In patients presenting with a minimal trauma non-vertebral fracture, active identification and management significantly reduces the risk of refracture (Australian New Zealand Clinical Trials Registry ACTRN 12606000108516).

Introduction. Obesity and diabetes are difficult to treat in public clinics. We sought to determine the effectiveness of the Metabolic Rehabilitation Program (MRP) in achieving long-term weight loss and improving glycaemic control versus “best practice” diabetes clinic (DC) in obese patients using a retrospective cohort study. Methods. Patients with diabetes and BMI > 30 kg/m2 who attended the MRP, which consisted of supervised exercise and intense allied health integration, or the DC were selected. Primary outcomes were improvements in weight and glycaemia with secondary outcomes of improvements in blood pressure and lipid profile at 12 and 30 months. Results. Baseline characteristics of both cohorts (40 MRP and 40 DC patients) were similar at baseline other than age (63 in MRP versus 68 years in DC, P = 0.002). At 12 months, MRP patients lost 7.65 ± 1.74 kg versus 1.76 ± 2.60 kg in the DC group (P < 0.0001) and 9.70 ± 2.13 kg versus 0.98 ± 2.65 kg at 30 months (P < 0.0001). Similarly, MRP patients had significant absolute reductions in %HbA1c at 30 months versus the DC group (−0.86 ± 0.31% versus 0.12% ± 0.33%, P < 0.038), with nonsignificant improvements in lipids and blood pressure in MRP patients. Conclusion. Further research is needed to establish the MRP as an effective strategy for achieving sustained weight loss and improving glycaemic control in obese patients with type 2 diabetes.

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Background: Bisphosphonate therapy has been readily accepted as standard of care for individuals with bone metastases from breast cancer. In this study we determined whether the proportion of patients experiencing a skeletal related event (SRE) in a clinical practice population was similar to that observed in phase III randomized controlled studies.

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Glulisine (Apidra TM) is a rapid acting recombinant insulin analogue which differs from regular human insulin (RHI) by the substitution of lysine for asparagine at position B3 and glutamic acid for lysine at position B29. The chemical name is 3B-Lys-29-B-Glu-human insulin.The amino acid substitutions of glulisine and other rapid acting insulin analogues promote monomer stability, allowing for rapid dissociation and absorption after subcutaneous injection. It has a favourable pharmacokinetic and pharmacodynamic profile when compared with RHI, characterised by quicker absorption and a greater early disposal of glucose, thus replicating a more physiological response to a meal. It has been demonstrated to be superior to RHI in patients with Type 1 diabetes mellitus (DM) and at least non-inferior in the management of Type 2 DM with respect to reducing HbA1c and post-prandial glucose excursions, with a comparable safety profile. In efficacy trials comparing glulisine with lispro in patients with type 1 DM, glulisine was non-inferior with no significant difference in change in HbA1c or post-prandial glucose levels. However, although glulisine and lispro have been demonstrated to induce comparable total glucose disposals in normal subjects, glulisine causes earlier glucose disposal in both lean and obese subjects, has significantly faster subcutaneous absorption along with similar rates of adverse events, hypoglycemia and weight gain. There are limited data comparing the pharmacokinetics, pharmacodynamics, efficacy and safety of glulisine and aspart insulins.

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