Sunday, August 18, 2019

Endoscopic Sleeve Gastroplasty Is Safe and Effective

For some time, the most frequently used forms of weight loss surgery have been gastric bypass surgery, sleeve gastrectomy, and lap band surgery. And for some a long while, the most employed form of weight loss surgery has been gastric bypass surgery. But sleeve gastrectomy, by some accounts, is rapidly becoming "the most commonly performed bariatric surgery worldwide." And a new form of sleeve gastrectomy, called endoscopic sleeve gastroplasty (ESG), is gaining attention. A recent study has determined that the technique is safe and effective.

Endoscopic procedures are performed by first inserting a flexible endoscope into the gastrointestinal tract, and a suturing device is used to reduce the size of the stomach. There are usually no surgical incisions associated with endoscopic procedures. Thus, these surgeries are minimally invasive.

The above mentioned study interrogated publications on Pubmed, EMBASE, Cochran and other sources for ESG related research. Fifteen hundred and forty-two patients from nine studies were looked at for the analysis. The investigators analyzed the weight loss and safety of the patients. And the investigators found that the weight loss was 11.85% at six months and 14.47% weight loss at 12 months. While there were adverse events, 72% of the events were mild, and only 1% of the events were severe. The investigators concluded that "although we still view conventional surgical sleeve gastrectomy as the gold standard, ESG can be considered an alternative, since ESG is effective with minimal risk."

Other studies have shown that ESG should be given consideration for weight loss. In one study, done by researchers at the Mayo Clinic in Rochester, MN, it was determined that ESG is very effective at reducing body weight and could be a good alternative weight loss surgery for some patients. And another study suggested that ESG is safe, effective and reproducible.
Therefore, ESG should be added to the arsenal of weight loss approaches. It is a procedure that providers should become familiar with, so that they can advise their patients. 

Saturday, July 27, 2019

Laparoscopic Roux-En-Y Gastric Bypass vs Sleeve Gastrectomy for Weight Loss and Type 2 Diabetes

Today, more and more U.S. citizens are  experiencing obesity and type 2 diabetes. Furthermore, obesity and type 2 diabetes among children are also at high levels. Usually, bariatric surgery is used to treat obesity. But some forms of bariatric surgery are being viewed as a viable treatment for type 2 diabetes. Two frequently used bariatric surgery methods in use today, for weight loss, are laparoscopic roux-en-y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG). And both of these surgical methods are also considered to be viable treatments for type 2 diabetes. But one study suggests that gastric bypass surgery may be the most effective treatment, in general, for obesity and type 2 diabetes.

RYGB and LSG are similar in one respect: both surgeries "modify the upper gastrointestinal tract anatomy." And this characteristic appears to make gastric bypass and sleeve gastrectomy more effective at weight loss and type 2 diabetes management than other forms of bariatric surgery.
However, a recent study shows that gastric bypass surgery may be the best choice in most cases. The study was a meta-analysis consisting of 16 randomized controlled trials. Eleven hundred thirty-two overweight or obese patients were included in the analysis.

The investigators concluded that "RYGB is more effective than SG in improving weight loss and short- and mid-term glycaemic and lipid metabolism control in patients with and without T2DM. Therefore, unless contraindicated, RYGB should be the first choice to treat patients with obesity and T2DM ..."

Of course there may be contraindications and other potential issues to consider when deciding on the appropriate surgery. For example, the possibility of reintervention should be kept in mind. One study showed that "[LSG] has significantly lower risk of reintervention in all categories studied when compared with RYGB at 5-year follow-up.

[Indeed,] the long-term safety profile of LSG compared with RYGB should be an essential part of the discussion in patient-centered decision making when choosing between bariatric procedure options." And under the right conditions, LSG could be the best choice. 

Monday, July 22, 2019

Obesity, Inflammation and Cancer

When our body is infected, our body's immune system fights the infection. While fighting the infected area, our body will often cause the affected area to become inflamed. And under normal conditions, once the infection is over, and the immune system no longer needs to fight the infection, the inflammation will subside. But when the inflammation lasts too long, it can cause problems in our bodies. Overweight and obesity can cause inflammation in the body. And if the overweight or obesity is long term, they may cause long term, harmful, inflammation. Further, this inflammation can lead to serious diseases, including colorectal cancer.

