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If you're an affluent car enthusiast who has always desired a vintage Volvo station wagon that has no problem embarrassing a new Ferrari in a straight line (who hasn't), you're in luck. The car you see here, which may be the only one in the world that fits this description, is currently for sale.
Ever since this amazing 788 horsepower 1967 Volvo Amazon station wagon made its debut at SEMA in 2006 (it was producing a still impressive 600 horsepower at that point) we've been in awe of how unbelievably well built and simply awesome this wagon is.
Mattias Vöcks—who spends his days working as an engineer for Koenigsegg—is the mad scientist responsible for this Swedish hot rod. Although the car is obviously heavily modified, it's still all Volvo under the hood—a 2.8 liter turbocharged inline six hooked up to a Getrag six-speed transmission are responsible for the wagons unbelievable straight line performance.
Equally unbelievable is the fact that Vöcks is now ready to part with this oddly beautiful monster. According to Carscoop.com there is an asking price of $109,000 attached to the car, but the price is negotiable. We have not yet received a response to our offer of several non-essential organs and a well worn Toyota 4runner.
Hat tip to #1785935 - Mikeado!
(Engine Photo Credit: SwedeSpeed.com)


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Should Christians vote for a Mormon? Is Mormonism a cult? Let me say right off: These questions are an enormous distraction in an important presidential campaign. The secular media is using the pastor's comments to paint evangelicals as bigots. The Chicago Tribuneis calling this "hate speech."
I want to say this to every Christian listening to my voice: Let's stop criticizing candidates for their religious convictions.
And let me make a few things, as my former boss used to say, perfectly clear.
First, there is no religious test for public office. If you don't believe me, check out the Constitution of the United States, Article VI, Paragraph 3. The public statements of some evangelicals that they wouldn't vote for Romney because of his Mormonism would cause the Founding Fathers to spin in their graves.
Second, as voters we are to choose the most competent people to be God's magistrates to do
"I want to say this to every Christian listening to my voice: Let's stop criticizing candidates for their religious convictions."
Third, let me answer the question that is causing so much angst. Is the Mormon faith Christian? No. It is not. There are significant and un-reconciled doctrinal differences between Mormonism and Christianity, like the sole sufficiency of Christ and the exclusivity of the Bible.
For me to say there are such differences is not "hate speech." To deny that there are differences would be disrespectful of the truth claims made by Mormons and degrades my own truth claims. No one in good conscience can do that.
Having said that, there may be no othergroup of people I appreciate more as co-belligerents than the Mormons. They are stalwarts on life, traditional marriage, and religious liberty issues.
To sum up, I'm with Luther, who reportedly said that he would rather be governed by a competent Turk than an incompetent Christian.
Now I've never publicly endorsed a candidate, and I'm not doing it now. *But I would personally
"For me to say there are such differences is not "hate speech." To deny that there are differences would be disrespectful of the truth claims made by Mormons and degrades my own truth claims."
Our ultimate decision has to be based on what Augustine taught. We must live obediently in the City of Man as the best of citizens, doing our civic duty, which includes voting responsibly, as a reflection of our primary citizenship in the City of God.
Where does this leave us? Come on: Stop talking about the candidates' religion. It's distracting and it marginalizes Christianity in the public debate. Let's continue instead to work to advance the Kingdom of God and pick, to the best of our ability, a candidate of competence and sound character who will preserve order and promote justice in our land.
Chuck Colson is the founder of Prison Fellowship and theColson Center for Christian Worldview.
This article originally appeared atBreakPoint.org. Republished with permission.

subset: commoncrawl


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ANAHEIM, CA. (November 9, 2012) – Meat lovers living in the central and southern regions of the country might be opting for a vegetarian lifestyle if meat comes with an unwanted side of a life-threatening allergic reaction. According to a study presented at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI), the lone star tick inhabiting these regions is the primary reason for what's known as a meat induced alpha-gal allergic reaction.
