Health Topics – Johns Hopkins Medicine Podcasts

The number of people who have diabetes continues to increase but controlling it, along with other common health conditions that can make things worse, has stagnated, a recent study concludes. Rita Kalyani, a diabetes expert at Johns Hopkins, describes the data.

Kalyani: Diabetes prevalence increased from about 9.8% to about 14%. Discouragingly risk factor control really did not improve. Individualized A1c targets, they found out there really wasn’t much change at all. How many had achieved a blood pressure less than 130 over 80 they also found it had definitely not improved. When they looked at the percentage that had attained LDL less than 100 they also did not find find significant improvement. Only one in five achieved all three targets.  :32

Kalyani says keeping blood pressure, blood sugar and cholesterol in check is your best bet to avoid cardiovascular disease if you have diabetes, and even if you don’t. At Johns Hopkins, I’m Elizabeth Tracey.

The majority of people with diabetes who were only in their twenties had a least one complication of the condition already, a recent study shows. Rita Kalyani, a diabetes expert at Johns Hopkins, says this study points very squarely to obesity as the underlying cause.

Kalyani: If we take a step back and ask ourselves why are so many youth now being diagnosed with type 2 diabetes, racial and ethnic minorities are more likely to develop it, but really it’s becoming an epidemic in youth as well. And when we look at BMI as a measure of obesity, the average BMI in this cohort was 35. These children were quite obese. This is not necessarily generalizable to the population of children in the United States but it shows how important weight management is from a young age.  :33

Kalyani notes that long term complications of diabetes are also linked to increased rates of cardiovascular disease and earlier death. She urges policymakers to focus on mitigating the childhood obesity epidemic we’re witnessing worldwide. At Johns Hopkins, I’m Elizabeth Tracey.

Even if you’re only in your twenties if you’ve had diabetes for 10 years or more kidney disease, eye disease and nerve disease are likely, a sobering new study finds. Rita Kalyani, a diabetes expert at Johns Hopkins, says this study also finds the underlying common denominator, a measure of blood sugar known as hemoglobin A1c.

Kalyani: Now the question becomes how do we prevent these complications from developing? And when you look at their glycemic control, which is important, they weren’t able to maintain their glycemic control during this time. In fact only about 20% of them at the end of 15 years, had an A1c less than 6.5%, and one-third of them had an A1c greater than 10%. And so I think what this study really reveals is the importance of focusing on glycemic management from a young age.  :31

Kalyani urges young people with diabetes to focus first on controlling their blood sugar. At Johns Hopkins, I’m Elizabeth Tracey.

Some children develop type 2 diabetes in childhood or teenage years, and now a study looking at what happens to them as they age into their twenties comes to some disturbing conclusions. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: The burden of diabetic complications was relatively high in this cohort. On average most of these individuals who were now young adults had had diabetes for a little over a decade. What they found was that the majority of them developed high blood pressure, they developed high cholesterol, they developed diabetic kidney disease, they also quite commonly developed nerve disease and also diabetic retinopathy. At least one of these complications occurred in 60% of them.  :31

Kalyani states that the longer someone has the complications of diabetes the worse the outcomes are likely to be, resulting in blindness, limb amputations, kidney failure, and cardiovascular disease. She says this study must act as a wake up call to those who develop diabetes early in life. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re a parent of a child younger than 12 years of age you may be struggling with the simplest of decisions right now regarding their welfare, a recent survey suggests, largely because of concerns about COVID-19. Helen Hughes, a pediatrician at Johns Hopkins, says she is hearing this from parents again and again.

Hughes: I do personally really struggle with the balance of the risks of contracting the coronavirus with the risks of kind of not allowing children to exist in the world. You have to take your own family dynamic and your own children and make the best decision you can with the information you have, and then those decisions may change week to week, month to month, depending on the new information you have. It’s a really exhausting time to be a parent of young kids, because those normal decisions, which were always fraught with difficulties, where do you send your child to school, what activities do you do with them, now have these additional layers of confusion and frustration and anxiety.  :34

Hughes is hopeful vaccines will be provided for younger children soon. At Johns Hopkins, I’m Elizabeth Tracey.

