The prevalence and treatment of metformin associated Vitamin B12 deficiency in patients with type 2 Diabetes Mellitus in New Zealand

<p>With an ever increasing incidence of type 2 diabetes in the New Zealand population, continual assessment must be made to ensure the ongoing evaluation of treatment options to ensure patient care is not compromised. Previous research has shown higher prevalence of Vitamin B12 deficiency in patients with type 2 Diabetes Mellitus who have had long term metformin treatment. An investigation into patients attending secondary care clinics at the Diabetes Clinic at Wellington Regional Hospital as well as primary health care patients has explored the prevalence of this interaction in the New Zealand population as well as assessed the factors that may contributed to such an effect. It was found that there is a high prevalence of decreased serum Vitamin B12 level in patients with type 2 Diabetes exposed to metformin treatment. Factors such as age and ethnicity were seen to be key predictors of this interaction and have shown a unique view of how the population of New Zealand may be affected. Treatment of decreased serum Vitamin B12 levels was seen to be effective through both sublingual and intramuscular methods with variations in both short and long term effects. The use of sublingual treatment administration of Vitamin B12 supplementation is unique in the scope of metformin induced Vitamin B12 deficiency and has shown potential to be a therapeutic route for patients affected by such an interactions. Current views on the interaction between metformin and serum Vitamin B12 levels are currently under debate in regards to physiological relevance and clinical outcomes. This paper provides a first look at the effect of this interaction in a New Zealand population and evaluates treatment options for such. Furthermore a proposal is made for an alternate mechanism of metformin action on Vitamin B12 levels which may aid understanding of observations made in both in this paper and previous studies.</p>

The prevalence and treatment of metformin associated Vitamin B12 deficiency in patients with type 2 Diabetes Mellitus in New Zealand

<p>With an ever increasing incidence of type 2 diabetes in the New Zealand population, continual assessment must be made to ensure the ongoing evaluation of treatment options to ensure patient care is not compromised. Previous research has shown higher prevalence of Vitamin B12 deficiency in patients with type 2 Diabetes Mellitus who have had long term metformin treatment. An investigation into patients attending secondary care clinics at the Diabetes Clinic at Wellington Regional Hospital as well as primary health care patients has explored the prevalence of this interaction in the New Zealand population as well as assessed the factors that may contributed to such an effect. It was found that there is a high prevalence of decreased serum Vitamin B12 level in patients with type 2 Diabetes exposed to metformin treatment. Factors such as age and ethnicity were seen to be key predictors of this interaction and have shown a unique view of how the population of New Zealand may be affected. Treatment of decreased serum Vitamin B12 levels was seen to be effective through both sublingual and intramuscular methods with variations in both short and long term effects. The use of sublingual treatment administration of Vitamin B12 supplementation is unique in the scope of metformin induced Vitamin B12 deficiency and has shown potential to be a therapeutic route for patients affected by such an interactions. Current views on the interaction between metformin and serum Vitamin B12 levels are currently under debate in regards to physiological relevance and clinical outcomes. This paper provides a first look at the effect of this interaction in a New Zealand population and evaluates treatment options for such. Furthermore a proposal is made for an alternate mechanism of metformin action on Vitamin B12 levels which may aid understanding of observations made in both in this paper and previous studies.</p>

Risk factors at five-year survival in grade 3 breast cancer: a retrospective observational study of the New Zealand population

Background Breast cancer is the most common cancer in New Zealand, with approximately 3000 new registrations annually, affecting one in nine women and resulting in more than 600 deaths. This study analyzed data of patients with selected prognostic factors of Nottingham grade 3 tumors over a specified five-year period. The study aimed to identify factors that result in differential survival in the female, New Zealand population. Method This is an observational, retrospective cohort study of prospectively collected data from New Zealand Breast Cancer Register. The selected period of 1st January 2011 to 31st, December 2015 allowed a consistent overlap for a national five-year data of grade 3 breast cancer in New Zealand. Mortality was carried out using univariate Fine-Gray competing risk statistical models. Results This study showed that women in the older age group (> 70 years) had higher five-year mortality risk (HR: 1.7, 95% CI: 0.9–3.0, p = 0.053). Hormonal receptor analysis showed that ER positive, PR negative, and ER negative, PR negative subjects were at increased risk (HR = 3.5, 95% CI 2.3–5.4, p < 0.001) and (HR = 2.6, 95% CI, 1.8–3.9, p < 0.001) respectively. Molecular subtypes Triple Negative Breast Cancer and Luminal B subjects were at increased risk (HR = 3.0, 95% CI, 1.8–4.7, p < 0.001 and (HR = 3.3, 95% CI, 1.7–6.3, p < 0.001) respectively. HER2 enriched subjects were at a higher, but not significant, risk of five-year mortality compared to luminal A (HR = 1.6, 95% CI, 0.8–3.0, p = 0.10). NZ Europeans were at increased risk (HR = 1.7, 95% CI, 0.8–3.2, p = 0.11), with the highest Cumulative Incidence Function CIF, the largest proportion of HER2 enriched and TNBC across ethnicities.; however, Pacific Islanders experienced the highest HER2 CIF. Conclusion The survival rates for grade 3 breast cancer vary across the selected prognostic factors and ethnicity. The results of this study make an initial contribution to the understanding of grade 3 breast cancer in the New Zealand population.