Alpha-gal is a sugar carbohydrate found in red meats such as beef, pork and lamb. According to the study, positive alpha-gal rates are 32 percent higher in lone star tick population areas as compared to other regions. The central and southern regions of the United States have the highest rates of alpha-gal sensitization due to the lone star tick.
"Blood levels of antibodies for alpha-gal in the human body can rise after a single bite from the lone-star tick," said allergist Stanley Fineman, M.D., ACAAI president. "This can result in allergic symptoms which are usually delayed after meat ingestion and may present as mild hives but may also be a severe, potentially deadly reaction known as anaphylaxis."
The study also found positive rates higher than expected in the north-central and west regions of the country, where the lone star tick is not found.
"These findings suggest that other species of ticks, or possibly human factors, may play a role in allergic reactions to alpha-gal," said Dr. Fineman. "Patients with delayed allergic reactions after eating meats should see an allergist to determine if it is an alpha-gal allergy. The best treatment is strict avoidance of meat. An allergist may also prescribe epinephrine in the event of a life threatening emergency."
Unlike other food allergies, alpha-gal meat allergy can be delayed as long as three to six hours after eating meat. Symptoms range from mild to severe and may include:
- Hives or skin rash
- Nausea, stomach cramps, indigestion, vomiting, diarrhea
- Stuffy/runny nose
- Sneezing
- Headaches
- Asthma
- A severe allergic reaction is known as anaphylaxis, which starts rapidly and may cause death
If you experience an allergic reaction after eating meat, seek emergency medical attention. Follow up with a board-certified allergist who can develop a treatment plan for you and prescribe life-saving epinephrine.
Information about allergies and asthma can be found at AllergyAndAsthmaRelief.org. To see if lone star ticks populate your region, visit The Centers for Disease Control and Prevention distribution map at http://1.usa.gov/PEsBDM. More news and research from the annual meeting, being held Nov. 8-13, 2012 can be followed via Twitter at #ACAAI.
About ACAAI
The ACAAI is a professional medical organization of more than 5,700 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit www.AllergyandAsthmaRelief.org. Join us on Facebook and Twitter.
The ACAAI Press Room is located in Room 304B at the Anaheim Convention Center, Nov. 9-12, 2012. To arrange an interview, please contact Christine Westendorf, ACAAI Media Relations Manager, at 847-427-1200 or firstname.lastname@example.com


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Editor's Note: This article is from 2019, but is being reposted on ScheerPost for Martin Luther King Jr. Day as a reminder of Dr. King's class-based views that are so often whitewashed and omitted by the political class.
By Katie Halper / Common Dreams
Happy Martin Luther King, Jr. Day. To be fair, I guess I should wish "Sorry it's Martin Luther King, Jr. Day" to the people who don't believe it should be a holiday and the politicians who voted against making it one. I'm talking to you, Sen. Chuck Grassley (R-IA), Sen. Orrin Hatch (R-UT) Sen. John McCain (R-AZ), Sen. Richard Shelby (R-AL), Rep. Jim Sensenbrenner (R-WI) Rep. Hal Rogers (R-KY), Sen. Johnny Isakson (R-GA), Rep. John Culberson (R-TX) and Rep. Steve Scalise (R-LA).
While both parties attempt to claim Dr. King, the Republicans have a much harder time doing so without distorting history and the truth. But the truth is, most politicians would distance themselves from Dr. King's stunning (and spot on) indictments of capitalism. There are, of course, a few exceptions, here and there.
As we celebrate Martin Luther King Day, let's look at some of the things he said challenged capitalism and are left out of most history books.
- "I imagine you already know that I am much more socialistic in my economic theory than capitalistic… [Capitalism] started out with a noble and high motive… but like most human systems it fell victim to the very thing it was revolting against. So today capitalism has out-lived its usefulness."
– Letter to Coretta Scott, July 18, 1952.
- "In a sense, you could say we're involved in the class struggle."
–Quote to New York Times reporter, Jose Igelsias, 1968.
