UPMC Physician Resources

Pitt Study Finds Telephone Treatment of Depression After Cardiac Bypass Surgery Improves Outcomes, Saves Money

PITTSBURGH, July 8, 2014 –Screening for depression and then providing a telephone-delivered, nurse-led “collaborative care” intervention following coronary artery bypass graft (CABG) surgery not only improves health-related quality of life, physical functioning and mood symptoms, but also lowers medical costs and is highly cost-effective compared to doctors’ usual care, according to researchers at the University of Pittsburgh School of Medicine.

This analysis of the National Institutes of Health-funded Bypassing the Blues trial was published online today in General Hospital Psychiatry. While previous research showed this collaborative care model to be effective for treating post-CABG depression, the latest study establishes the “business case” to policy makers and insurers for widespread adoption, said Bruce L. Rollman, M.D., M.P.H., professor of medicine, psychiatry, and clinical and translational science at the University of Pittsburgh School of Medicine and principal investigator of the trial.

“One of the holy grails in mental health services research is to demonstrate that treating a common mental health condition such as depression is not only effective and cost-effective, but is also cost-saving. This is the first trial to demonstrate all three outcomes,” said Dr. Rollman. “We now know that screening for and then providing effective depression treatment to medically complex patients with cardiovascular disease is very likely to pay for itself.” A recent American Heart Association science advisory already recommends routine screening and treatment of depression in patients with cardiac disease, he noted.

Researchers examined Medicare and private medical insurance claims data for 189 trial participants. After incorporating the $460 average cost to deliver the intervention that included nurse and supervising physician time, patients randomly assigned to the intervention had $2,068 lower median claims costs at one year after bypass surgery compared to those who received their doctors’ usual care ($16,126 vs. $18,194). The intervention was also highly cost-effective, producing more quality-adjusted life-years (QALY), a measure analysts use to determine the value of different medical actions, while significantly lowering medical claims costs by $9,889 per additional QALY generated, a first for a collaborative care strategy for treating depression in any patient population.

About 400,000 CABG surgeries are performed annually in the U.S., and studies indicate approximately one in five patients who undergo the procedure experience clinical depression. Extending this $2,068 savings to all depressed post-CABG patients has the potential to save over $165 million in medical claims in the first year following surgery, said Dr. Rollman.

The collaborative care model involves care managers who follow an evidence-based treatment protocol under the supervision of a primary care physician. The team systematically contacts patients to monitor their mood symptoms and recommends appropriate adjustments in treatment. Although team-based collaborative care for depression has yet to be widely adopted, it is increasingly being provided by integrated health care systems through “patient-centered medical homes” supported by payment reforms under the Affordable Care Act.

Collaborators on this study include Julie M. Donohue, Ph.D., Bea Herbeck Belnap, Ph.D., Aiju Men, M.S., Fanyin He, Ph.D., Mark S. Roberts, M.P.P., M.D., and Charles F. Reynolds III, M.D., all of the University of Pittsburgh, and Herbert Schulberg, Ph.D., of Weill Cornell Medical College.

The research was supported by the Fine Foundation and by The National Heart Lung and Blood Institute, part of the National Institutes of Health grant number R01HL70000.

For more information about the Bypassing the Blues trial, visit: www.bypassingtheblues.pitt.edu.

Weight Loss for Overweight Women Could Help Control Hot Flashes, Pitt Study Finds

PITTSBURGH, July 7, 2014 – Weight loss achieved through moderate calorie reduction and physical activity could help control hot flashes in women going through menopause, a study from the University of Pittsburgh School of Medicine reports.

The study is available online this month in the journal Menopause.

“Currently, the most effective treatment for hot flashes is hormone therapy. However, many women are reluctant to take hormone therapy due to its potential health risks, including risk for heart attacks and thromboembolic events,” said Rebecca C. Thurston, Ph.D., associate professor of psychiatry, psychology and epidemiology with Pitt. “In the past, we thought body fat might protect against hot flashes, but that idea has recently been challenged with research indicating women with a higher body mass index report more hot flashes than their leaner counterparts. Our study suggested that weight loss achieved through diet and exercise may be a promising strategy to help manage hot flashes.”

Hot flashes are one of the most common symptoms associated with menopause, and for many women they can be frequent and severe. Women with hot flashes are at a greater risk for sleep problems and depression than women without them, and they are the main cause of out-of-pocket gynecologic expenditures, according to Dr. Thurston.

