Bariatric Surgery Dramatically Outperforms Standard Treatment for Type 2 Diabetes

In the first published study of its kind, researchers from the Catholic University/Policlinico Gemelli in Rome, Italy, and NewYork-Presbyterian/Weill Cornell Medical Center found that bariatric surgery dramatically outperforms standard medical treatment of severe type 2 diabetes.

These findings were published March 27 in an advanced online edition of the New England Journal Medicine (NEJM).

The study’s authors report that most bariatric surgery patients were able to discontinue all diabetes medications and maintain disease remission for the two-year study period, while none of those randomly assigned to receive standard medical treatment did.

“Although bariatric surgery was initially conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease,” says senior author Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery and director of the Metabolic and Diabetes Surgery Center at NewYork-Presbyterian/Weill Cornell and associate professor of surgery at Weill Cornell Medical College.

It is particularly challenging to treat obese patients who have type 2 diabetes, because insulin therapy and other hypoglycemic medications often cause additional weight gain. In this study, most surgery patients experienced improvements in blood sugar levels, decreased total cholesterol and triglycerides, and improved HDL-cholesterol concentrations. This suggests that bariatric surgery for the treatment of diabetes may reduce a patient’s cardiovascular risk.

“The unique ability of surgery to improve blood sugar levels and cholesterol levels as well as reduce weight makes it an ideal approach for obese patients with type 2 diabetes,” says lead author Dr. Geltrude Mingrone, chief of the Division of Obesity and Metabolic Diseases and professor of medicine at Catholic University in Rome.

Click here to read in ‘Science Daily’ how the study was conducted

Obesity patients are not victims

by David Gratzer, MD

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.

The peak of the trend: A recently released Ohio study, using mice, suggests “fine-particulate air pollution” could be causing a rise in obesity rates.

How long before we’re told that the devil made us eat it?

The McVictim syndrome spins a convenient — and unhealthy — narrative on America’s emerging preventable disease crisis. McVictimization teaches Americans to think that obesity is someone else’s fault — and therefore, someone else’s problem to solve.

The truth: In the vast majority of cases, obesity is a preventable condition. So those of us in the medical community must be candid with overweight patients about the risks they face and the rewards of better health choices. But it’s also time for American policymakers to show the same level of candor.

All things being equal, the simplest explanation is often the right one. And the simplest explanation for the dramatic rise in obesity rates — roughly doubling as a percentage of the total population in just a quarter-century — is the surge in our daily caloric intake. Excess food now, excess weight later. And Americans won’t make better choices if the McVictim syndrome provides a convenient excuse to carry on as before.

Obesity is preventable, but its consequences seem difficult to avoid. Consider that the cost of treating resulting conditions such as diabetes is about 7% of all U.S. healthcare spending — and a significant drain on federal and state budgets. Obesity is a national security threat because it severely limits the pool of military recruits; in 2009, the Pentagon indicated that since 2005, 48,000 potential troops had flunked their basic physical exams because they weighed too much. Most important, obesity is a human threat, destroying otherwise healthy lives and increasing personal health costs, all for the sake of a few daily moments of instant gratification.

For these reasons, there is a role for government to play in attacking obesity. Public policy can help. School lunch programs shouldn’t push our children toward obesity at taxpayers’ expense. We should stop subsidizing agribusinesses; many are using taxpayer dollars to produce and market unhealthful foods. We should promote insurance reforms that support preventive medicine.

But we must also launch a direct attack on the philosophy behind the McVictim syndrome. Policymakers must accept the fact that a poor diet is almost always a poor personal choice.

Yes, it’s fair to say that many Americans try to choose better — and fail because they’ve chosen quack drugs or crash diets as the solution. Yes, it’s fair to say that losing weight solely for appearance’s sake isn’t a healthful choice. Yes, it’s fair to say we shouldn’t crush the self-esteem of those who’ve tried, and failed, to keep off excess weight. In other words, our society makes healthful choices tougher.

But even so, encouraging Americans to cut their dietary health risks is a responsible act of citizenship. And it’s absurd to pretend that Americans are helpless to make that choice — or that it’s too late for them to reap the benefits. Contrary to claims like Etzioni’s, even a modest, voluntary improvement in the average American diet could pay huge dividends.

Just as a little more weight causes more damage over time (to joints, to cardiovascular systems, to organs), a little less weight can produce dramatic health benefits. To take one example, a study cited in the Journal of the American College of Cardiology found that obese patients on a program of mild weight loss and modest exercise cut their odds of getting diabetes by as much as 60%. Imagine the benefits that would flow from keeping millions of future Medicare recipients from ever needing an insulin prescription.

The McVictim syndrome is far too prevalent, which promotes the notion that regulations and laws are the primary solution to the problem. But governments can’t micromanage your waistline for you. Even if governments could magically walk you to work, ban food advertising, regulate sugar out of food and suck those fat particles out of the air, in a free society you would still have the power to drive to the nearest restaurant, shake your salt shaker and order a second piece of pie.

That’s why understanding — and rejecting — the McVictim culture is crucial to obesity reduction policy. And the first step in that process is to reject the temptation to find an easy scapegoat.

David Gratzer is a physician and senior fellow at the Manhattan Institute. He is author of The Cure: How Capitalism Can Save American Health Care.

FDA recommends recall of Avandia diabetes drug due to heart-related deaths

by Aleksander Phillips

Millions of diabetics have been prescribed Avandia, which is sold by GlaxoSmithKline PLC, since it came on the market in 1999.

However, in May 2007, Avandia was linked to a 43 percent greater risk of heart attack and death in a scientific analysis published by the New England Journal of Medicine.