Too much inflammation creates a condition in which the "immune response has not been turned off so your immune system is running out of control, releasing pro-inflammatory immune cells when they’re not needed anymore." Pro-inflammatory proteins, called cytokines, are associated with these cells. These cytokines are also associated with fat cells. So with an abundance of fat cells, there can be an increase in pro-inflammatory cytokines. And a recent study has shown that this increase in pro-inflammatory cytokines can lead to colorectal cancer.

The study was done at Tufts University. One of the investigators indicated that their study 'results establish, for the first time, that concentrations in the colon of two major cytokines increase in concert with increasing BMI in humans. The increased concentrations are accompanied by changes in gene activation within the lining of the colon that are pro-cancerous in nature.'

Overweight and obese persons can suffer from a number of unhealthy conditions. And many of the conditions may be linked to inflammation. One of these conditions is colorectal cancer.

As we learn more about the link between inflammation and cancer, therapies can be devised to target the inflammation. But one thing is obvious: treating overweight and obesity should be an ongoing endeavor, since there is a link between overweight or obesity and inflammation.

Tuesday, June 25, 2019

Lorcaserin and Prediabetes

The FDA has approved four anti-obesity drugs for long-term use in the past several years. The anti-obesity drugs are: contrave, a combination of bupropion and naltrexone; qsymia, a combination of phentermine and topiramate; saxenda, which contains the active ingredient liraglutide that is used to treat type 2 diabetes; and lorcaserin which has the brand name belviq. In this post, we are going to focus on lorcaserin that has been found to reduce the risk of type 2 diabetes.

In the study, done at the Brigham and Woman's Hospital in Boston, MA, researchers concluded that taking lorcaserin twice-a-day can reduce the risk of type 2 diabetes by as much as one fifth. Lorcaserin controlled "high blood sugar in obese and overweight patients." Further, the use of lorcaserin, in conjunction with lifestyle interventions, "significantly reduced incidence of diabetes, increased rates of diabetes remission and reduced the risk of diabetic microvascular complications."

As stated above, lorcaserin is FDA approved for weight loss. And the aforementioned study shows that for obese individuals with abnormally high glucose levels, lorcaserin should be considered as a treatment option. And combining lorcaserin with physical activity and lifestyle changes might be especially effective.

Indeed, lorcaserin has been found to improve metabolic parameters. In one study, investigators found that lorcaserin can lower fasting glucose. And finally, in another study, researchers have determined that lorcaserin "improved multiple cardio metabolic parameters through both weight loss dependent and independent mechanisms.”

Therefore, as implied above, lorcaserin should be considered by practitioners when they are treating a patient who is overweight or obese and who experiences overweight or obesity related metabolic diseases. This may be particularly true for overweight or obese patients with prediabetes.

In the future, using lorcaserin for the treatment of those prediabetic patients who are overweight or obese may gain wide acceptance. Lorcaserin's effectiveness in weight loss and improved metabolic parameters may benefit many patients.

Sunday, June 23, 2019

Nuts, Insulin Resistance and Prediabetes

There is a lot of concern today about prediabetes. It is estimated that more than 84 million adults in America have the condition. And prediabetes is often a forerunner of type 2 diabetes. Insulin resistance is also often a forerunner of type 2 diabetes. And many of the risk factors associated with type 2 diabetes and prediabetes are also associated with insulin resistance. Therefore, interventions that can minimize the risks for insulin resistance may minimize the risks for diabetes and prediabetes. One study indicates that eating nuts may reduce the risk of insulin resistance.

Insulin is a hormone made by the pancreas. The hormone removes sugar from the bloodstream and takes the sugar to the cells. Insulin resistance happens when cells in your body will not accept the glucose that insulin is trying to deliver. Prediabetes typically occurs when there is some insulin resistance and the pancreas is not making enough insulin to cause the cells to accept the glucose.

Eating nuts may reduce the risks of insulin resistance, therefore, reducing the prediabetes state. The study that showed that eating nuts may reduce the risks of insulin resistance was done at Pennsylvania State University. According to the researchers, “eating an average of 52g of nuts a day can reduce the likelihood of developing insulin resistance.” Further, “eating nuts was … tied to significantly reduced fasting insulin and insulin resistance … in people with prediabetes.”