- "And one day we must ask the question, 'Why are there forty million poor people in America? And when you begin to ask that question, you are raising questions about the economic system, about a broader distribution of wealth.' When you ask that question, you begin to question the capitalistic economy. And I'm simply saying that more and more, we've got to begin to ask questions about the whole society…"
–Speech to Southern Christian Leadership Conference Atlanta, Georgia, August 16, 1967.
- "Capitalism forgets that life is social. And the kingdom of brotherhood is found neither in the thesis of communism nor the antithesis of capitalism, but in a higher synthesis."
–Speech to Southern Christian Leadership Conference Atlanta, Georgia, August 16, 1967.
- "Call it democracy, or call it democratic socialism, but there must be a better distribution of wealth within this country for all God's children."
– Speech to the Negro American Labor Council, 1961.
- "We must recognize that we can't solve our problem now until there is a radical redistribution of economic and political power… this means a revolution of values and other things. We must see now that the evils of racism, economic exploitation and militarism are all tied together… you can't really get rid of one without getting rid of the others… the whole structure of American life must be changed. America is a hypocritical nation and [we] must put [our] own house in order."
– Report to SCLC Staff, May 1967.
- "The evils of capitalism are as real as the evils of militarism and evils of racism."
–Speech to SCLC Board, March 30, 1967.
- "I am now convinced that the simplest approach will prove to be the most effective – the solution to poverty is to abolish it directly by a now widely discussed matter: the guaranteed income… The curse of poverty has no justification in our age. It is socially as cruel and blind as the practice of cannibalism at the dawn of civilization, when men ate each other because they had not yet learned to take food from the soil or to consume the abundant animal life around them. The time has come for us to civilize ourselves by the total, direct and immediate abolition of poverty."
– Where do We Go from Here?,1967.
- "You can't talk about solving the economic problem of the Negro without talking about billions of dollars. You can't talk about ending the slums without first saying profit must be taken out of slums. You're really tampering and getting on dangerous ground because you are messing with folk then. You are messing with captains of industry. Now this means that we are treading in difficult water, because it really means that we are saying that something is wrong with capitalism."
– Speech to his staff, 1966.
- "[W]e are saying that something is wrong … with capitalism…. There must be better distribution of wealth and maybe America must move toward a democratic socialism."
– Speech to his staff, 1966.
- "If America does not use her vast resources of wealth to end poverty and make it possible for all of God's children to have the basic necessities of life, she too will go to hell."
– Speech at Bishop Charles Mason Temple of the Church of God in Christ in support of the Memphis sanitation workers' strike on March 18th, 1968, two weeks before he was assassinated.


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ForumsTips & TricksToodledo Toosdays: Locations
Toodledo Toosdays: Locations
Sabina A.
Todays Toodledo Toosday Tip:
Did you know that you can assign a location to a task? You can also group and sort your tasks by location, so you can visually see them on a map. Also, receive alerts on your iOS device when you are near a location associated with a task.
For more information: http://www.toodledo.com/organize/locations.php
Submit your Toodledo tips to email@example.com. If you're the first one with a new idea, we'll give you a free month subscription!
I love this feature. Unfortunately the feature is not available in any Android apps or mobile web.
I have to set the locations to Context and manually select the Context at each location.
This message was edited Oct 12, 2013.
Posted: Oct 13, 2013
Score: 0 Reference
I don't need to use 'Locations' with the map, so I have not activated its GPS and use this field as work Contexts (Work, Home, Anywhere, etc.). This frees up the Contexts field for other use (delegation to people, marking frog tasks, etc.).
Hope Toodledo continues to offer this feature (manual overide) rather than forcing automatic usage.
Anyone else use it like this?
Posted: Oct 13, 2013
Score: 0 Reference
This is one of the areas Android suffer the most from not having a native app. Not many third party apps does this very well. I still cannot believe it should be that difficult to make an Android app if Toodledo wanted to.
You cannot reply yet
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This site is the archived OWASP Foundation Wiki and is no longer accepting Account Requests.
To view the new OWASP Foundation website, please visit https://owasp.org
January 3, 2011
- Operational Budget status ($25k total available)
- Should remainder be moved to Sponsorship fund?