Respiratory syncytial virus, or RSV, is a viral infection typically experienced early in life, and for most, isn’t a problem. Now more children seem to be experiencing RSV out of season, sometimes along with COVID infection. Helen Hughes, a pediatrician at Johns Hopkins, describes the dynamics.

Hughes: I think what we’re seeing is that a lot of the winter respiratory viruses including RSV and parainfluenza that we would often see in the fall and winter we did not see because kids weren’t around each other. Now we’ve seen very quickly with everything opening up and no mask mandates, circulation of a lot of the winter respiratory viruses that we would typically see.  All of these viruses are cocirculating  because no one’s been around each other and now everyone is around each other at the same time, and so you’re probably seeing some of those co-occur.  :31

Hughes says that keeping children masked along with all of the other measures known to limit infection risk is prudent. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re worried about your cancer risk you might want to consider your alcohol consumption, Elizabeth Tracey reports

Alcohol consumption is associated with a greater risk for cancer, a new global analysis concludes, with some cancers very strongly associated with consumption. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the data.

Nelson: They tried to look at cancer on a global scale and then look at alcohol on a global scale and then estimate alcohol intake per adult and they believe as many as 4% of all cancers newly diagnosed in 2020 were likely associated with drinking alcohol. There were 6.3 million cases of cancer of the mouth and pharynx. Most of that is attributable to alcohol and smoking. Of the voicebox or larynx, the esophagus, colon, rectum, liver and breast cancer all of which have pretty established connections to alcohol intake.  :33

Nelson says this study established a threshold of more than two drinks per day as associated with increased risk, especially if coupled with smoking for mouth and throat cancers. At Johns Hopkins, I’m Elizabeth Tracey.

Has a blood test for cancer reached a point where it can be useful clinically? Elizabeth Tracey reports

A blood test looking for modifications to DNA known as methylation is moving closer to usefulness as a screening test for many cancers, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says there’s still a ways to go, but this strategy has a good chance of success.

Nelson: And what they found was that when that test suggested that a cancer would be present it was 99.5% specific. And the sensitivity – were they finding all the cancers – was about 67% and seemed to be better if the cancer was at a higher stage. If you had a positive test how likely are you to have a problem and if you have a negative test how easy is it going to be to be for you to sleep at night? Those things are not tested in this model, they’re estimated, they haven’t rigorously tested them.  :29

Nelson says that the test performed best when cancers were advanced, but what is needed in a screening test is one that performs well at very early stages of disease, when the chance for a cure is greatest. He predicts that a blood-based screening test for cancer will be practical in just a couple of years. At Johns Hopkins, I’m Elizabeth Tracey.

Can your gut bacteria impact on how you respond to cancer treatment? Elizabeth Tracey reports

For people with advanced melanoma who were being treated with a class of targeted therapies known as checkpoint inhibitors, response to therapy was associated with which types of bacteria they had in their intestine, a new study shows. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: The microbiota, these are the bacteria that are residents of the intestine. That ecosystem, which bacteria are there in certain individuals versus others, makes a difference for people with advanced melanoma who are treated with immune checkpoint inhibitors, like ipilimumab, nivolumab, it makes a difference to how well they respond. When they are looking at 77 or so folks with advanced melanoma, who got a combination of ipilimumab and nivolumab or one of the other immune checkpoint inhibitors, turns out almost half of them had very significant immune related adverse events.  :34

Nelson says many researchers are looking at ways to modify gut bacteria to help. At Johns Hopkins, I’m Elizabeth Tracey.

When a man is suspected of having prostate cancer he will likely undergo a biopsy, where a needle is inserted into the prostate gland to look for cancer. Now a new study shows that using magnetic resonance imaging or MRI along with ultrasound helps identify suspicious areas and improves the technique. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the study.

Nelson: Three to four biopsy cores were going to be aimed at that suspicious lesion then the men would have the ten to twelve biopsy cores. They found the clinically significant cancer in 21% of the men who got the targeted biopsy, a little bit more than the men in the ten to twelve core biopsies, 18% of them. But the clinically insignificant cancers were somewhat lower in the experimental group. Have the focused biopsy highlighted by MRI, followed by the core biopsy seemed to be better.  :31

At Johns Hopkins, I’m Elizabeth Tracey.