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May 2009

Is tighter glucose control better for the heart in diabetes?

Ami Banerjee
Last edited 7th June 2009
The global burden of diabetes mellitus (DM) is the theme of this week’s Lancet. Four-fifths of the 225 million diabetic patients live in developing countries and type 2 DM is the most common form. The major cause of morbidity and mortality is coronary heart disease (CHD). Tight control of glucose in diabetic patients has a proven benefit for microvascular disease (retinopathy, nephropathy and neuropathy) [1]. However, the existing trials have not consistently shown a benefit for macrovascular disease (coronary heart disease, or CHD, and stroke) [2].

464,000 people can’t be wrong, or can they?

Carl Heneghan
Last edited 7th June 2009
In this week’s BMJ Law and colleagues have undertaken a notable meta-analysis on the use of blood pressure lowering treatments from randomized controlled trials. For the BMJ this is an impressive piece, signalling a potential return to some of the significant research published in the past. For instance, in the early 90s nearly a whole edition of the BMJ was given over to the aspirin triallist collaboration systematic reviews. In those days, all of the report appeared in the print version, whereas today the print version carries a meagre synopsis whilst the pdf downloadable from the web runs to an impressive 19 pages.

Bang for buck

Ami Banerjee
Last edited 26th May 2009
Cost effectiveness is flavour of the week, whether in relation to the NHS, global health or politics. It makes sense to optimise use of limited resources, particularly public goods (e.g. taxpayers’ money). The Gates Foundation (GF) has changed the global health landscape both in terms of scale of funding and policy agenda. This week’s Lancet focused on the GF’s efficiency, based on an analysis of its funded projects [1-3]. It awarded 1094 global health grants over the last decade: a massive US$8·95 billion, of which $5·82 billion (65%) was shared by only 20 organisations. 40% of all funding was given to “supranational” organizations such as the World Health Organisation. Of the remaining amount, 82% went to recipients based in the USA. Just over a third ($3·27 billion) of funding was allocated to research and development (mainly for vaccines), or to basic science research [1].
More than 25% of global child mortality occurs in India (greater than 2 million deaths in children younger than 5 years) [1]. The spectrum of child underdevelopment runs from underweight to stunting and wasting. Nearly half of Indian children are underweight and 70% are anaemic [2]. Therefore, studies of the causes of mortality and nutritional outcomes in children should include representative data from India. Last week’s JAMA reported a study conducted in India which investigated the role of a mother’s height in determining her child’s mortality and development [3].

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