- Sponsorship Fund status
- $15k remaining
- >30 sponsorship applicants
- Board has taken responsibility of selecting applicants
- OSTF status (??)
Reg online up and running. Phase 2 is to upload existing data
Tesaruo Consulting
Each of you must commit 3-4 hours of focused, independent effort plus phone time for Board facilitated discussions of each phase. Thoughtful, contemplative, hard work is required to draft an enduring OWASP Vision.
Google invite for every Friday 12 noon EST.
Membership Committee
Approved by Committee 12/21 - spells out honorary membership details.
Conferences Committee
Passed: 2011 Plan
Includes 3 Items adressing/requiring board approval. Complete details can be found here
• Requirement for GCC Member to be present at all Global AppSec and Regional/Theme conferences
• OWASP Foundation signature authority for the GCC Membership
• A Global Conference Committee Operational Budget of $33,000 USD
Projects Committee
- ASVS Leader selection process complete. Suggestion by GPC (formal recommendation document soon). Board approval?
- GPC Passed Internal GPC Governance rules (publication soon)
Education Committee
Chapter Committee
Industry Committee


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I was born to reflect the image of a God who is powerful enough to create my universe, attentive enough to hear my prayers and loving enough to be defined by self-sacrifice. I find my greatest fulfillment on a journey toward purpose and wholeness.SpiritualityMy God loves without restraint... VitalityMy Life is a gift to be valued... ServiceMy World is a place where people find hope...
Seventh-day Adventist beliefs are meant to permeate your whole life. Growing out of scriptures that paint a compelling portrait of God, you are invited to explore, experience and know the One who desires to make us whole.Learn More


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LOS ANGELES—In the largest deal ever made to shit out a movie, Warner Bros. and director Michael Bay announced a landmark $50 million agreement this week to monumentally fuck up ThunderCats.
"I couldn't be more excited to completely fuck this up," said Bay, who plans to begin production on destroying the live-action adaptation next month. "ThunderCats has a great story, endearing characters, action, adventure, space-travel, and fantasy. It will be an honor to run it into the ground."
"I'll use every directorial tool I have to suck the very life and charm out of this beloved cartoon," added Bay, claiming that the film could turn out to be the most colossal piece of shit he's ever worked on. "I won't rest until I get every last scene exactly wrong."
According to executives, Warner Bros. settled on Bay after a 12-month search of Hollywood's most reviled directors, including Joel Schumacher, Roland Emmerich, and Brett Ratner. In the end, the studio decided only Bay could be relied upon to deliver a 220-minute cinematic clusterfuck with enough tedious performances, overblown cinematography, and CGI explosions to make even the most casual fan want to scratch their eyes out.
"No filmmaker working today has Bay's ability to somehow direct his actors to be both emotionless and melodramatic at once," Warner Bros. CEO Barry Meyer said. "And I personally can't wait to see how he needlessly overcomplicates the plot."
Bay reportedly only agreed to fuck up ThunderCats after several specific conditions were written into his contract. According to the terms of the deal, Bay must be allowed to eliminate the character Panthro entirely to focus on the asinine relationship between Snarf and Snarfer, and include nearly 22 minutes of frenetic, impossible-to-follow action sequences that he hopes will annoy the living Christ out of audiences.
"We're just getting started on the storyboards, but I've already got a lot of really contrived ideas about zooming in way too close and shooting everything at nauseating angles," said Bay, who claimed viewers won't be able to tell if the climactic final battle is between two blurry elbows or a half dozen leopard-print pillows. "I promise you'll walk out of the theater feeling like you just flushed $12 down the toilet."
"You will all fucking hate me," he continued.
Hollywood insiders agreed that Bay—who has reportedly been closely involved in each of the 45 progressively worse rewrites of the script—was a natural choice to take a steaming dump on the popular ThunderCats property.
