Wednesday

Gastric Bypass Halts Diabetes in Obese Teens

MONDAY, Dec. 29 (HealthDay News) -- Obese teenagers who have gastric bypass surgery not only lose weight but see their type 2 diabetes disappear, a new study finds.

Also called bariatric surgery, the procedure works by limiting the size of the stomach and thereby reducing the amount of food one can eat. In this study, researchers used the Roux-en-Y method, which involves placing an adjustable band to block off most of the stomach. The band limits how much food the body absorbs.

"Previous studies have shown frequent remission of type 2 diabetes in adults following bariatric surgery, but until now, no research had been done to provide information about outcomes of adolescent diabetics who are considering surgical weight loss," said lead researcher Dr. Thomas H. Inge, an associate professor of surgery and pediatrics at Cincinnati Children's Hospital Medical Center.

"Our study found that, in most cases, teens can lose one-third of their weight and come off diabetes medications with remission of their diabetes one year after bypass surgery. This is certainly not the case for similar diabetic teenage patients who did not undergo surgery," Inge noted.

The report is published in the January issue of Pediatrics.

For the study, Inge's group looked at 78 teens with type 2 diabetes. Eleven patients underwent gastric bypass surgery, while the other 67 patients received usual care for their diabetes.

For the teens who had surgery, not only did they have an average 34 percent reduction in their weight, but their diabetes went into remission. Teens that did not have surgery saw an average weight loss of less than two pounds and still needed their diabetes medication.

"In addition to the impressive weight loss and type 2 diabetes results, patients undergoing the gastric bypass surgery also showed significant improvement in blood pressure, insulin, glucose, cholesterol and triglyceride levels," Inge said.

Type 2 diabetes takes a huge toll on the body, and the earlier it starts, the more of an impact it can have, Inge explained.

"These early surgical research findings suggest that diabetes may not be a diagnosis kids have to live with for the rest of their lives," Inge said. "They may not have to face diabetic retinopathy, progressive coronary heart disease and renal failure. In fact, there is good reason to be optimistic about their future cardiovascular health."

"If you are a type 2 diabetic and morbidly obese, gastric bypass surgery should be considered in the treatment pathway," Inge added.

Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine, thinks that while surgery is effective it does not deal with the cause of the obesity epidemic among teens.

"Bariatric surgery is clearly effective in treating severe obesity, preventing and reversing type 2 diabetes, and even extending survival when applied to adults," Katz said. "That similar benefits ensue when the procedure is applied to adolescents is important, but by no means surprising."
Despite the success of surgery, these results should be viewed with caution, Katz said.

"A large and growing proportion of all children and adolescents are subject to obesity, and its complications," Katz said. "Surgery can mitigate those complications, but can we really condone ushering more and more young people through the OR doors for a major surgical procedure to fix what policies and programs that foster healthful eating and regular activity could have prevented in the first place?"

Gastric bypass surgery is an effective last resort for severe obesity in adolescence, as in adulthood, Katz said. "But a last resort it should be, and we should do all we can to minimize the need for this procedure by combating the root causes of obesity in our society."

Friday

Class Of Diabetes Drugs Carries Significant Cardiovascular Risks

A class of oral drugs used to treat type 2 diabetes may make heart failure worse, according to an editorial published online in Heart Wednesday by two Wake Forest University School of Medicine faculty members.

"We strongly recommend restrictions in the use of thiazolidinediones (the class of drugs) and question the rationale for leaving rosiglitazone on the market," write Sonal Singh, M.D., M.P.H., assistant professor of internal medicine, and Curt D. Furberg, M.D., Ph.D., professor of public health sciences.

Rosiglitazone and pioglitazone are the two major thiazolidinediones.In the editorial Singh and Furberg say, "At this time, justification for use of thiazolidinediones is very weak to non-existent."Oral drugs are given to control diabetes by lowering blood sugar.But diabetics also experience elevated rates of high blood pressure and high levels of cholesterol and triglyceride, which "further compound their already increased risk of developing ischemic heart disease," Singh and Furberg say.