“Identifying behavioral methods that bring relief to hot flashes could greatly improve the quality of life for millions of women,” said Dr. Thurston.

The pilot study had two goals: The first was to evaluate the feasibility and acceptability of a behavioral weight loss intervention for reducing hot flashes and the second was to understand whether women showed greater reductions in hot flashes if they lost weight.  For the study, 40 overweight or obese women experiencing four or more hot flashes a day who also wanted to lose weight were recruited from Pittsburgh and surrounding communities. The women were randomly assigned to a weight loss arm or the control arm of the study. The weight loss intervention included calorie reduction and moderate exercise, and was tailored to midlife women, addressing dietary and activity choices in the context of sleep loss, work and caretaking demands.

Women in the weight loss group lost approximately 10.7 percent of their weight. There was little weight or body change in the control group. Women in the intervention group showed a tendency toward greater hot flash reduction compared to women in the control group.

“The results of this initial study challenge some long-held theories about hot flashes, and offer us a potential way to manage them,” said Dr. Thurston. “We are now designing a larger study which will more definitively test whether behavioral weight loss may reduce hot flashes.”

This study was supported by the National Institutes of health through the National Institute on aging, grant number AG029216.

Better Quality of Life: Brain Stimulation For Movement Disorders, OCD, and Epilepsy

PITTSBURGH, July 7, 2014 – Better Quality of Life: Brain Stimulation For Movement Disorders, OCD, and Epilepsy will be held at the University Club in Pittsburgh, Pa., on Friday, September 19, 2014.

This course will provide an overview of Deep Brain Stimulation (DBS), including discussions of patient selection, surgery and expected outcomes, Parkinson’s disease, dystonia, and obsessive compulsive disorder. The recently FDA-approved Responsive Neurostimulation System (RNS) for epilepsy also will be reviewed. Preoperative evaluation and postoperative management will be considered, and new developments and technologies will be highlighted. Interactive sessions will include case presentations from faculty and patient perspectives. Participants also are encouraged to bring their own cases for discussion.

Who Should Attend
Neurologists, psychiatrists, internal medicine and family practice referring physicians, physician assistants, nurses, and others involved in the management of treating tremor, Parkinson’s disease, dystonia, obsessive compulsive disorder, and epilepsy. This course is also open to the general public.

Location
The University Club at the University of Pittsburgh
123 University Place
Pittsburgh, PA 15213

Course Director
R. Mark Richardson, MD, PhD
Assistant Professor of Neurological Surgery
Director, Epilepsy and Movement Disorders Surgery
Director, Brain Modulation Laboratory

To view the full course brochure, or to register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences, and click the ‘Better Quality of Life: Brain Stimulation For Movement Disorders, OCD, and Epilepsy′ link.

Continuing Education Credit
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this live activity for a maximum of 6.0 AMA PRA Category 1 Credits™. Each physician should claim only credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 0.6 continuing education units (CEUs) which are equal to 6.0 contact hours.

Save the Date: Stroke Update 2014

PITTSBURGH, July 7, 2014 – Stroke Update 2014 will be held at the Wyndham Grand Pittsburgh Downtown in Pittsburgh, Pa., on Friday, September 5, 2014.

This conference will cover the identification, management, and treatment of stroke in young adults, intracerebral hemorrhage, subarachnoid hemorrhage, and intracerebral swelling. Clinical applications for telemedicine and the benefits of telestroke also will be discussed.

Who Should Attend
This conference is designed for neurologists, neurosurgeons, interventionalists, emergency medicine physicians, family practitioners, internists, nurses, nurse practitioners, pre-hospital personnel, and hospital administrators.

Location
Wyndham Grand Pittsburgh Downtown
600 Commonwealth Place
Pittsburgh, PA, 15222

Course Directors
Tudor G. Jovin, MD
Associate Professor of Neurology and Neurosurgery
Director, UPMC Stroke Institute
Department of Neurology

Lori M. Massaro, MDN, CRNP
Clinical Supervisor
UPMC Stroke Institute
Department of Neurology

Ashutosh P. Jadhav, MD, PhD
Assistant Professor of Neurology
UPMC Stroke Institute
Department of Neurology

To view the full course brochure, or to register online, please visit the Upcoming Events page at the Center for Continuing Education in the Health Sciences and click the ‘Stroke Update 2014′ link.