"Michael Bay has this innate sense of how to ruin a great story," Variety reporter Todd Brick said. "His ability to create astonishing plot holes, pepper dialogue with groan-inducing clichés, and abandon storylines halfway through is unparalleled. He was born to destroy this movie."
Though he admitted there was still "a lot of fucking up to do" before the script attains his trademark shit-slicked sheen, Bay has recruited hack writers Alex Kurtzman and Roberto Orci to punch-up the screenplay with hollow characters and by-the-numbers jokes about kitty litter boxes and hair balls.
But all the time and effort, Bay claimed, is worth it to ensure that he fucks ThunderCats up as badly as he knows he can.
"Ever since I failed to ruin Scarlett Johansson's career with The Island, I've been looking for a challenge like this," Bay said. "Who knows? With Transformers: Revenge of the Fallen and ThunderCats coming out in the same year, I may finally reach my goal of making all of America hate cinema forever."


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In 2006, a new class of medicine for Type 2 diabetes[1] was introduced to the U.S. market. Called DPP-4 inhibitors, these drugs work in a way that is different from any previous diabetes treatment. Sitagliptin (brand name Januvia) was the first drug in this class to be approved; it can be used alone or in combination with other oral diabetes drugs[2]. Saxagliptin (Onglyza), another DPP-4 inhibitor, received approval in July 2009.
At the turn of the 20th century, several different researchers were examining the role of the intestines and the pancreas in diabetes. Research soon demonstrated, through experiments with animals and autopsies of people who had died of diabetes complications[3], that Type 1 diabetes was caused by a problem with the pancreas. After extracts of the pancreas were shown to treat diabetes, a research team at the University of Toronto (Frederick Banting and Charles Best) isolated insulin[4] in 1921.
Further experiments went on to explore the relationship between the pancreas and the intestines. Some of these demonstrated that intestinal extracts could lower blood glucose by stimulating the pancreas to produce more insulin. Hormones from the intestines with this effect are called incretins. Significant research on incretins was not conducted again until the 1960's, when researchers were faced with a puzzle: When people were given the same amount of glucose at different times by vein and by mouth, the amount of insulin produced was much greater when the glucose was given by mouth. The researchers concluded that the gastrointestinal tract was signaling the pancreas to produce insulin. The hunt was on for the exact chemicals involved in this process, and finally a hormone was isolated: gastric inhibitory polypeptide, or GIP. A second hormone called glucagon-like polypeptide 1, or GLP-1, was later isolated.
GLP-1 was found to have a profound effect on stimulating the release of insulin from the pancreas. It was also found to be active for a very short time in the blood. This is because it is broken down quickly by an enzyme called dipeptidyl peptidase 4, or DPP-4. A drug that could inhibit the action of DPP-4 would extend the insulin-releasing effect of GLP-1.
Drugs that inhibit the action of DPP-4 are intervening in a complex set of reactions that occur when food is eaten. In response to meals, specialized cells in the intestines called L cells secrete GLP-1. L cells are mainly found in the ileum, the last segment of the small intestine, and in the large intestine (also known as the colon). GLP-1 appears to be secreted, however, before food from a meal reaches these areas of the intestines. The L cells have receptors for a variety of hormones secreted by the digestive system, which helps them determine the type of nutrients that have been consumed and control the amount of GLP-1 they release. It is thought that hormonal signals from the upper intestine, as well as a chemical released by nerves in response to eating, stimulate the release of GLP-1.
GLP-1 has several effects in the body other than stimulating the release of insulin. It also slows stomach emptying, inhibits the release of glucagon[5] (glucagon is a hormone that signals the liver to release glucose and is usually elevated in people with Type 2 diabetes), and enhances the survival and growth of pancreatic beta cells[6], which secrete insulin. It has been found in laboratory studies that animals treated with DPP-4 inhibitors seem to have an increased number of pancreatic beta cells, indicating that these drugs may stimulate beta-cell growth (most likely through the action of GLP-1). This effect has not yet been demonstrated in humans, but if confirmed, it means that DPP-4 inhibitors could play a significant role in delaying and possibly reversing the progression of Type 2 diabetes.
