Gastric Bypass: Half of Diabetic Patients In Remission 12 Years After Surgery

MedicalResearch.com Interview with:
Ted Adams PhD
Adjunct Professor, Internal Medicine
Adjunct Associate Professor, Nutrition & Integrative Physiology
The University of Utah 

MedicalResearch.com: Why did you decide to conduct this study?

Response: The primary aim of the study was to determine the clinical outcomes in patients who underwent gastric bypass surgery.

As NIDDK/NIH continued to fund the study, the aim was extended to determining the durability) long-term outcomes) of gastric bypass surgery when compared to non-surgical, severely obese patients.

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Diabetes In Elderly May Be Overtreated Leading To Hypoglycemia

MedicalResearch.com Interview with:

Matthew L. Maciejewski, PhD Professor in Medicine Division of General Internal Medicine, Department of Medicine Center for Health Services Research Primary Care Durham VA Medical Center Duke University

Dr. Maciejewski

Matthew L. Maciejewski, PhD
Professor in Medicine
Division of General Internal Medicine, Department of Medicine
Center for Health Services Research Primary Care
Durham VA Medical Center
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Treating diabetes requires balancing the risks of long-term harm from under-treatment with the short-term and long-term harm from potential over-treatment. Randomized trials have shown that the benefits of aggressive glycemic control only begin after at least 8 years of treatment. Yet, the harms of aggressive glycemic control –  hypoglycemia, cardiovascular events, cognitive impairment, fractures, and death – can happen at any time.

In some older people, “deintensification” of diabetes treatment may be the safer route, because of the risks that come with too-low blood sugar. The American Geriatrics Society (AGS) specifically states that medications other than metformin should be avoided when an older patient’s hemoglobin A1c is less than 7.5%, because the risks of hypoglycemia are larger and the potential benefits of treatment are smaller for older adults with diabetes.  Most attention in prior work has focused on undertreatment of diabetes and there has been only limited investigation of patient characteristics associated with overtreatment of diabetes or severe hypoglycemia.

Since the elderly are therefore at greatest risk of overtreatment and Medicare is the primary source of care of the elderly, we examined rates of overtreatment and deintensification of therapy for Medicare beneficiaries, and whether there were any disparities in these rates.  We found that almost 11 percent of Medicare participants with diabetes had very low blood sugar levels that suggested they were being over-treated. But only 14 percent of these patients had a reduction in blood sugar medication refills in the next six months.

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Pandemic Flu May Increase Risk of Type 1 Diabetes In Genetically Predisposed Patients

MedicalResearch.com Interview with:
Paz Lopez-Doriga Ruiz MD, PhD candidate Norwegian Institute of Public Health Department of Non Communicable Diseases OsloPaz Lopez-Doriga Ruiz MD, PhD candidate

Norwegian Institute of Public Health
Department of Non Communicable Diseases
Oslo 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Some case reports have linked pandemic influenza to the development of type 1 diabetes. Other studies have suggested that also respiratory infections may contribute to type 1 diabetes risk.

 Our findings supports a suggested role of respiratory infections in the etiology of type 1 diabetes and influenza virus could be a contributing factor to the development of clinical diabetes, due to stress and inflammation in predisposed individuals.

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Patients Frequently Decline Insulin For About Two Years After Recommendation

MedicalResearch.com Interview with:

Alexander Turchin, MD, MS Director of Quality in  Diabetes in the Division of Endocrinology, Diabetes and Hypertension Brigham and Women's Hospital

Dr. Turchin

Alexander Turchin, MD, MS
Director of Quality in
Diabetes in the Division of Endocrinology, Diabetes and Hypertension
Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Anecdotally, many clinicians report that their patients with diabetes frequently decline recommendations to start treatment with insulin. However, until now, there was no systematic information available on this phenomenon.

Our study has found that 30% of patients initially decline their healthcare providers’ recommendation to start insulin therapy. Patients who do ultimately start treatment with insulin, do it on average more than two years after initially declining it.

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Low-Fat Dairy Products Linked To Decreased Abdominal Fat, Increased Lean Body Mass

MedicalResearch.com Interview with:

Dr Nita Forouhi, MRCP, PhD, FFPHM Programme Leader MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Institute of Metabolic Science Cambridge Biomedical Campus

Dr Nita Forouhi

Dr Nita Forouhi, MRCP, PhD, FFPHM
Programme Lead & Consultant Public Health Physician
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine
Institute of Metabolic Science
Cambridge Biomedical Campus, Cambridge

MedicalResearch.com: What is the background for this study?

