Bariatric Surgery Associated With Reduced Need For Diabetes Medications at Six Years

MedicalResearch.com Interview with:
Dr Jérémie Thereauz
Praticien Hospitalier
Chirurgie viscérale et digestive 

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

Response: Bariatric surgery has been proved to reduce type 2 diabetes in morbid obese patients. However, results of bariatric surgery at a nationwide level are lacking.

The aim of our study was to assess the 6-year antidiabetic treatment continuation, discontinuation or initiation rates after BS compared with matched control obese patients.

This large-scale nationwide study confirms that bariatric surgery is responsible for a significant 6-year postoperative antidiabetic treatment discontinuation rate compared to baseline and compared to an obese control group without surgery, and a low treatment initiation rate, with gastric bypass being the most effective procedure. 

MedicalResearch.com: What should readers take away from your report?

Response: This long term study confirms at a nationwide level, previous mid term randomized studies finding effiicency of bariatric surgery in type 2 diabetes for patients with morbid obesity associated.

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

Response: Patients and physicians must be aware that morbid obesity still remains a chronic disease even after bariatric surgery, as 50% of patients with pre-existing antidiabetic treatment remained on treatment 6 years after surgery. Our study highlights the message that these patients require careful lifelong follow-up to monitor obesity complications. Complementary medico-economic study would be helpful to determine the relevance of such treatment in a national health care system.

No disclosures

Citations:

Thereaux J, Lesuffleur T, Czernichow S, Basdevant A, Msika S, Nocca D, Millat B, Fagot-Campagna A. Association Between Bariatric Surgery and Rates of Continuation, Discontinuation, or Initiation of Antidiabetes Treatment 6 Years Later. JAMA Surg. Published online February 14, 2018. doi:10.1001/jamasurg.2017.6163

https://jamanetwork.com/journals/jamasurgery/fullarticle/2672216?resultClick=1

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Irregular or Rotating Night Shifts Linked To Increased Risk of Diabetes

MedicalResearch.com Interview with:
“Night Shift - Hard@Work (5of8)” by cell105 is licensed under CC BY 2.0Dr. Céline Vetter

Assistant Professor
Department of Integrative Physiology
University of Colorado at Boulder
Boulder, CO

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

Response: Shift work, particularly night shifts, can change our social rhythms, as well as the internal biological rhythms including our sleep, and these effects could explain why shift work is linked to conditions such as obesity and type 2 diabetes. However, we don’t know which type of shift pattern is most strongly linked to type 2 diabetes. In addition, we know that some lifestyle factors can modify the link between a genetic predisposition to a disease and the disease itself, but we don’t know if this applies to shift work and type 2 diabetes.

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Pregnancy in Type 1 Diabetes: Glucose Control Can Reduce Fetal Overgrowth

MedicalResearch.com Interview with:

Rachel McGrath BSc (Hons), PhD Senior Research Fellow - Department of Endocrinology, RNSH Clinical Senior Lecturer - Northern Clinical School University of Sydney

Dr. Rachel McGrath

Rachel McGrath BSc (Hons), PhD
Senior Research Fellow – Department of Endocrinology, RNSH
Clinical Senior Lecturer – Northern Clinical School
University of Sydney 

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

Response: Women with type 1 diabetes are significantly more likely to experience complications during pregnancy and to have infants with high birth weights. This can result in adverse outcomes at the time of delivery for both mother and baby, and can also predispose infants to obesity and chronic disease in later life.

The relationship between maternal blood glucose levels and foetal growth in type 1 diabetes in pregnancy has not been completely elucidated. Thus, we examined the association between maternal glycaemic control and foetal growth by examining serial ultrasound measurements and also by determining the relationship between HbA1c (a measure of circulating glucose exposure over a three month time period) and infant birth weight.

We found that maternal glucose levels were directly related to foetal abdominal circumference in the late second and third trimesters and also to birth weight. We also confirmed the results of previous studies to show that the optimal HbA1c during pregnancy to reduce the likelihood of large-for-gestational-age neonates is < 6%.  Continue reading

Experimental Bioelectronic Modulation of the Carotid Sinus Improves Glucose Tolerance

MedicalResearch.com Interview with:

Silvia Conde, PhD CEDOC, NOVA Medical School Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisboa

Dr. Conde

Silvia Conde, PhD
CEDOC, NOVA Medical School
Faculdade de Ciências Médicas
Universidade Nova de Lisboa
Lisboa

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

Response: In 2013, Silvia Vilares Conde and her research group described that the carotid body, a paired organ that is located in the bifurcation of the common carotid artery and that is classically defined as an oxygen sensor, regulates peripheral insulin sensitivity and that its dysfunction is involved in the development of metabolic diseases.

This first study (Ribeiro et al. 2013, Diabetes, 62:2905-16) and others afterwards performed by her group in diabetic rats (Sacramento et al. 2017, Diabetologia 60(1):158-168) showed that the bilateral resection of the carotid sinus nerve, and therefore the abolishment of the connection between the carotid body and the brain, restore insulin sensitivity and glucose tolerance. Although efficient this surgical irreversible approach has disadvantages, since the carotid body possesses other physiological functions as the response to the lack of oxygen (hypoxia) or the adaptation to exercise. Silvia Conde’s team also described that the carotid body is over-activated in animal models of type 2 diabetes, suggesting that decreasing the activity of the organ could be a good therapeutic strategy.

