South Asians with type 2 diabetes are significantly more at risk of losing their eyesight and losing it at an earlier age, compared to White Europeans with the same condition.

A UK study carried out by the University of Warwick shows diabetic retinopathy (damage to the retina) is more prevalent in South Asians and occurs earlier than in White European people with diabetes.

The study, published in the latest issue of Diabetes Care, looked at 1.035 patients with type 2 diabetes, 421 were of South Asian origin and 614 were White Europeans. The results showed 45% of South Asians had retinopathy, compared to 37% of White Europeans, and 16% of the South Asian group had sight threatening retinopathy, compared to 12% White Europeans.

South Asian diabetes patients were also significantly younger than the White European group. The average age of the South Asian group at diagnosis of diabetes was 53 years, compared to 57 years for White Europeans. The study also suggested South Asians developed diabetic retinopathy about seven years earlier than White Europeans.

This study is part of the UK Asian Diabetes Study, a randomised controlled trial designed to evaluate the benefits of an enhanced diabetes care package for people of South Asian ethnicity with type 2 diabetes in Coventry and Birmingham.

For this project, researchers collected clinical data from 10 GP practices in the Foleshill area of Coventry. Details on risk factors including blood pressure, duration of diabetes, age at onset of diabetes and cholesterol were recorded.

One of the study’s authors Professor Sudhesh Kumar, Professor of Medicine, Diabetes & Endocrinology at Warwick Medical School, said the results emphasised the need for effective screening and earlier diagnosis of diabetes among the South Asian population.

He said: “The South Asian participants in this study had significantly higher systolic and diastolic blood pressures and cholesterol levels. Systematic screening for retinopathy, combined with intensive management of diabetes, including reduction of blood glucose and blood pressure, could help to reduce the incidence of visual impairment and blindness in ethnic minority groups across the world, addressing an important health inequality.”

In adults, the systolic pressure should be less than 120 mmHg and the diastolic pressure should be less than 80 mmHg. In this study, the South Asian participants recorded 144 mmHg systolic pressure and 84 mmHg diastolic pressure.

Professor Kumar added: “Health care professionals in developed and developing countries need to be aware of the potential contribution of diabetic retinopathy to visual loss in South Asian communities.”

Fellow author Dr Paul O’Hare, from Warwick Medical School, said: “Screening for diabetic retinopathy is becoming more systematic across the UK and the developed world. However, coverage rates and uptake among ethnic minority groups in inner city areas may be much lower than those for white Europeans. We need to address this to try and rectify these important health inequalities.”

Diabetes Care, volume 32, number 3, March 2009

Warwick University
http://www.warwick.ac.uk

Men with premature ejaculation who used a topical spray five minutes before intercourse were able to delay their orgasm six times longer than normal, according to a study in the April issue of BJU International.

Three hundred men with clinically diagnosed lifelong premature ejaculation (PE) from 31 centres in the UK, Czech Republic, Hungary and Poland, were randomised into two groups. Two hundred used the PSD502 spray, which contains 7.5mg of lidocaine and 2.5mg of prilocaine, and 100 used a placebo spray with no active ingredients.

Every time they had intercourse during the three-month study period, each couple measured the time from vaginal penetration to ejaculation with a stopwatch. The men were asked to abstain from sexual activity or masturbation for 24 hours before each recorded encounter.

The time from penetration to ejaculation increased from an average of 0.6 minutes to 3.8 minutes in the medicated group and to just 1.1 minutes in the placebo group.

When these figures were adjusted to take account of any variations between the two groups, these showed that the treatment group were able to last 6.3 times longer after penetration when they used the spray. The placebo group lasted 1.7 times longer.

“Premature ejaculation can be a very distressing condition for men and can cause distress, frustration and make them avoid sexual intimacy” says lead researcher Professor W Wallace Dinsmore from the Royal Victoria Hospital, Belfast, UK.

The research team used the evidence-based definition of lifelong PE developed by the International Society for Sexual Medicine to select their study subjects. This states that ejaculation occurs within about one minute of vaginal penetration in the majority of encounters.