Response: Past research has shown a beneficial link between some dairy products and risk of developing type 2 diabetes, but the mechanisms are not well understood. Body composition (total fat and lean mass) has been suggested as one pathway for the link, but the distribution of body fat and lean mass in relation to dairy consumption is not well studied. Based on this research gap, we aimed to investigate associations between types of dairy consumption and markers of body fat and lean mass distribution including: peripheral fat, the ratio of visceral (fat that surrounds the body organs) to abdominal subcutaneous fat (fat that accumulates under the skin) and appendicular lean mass (i.e., in the limbs).

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Regular Use of Artificial Sweeteners May Worsen Blood Glucose Control

MedicalResearch.com Interview with:

Dr. Richard L. Young PhD Associate Professor Adelaide Medical School The University of Adelaide Group Leader, Intestinal Nutrient Sensing Group Centre for Nutrition & Gastrointestinal Diseases South Australian Health & Medical Research Institute North Terrace, Adelaide | SA 

Dr. Young

Dr. Richard L. Young PhD
Associate Professor Adelaide Medical School
The University of Adelaide
Group Leader, Intestinal Nutrient Sensing Group
Centre for Nutrition & Gastrointestinal Diseases
South Australian Health & Medical Research Institute
North Terrace, Adelaide | SA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was a clinical trial in healthy subjects dosed a sweetener combination (sucralose and acesulfame-K) at a  dose to equal 1.5 L of artificial sweetened drink per day. This was given in capsules to dissolve in the proximal intestine (3 capsules per day, 2 weeks) and was a randomised, placebo-controlled double-blind study.

Sweetener treatment increased glucose absorption (assessed by serum 3-O-methy glucose), increased glycemic responses to duodenal glucose infusion and decreased GLP-1 responses.

These data show that intake of these sweeteners in healthy subjects may increase glycemic responses, and are the first to document an effect of these sweeteners to increase glucose absorption in humans.

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Risk of Type 2 Diabetes Elevated in Women With PCOS – Polycystic Ovary Syndrome

MedicalResearch.com Interview with:

Dorte Glintborg Overlæge, ph.d, dr.med Endokrinologisk Afdeling M Odense Universitetshospital

Dr. Glintborg

Dorte Glintborg
Overlæge, ph.d, dr.med
Endokrinologisk Afdeling M
Odense Universitetshospital

MedicalResearch.com: What is the background for this study?

Response: Polycystic ovary syndrome (PCOS) is a common endocrine disorder. PCOS is most often defined according to the Rotterdam criteria, which include irregular ovulation, biochemical/clinical hyperandrogenism, and/or polycystic ovaries when other etiologies are excluded. PCOS is associated with insulin resistance and obesity, but data regarding development and risk factors for type 2 diabetes (T2D) in PCOS are limited.

We performed a National Register-based study on Danish women with PCOS and included data regarding T2D events according to diagnosis codes and filled medicine prescriptions (N=18,477). Three age-matched controls were included per patient (N=54,680).

MedicalResearch.com: What are the main findings?

Response: We found that the risk for development of type 2 diabetes was 4 times increased in women with PCOS compared to controls. The median age at diagnosis of  type 2 diabetes was 31 years in women with PCOS compared with 35 years in controls suggesting that T2D was diagnosed 4 years earlier in PCOS. Increasing body mass index was associated with increased risk of development of T2D, whereas higher number of births was negatively associated with development of type 2 diabetes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further studies are needed regarding predictors of  type 2 diabetes in PCOS. Our data support a considerable increased risk for type 2 diabetes in obese women with PCOS. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome

Katrine Hass Rubin Dorte Glintborg Mads Nybo Bo AbrahamsenMarianne Andersen

The Journal of Clinical Endocrinology & Metabolism, jc.2017-01354,https://doi.org/10.1210/jc.2017-01354

Published29 August 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

Victoza® Receives FDA Approval To Reduce Heart Attack and Stroke in Patients With Type 2 Diabetes and Heart Disease

MedicalResearch.com Interview with:

Todd Hobbs, MD Vice President and Chief Medical Officer Novo Nordisk North America

Dr. Hobbs

Todd Hobbs, MD
Vice President and Chief Medical Officer
Novo Nordisk North America 

MedicalResearch.com: Would you tell us a little about liraglutide? How does it work to control diabetes/blood sugar? 

