Australian Doctor Australian Doctor 7th July 2017 | Page 9

News
JOCELYN WRIGHT
THE first study to look
at the risks of exposure to
loose-fill asbestos in the
home has found a weak
link with mesothelioma, but
nevertheless one that “can-
not be ignored”.
The findings came from
an ACT Government report
that looked at cancer rates
over a 30-year period in
more than 17,000 people
who had lived in a home
with ‘Mr Fluffy’ asbestos
insulation.
In total, 285 current and
former residents of the ACT
were diagnosed with meso-
thelioma, of whom seven
had lived in a home with
loose-fill asbestos.
Men were more than two
and half times more likely
to be diagnosed with meso-
thelioma if they had lived in
an asbestos-affected house
than men who had not,
according to the Austral-
ian National University-led
research.
In total, this equated to
four more cases of mesothe-
lioma among men who had
lived in an asbestos-affected
house. There were no cases
of mesothelioma in women
who had lived in an asbes-
tos-affected house.
“Higher rates of meso-
Asbestos findings ‘can’t be ignored’
thelioma in men could have
been due to their greater
frequency of entry into the
roof space of their house …
or of making renovations
to their house,” the report
authors suggested.
The association between
mesothelioma and living in
a house with loose-fill asbes-
tos was considerably weaker
compared with workers
exposed to asbestos, they
noted.
“However the findings
cannot be ignored.”
In summing up, they
emphasised that there was
considerable
uncertainty
around the estimates of can-
cer risk for loose-fill asbes-
tos, especially as higher rates
of colorectal and prostate
cancers had been seen in peo-
ple exposed to the substance.
“The role of random
error in explaining the find-
ings cannot be ruled out,”
they said.
The report noted that
loose-fill
asbestos
was
installed as insulation in the
roof spaces of many Can-
berra houses in the 1970s.
A remediation program
had since removed it from
more than 1000 houses, but
concerns remained over the
long-term health risks of
exposure to asbestos fibres
found in wall cavities and
living areas.
Until now, estimates of
cancer risk for asbestos had
come from high levels of
occupational exposure, and
there was no scientific evi-
dence for household expo-
sure. It would be useful to
extend the study to include
more years of data, the
authors suggested.
Concern over diabetes drugs initiated in older patients
RACHEL WORSLEY
AUSTRALIAN researchers
are concerned that SGLT2-
inhibitors such as dapagliflozin
are being used inappropriately
in elderly patients with type 2
diabetes.
Their study of more than
3000 people taking SGLT2-
inhibitors or DPP-4 inhibitors
found a majority over the age
of 75 had been initiated on
dapagliflozin.
This was contrary to product
indications and there was a
lack of evidence to back its
use in this population, said the
University of SA researchers.
Furthermore, only one-
quarter of patients had renal
function documented.
“This … raises concerns
as adverse events of renal
impairment and volume
depletion-related events in
elderly patients were more
frequent in clinical trials of
dapagliflozin 10mg compared
with placebo,” the authors
said.
However, they cautioned
that the 25% figure for renal
function reporting might not
be entirely accurate and
could represent a lack of
documentation rather than a
lack of monitoring by GPs.
A spokesperson
for AstraZeneca, the
manufacturers of dapagliflozin,
3980_bp_learn_AUSDOC_260x193_AD.indd 1
said the company was
committed to ensuring
doctors were well informed
of the product information as
approved by the TGA.
The study also found a
higher risk of genital infections
with SGLT2-inhibitors, but
no increased risk of urinary
tract infections compared
with DPP-4 use. About 6% of
patients on SGLT2-inhibitors
were prescribed frusemide.
These patients could be at
risk of dehydration because
SGLT2-inhibitors had been
li