Clinical Briefs
March 15, 1999
Clinical Briefs
By Louis Kuritzky, MD
Prevention of Falls in the Elderly Trial (PROFET)
More than one-third of the 8% of persons older than 70 who seek care for fall-related injuries are admitted to the hospital. Improved management tools to prevent fall-related injury would be desirable, but limited, and sometimes, conflicting previous studies fail to fulfill this need. The current randomized, controlled trial evaluated a structured assessment of elderly persons (³ 65 years), who obtained emergency care because of a fall, to see if such an approach could improve future outcome and reduce future falls.
Evaluation (n = 1031) included general physical status plus details on visual acuity, balance, cognition, effect, prescription medications, and postural hypotension. Each patient was also visited on a single occasion by an occupational therapist, with environmental hazards identified and corrected when possible.
Only one out of six patients had evidence of a cardiovascular or circulatory disorder likely to have contributed to a fall. More than half of the patients had visual impairment, almost two-thirds had poor stereoscopic vision, and more than one-third had cataracts in one or both eyes. Almost three-fourths of the patients were unable to stand on one leg with their eyes open, and cognitive impairments or depression were present in half of patients.
Over the 12-month follow-up period, there were significantly fewer falls in the intervention group. A reduction of 50% in fractures was also noted. Close and colleagues conclude that incorporation of falls and injury prevention strategies provides substantial clinical benefit and should be more widely used.
Close J, et al. Lancet 1999;353:93-97.
Primary Care Physicians’ Perceptions of Diabetes Management
Evidence continues to accumulate that better control of diabetes results in better patient outcomes. Unfortunately, more than half of diabetic adults have a glycosylated hemoglobin greater than 9.5%, despite the suggested goal of less than 7%. To gain insight into how primary care physicians view and manage diabetes, a trained research interviewer performed in-depth personal interviews with primary care physicians (FPs and internists), specifically directed toward learning the clinicians’ approach to diabetes, feelings about the seriousness of the disorder, observations about patient attitudes toward diabetes, and changes in clinician views about diabetes.
The most consistent emerging theme from clinicians was that diabetes management is a balancing act between ideal medical goals, and realities of patient adherence, preferences, and personal circumstances. Physicians acknowledge that most diabetic patients do not follow management recommendations. Physicians were in agreement with the overall established goals of good glycemic control and complication prevention but did not possess readily accessible tools with which to attain these goals. Helseth and associates suggest that groups that develop guidelines spend additional energies to enhance tools or strategies with which clinicians might better achieve the biochemical and behavioral goals of diabetes management.
Helseth LD, et al. J Fam Pract 1999; 48:37-42.
Sildenafil for Treatment of Erectile Dysfunction in Men with Diabetes
Sildenafil has an established role in the approximately 50% of 40- to 70-year-old men who suffer erectile dysfunction (ED). ED is substantially more common and occurs at a younger age in diabetic men than in the general population. The current randomized, double-blind study specifically examined the role of sildenafil in middle-aged diabetic men (n = 268) with ED.
Patients received 25 mg, 50 mg, or 100 mg of sildenafil or placebo, depending upon efficacy and adverse effect profile, for 85 days. Maintenance dose for 93% of patients receiving an active drug was 100 mg; no patient in this study responded adequately to 25 mg.
Use of sildenafil almost doubled the frequency of adequate erections and intercourse experiences, as well as substantially improving overall satisfaction with sex life. There was no change in frequency of sexual desire. Of these measured factors, placebo only affected overall satisfaction with sex life, though erection rigidity and frequency of satisfactory intercourse did not change. Anticipated side effects of sildenafil (headache and dyspepsia) were proportionally frequent in this population as in previous study populations, but no patient discontinued treatment due to an adverse drug effect. Rendell and colleagues conclude that sildenafil is an efficacious, well-tolerated treatment for ED in diabetic patients.
Rendell MS, et al. JAMA 1999; 281:421-426.
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