Response: Victoza® (liraglutide) is a human glucagon-like peptide-1 (GLP-1) analog that was approved by the U.S. Food and Drug Administration (FDA) in 2010 to help lower blood sugar in adults with type 2 diabetes. Victoza® is the #1 prescribed (GLP-1) receptor agonist.

Victoza® is a non-insulin, once-a-day medication that helps lower blood sugar levels in adults with type 2 diabetes by increasing glucose-dependent insulin release, inhibiting glucagon secretion, and slowing gastric emptying.

On August 25, the FDA approved a new indication for Victoza®, making it the only type 2 diabetes treatment approved to reduce the risk of major adverse cardiovascular (CV) events, heart attack, stroke and CV death, in adults with type 2 diabetes and established CV disease.

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Liver Key To Development of Diabetic Vascular Complications

MedicalResearch.com Interview with:

Dr. Mauricio Berriel Diaz Deputy Director & Head of Division Metabolic Dysfunction and Cancer Institute for Diabetes and Cancer IDC Helmholtz Center Munich and Joint Heidelberg-IDC Translational Diabetes Program Heidelberg University Hospital, Molecular Metabolic Control Medical Faculty, Technical University Munich Neuherberg, Germany

Dr. Berriel Diaz

Dr. Mauricio Berriel Diaz
Deputy Director & Head of Division Metabolic Dysfunction and Cancer
Institute for Diabetes and Cancer IDC
Helmholtz Center Munich and
Joint Heidelberg-IDC Translational Diabetes Program
Heidelberg University Hospital, Molecular Metabolic Control
Medical Faculty, Technical University Munich
Neuherberg, Germany 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our institute takes part in a german collaborative research consortium (https://www.klinikum.uni-heidelberg.de/index.php?id=132204&L=1), in which the key objective is to understand why in diabetes mellitus late complications occur even when blood sugar is well controlled.

Our study focused the role of the liver and of inflammatory signaling, as the latter is known to be increased in metabolic diseases such as obesity and diabetes mellitus. We found that TNF-α-induced reactive oxygen species (ROS) formation in the liver abolished the function of the transcription factor GAbp. Impaired hepatic GAbp function resulted in transcriptional inactivation of the cellular energy sensor AMPK, which in turn induced hepatic cholesterol secretion, hypercholesterolemia and eventually atherosclerotic lesion formation.

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Neonatal Hypoglycemia Linked To Neurodevelopmental Outcomes at 4.5 Years

MedicalResearch.com Interview with:

Jane E. Harding, DPhil Liggins Institute The University of Auckland Auckland, New Zealand

Prof. Harding

Jane E. Harding, DPhil
Liggins Institute
The University of Auckland
Auckland, New Zealand

MedicalResearch.com: What is the background for this study?

Response: Neonatal hypoglycaemia – low blood sugars in newborns – affects up to one in six babies born. It involves a sustained dip in blood sugar levels following birth. Blood glucose is the only fuel for babies’ brains (adults have alternative, back-up sources). So, if left untreated, this condition can cause developmental brain damage and lowered education outcomes later in life.

In developed economies, as many as a third of babies born are at risk. Risk factors include being born smaller or larger than usual, preterm babies and babies whose mothers have any form of diabetes – this last a growing group, with the rising incidence of gestational (pregnancy-related) diabetes.

We wanted to systematically track a cohort of babies to see if hypoglycaemia in babies affects their long-term health and development. So we designed the CHYLD study – Children with Hypoglycaemia and their Later Development. We are following 614 New Zealand babies born at risk of low blood sugar levels (neonatal hypoglycemia) into childhood to see if the condition affects their later growth and development. Our team includes researchers from the Liggins Institute, the University of Auckland, Waikato Hospital, the University of Canterbury and the University of Waterloo.

Half of the babies in the study were diagnosed with, and treated for low blood sugars. Seventy percent received extra, continuous monitoring of their blood sugar levels, which detected in some babies low levels that were not diagnosed by the heel-prick tests.

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