Upon the release of the 2007 study, GlaxoSmithKline downplayed the report and encouraged continued use of Avandia.  Dr. Lawson McCartney, who led Glaxo’s diabetes drug development, said, “We remain very confident in the safety and of course in the efficacy of Avandia as an important diabetic medicine.”

But a piece in today’s New York Times says hundreds of people taking Avandia needlessly suffer heart attacks and heart failure every month, according to confidential Food and Drug Administration (FDA) reports obtained by the newspaper, recommending the drug be removed from the market.

The reports say that if every diabetic now taking Avandia were instead given a similar pill named Actos, about 500 heart attacks and 300 cases of heart failure would be averted every month because Avandia damages the heart.

Avandia, whose generic name is rosiglitazone, is intended to treat Type 2 diabetes.  It was linked to 304 deaths during the third quarter of 2009.

In cases such as this, where a drug maker refuses to pull a potentially fatal medication off the market, doesn’t the FDA have the authority to force a recall?  Not necessarily.  The FDA has authority to force a “black box warning” be placed on the drug, but does not have explicit power to force a company to remove the drug from the market, in the interest of free commerce.  As long as the risks and benefits of a drug are fully disclosed to a patient and the patient voluntarily consents to its use, the FDA has no power to interfere in that patient’s treatment.

Article link: FDA recommends recall of  Avandia

Coping with the ups and downs of managing diabetes

By Nancy Klobassa, R.N., and Peggy Moreland, R.N.

I recently found out that someone from my past, whom I had lost contact with, died several years ago at age 51. This young man had a special place in my teenage heart and I’m grieving his death. I was also informed that he had developed type 1 diabetes, after my knowing him (it’s my understanding his death was unrelated to the diabetes).

Lately, I’ve been feeling a little more philosophical and I’ve been thinking about the ups and downs we all face in life. Just when we think everything is going well, we hit a speed bump, a roadblock or even our own demise. I think being diagnosed with type 1 diabetes would be a definite roadblock — or more likely make you feel like you got hit by a Mack truck.

How does one, day in and day out, cope and continue to cope with a chronic disease such as diabetes? Is there ever a halcyon time? “Halcyon” comes from a bird identified with the kingfisher, and in an ancient legend it nested at sea during winter solstice and just by its very presence calmed the waves during incubation. Does it seem that there periods when managing your diabetes is easier than usual, and other times it seems like no matter what you do the blood sugars are out of control?

I see in my practice some people who never find a halcyon period in coping with their diabetes. We all know that everyone has different coping skills, and I’ve seen individuals with diabetes who have great coping skills. To them, diabetes is little more than an inconvenience.

What are good coping skills and how do we develop them? Try these tips:

§ Avoid negative thinking — “It doesn’t matter what I do, I’ll get diabetes complications anyway (not true).”

§ Self talk — It’s OK to talk to yourself, you’ll feel better.

§ Play music — I play the drums and there are times they really vibrate.

§ Do something — Walk, dance, clean the house, wash the car.

§ Call someone — Friends are good.

§ Pray — Someone who always listens.

§ Ride it out — Experience the wave of emotion and let it go.

§ Take a bath and add candlelight

§ Help someone else — Take the focus off yourself (poor you).

§ Write a blog — This week it was a helpful coping skill.

A1C test helps diagnose diabetes

By Nancy Klobassa, R.N., and Peggy Moreland, R.N.

Our office recently received a call asking about a “new” blood test to diagnose diabetes. You may have heard on the news earlier this year that at the American Diabetes Association’s annual meeting an international committee of experts announced their consensus that the A1C blood test is an accurate way to diagnose diabetes.

The A1C test, also known as glycated hemoglobin or HbA1C, is a blood test that provides a picture of average blood sugar control for the past two to three months.

When you have uncontrolled diabetes, you have too much sugar in your blood stream. The extra blood glucose enters your red blood cells and sticks to the molecules of the hemoglobin.

The A1C measures the percentage of glycosylated hemoglobin in your blood and this gives your doctor an overview of your average blood glucose control over the past 2-3 months. So, the A1C test is not new, it is just that it’s now being recommended as a tool to diagnose diabetes.

The A1C helps:

  • Confirm self-testing blood glucose results
  • To evaluate whether or not your diabetes management plan is working
  • You see how healthy choices make a difference in blood sugar control

The A1C does not:

  • Replace daily self-testing of blood glucose
  • Measure your day-to-day control. You cannot adjust your insulin doses based on A1C tests

Daily self-testing of blood glucose and your log results are important to staying in effective control. The A1C test is used along with your daily blood glucose checks for the best possible control.

A1C chart

Complications of Diabetes

Heart and Blood Vessel Disease

Heart disease is the leading cause of death for people with diabetes.Three out of four diabetes-related deaths are caused by heart and blood vessel (cardiovascular) disease. People with diabetes are 2-4 times more likely to have heart disease than persons without diabetes. Even people with type 2 diabetes who do not have heart disease have an increased risk of having a heart attack.

People with diabetes also tend to have other risk factors for heart disease including obesity, high blood pressure, and hardening of the arteries (atherosclerosis).In recent years, FDA has approved drugs that lower blood pressure and reduce the risk of heart attacks and strokes. It has also approved lipid-altering drugs that target abnormalities of cholesterol and triglycerides.

For more information about diabetes and heart disease, click on this link: HEART DISEASE AND HIGH BLOOD PRESSURE

National Heart, Lung, and Blood Institute link: CARDIOVASCULAR INFORMATION

Practical Medicine and Healthcare Information


I have been a community and hospital pharmacist for over thirty years … trained in clinical pharmacy at one of the largest healthcare centers in the South. I am a consultant pharmacist for Medication Therapy Management (MTM) for the State of North Carolina.

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Bob Diamond R.Ph Pharmacist