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Tag: type 2 diabetes
It’s The Artificial Sweetener That’s Giving You Diabetes

It’s The Artificial Sweetener That’s Giving You Diabetes

If you’ve been scarfing down diet soda and other artificially sweetened foods for a good part of your life because you think it’s good for weight control, you’re not going to like this news.

According to an Israeli study published in the journal Nature, researchers found that artificial sweeteners given to lab mice as well as to humans played havoc with the bacteria in the gut and brought about the onset of glucose intolerance, which is frequently a precursor of diabetes.

Type 2 diabetes, which used to be known as adult-onset diabetes, or non-insulin dependent diabetes, has become a serious health problem for both adults and children in the United States and other countries. People who have Type 2 diabetes take insulin, unlike those with Type 1 diabetes, but in Type 2 it’s either not enough to metabolize the sugar and carbohydrates consumed or it’s used ineffectively. Lack of or ineffective use of natural insulin by the body causes sugars to build up on the blood instead of moving to the body’s other cells and causes them to malfunction.  This leads to dehydration, nerve damage, blood vessel damage in the eyes, heart, and kidneys, and diabetic coma. If left untreated it can lead to heart attack, stroke, and death.

The researchers at Israel’s Weizmann Institute of Science stated “our findings suggest that NAS (non-calorific artificial sweeteners) may have directly contributed to enhancing the exact epidemic that they themselves were intended to fight.”

Photo: Flickr via PunchingJudy

Bariatric Surgery Found To Ease Type 2 Diabetes Symptoms

Bariatric Surgery Found To Ease Type 2 Diabetes Symptoms

By Melissa Healy, Los Angeles Times

Bariatric surgery did more to improve symptoms of diabetes, high blood pressure, and high cholesterol after three years than intensive treatment with drugs alone, according to new results from a closely watched clinical trial involving patients who were overweight or obese.

Study participants who had gastric bypass surgery or sleeve gastrectomy also lost more weight, had better kidney function and saw greater improvements in their quality of life than their counterparts who did not go under the knife, researchers reported Monday.

The latest findings from the trial, known as STAMPEDE — for Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently — should prompt more patients with Type 2 diabetes to consider surgery as a viable treatment, even if their body mass index isn’t high enough for them to qualify as severely obese, said Dr. Philip Schauer, director of the Cleveland Clinic’s Bariatric and Metabolic Institute and leader of the trial.

“Right now, bariatric surgery is way underutilized,” Schauer said. “I wouldn’t say that every diabetic needs bariatric surgery. But I would say there are a lot of patients on aggressive medical treatment that are looking at some surgery down the road — including extremely costly interventions such as amputations and coronary bypass procedures.”

Bariatric surgery, including the two procedures tested in the STAMPEDE trial, can cost as much as $60,000, depending on complications. That price tag has prompted skepticism among insurers about its worth as a diabetes treatment. But it “seems like a bargain” compared with the future surgical costs many of the 17 million Americans with Type 2 diabetes will face if they cannot get their blood sugar under control, Schauer said.

The trial results were presented Monday at a meeting of the American College of Cardiology and the American Heart Association in Washington, and published by the New England Journal of Medicine.

The study randomly assigned 150 overweight and obese people with Type 2 diabetes to one of three groups. Those in the control group had their diabetes managed with medications and daily blood-glucose monitoring. They also received intensive counseling about diet and exercise, including regular weigh-ins to monitor their progress. After three years, they had lost an average of 9.5 pounds.

The second group in the trial got Roux-en-Y gastric bypasses, in which the stomach is reshaped and relocated to divert most food past much of the lower intestine, where nutrients and calories are largely absorbed. The third group got a procedure called sleeve gastrectomy, which staples some 80 percent of the stomach closed, creating a banana-shaped tube where once a large pouch existed. Patients who had surgery received intensive medical management and lifestyle counseling as well.

Three years later, those who had the Roux-en-Y bypass had lost an average of nearly 58 pounds, and those who had sleeve gastrectomy lost an average of 47 pounds.

More importantly, Schauer said, the patients in the surgery groups were much more likely to have their diabetes under control — 58 percent of those who had Roux-en-Y and 33 percent of those who had sleeve gastrectomy were able to stop taking diabetes medications. Only five percent of patients in the control group achieved the same endpoint after three years, and none was able to discontinue medications completely.

In addition, study volunteers who had gastric bypass whittled their daily number of blood pressure and cholesterol-lowering medications from 2.73 to 0.96, on average. And subjects who had sleeve gastrectomy reduced their average number of cardiovascular medications from 2.18 to 1.35 three years later.

The medication tally for the control group didn’t budge.

Ultimately, Schauer said, better health should afford patients a fuller, happier life — and by that measure too, bariatric surgery yielded superior results.

The Roux-en-Y subjects showed greatest improvement in quality of life, including measures of bodily pain, physical functioning, general health, emotional well-being, and energy and fatigue. Those who got the sleeve gastrectomy also reported more significant improvements than those in the control group.