“Because this definition was only launched in 2008, studies have yet to determine the prevalence of lifelong PE in the male population” says Professor Dinsmore. “But previous research suggests that as many as 40% of men will experience premature ejaculation at some time in their lives.”

The 300 men who took part in the phase three, multicentre, double-blind, randomised study had an average age of 35. The majority had used other treatments before, the most common being oral antidepressants.

After three months of treatment the researchers reported that:

– 90% of the men in the treatment group were able to delay ejaculation for more than one minute following vaginal penetration, compared with 54% in the placebo group.

– 74% of men in the treatment group managed to last more than two minutes before ejaculation, compared with 22% in the placebo group.

– 62% of men in the treatment group said their orgasms were ‘good’ or ‘very good’ after three months, compared with 20% before the study started. The figures for the placebo group were slightly lower at the end (19%) than at the start (21%).

– 66% of men in the treatment group said the medication was ‘good’ or ‘excellent’ compared with 15% in the placebo group.

– A significantly higher percentage of the patients and partners in the treatment group reported improvements when it came to perceived control, personal distress, satisfaction with sexual intercourse and interpersonal difficulties.

– There were no serious adverse events reported during the study. Adverse treatment-related reactions were reported by five men and six women from the treatment group and one man from the placebo group. The most common problems were loss of erection and a burning sensation in the vagina.

“Our study shows that when the PSD502 spray was applied to the man’s penis five minutes before intercourse it improved both sexual performance and sexual satisfaction, which are key factors in treating premature ejaculation” says Professor Dinsmore.

“It was well tolerated by both patients and their partners, with no systemic side effects and a low incidence of localised effects and was rated favourably by the majority of users.

“We believe that this shows that PSD502 offers significant advantages over other therapies being developed for the treatment of premature ejaculation.”

Source: Wiley - Blackwell

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that although surveyed primary care physicians (PCPs) are generally satisfied with the efficacy of available phosphodiesterase type 5 (PDE5) inhibitors such as Pfizer’s ED drugs and Bayer Healthcare/Schering-Plough/GlaxoSmithKline’s Levitra (vardenafil), they are less satisfied with the efficacy of this drug class in difficult-to-treat patient subpopulations. PCPs’ satisfaction with available PDE5 inhibitors on key measures of clinical efficacy suggests that opportunity exists for improvement in the treatment of erectile dysfunction patients with comorbid conditions such as hypertension and diabetes.

The new report entitled Erectile Dysfunction: Physicians Seek Improvements in Efficacy for Underserved Patients and Product Differentiation on Onset and Duration of Action finds that a therapy that provides greater improvement in erectile function than Levitra in patients with hypertension and that is priced at a five percent discount to Levitra would earn a 50 percent patient share in the United States and a 40 percent patient share in Europe, according to surveyed U.S. primary care physicians and European general practitioners.

Additionally, while there are several second-generation PDE5 inhibitors in clinical trials for the treatment of erectile dysfunction, interviewed experts do not expect these agents to provide efficacy superior to that of currently marketed drugs in this class. The report also finds that limited reimbursement for erectile dysfunction drugs and the availability of less-expensive generic versions of Viagra beginning in 2012, will constrain the uptake of emerging PDE5 inhibitors.

“Most therapies for erectile dysfunction do not qualify for reimbursement by third-party payers,” said Decision Resources Analyst Kathryn Benton, B.S. “As a result, many patients pay out-of-pocket for treatment — this will be among the factors that will cause premium-priced emerging therapies to struggle to capture market share.”

About the Report

Erectile Dysfunction: Physicians Seek Improvements in Efficacy for Underserved Patients and Product Differentiation on Onset and Duration of Action is a DecisionBase 2009 report. DecisionBase 2009 is a decision-support tool that provides in-depth analysis of unmet need, physician expectations of new therapies and commercial dynamics to help pharmaceutical companies optimize their investments in drug development.

The report can be purchased by contacting Decision Resources. Members of the media may request an interview with an analyst.

About Decision Resources

Decision Resources is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions.

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Source: Decision Resources