Heart disease and high blood pressure "represent conditions that are major precursors of congestive heart failure."About 22 percent of diabetics have heart disease. Among elderly patients with diabetes, more than half will develop congestive heart failure over a 10-year period, the editorial says.

The thiazolidinediones were approved for use based on the ability to reduce blood sugar.In contrast, "we reported [in the journal Diabetes Care] in June 2007 that thiazolidinediones doubled the risk of congestive heart failure in patients with type 2 diabetes," is says. "The increased heart failure appears to be a class effect."

Singh and Furberg reported in The Journal of the American Medical Association in 2007 after an analysis of four long-term trials that use of rosiglitazone was associated both with increased heart attacks and a doubling of heart failure.

They said that results from three large randomized clinical trials published this past June all failed to demonstrate that intensive control of blood sugar reduces mortality or events from cardiovascular disease in patients with type 2 diabetes.The three trials were ACCORD, ADVANCE, and the Veterans Affairs Diabetes study. In ACCORD, the patients who received intensive treatment to control blood sugar actually had more cardiovascular disease mortality than patients receiving standard treatment.

In ADVANCE, intensive control of blood sugar produced no benefit; there was no effect on cardiovascular events or deaths from cardiovascular causes compared to standard oral diabetes agents.In the VA Diabetes trial, when intensive blood sugar control produced levels of blood sugar that were too low and led to loss of consciousness, that was a strong predictor of future cardiovascular events.

"The unfavorable findings from the three trials have not been fully realized by the medical community," Singh and Furberg say.

They say that at a recent U.S. Food and Drug Administration advisory committee meeting, there was "overwhelming support for requiring reductions" of heart disease and heart failure "before approval of new oral hypoglycemic agents."

Singh said in an interview, "Safer, cheaper and more effective treatment alternatives are available that do not carry these negative cardiovascular risks in patients with diabetes. The rationale for the use of the thiazolidinediones is unclear."

Wake Forest University Baptist Medical Center (http://www.wfubmc.edu) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.

6 Grocery Shopping Tips for People With Diabetes

Following a diabetes meal plan can seem challenging when you're faced with hundreds of shelves worth of choices combined with all those confusing food labels. Although it would certainly make life easier if you could just follow a grocery list for your diabetes diet, it doesn't necessarily work that way.

Everyone's diabetes and individual nutritional needs are different. That means what and how much you can eat and therefore, the foods you choose to put in your cart — may also be different compared to the cart of the person with diabetes who's standing next to you in line.

But the heart of every diabetes eating plan is pretty much the same as any healthful diet — a nutrient-rich blend of foods that are low in fat and calories and based on moderate serving sizes. So, with a little know-how and practice, you can turn food shopping into a regular to-do — not a complicated excursion.

Asking the expertsWe turned to two experts: Marlee Zweifach, a registered dietitian, certified diabetes educator and certified nutritionist with a private practice in New York City, and Kathie Swift, nutrition director at The UltraWellness Center in Lenox, Mass.Revolution Health: Are there certain diabetes do's and don'ts to consider when grocery shopping?

Marlee Zweifach: When I see patients, they always want a list of what's "allowed" and what to "avoid," but it's just not that simple. That's why it's so important for patients to see a dietitian so that they can have a plan designed especially for them. There are so many things to consider when evaluating whether a food is appropriate for any individual with diabetes. To generalize is unfair to the patient and often is inappropriate.

Foods that are high in saturated fat are foods that should be avoided. People with diabetes are at a higher risk of developing cardiovascular complications. So, they need to be especially careful to manage their blood lipids [fats in the blood]. This means a diet low in saturated fat. Fats that are solid at room temperature [like butter and Crisco] are saturated fats.

RH: Are there any rules of thumb that people with diabetes need to remember as they're searching the food aisles?

Zweifach: Eat a healthful diet and follow your carbohydrate prescription [i.e., how many carbohydrates you're allowed to have based on the meal plan your registered dietitian creates].