Continuing Education Credit
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine designates this live activity for a maximum of 6.5 AMA PRA Category 1 Credits™. Each physician should claim only credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded 0.6 continuing education units (CEUs) which are equal to 6.5 contact hours.

Nursing: The University of Pittsburgh Medical Center (UPMC) is an approved provider of continuing nursing education by PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This program is awarded 6.5 contact hours. Participants must attend the entire day and complete an evaluation form to be awarded a certificate and 6.5 contact hours.

UPMC Patient First in U.S. Implanted with Hemolung Before Lifesaving Double Lung Transplant

PITTSBURGH, July 2, 2014 – Suffering from cystic fibrosis and rejecting the transplanted lungs he had gotten just two years ago, Jon Sacker, 33, came to UPMC from his hometown in Moore, Oklahoma, as a last resort. But when his carbon dioxide levels spiked, making him too sick for another transplant, his family feared the worst.

“I thought I had brought my husband here to die,” said Mr. Sacker’s wife, Sallie.

Instead, UPMC clinicians turned to a Pittsburgh-made device called the Hemolung Respiratory Assist System (RAS) that would filter out harmful carbon dioxide and provide healthy oxygen to his blood, giving Mr. Sacker a chance to gain enough strength to undergo a lifesaving transplant. In February, he became the first person in the U.S. to be implanted with the Hemolung RAS; in March, he underwent a double lung transplant and today is on the road to recovery.

“The entire series of events that led to this transplant and Jon’s recovery have been amazing,” said Christian Bermudez, M.D., chief of UPMC’s Division of Cardiothoracic Transplantation. “Jon had previously been very active and fit, and we knew we had to do whatever it took to help him.”

“Jon was in very critical condition when he came to Pittsburgh, and the Hemolung was a lifesaver for him while waiting for his second lung transplant. We are very proud of his good recovery,” said Mr. Sacker’s pulmonologist, Maria Crespo, M.D., associate medical director of UPMC’s Lung Transplant Program.

Many patients waiting for lungs or a heart use mechanical devices as a bridge to transplant. But doctors said Mr. Sacker was too sick for the traditional extracorporeal membrane oxygenation, or ECMO. However, UPMC doctors knew about the Hemolung RAS, which removes carbon dioxide and delivers oxygen directly to the blood, allowing a patient’s lungs to rest and heal.

Several years before, William Federspiel, Ph.D., director of the Medical Devices Laboratory at the joint UPMC- and University of Pittsburgh-run McGowan Institute for Regenerative Medicine, along with a designer fabricator and a bioengineering doctoral student, developed what was known as the Paracorporeal Respiratory Assist Lung. The device underwent product development and was commercialized by ALung Technologies as the renamed Hemolung RAS. ALung was founded by Dr. Federspiel and UPMC’s former chief of lung transplant, Brack G. Hattler, M.D.

“We had seen the Hemolung RAS used in other countries and wanted to do whatever we could to help this patient,” said Peter M. DeComo, chairman and chief executive of ALung Technologies.

Drs. Bermudez and Crespo worked with Diana Zaldonis, M.P.H., B.S.N., in the Division of Cardiac Surgery, to notify Food and Drug Administration officials of the intent to use the Hemolung RAS, which isn’t approved for use in the U.S., and to get emergency approval from the local hospital officials. Meanwhile, Mr. DeComo drove with another ALung official in the middle of the night to Toronto, where the closest Hemolung RAS was available.

“Jon’s story is a tremendous example of the depth of the work we do here every day. Most hospitals across the country couldn’t handle a situation as complex as Jon’s, but we can because of our collective experience and an extensive team that includes transplant surgeons, pulmonologists, nurses and so many more,” said James D. Luketich, M.D., chairman of the Department of Cardiothoracic Surgery. “

Mr. Sacker will remain in Pittsburgh for several months during his recovery, with his wife splitting her time between here and their hometown in Oklahoma. He said he’s looking forward to getting back home, where he had been a runner and public speaker spreading the word about the importance of organ donation after writing the book “Imperfect Perfection.”

“Out of all of the transplant centers we could have come to, we came here to Pittsburgh,” he said. “It’s a miracle that’s just not explainable. You just have to thank God.”

News Directors: Video is available of Mr. Sacker on the Hemolung RAS device at http://youtu.be/Uwe1-LN8P-4.

