Curalin Supplement for Patients with Type 2 Diabetes Mellitus

OBJECTIVE

To examine the efficacy and safety of Curalin supplement in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Adult patients with type 2 diabetes were randomized 1:1 to receive Curalin supplement or placebo. The primary endpoint was HbA1c decrease at 1-month. The secondary endpoint was decrease in HbA1c by more than 0.5% and 1%, and change in 7 daily blood glucose measurements. Satisfaction questionnaire was used as an exploratory endpoint. Safety variables and adverse events were assessed.

RESULTS

After 1 month of intervention, HbA1c was reduced by 0.94% in the Curalin arm vs. 0.4% in the placebo arm (P=0.008). 72% of Curalin patients had decreased HbA1c levels >0.5% vs. 35% in the placebo arm (P<0.05). Treatment Satisfaction Questionnaire indicated that Curalin arm patients reported higher overall satisfaction.

CONCLUSIONS

Curalin treatment significantly reduced HbA1c over a 1-month period and was well-tolerated. This article is protected by copyright. All rights reserved.

An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction

BACKGROUND

Endoscopic sphincterotomy and stone extraction are standard procedures for the removal of bile duct stones. Stone recurrence can, however, occur in up to 25% of cases. Risk factors have been poorly defined, but are believed to be related to bile stasis. This study investigated whether an angulated common bile duct (CBD) that may predispose to bile stasis influences symptomatic stone recurrence after successful endoscopic therapy.

METHODS

This study included 232 consecutive patients (mean age, 64.1 years; 86 men) who had undergone therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones. Data from the follow-up period (36 +/- 17 months) were obtained from medical records and patient questioning. Common bile duct angulation and diameter were measured from the cholangiogram after stone removal.

RESULTS

Symptomatic bile duct stones recurred in 16% of the patients (36/232). Three independent risk factors were identified by multivariate analysis: an angulated CBD (angle, < or = 145 degrees; relative risk [RR], 5.2; 95% confidence interval [CI], 2.2-12.5; p = 0.0002), a dilated CBD (diameter, > or = 13 mm; RR, 2.6; 95% CI, 1.2-5.7; p = 0.017), and a previous open cholecystectomy (RR, 2.7; 95% CI, 1.3-5.9; p = 0.0117). Gender, age, urgency of procedure, or a periampullary diverticulum did not influence the recurrence rate.

CONCLUSIONS

Angulation of the CBD (< or = 145 degrees) on endoscopic cholangiography, a dilated CBD, and a previous open cholecystectomy are independent risk factors for symptomatic recurrence of bile duct stones. The findings support the role of bile stasis in stone recurrence. Further studies using these data prospectively to identify high-risk patients are warranted.

Recurrent symptomatic common bile duct stones after endoscopic stone extraction in elderly patients

BACKGROUND

Endoscopic sphincterotomy (EST) and stone extraction are established therapeutic procedures for common bile duct (CBD) stones. Little is known about the outcomes of EST for CBD stones among elderly patients.

OBJECTIVES

To examine the rate and the risk factors (CBD dilation and/or angulation, periampullary diverticulum, and past open cholecystectomy) for recurrent symptomatic CBD stones after EST in the elderly.

DESIGN AND PATIENTS

A total of 228 patients who underwent EST for CBD stones in the period 1997 to 2004 were included. Follow-up data were obtained from medical records and by questioning all the patients. The correlation between age and stone recurrence, as well as between age and the prevalence of risk factors for recurrence was calculated. In addition, a subgroup of 45 elderly patients aged > or =80 years was compared with a control subgroup of 51 young patients aged < or =50 years, in terms of stone recurrence and associated risk factors.

SETTING

Single-center, retrospective study.

INTERVENTIONS

Endoscopic sphincterotomy.

MAIN OUTCOME MEASUREMENTS

Symptomatic CBD stone recurrence rate and frequency of risk factors for it.

RESULTS

In the group of all patients, a correlation was found between the age and stone recurrence, as well as between age and the known risk factors for recurrent stones. In analyzing the 2 subgroups, CBD stones recurred in 20% of the elderly patients compared with 4% of the young patients. Risk factors for recurrent CBD stones were more common in the elderly, and so was the presence of multiple risk factors in the same patient.

CONCLUSIONS

Recurrence of symptomatic CBD stones after endoscopic therapy was more frequent in the elderly patients because of an increased frequency of risk factors.