In this new work (Sacramento et al. 2018, doi: 10.1007/s00125-017-4533-7), her group in collaboration with Galvani Bioelectronics (former Glaxo Smith Kline Bioelectronics) demonstrated that is possible to electrically modulate the carotid sinus nerve to maintain glucose homeostasis in diabetic animals without significant adverse effects.  Continue reading

Benefits of Gastric Bypass in Diabetes Control Significant But Diminish Over Time

MedicalResearch.com Interview with:

Charles Billington MD Chief, Section of Endocrinology and Metabolism Minneapolis VA Health Care System Professor of Medicine, University of Minnesota 

Dr. Billington

Charles Billington MD
Chief, Section of Endocrinology and Metabolism
Minneapolis VA Health Care System
Professor of Medicine, University of Minnesota 

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

Response: We wanted to know if adding gastric bypass to intense lifestyle and medical therapy would improve overall diabetes treatment as represented by the triple endpoint of blood sugar, blood pressure and cholesterol control. We found that adding gastric bypass did provide significant benefit at five years after surgery, but that the size of the benefit declined substantially from the first to the fifth year. We also found that gastric bypass did provide significantly better blood sugar control throughout the five years, but the rate of diabetes remission at five years was low. There were many more adverse events in the gastric bypass group. 

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Viral Vector Delivered Gene Therapy That Reversed Diabetes in Mice

MedicalResearch.com Interview with:
Xiangwei Xiao, M.D., Ph.D.
Assistant Professor of Department of Surgery,
Children’s Hospital of Pittsburgh
University of Pittsburgh School of Medicine,
Pittsburgh, PA

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

Response: Diabetes is a prevalent chronic disease characterized by persistently high blood glucose. Diabetes has two main subtypes, type 1 diabetes and type 2 diabetes. In type 1 diabetes, the immune system attacks and destroys insulin-producing beta cells in the pancreas, resulting in high blood levels of glucose. In type 2 diabetes, the beta cells do not produce enough insulin or the body is not able to use insulin effectively.

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Increased Diabetes Risk in African Americans Explained by Greater Obesity Rates

MedicalResearch.com Interview with:

Michael P. Bancks, PhD Northwestern University Chicago, Illinois 

Dr. Bancks

Michael P. Bancks, PhD
Northwestern University
Chicago, Illinois 

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

Response: We know that the disparity in diabetes between black and white youth and young adults is growing, but the reasons why are unclear. We also know that traditional risk factors for diabetes, such as obesity and low socioeconomic status, are more common among blacks as compared with whites.

Our study describes how the unequal rates of these traditional diabetes risk factors explain or account for the higher rates of diabetes among blacks.

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Weaning To Hydrolyzed Infant Formula Did Not Reduce Risk of Type 1 Diabetes

MedicalResearch.com Interview with:
“Baby Bottle” by brokinhrt2 is licensed under CC BY 2.0Mikael Knip, MD, PhD

Professor of Pediatrics
TRIGR PI 

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

Response: Experimental studies have indicated that the avoidance of early exposure to cow’s milk proteins reduces the cumulative incidence of autoimmune diabetes in animal models of human type 1 diabetes, e.g. BB rats and NOD mice. Epidemiological studies in humans have suggested that there may be a link between type 1 diabetes and short breastfeeding or early introduction of infant formulas. All regular infant formulas contain intact cow’s milk proteins.

The main finding was that weaning to an extensively hydrolyzed formula did not reduce the cumulative incidence of Type 1 diabetes in at-risk children by the mean age of 11 years.

The extensively hydrolyzed formula did not contain any intact cow’s milk proteins but only small peptides (maximal size 2000 daltons).

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Hypoglycemia All Too Common In Hospice and End of Life Care

MedicalResearch.com Interview with:
Dr. Laura A. Petrillo MD
Instructor in Medicine
Harvard Medical School, and Palliative Care Physician
Massachusetts General Hospital

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

Response: Hospice is end-of-life care focused on maximizing quality of life. Hospice often involves reducing or stopping treatments that are unlikely to have short-term benefit in order to avoid uncomfortable side effects. About a quarter of Americans die in nursing homes, and some of them receive hospice care in their final days. We looked at whether adults with type 2 diabetes experience low blood sugar while on hospice in veterans’ nursing homes, since low blood sugar signals inappropriately aggressive diabetes treatment in patients close to death and contributes to unnecessary discomfort.

We found that one in nine people experienced low blood sugar at least once while receiving hospice care. Among people who were on insulin, the number was one in three.

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Deep Learning System Can Screen For Diabetic Retinopathy, Glaucoma and Macular Degeneration

MedicalResearch.com Interview with:

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. Illustration depicting diabetic retinopathy

Illustration depicting diabetic retinopathy

Dr. Tien Yin Wong MD PhD
Singapore Eye Research Institute, Singapore National Eye Center,
Duke-NUS Medical School, National University of Singapore
Singapore

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

Response: Currently, annual screening for diabetic retinopathy (DR) is a universally accepted practice and recommended by American Diabetes Association and the International Council of Ophthalmology (ICO) to prevent vision loss. However, implementation of diabetic retinopathy screening programs across the world require human assessors (ophthalmologists, optometrists or professional technicians trained to read retinal photographs). Such screening programs are thus challenged by issues related to a need for significant human resources and long-term financial sustainability.

To address these challenges, we developed an AI-based software using a deep learning, a new machine learning technology. This deep learning system (DLS) utilizes representation-learning methods to process large data and extract meaningful patterns. In our study, we developed and validated this using about 500,000 retinal images in a “real world screening program” and 10 external datasets from global populations. The results suggest excellent accuracy of the deep learning system with sensitivity of 90.5% and specificity of 91.6%, for detecting referable levels of DR and 100% sensitivity and 91.1% specificity for vision-threatening levels of DR (which require urgent referral and should not be missed). In addition, the performance of the deep learning system was also high for detecting referable glaucoma suspects and referable age-related macular degeneration (which also require referral if detected).

The deep learning system was tested in 10 external datasets comprising different ethnic groups: Caucasian whites, African-Americans, Hispanics, Chinese, Indians and Malaysians

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