University of Pittsburgh School of Medicine Appoints Dario Vignali, Ph.D., New Vice-Chair of Immunology

PITTSBURGH, June 30, 2014 – Renowned researcher Dario Vignali, Ph.D., will join the faculty at the University of Pittsburgh School of Medicine on July 1 as the vice-chair of the Department of Immunology. He also will co-direct both the Cancer Immunology Program at the University of Pittsburgh Cancer Institute (UPCI) and the recently expanded Tumor Microenvironment Center.

According to Mark Shlomchik, M.D., Ph.D., professor and chair, Department of Immunology, “Dr. Vignali is an eminent scientist with a stellar publication record. For the last two decades, he has produced innovative research focusing on identifying and understanding the disease pathways that prevent the immune system from eliminating cancer cells, as well as the causes of autoimmune disorders.”

“We now stand at an unprecedented point in time when immunotherapy is starting to have a substantial impact on clinical care,” said Dr. Vignali. “We have a growing list of novel targets for further therapeutic development and powerful new tools for genomic and mechanistic analysis.”

He plans to continue and expand his research in his new role at Pitt; one of his labs, in the Department of Immunology, will focus on analysis of immune cell function in mouse model systems and disease models of cancer and autoimmune disease, and his second lab, at UPCI, will work on inhibitory immune pathways in human cancers.

Dr. Vignali’s research findings have been published in some of immunology’s leading journals, and he has been awarded five patents worldwide with several more awaiting approval. He also is a current member of the scientific advisory boards at two biopharmaceutical companies.

Since 1993, Dr. Vignali worked at St. Jude Children’s Research Hospital in Memphis, Tennessee, and served as vice-chair of its immunology department since 2008. He taught in the Department of Pathology at the University of Tennessee Medical Center since 1996.

He received his undergraduate education at North East London Polytechnic, now East London University, and completed his doctoral studies at the London School of Hygiene and Tropical Medicine at the University of London. Dr. Vignali completed two postdoctoral fellowships, one at the Institute for Immunology and Genetics at the German Cancer Research Center in Heidelberg, Germany, and the second in the Department of Biochemistry and Molecular Biology at Harvard University.

Dr. Vignali moved to Pittsburgh with his wife, Kate, who works as a scientist in his laboratory, and two of their four children.

Sex Hormone Levels at Midlife Linked to Bad Cholesterol Carriers that Increase Heart Disease Risk in Women

PITTSBURGH, June 27, 2014 – As hormone levels change during the transition to menopause, the quality of a woman’s cholesterol carriers degrades, leaving her at greater risk for heart disease, researchers at the University of Pittsburgh Graduate School of Public Health discovered.

The first-of-its-kind evaluation, supported by the National Institutes of Health (NIH), was done using an advanced method to characterize cholesterol carriers in the blood and is published in the July issue of the Journal of Lipid Research.

The results call for further research to evaluate the menopause-related dynamic changes in sex hormones on the quality of cholesterol carriers over time, as well as increased emphasis on the importance of healthy diet and exercise for women undergoing menopause.

“Higher levels of HDL, or what we know as ‘good cholesterol,’ may not always be as protective as we had thought before,” said lead investigator Samar R. El Khoudary, Ph.D., M.P.H., assistant professor in Pitt Public Health’s Department of Epidemiology.

Dr. El Khoudary explains that normal levels of LDL, or “bad cholesterol,” do not imply normal cholesterol levels in all individuals. Rather, quality of cholesterol carriers may provide more accurate information about risk related to levels of cholesterol.

“We found that lower levels of estradiol, one of the main hormonal changes that mark menopause, are associated with low-quality cholesterol carriers, which have been found to predict risk for heart disease,” she said. “Our results suggest that there may be value in using advanced testing methods to evaluate changes in cholesterol carriers’ quality in women early in menopause so that doctors can recommend appropriate diet and lifestyle changes.”

Cholesterol travels through the bloodstream in small particles called lipoproteins, or cholesterol carriers. Conventional blood tests show the amount of cholesterol carried by these lipoproteins, rather than the characteristics of the lipoproteins themselves. There are two major types of lipoproteins: high-density lipoprotein (HDL), which helps keep cholesterol from building up in the arteries, and low density lipoprotein (LDL), the main source of cholesterol buildup and blockage in the arteries. Research studies have shown that the characteristics of LDL and HDL particles, including the number and size of these particles, significantly predict risk of heart disease.

Previous studies evaluating the associations between sex hormones and cardiovascular disease as women went through menopause looked only at cholesterol measured through conventional blood tests. Dr. El Khoudary and her colleagues used nuclear magnetic resonance spectroscopy to measure the size, distribution and concentration of lipoproteins that carry cholesterol in the blood.