A healthful diet contains a variety of fruits, vegetables and whole grains — all of which contain carbohydrates. The amount of carbohydrates they contain must be considered when including them in the diet for a patient with diabetes.

RH: What's the biggest mistake patients with diabetes make at the supermarket?

Zweifach: Looking for foods that are sugar-free. Sugar-free means sucrose-free, or that there's no added sugar. But these foods can have just as much carbohydrates as the same food that's not sugar-free. Carbohydrate means sugar. A carbohydrate is a nutrient that's made of sugar.

RH: The word "dietetic" on food packaging can be deceptive, too. Why is that?

Kathie Swift: "Dietetic" labeling on food products is misleading and, unfortunately, these foods are heavily marketed to individuals with diabetes. The term "dietetic" — "diet" and "diabetic" — on food labels has no uniform meaning and is a source of confusion.

Most "dietetic" foods are a highly processed "chemical soup," lacking in fiber and most often containing a mix of artificial ingredients including sweeteners, colorings or sugar alcohols (xylitol, etc.) that offer no nutritional benefits.

In fact, one of the problems with these foods is that the "dietetic" seduction may serve only to mislead [people with diabetes into] thinking that they can eat more of the product — which may, in turn, have a negative effect on blood glucose management.

Here's a simple recommendation to evaluate a "dietetic" product. Look at the ingredients and ask yourself: "How close to nature is this food product?" Then make a choice. In addition, "dietetic" foods often are costly, so not only [are people] robbed of good nutrition, they are paying a high price for it!

RH: People with diabetes need to read food labels. On top of things like calories, nutrients and serving size, what other specific things should they look for?

Zweifach: One important thing to look at on a food label is the total carbohydrate grams. This includes the sugar grams listed on the label as well as the other carbohydrates in the food.

Saturated fat is listed, and the best choices have little or no saturated fat. Again, though, each individual must check with her physician or registered dietitian to see if there are other important things to look at on the food label.

RH: Is it OK to splurge and pick up some things that are higher in fat, sugar or salt every once in a while?Swift: My hope is that the transition to a delicious whole-foods eating plan will temper the desire to splurge on items that are high in fat, sugar and salt. One of the things I hear most often from my clients is that their cravings disappear when they eat a whole-foods diet that satisfies all their taste preferences.

For example, avocados, olives, nuts, seeds and nut butters satisfy the desire for fat. Fresh fruit, berries in a homemade smoothie, baked fruit with cinnamon or nutmeg, or a small piece of dark chocolate that's rich in antioxidants will satisfy the desire for sweets. And the avoidance of highly processed foods that are loaded with sodium will tame the desire for salt.

I believe by taking a processed food sabbatical for at least two to three weeks, you will find that the desire to "splurge" dissipates. However, let's face it — one of the reasons we eat what we do is availability. And you certainly may be in a social situation where a rich dessert is offered or a fresh baked cookie is in the office. So, in that case, if you do decide to splurge "every once in while," make it a mindful splurge. Eat it very slowly and with awareness — and keep your intention in mind. My guess is that your splurge will be short-lived!

Diabetes Doesn't Have to Be Scary

A Type 2 diabetes diagnosis doesn't end with just a prescription.

A prescription or two may be part of that plan. But for many, treatment is far more than drugs, blood sugar checks and follow-up visits. It's a life-changing course of diet and exercise that for some is a complete overhaul of their current lifestyles.

For newly diagnosed diabetes patients, some of whom have gone their entire lives not thinking about the foods they're putting into their bodies, a healthy meal plan seems impossible.

"There are a lot of myths out there: You can't eat any starchy foods. You can't eat fruit. You can't eat sweets. One patient told me he heard, 'If it tastes good, don't eat it,' " said Anna Reinwand, registered dietitian and diabetes educator for the Center for Diabetes Education at the Oklahoma State University Medical Center.

Faced with myths like those, it's understandable that patients would fear meeting a dietitian.
"But what they find out is it's not that bad. Changes will be needed in most diets, but they find out that a lot of foods taste good and are good for them," Reinwand said.