Schauer noted that some of the patients who benefited from bariatric surgery did not have a body mass index high enough to qualify for the procedure under most clinical guidelines and insurance plans. More than one-third of the volunteers enrolled in the trial had a body mass index between 27 and 34, below the usual threshold of 35.

But the overweight and mildly obese patients who got bariatric surgery showed health improvements on a par with much heavier diabetics, Schauer said.

“Hopefully, insurance policymakers will look at this data and consider expanding their coverage,” he said.

Randy Seeley, a University of Cincinnati professor of endocrinology who was not involved in the trial, said the latest results showed that both Roux-en-Y and sleeve gastrectomy worked “demonstrably better than standard diabetes interventions.”

But with its steep price, bariatric surgery is unlikely ever to be available to many who suffer from both obesity and diabetes, he said. Currently, about one percent of those who might benefit from such surgery are getting it, and even with a mighty effort to expand access, experts predict that figure is unlikely to rise above four percent.

“This highlights the need to understand the mechanistic similarities and differences” between the two procedures, “so that we might harness their efficacy to help more patients with diabetes,” Seeley said.

Last week, Seeley and colleagues from Denmark and Sweden published a study in Nature describing a key genetic switch that appears to be activated in sleeve gastrectomy, prompting changes in gut bacteria that improve metabolic function, appetite changes and weight loss. Someday, those changes might be induced without surgery, he said.

AP Photo/Richard Drew, File

Surgery Is Best For Managing Diabetes In Heavy People

Surgery Is Best For Managing Diabetes In Heavy People

Washington (AFP) – When it comes to managing type 2 diabetes in overweight people, stomach-shrinking surgeries are still more effective than trying to shed pounds with pills and lifestyle changes, researchers said Monday.

Three years into a U.S. study that compares various approaches — gastric bypass, sleeve gastrectomy and simply trying medical counseling, diet, exercise and weight loss medications — the findings show that the two surgical procedures are still superior at reducing blood sugar and weight.

Researchers said their findings could provide a way to help the some 23 million American adults who have type 2 diabetes, most of whom are overweight or obese.

Fewer than half of adults with diabetes are able to get their blood sugar under control with medication, experts say.

The latest results from the largest randomized controlled trial of its kind were published in the New England Journal of Medicine and discussed at the American College of Cardiology annual meeting.

“Bariatric surgery was more effective than medical therapy in achieving glycemic control with weight loss as the primary determinant of this outcome,” said study author Sangeeta Kashyap, associate professor medicine at Cleveland Clinic Lerner College of Medicine. “We concluded that bariatric surgery should be considered as a treatment option for the treatment of type 2 diabetes in patients who are moderately and severely overweight.”

The research included 150 overweight people with uncontrolled diabetes that had persisted for at least eight years when they began the study, despite taking three or more medications.

They were randomly assigned to undergo one of the two surgeries plus counseling, or simply expert therapy in health changes without surgery.

After three years, just five percent of patients who did not have surgery had achieved the desired level of glycemic control, defined as a three-month average blood glucose level of six percent or lower.

That target is slightly more aggressive than the American Diabetes Association recommendation of seven percent.

The surgery groups did much better, with 37.5 percent of gastric bypass and 24.5 percent of sleeve gastrectomy patients meeting the mark, after starting at an average blood sugar level of 9.2 percent.

Weight loss was five to six times greater in patients who had one of the surgeries.

The gastric bypass group lost on average a quarter of their body weight while the sleeve gastrectomy patients shed 21 percent. Those on medical therapy alone lost four percent.

Meanwhile, people who did not undergo surgery reported no improvements in quality of life, according to eight measures including body pain, general health, energy and fatigue.

Gastric bypass patients reported five improvements and sleeve patients reported two. There were no major complications among those who underwent the surgeries.

Gastric bypass involves reducing the stomach to below three percent of its natural volume, then connecting a new gastric pouch that bypasses the stomach and goes straight to the intestine.

In sleeve gastrectomy, part of the patient’s stomach is removed to reduce its volume by about 75 percent.

Gastric bypass outperformed the sleeve gastrectomy in the study, which was funded by the National Institutes of Health, the Cleveland Clinic and Ethicon, a division of pharmaceutical giant Johnson and Johnson which sells surgical products for weight loss.

Amit Khera, associate professor at the University of Texas Southwest Medical Center, who was not involved in the study, described the research as “important” because it addresses the longer-term benefits from surgery versus counseling and weight loss attempts alone.

“In the surgical arm, it does seem to be quite durable,” he told reporters. “Normalizing blood sugar seems to be retained at three years. That is a really important observation.”

On the other hand, people who did not have surgery showed early improvements in their blood sugar, dropping close to the target of 7.5 in the first year.

But that group was back up to 8.4 percent in year three.

The study, called the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, is designed to follow its patients for a total of five years.

AFP Photo/Vanderlei Almeida