DPP-4 is a protein that is found both circulating in the blood and attached to cell membranes. It breaks down several hormones, not just GLP-1, and helps transmit signals from outside cells to the inside. DPP-4 was originally identified as a protein on lymphocytes, a type of white blood cell in the immune system. It was later found on many different types of tissue, including the kidneys, lungs, liver, intestines, pancreas, blood vessels, and brain. The breakdown of GLP-1 occurs within several minutes of DPP-4 being released into the blood.
Several studies have shown that people with Type 2 diabetes tend to have impaired GLP-1 secretion as well as elevated DPP-4 activity. This combination results in substantially reduced insulin production. Researchers have found that after gastrointestinal surgery to treat obesity (such as gastric banding[7] or gastric bypass[8]), GLP-1 levels increase and glucose control improves, suggesting that enhanced GLP-1 activity may be one way that these surgeries help reverse Type 2 diabetes in many patients.
Since DPP-4 inhibitors only enhance the body's own ability to release insulin and regulate blood glucose, these drugs can only treat Type 2 diabetes. Their effect is dependent on some function of the insulin-releasing beta cells in the pancreas, and people with Type 1 diabetes generally do not have a significant number of functioning pancreatic beta cells.
Many compounds believed to inhibit the activity of DPP-4 have been tested in humans. The ones that have been developed the furthest for medical use are sitagliptin (Januvia), approved by the Food and Drug Administration (FDA) in 2006, saxagliptin (Onglyza), approved by the FDA in 2009, and vildagliptin (Galvus), whose approval has been delayed by the FDA pending further data on people with kidney disease. (Vildagliptin was approved in Europe in 2007.) Another drug in the same family, alogliptin, was recently tested in large, Phase III trials (the results of Phase III trials provide much of the information that the FDA requires to grant marketing approval).
Numerous studies have been carried out to evaluate the effects of DPP-4 inhibitors in people with diabetes. These studies have generally shown an increase in both GLP-1 and insulin, as well as a decrease in blood glucose and glucagon levels after meals with use of the drugs. Long-term DPP-4 inhibition has been shown to reduce HbA1c[9] levels, as well (HbA1c is a measure of blood glucose control over the previous 2—3 months). Since only sitagliptin is currently available in the United States, studies of it are probably the most widely relevant.
Sitagliptin was tested as a stand-alone treatment in five large studies whose size ranged from 151 to 743 participants. In the largest study, subjects had an average starting HbA1c level of 7.9%. The participants were divided into six groups, with one group receiving a placebo (inactive pill), four groups receiving different doses of sitagliptin, and one group receiving glipizide, a diabetes drug that stimulates the pancreas to release more insulin. All groups were treated for 12 weeks. When compared with the placebo group, all of the drug-treated groups had a reduction in average HbA1c level. The group that took 50 mg of sitagliptin experienced an average drop of 0.77%, and the glipizide group saw a drop of 1.0%. (A 1% drop in HbA1c level has been found to reduce microvascular complications, like diabetic eye [10]and kidney [11]disease, by 35% and is believed to reduce the risk of heart disease[12] and overall death, as well.) While the glipizide group had a greater average reduction in HbA1c level, that group also had a much higher rate of low blood glucose, or hypoglycemia[13], (17%) than groups that took sitagliptin (4%) and experienced greater average weight gain (2.4 pounds versus no change in weight).
In another 12-week study, participants with an average starting HbA1c level of 7.8% were divided into four sitagliptin groups with different dose sizes and a placebo group. The group that received 100 mg once daily had the greatest average reduction in HbA1c level, 0.56%.
The three other studies tested daily doses of either 100 mg or 200 mg of sitagliptin over a period of 12—24 weeks. These studies showed average reductions in HbA1c level of 0.60% to 1.05%. Sitagliptin used alone to treat Type 2 diabetes generally lowered HbA1c levels 0.77% more than a placebo did.