According to the American Diabetes Association, 23.6 million Americans have diabetes, an additional 57.6 million have prediabetes, and a quarter of Americans age 60 and older have the disease.

"It's very scary for a lot of folks because they know someone who has been affected," Reinwand said. "The possible complications are scary -- blindness, amputation. But managing diabetes has changed a lot over the last 10 years."

Easy-to-use blood sugar meters have been a life-changer, she said. Patients can check their sugars before and after meals for instant reads on their levels.

When it comes to nutrition, Reinwand takes the approach of one step at a time, easing patients into the change. Telling a diabetic he or she can never eat pasta again is not the answer.

"Instead, use a whole-wheat pasta and scale down the portion," she said.

Here are some practical suggestions, good for any diet, that Anna Reinwand gives her Type 2 diabetes patients.

Try red potatoes with their skins on over regular russet potatoes.
- Make meat 1/4 of your plate, using the remainder for whole grains and vegetables.
Choose brown rice over white rice. Take advantage of fresh, seasonal vegetables, like inexpensive zucchini.

Don't rule out fruit just because it's sweet. In small portions, fruit is an important part of the diet.

Cut back on solid fats, such as butter.
Swap canola oil or olive oil for oils with saturated fats.
Incorporate whole grains, including wholewheat pasta, into dinner time.

Originally published by NATALIE MIKLES World Scene Writer.

(c) 2008 Tulsa World. Provided by ProQuest Information and Learning. All rights Reserved.

Recently Diagnosed with Diabetes? What Could Be the Cause?

The number of people living with diabetes keeps growing. It is estimated that over 23 million people, or 7.8% of the US population, has diabetes. That is a staggering number.

If you or a loved one have been recently diagnosed with diabetes, then no doubt you are full of questions. You are asking yourself and others: What comes next? How do we treat this? What do we do? And probably also asking, what caused this? How did this happen?

Your first priority should be to get proper medical attention and care. Find a doctor who truly understands the disease and its complications and will counsel you through the ups and downs, and ins and outs of living with diabetes. Your healthcare provider will be your best resource for information.

However, what your doctor may not tell you is that medications you have taken may be the cause of your diabetes. It is well known that some medications will raise blood sugar levels and, therefore, present a risk for the development of diabetes. This risk is known to physicians who warn their patients of the risk and monitor their patients accordingly. However, some drugs cause diabetes without the doctor's knowledge.

The drug manufacturers may know that their drugs cause diabetes, or raise blood sugar levels increasing the risk for developing diabetes, but they do not warn doctors or consumers. There are several drugs on the market right now that pose a risk for diabetes: Zyprexa, Chantix and Seroquel, to name a few. In 2004, the FDA caused manufacturer Eli Lilly to warn of the risk of diabetes associated with the use of Zyprexa. Patients who developed diabetes after taking Zyprexa have won lawsuits against Eli Lilly and several states have sought reimbursement from the company for additional expenses paid out by state Medicare and Medicaid programs to treat the cases of diabetes caused by Zyprexa.

A big concern of mine right now is the number of people who may be at risk for developing diabetes because of the new smoking cessation pill, Chantix. While I encourage anyone to stop smoking and this pill certainly showed promise when it first promoted, I do not believe that Chantix is the answer because it poses too much risk for complications. Chantix has been associated with seizures, heart problems, and now, diabetes.

Manufacturer Pfizer has warned that Chantix may interfere with other diabetes medications like insulin, but we are starting to see new onset diabetes being diagnosed in people who have used Chantix. The FDA has received over 500 such reports, but Pfizer has not added any additional warnings to the Chantix label.

Never take any medication without consulting your doctor, and never stop taking any prescribed medication without consulting your doctor. That being said, if you are currently taking Chantix, then I encourage you to talk to your doctor about the adverse effects being associated with use of the pill. And if you want to quit smoking, then I highly encourage you to do so, but please: Just Say No To Chantix!