Lancet 11 Nov 2006

What is the equation used to calculate the cardiovascular mortality burden in populations due to higher-than-optimum blood glucose? Pencils at the ready: you have thirty minutes. Or you may prefer to read this paper, which estimates that cardiovascular deaths associated with mildly elevated blood sugar are about twice those associated with diabetes.

The biggest favour we can do most of our type 2 diabetic patients is to help them lose weight. Rimonabant, the cannabinoid receptor blocker which became available at a dose of 20mg in the UK this summer, helped diabetic patients to lose 5.3 kg in this year-long study, compared with 1.4 kg from diet and exercise alone. There was a reduction in markers of cardiovascular risk, but we will have to wait for hard end-points.

The Finnish Diabetes Prevention Study finished intervening after 4 years, but the investigators have not finished with these Finns. Those randomised to receive intensive lifestyle intervention continue to show a marked reduction in the incidence of diabetes three years after discontinuation of personal counselling. The differences in body weight and reported physical activity are not great, but clearly they matter.

With obesity and diabetes increasing, could the answer be incretin? The incretins are yet another gut hormone signalling system which has managed to elude my radar and probably yours. They stimulate insulin production and suppress glucagon. They are even alleged to increase β-cell mass, which sounds too good to be true. Orally available incretin mimetics and enhancers have already undergone human trials, with few reported adverse effects so far. I can feel incretin excitement.

The later pages of The Lancet are now given over to sex and Mexico. Here is yet another of those astonishing global overviews which are the glory of this journal; if you want to know when people become sexually active in Kazakhstan, don’t rely on Borat, look here. How many partners? With or without condoms? Before or after marriage? If it’s ever been recorded anywhere, you’ll find it in this paper.