Sitagliptin was also tested in combination with other drugs in four major trials. Three of the trials used sitagliptin combined with one other drug. These include studies that compared sitagliptin plus pioglitazone (Actos) with pioglitazone alone, and ones that compared sitagliptin plus metformin [14]with both metformin alone and glipizide plus metformin. The studies ranged in length from 24 to 52 weeks. When sitagliptin was combined with metformin and with pioglitazone, the average HbA1c level of participants decreased by 0.65% and 0.70% more, respectively, than in those who took metformin alone and pioglitazone alone. When sitagliptin plus metformin was compared with glipizide plus metformin, there was no significant difference in reduction of HbA1c levels; both groups experienced an average drop of 0.67% (from an average starting HbA1c level of 7.5%).
Sitagliptin was also tested in combination with both glimepiride and metformin. (Like glipizide, glimepiride stimulates the pancreas to release more insulin.) In this study, participants were divided into four treatment groups, receiving either glimepiride only, sitagliptin and glimepiride, metformin and glimepiride, or sitagliptin, metformin, and glimepiride. Compared with glimepiride alone, the addition of sitagliptin reduced the average HbA1c level by 0.6% more, and compared with metformin plus glimepiride, the addition of sitagliptin caused a drop of 0.9% more.
Based on all of the studies mentioned, the recommended dose of sitagliptin is 100 mg taken once daily, either alone or in combination with metformin, a sulfonylurea[15] drug such as glipizide or glimepiride, or a thiazolidinedione such as pioglitazone. It should be noted that these recommendations were created prior to the new warnings that thiazolidinediones may lead to an increased rate of heart problems, notably congestive heart failure. Sitagliptin is also available in a combination pill with metformin (Janumet) in two dose sizes.
As the studies that were just described show, sitagliptin tends to lower HbA1c levels about as much as glipizide (and in some cases, not quite as much). It is not automatically clear, then, how sitagliptin should fit into diabetes treatment. The American Diabetes Association has not said in a definitive way how DPP-4 inhibitors should be used; it simply states that they may play a role in diabetes care. This is due to the relatively few studies done on sitagliptin compared with the wealth of information available for other drugs, as well as the newness of the data on sitagliptin.
Yet sitagliptin does have potential advantages over other drugs, as well as known disadvantages and side effects. One disadvantage is that compared with placebo, sitagliptin causes a small weight gain (about 1 pound on average). used in combination with metformin, however, it is associated with a loss of 5.5 pounds on average, compared with a gain of 2 pounds from the combination of metformin and glipizide.
Since sitagliptin is metabolized, or broken down, primarily by the kidneys and only metabolized by the liver to a small extent, the potential for it to interact with other drugs is relatively low; this finding has been confirmed in studies that have directly tested drug interactions in humans. However, this also means that the dose size of sitagliptin may need to be reduced for people in the later stages of kidney disease.
Sitagliptin results in a low incidence of hypoglycemia, comparable to that of placebo, when tested as a stand-alone therapy. It is associated with a somewhat higher rate of hypoglycemia when used in combination with other drugs, especially with a sulfonylurea such as glipizide or glimepiride.
As mentioned earlier, DPP-4 was discovered through its association with the immune system, and some researchers thought that inhibiting it might impair the immune system. So far, data from clinical studies have not demonstrated a serious immunosuppresive effect. They do indicate, though, that sitagliptin increases the risk of upper respiratory infections and nasopharyngitis (inflammation of the nose and pharynx), found in 6.3% and 5.2% of study subjects, respectively, who took sitagliptin versus 3.3% and 3.4% for placebo.
The most worrying side effects are those reported since the drug came onto the market. These reactions seem to be allergic in nature and include anaphylaxis, a bodywide reaction that results in low blood pressure[16], and angioedema, a swelling of the tongue, face, and throat. Both of these may be life-threatening. The reactions have occurred anytime from immediately after taking the first dose until three months after starting the drug. There have also been reports of skin reactions, including a very severe type of drug reaction called Stevens—Johnson syndrome. Other diabetes drugs are not typically associated with Stevens—Johnson syndrome.