The Pitt Public Health team found that as estrogen levels fall, women have higher concentrations of low-quality, smaller, denser LDL and HDL particles, which are associated with greater risk of heart disease. The conventional blood tests often don’t pick up on such a nuance in particle size.

The study evaluated 120 women from Pittsburgh who were enrolled in the Study of Women’s Health Across the Nation (SWAN). The women were an average of 50 ½ years old and not on hormone replacement therapy.

SWAN is an ongoing study of the biological, physical, psychological and social changes in more than 3,000 middle aged women who were recruited at seven sites across the U.S. The goal is to help scientists, health care providers and women learn how mid-life experiences affect health and quality of life during aging.

“As a woman transitions to menopause, many biological changes take place that can put her at greater risk of many conditions, including osteoporosis and heart disease,” said Dr. El Khoudary. “Our most recent study underscores the importance of having clinicians aware of these risk factors and prepared to work with their patient to help her best mitigate these risks.”

Dr. El Khoudary is collaborating with other scientists to identify funding to study a larger sample of women over time to definitively tie changes in hormone levels and the quality of cholesterol carriers with heart disease.

Additional authors on this study are Maria M. Brooks, Ph.D., Rebecca C. Thurston, Ph.D., and Karen A. Matthews, Ph.D., all of Pitt.

This research is supported by NIH grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, HL065581 and HL065591.

Lowering Toxicity of New HIV Drugs Predicted to Improve Life Expectancy

PITTSBURGH, June 25, 2014 – While bringing new drugs to market is important for increasing life expectancy in younger people with HIV, lowering the toxicity of those drugs may have an even greater health impact on all HIV patients, a University of Pittsburgh Graduate School of Public Health analysis reveals.

The research, supported by the National Science Foundation (NSF) and National Institutes of Health (NIH), and published June 25  in the journal PLOS ONE, used a computer simulation to examine what would happen if guidelines for starting HIV treatment took into account the rate of new drug development and the toxicity of those drugs.

“The side effects of treatment remain one of the primary reasons that HIV drug regimens are discontinued,” said senior author Mark Roberts, M.D., M.P.P., professor and chair of Pitt Public Health’s Department of Health Policy and Management. “By decreasing the toxicity and side effects of HIV drugs, you increase the amount of time that patients can stay on that life-saving treatment regimen. Some side effects, such as increased cardiovascular risk, also cause problems that directly contribute to premature mortality.”

The simulation, which built upon a model developed at New York University School of Medicine, found that if the toxicity of new HIV drugs is reduced compared to existing drugs, those new drugs will increase the patient’s quality-adjusted life expectancy by as much as 11 percent, or more than 3 years.

“Quality-adjusted life years” and “quality-adjusted life expectancy” are measures that analysts use to determine the value of different medical actions. For example, a potentially life-saving drug that was highly toxic and left a patient debilitated would have a lower value than a life-saving drug that didn’t have such side effects.

New HIV drugs are approved for market nearly twice a year and recently revised World Health Organization guidelines on the initiation of HIV treatment recommend that, with this rate of drug development, all HIV patients start treatment before their immune system is significantly compromised.

Pitt Public Health’s simulation backed this recommendation, finding that, even at current drug toxicity levels, young people with HIV add nearly two years to their lives by initiating HIV treatment regimens soon after infection.

Antiretroviral therapy for HIV typically consists of the combination of at least three drugs that help control HIV. However, over time, these drugs become less effective.

In younger patients, doctors have tended to wait longer to start antiretroviral therapy because those patients will have to be on the drugs the longest in order to live an average lifespan. As such, they’ll need the drugs to be effective longer and have fewer side effects.

“This availability of new drugs means that as the drugs a patient is on become less effective, doctors can adjust the therapy to use a new, more effective drug,” said Dr. Roberts. “And if that new drug has a low toxicity and is well-tolerated by the patient, then they are more likely to take it regularly so that it is as effective as possible.”

Additional researchers on this study are Amin Khademi, Ph.D., of Clemson University; R. Scott Braithwaite, M.D., M.S., and Kimberly Nucifora, M.S., both of New York University; Denis Saure, Ph.D., of the University of Chile; and Andrew J. Schaefer, Ph.D., of Pitt.