Firearms and Homicide: the Influence of the Weapon Substitution Hypothesis on the American Gun Control Debate

<p>For several decades now the gun control literature in the United States has continued to produce conflicting accounts in regards to the availability of firearms on the U.S's high rate of homicide. This thesis proposes that this conflict is, in part, due to the implicit and continued influence of Wolfgang's (1958) 'weapon substitution hypothesis'. Wolfgang's hypothesis proposes that the intentions of an assailant, whether they be to kill or injure, determined the weapon selected. Since guns are recognised as being highly lethal, all assailants who use such weapons were believed by Wolfgang to have been highly determined to kill. Among other negative effects, it is argued that Wolfgang's hypothesis introduced a mind-set to this controversial research area that has continued to influence the opinions of academics from both sides of the debate. This mind-set revolves around the consensually held belief that if a firearm assailant is believed to have been determined to kill then they would have been capable of killing in the absence of firearms. Importantly, this belief implies that the best possible predictor of lethal weapon substitution is if a firearm assailant is determined to kill. This is unlikely to be true. Mischel (1968: 135) has argued: 'A person's relevant past behaviours tend to be the best predictors of his future behaviour in similar situations.' After adapting Mischel's logic to fit the weapon substitution debate, the following predictor was produced. The best possible predictor of lethal weapon substitution to non-firearm weapons is whether people who had killed with firearms were as experienced at killing victims with non-firearm weapons as assailants who had actually killed with such weapons. This predictor was further developed into a more workable methodology that was capable of testing the validity of both Wolfgang's hypothesis and the consensually held belief it initiated. This methodology involved a comparison of the previous serious to fatal violent non-firearm convictions between those most likely to be determined firearm and knife killers. It was discovered that only 2.94 percent of those most likely to be determined firearm assailants and 25.23 percent of those most likely to be determined knife assailants had previous convictions for serious to fatal non-firearm assaults. This result was statistically significant to the p< 0.005 (Z score=2.84). After eliminating all other possible explanations for these results it was concluded that, in conflict with both Wolfgang's hypothesis and the consensually held belief, not all determined firearm assailants are likely to be capable of lethal weapon substitution. Furthermore, if some proportion of determined firearm assailants are unlikely to be capable of lethal weapon substitution, then those not so determined are likely to be even less capable. Therefore, it was concluded that inhibiting all potential firearm assailants from accessing guns would be likely to reduce the overall rate of homicide. However, this thesis was limited in being able to apply this conclusion to the United States because it was based on a New Zealand population. Nevertheless, it is argued that the perpetuation of the consensually held belief has inhibited the best possible predictor of lethal weapon substitution from being applied to a research area where prediction is of paramount importance. When the best possible predictor of lethal weapon substitution has not previously been applied, it therefore becomes more understandable why this research area is plagued by such controversy.</p>

Firearms and Homicide: the Influence of the Weapon Substitution Hypothesis on the American Gun Control Debate

<p>For several decades now the gun control literature in the United States has continued to produce conflicting accounts in regards to the availability of firearms on the U.S's high rate of homicide. This thesis proposes that this conflict is, in part, due to the implicit and continued influence of Wolfgang's (1958) 'weapon substitution hypothesis'. Wolfgang's hypothesis proposes that the intentions of an assailant, whether they be to kill or injure, determined the weapon selected. Since guns are recognised as being highly lethal, all assailants who use such weapons were believed by Wolfgang to have been highly determined to kill. Among other negative effects, it is argued that Wolfgang's hypothesis introduced a mind-set to this controversial research area that has continued to influence the opinions of academics from both sides of the debate. This mind-set revolves around the consensually held belief that if a firearm assailant is believed to have been determined to kill then they would have been capable of killing in the absence of firearms. Importantly, this belief implies that the best possible predictor of lethal weapon substitution is if a firearm assailant is determined to kill. This is unlikely to be true. Mischel (1968: 135) has argued: 'A person's relevant past behaviours tend to be the best predictors of his future behaviour in similar situations.' After adapting Mischel's logic to fit the weapon substitution debate, the following predictor was produced. The best possible predictor of lethal weapon substitution to non-firearm weapons is whether people who had killed with firearms were as experienced at killing victims with non-firearm weapons as assailants who had actually killed with such weapons. This predictor was further developed into a more workable methodology that was capable of testing the validity of both Wolfgang's hypothesis and the consensually held belief it initiated. This methodology involved a comparison of the previous serious to fatal violent non-firearm convictions between those most likely to be determined firearm and knife killers. It was discovered that only 2.94 percent of those most likely to be determined firearm assailants and 25.23 percent of those most likely to be determined knife assailants had previous convictions for serious to fatal non-firearm assaults. This result was statistically significant to the p< 0.005 (Z score=2.84). After eliminating all other possible explanations for these results it was concluded that, in conflict with both Wolfgang's hypothesis and the consensually held belief, not all determined firearm assailants are likely to be capable of lethal weapon substitution. Furthermore, if some proportion of determined firearm assailants are unlikely to be capable of lethal weapon substitution, then those not so determined are likely to be even less capable. Therefore, it was concluded that inhibiting all potential firearm assailants from accessing guns would be likely to reduce the overall rate of homicide. However, this thesis was limited in being able to apply this conclusion to the United States because it was based on a New Zealand population. Nevertheless, it is argued that the perpetuation of the consensually held belief has inhibited the best possible predictor of lethal weapon substitution from being applied to a research area where prediction is of paramount importance. When the best possible predictor of lethal weapon substitution has not previously been applied, it therefore becomes more understandable why this research area is plagued by such controversy.</p>

Research Note: Current New Zealand Population Projections (June, 2021)

Key information from current population projections developed by Statistics NZ, especially those based on 2018 or since, are provided, with brief commentary on the results and their interpretation.