DPP-4 inhibitors may be a useful addition to the treatment options for Type 2 diabetes. While the current DPP-4 inhibitors do not seem to have major, clearcut advantages over other therapies, they may be a reasonable alternative for people who cannot take certain other drugs. They may also be used with metformin when blood glucose control is not ideal. Whether these drugs could be used to preserve or improve pancreatic beta-cell function, as well, will be determined through further clinical trials. As options for treating Type 2 diabetes expand, new drugs, including DPP-4 inhibitors, help make it possible for more people to follow an effective, individualized plan for their diabetes.
Source URL: https://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/dpp-4-inhibitors-2/
Disclaimer of Medical Advice: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information, which comes from qualified medical writers, does not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs.
Copyright ©2023 Diabetes Self-Management unless otherwise noted.


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You might think that going to California, Texas or New York exposes you to a lot of crime. But in fact it was Tennessee that had the nation's highest violent crime rate last year.
The FBI's latest statewide statistics offer a snapshot of the underside of the 50 states: where violent crime is most likely to occur. According to the FBI, violent crime includes murder, rape, robbery and aggravated assault. 24/7 Wall St. reviewed the states with the highest rates of violent crime in the country.
Click here to see America's 10 Most Dangerous States
While violent crime rose just under 1% nationally in 2012, the trend for the past 20 years has been steady decline. Crime peaked in the late 1980s, fueled by the crack cocaine epidemic. Beginning in the early 1990s, crime began to decline. Although the exact cause remains unclear, experts have pointed to factors such as better policing, demographic changes, higher incarceration rates, a drop in cocaine use and the introduction of a variety of social programs.
In an interview with 24/7 Wall St., Urban Institute senior fellow John Roman pointed out that the crime decline has not been uniform. It has improved markedly in some large cities, like New York, Dallas and Washington, D.C. However, the decline has been less impressive in cities like Baltimore and Detroit, where economic and racial segregation limit the ability of the poor to move into the middle class.
The more the population is integrated, Roman explained, the greater the chances of sizable crime declines. Most crime is committed by people at the bottom of the economic totem pole, he said.
The apparent relationship between low income, low education and higher crime rates has been well documented, although identifying the cause and effect is still a matter of debate. It is clear, though, that these states for the most part match the national trend. Of the 10 states with the highest rates of violent crime, eight have lower rates of adults with bachelor's degrees, and most of them had median income levels below the national figure in 2012.
There are notable exceptions to the national trend, however. Alaska, Delaware and Maryland all have higher educational attainment and higher income, but they still make the list. In Maryland and Delaware, this likely has to do with pockets of very high crime in the largest urban areas.
While Maryland has the ninth-highest violent crime rate in the country, it also has the third-lowest poverty rate, the highest median income and one of the highest proportions of adults with a college degree. The reason for this discrepancy is likely the concentration of high crime in Baltimore. The Baltimore metropolitan area also had the ninth highest violent crime rate in the country last year and accounted for nearly a third of all the incidents in the state that year.
On its website, the FBI instructs readers to avoid comparing state violence because rankings tend to be simplistic and ignore factors that influence crime, as well as the different ways crimes are measured and reported. For this reason, Roman cautioned against directly comparing states based on their individual crime rates. However, because the states with the highest and lowest violent crime rates have remained consistent for many years, he believes comparing state ranks was useful. "This exercise is worth doing. I don't know how you make policy without doing this kind of thing."
24/7 Wall St. identified the 10 states with the highest rates of violent crime per 100,000 residents. Using estimated populations and crime incidents from the FBI's Uniform Crime Report, which measures incidents of eight types of violent and nonviolent crime for 2012, 24/7 Wall St. calculated the incidence of the four types of violent crime per 100,000 persons for that year: murder, forcible rape, robbery and aggravated assault. In addition to crime data, 24/7 Wall St. reviewed income, poverty and education statistics from the U.S. Census Bureau's American Community Survey for 2012, the most recent available year.
These are the most dangerous states in America.
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