This research was funded by NSF grant CMMI-0546960, NIH National Institute of Allergy and Infectious Diseases grant 1R01AI099970 and NIH National Institute on Alcohol Abuse and Alcoholism grant 1R01AA017385.

Pitt Researchers Receive $1.8 Million to Build Unique ECG Database, Study Effectiveness of CPR

PITTSBURGH, June 24, 2014 – University of Pittsburgh researchers have received $1.8 million from the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, to create a unique database of electrocardiogram (ECG) information that could one day be used to better guide real-time decision making during cardiopulmonary resuscitation (CPR) for cardiac arrest. The database would be the largest repository of its kind and could lead to new ways to evaluate CPR and patient outcomes.

“We will make use of this information to better understand how the quality of CPR might change the ECG patterns, and then link that to the outcomes of the patient all the way to discharge. If we can see what works best, we can further refine CPR interventions and save more lives,” said lead investigator James Menegazzi, Ph.D., Endowed Professor of Resuscitation Research, Department of Emergency Medicine, University of Pittsburgh School of Medicine.

Nearly 351,000 Americans experience a sudden cardiac arrest outside the hospital, and fewer than 7 percent survive to hospital discharge. Many of those patients suffer from ventricular fibrillation (VF), a condition in which erratic contraction of the cardiac muscle of the ventricles in the heart impairs the pumping of blood to the lungs and the body. VF is a common cause of cardiac arrest and typically is treated with defibrillation, or a shock, to correct the rhythm, which can look like irregular waves or spikes on the ECG.

The multi-center study will examine data from 10,000 ECG reports collected by the Resuscitation Outcomes Consortium (ROC), a clinical research network funded by the NHLBI. The research team has created a data management and analytic platform that converts ECG information into a uniform format, which will allow them to identify and measure waveform differences and assess which VF episodes respond better to defibrillation than others.

Dr. Menegazzi and his team will examine ECG and clinical data from the ROC to identify associations between specific VF patterns and clinical presentations, CPR quality and patient survival rates.

Depressive Symptoms Associated With Premature Mortality in Type 1 Diabetes

PITTSBURGH, June 16, 2014 – People with type 1 diabetes have a higher risk of premature death as their number of depressive symptoms increases, a University of Pittsburgh Graduate School of Public Health analysis reveals.

The findings were presented in a press conference at the American Diabetes Association’s 74th Scientific Sessions in San Francisco and used data collected through the Pittsburgh Epidemiology of Diabetes Complications Study, a long-term study of health complications in people with type 1 diabetes.

“Through the 25 years that we’ve been running this study, we’ve found that there’s a lot more to diabetes than high blood sugar,” said senior author Trevor Orchard, M.D., professor of epidemiology at Pitt Public Health. “This link between premature mortality and depression adds to our previous findings, which show that depressive symptomatology predicts cardiovascular disease and demonstrates that doctors need to consider more than adjusting insulin doses when treating type 1 diabetes.”

Lead author Cassie Fickley, M.P.H., C.P.H., analyzed data on 458 study participants with type 1 diabetes who were assessed using the Beck Depression Inventory, a 32-point scale that measures depressive symptoms ranging from loss of appetite to suicidal tendencies. People who score 16 or more points are considered likely to be clinically depressed.

“For every one-point increase on the scale, participants showed a 4 percent increase in risk for mortality, even after controlling for other relevant factors, such as age, gender, smoking, cholesterol levels and high blood pressure,” said Ms. Fickley, a doctoral student in Pitt Public Health’s Department of Epidemiology. “That’s a significant increase and is something we’ll need to explore more to determine if treating depression would translate into lower mortality in people with type 1 diabetes.”

Type 1 diabetes is usually diagnosed in children and young adults and happens when the body does not produce insulin, a hormone that is needed to convert sugar into energy. The disease can lead to nerve, kidney, eye and heart complications but can be controlled with insulin therapy and other treatments.

The Pittsburgh Epidemiology of Diabetes Complications Study is an investigation to document long-term complications of type 1 diabetes among patients at Children’s Hospital of Pittsburgh between 1950 and 1980. Funded by the National Institutes of Health, the study recently was renewed for another five years.

“It is thanks to the volunteers who participate in this study that we are able to make discoveries like this that will contribute to better therapies and life expectancy for children diagnosed with type 1 diabetes today and in the future,” said Dr. Orchard.

Additional authors on this study are Tina Costacou, Ph.D., of Pitt; and Cathy E. Lloyd, Ph.D., of the Open University in the United Kingdom.

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