helping.
Those on the drug had a 30% lower risk of one of these problems — kidney failure, need for dialysis, need for a kidney transplant, death from kidney- or heart-related causes, or other signs that kidneys were failing.
For every 1,000 people taking the drug for 2.5 years, there would be 47 fewer cases of one of these problems, researchers estimate.
Rates of serious side effects were similar in the drug and placebo groups including leg, foot or toe amputations, a concern raised by a previous study of Invokana. One side effect, when the body can’t produce enough insulin, was more frequent among those on Invokana but rare overall.
Janssen, which is part of Johnson & Johnson, sponsored the study and many authors work or consult for the company. The drug costs about $500 a month in the US Out-of-pocket costs for patients may be different, depending on insurance.
The importance of this large and well-done study “cannot be overstated,” Drs. Julie Ingelfinger and Clifford Rosen, editors at the medical journal, wrote in an accompanying article.
In recent years, several studies have found that Invokana and some similar drugs can lower heart risks. The new results, showing that Invokana also may stall or prevent kidney failure, expand the potential benefits of the drug.


Blankets, bed-sharing common in accidental baby suffocations

In this March 22, 2012 file photo, a doctor demonstrates how an infant can die due to unsafe sleeping practices using a scene re-enactment doll in Norfolk, Va. (AP)
Updated 22 April 2019
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Blankets, bed-sharing common in accidental baby suffocations

  • The authors studied 2011-2014 data from a Centers for Disease Control and Prevention registry of deaths in 10 states
  • Young babies can’t easily move away from bedding or a sleeping parent; all of the study deaths were in infants younger than 8 months old

CHICAGO: Accidental suffocation is a leading cause of injury deaths in US infants and common scenarios involve blankets, bed-sharing with parents and other unsafe sleep practices, an analysis of government data found.
These deaths “are entirely preventable. That’s the most important point,” said Dr. Fern Hauck, a co-author and University of Virginia expert in infant deaths.
Among 250 suffocation deaths, roughly 70 percent involved blankets, pillows or other soft bedding that blocked infants’ airways. Half of these soft bedding-related deaths occurred in an adult bed where most babies were sleeping on their stomachs.
Almost 20 percent suffocated when someone in the bed accidentally moved against or on top of them, and about 12 percent died when their faces were wedged against a wall or mattress.
The authors studied 2011-2014 data from a Centers for Disease Control and Prevention registry of deaths in 10 states. The results offer a more detailed look at death circumstances than previous studies using vital records, said lead author Alexa Erck Lambert, a CDC researcher.
The authors said anecdotal reports suggest there’s been little change in unsafe sleep practices in more recent years.
“It is very, very distressing that in the US we’re just seeing this resistance, or persistence of these high numbers,” Hauck said.
The study was published Monday in Pediatrics.
For years, the US government and the American Academy of Pediatrics have waged safe-sleep campaigns aimed at preventing accidental infant suffocations and strangulations and sudden infant death syndrome. These include “back to sleep” advice promoting having babies sleep on their backs, which experts believe contributed to a decline in SIDS deaths over nearly 30 years. But bed-sharing has increased, along with bed-related accidental suffocations — from 6 deaths per 100,000 infants in 1999 to 23 per 100,000 in 2015, the researchers note.
Dr. Rachel Moon, a University of Virginia pediatrics professor not involved in the study, said the results are not surprising.
“Every day I talk to parents who have lost babies. They thought they were doing the right thing, and it seems safe and it seems OK, until you lose a baby,” Moon said.
Some studies have found bed-sharing increases breastfeeding and it’s common in some families because of cultural traditions. Others simply can’t afford a crib.
Erika Moulton, a stay-at-home mom in suburban New York, said bed-sharing was the only way her son, Hugo, would sleep as a newborn. Moulton struggled with getting enough sleep herself for months, and while she knew doctors advise against it, bed-sharing seemed like the only option.
Now 14 months old, “he’s still in our bed,” she said. “Trying to transition him out is a little difficult.”
The pediatricians group recommends that infants sleep on firm mattresses in their own cribs or bassinets but in their parents’ room for the first year. A tight-fitting top sheet is the only crib bedding recommended, to avoid suffocation or strangulation.
Young babies can’t easily move away from bedding or a sleeping parent; all of the study deaths were in infants younger than 8 months old.