Diet has always been an important part of fighting prediabetes and type 2 diabetes. And now we are learning more about those foods that might be most helpful in the fight. Indeed, if nuts can be effective in helping individual control glucose, clinicians and other providers should endeavor to work with patients to help them include nuts in their daily diet. This can be an easy addition to the diet with great health benefits.

Wednesday, May 29, 2019

The Importance of Physical Activity in Controlling Blood Glucose

Type 2 diabetes has been a dangerous chronic illness in the US for a number of years. And now, prediabetes is gaining attention because treating prediabetes can delay or avoid type 2 diabetes. Approximately 30 million US residents have type 2 diabetes, and more than 84 million US residents have prediabetes. A healthy diet and physical activity are seen as the tools to use in the fight against type 2 diabetes and prediabetes. And one study has suggested that a too-low level of physical activity is likely to lead to type 2 diabetes.

Investigators at McMaster University in Ontario, Canada looked at the effects of walking 1,000 steps or less a day for two weeks. The investigator focused, specifically, on overweight, elderly individuals, and found that the “sudden inactivity [of walking less than 1000 steps a day] caused blood sugar to spike in the pre-diabetic adults, and it stayed high even after people returned to normal levels of activity.”

It was reasoned that the limited physical activity meant that the body didn’t use as much of the glucose as it might have with more activity. And as glucose stays in the blood, more insulin is created to remove the glucose. Eventually, tissues become less sensitive to insulin, making it more difficult for insulin to remove the glucose from the blood.

The above study demonstrates the importance of physical activity. Some experts recommend 10,000 steps each day. Others argue that the number is less than 10,000 steps. However, based on the above study, the number of steps is probably at least a thousand.

Physical activity is needed to help regulate blood glucose. Physical activity, along with diet and lifestyle change, is an important tool in the fight against prediabetes and type 2 diabetes. And clinicians should always make physical activity a part of any type 2 diabetes and prediabetes treatment plan.

Saturday, May 25, 2019

Biomarkers Can Predict Type 2 Diabetes Two Decades Before the Diagnosis

For some time, diabetes has been a dangerous chronic illness in the US. And the disease has received a lot of attention. In recent years, prediabetes has also received a great deal of attention. Prediabetes has been given attention because it is often the forerunner of type 2 diabetes. Approximately 30 million Americans have type 2 diabetes, and over 84 million Americans have prediabetes. But luckily, there are biomarkers that can predict type 2 diabetes as much as two decades before a person is diagnosed with the disease. And there are proven lifestyle changes and medications that can help one delay or avoid type 2 diabetes.

In a Japanese study, 27,392 adults who did not have diabetes were studied. They were looked at between the years of 2005 and 2016. At the start of the study, blood glucose and weight were measured. During the 11 year period, 1067 of the subjects developed type 2 diabetes. The researchers concluded that since “the vast majority of people with type 2 diabetes go through the stage of prediabetes, [the researchers'] findings suggest that elevated metabolic markers for diabetes are detectable more than 20 years before its diagnosis.”

Another study, done in Sweden, also demonstrated that risk factors for type 2 diabetes exist up to 20 years before one is diagnosed with the disease. The study followed 296,439 individuals who were nondiabetic for 20 years. During that time about 10% of the study subjects received a diagnosis of type 2 diabetes. In looking at the biomarkers, BMI, triglycerides, and fasting glucose, it was revealed that those persons who had these biomarkers at higher than normal levels were at a higher risk of type 2 diabetes, about 20 years later.

Fortunately, intensive lifestyle intervention (ILI) and medication can help avoid or prevent type 2 diabetes after one is diagnosed with prediabetes. In one study where 422 adults in Southern California were examined, it was found that ILI or ILI in combination with medications can help individuals avoid type 2 diabetes. The researchers concluded that “after an average follow-up period of almost 3 years, the annual rate of transitioning to full diabetes was 4.1% among people who received only lifestyle therapy, and 1.7% in patients on two diabetes drugs.”

Further, “none of the patients on three diabetes drugs develop diabetes.” Patients in the study who received prescriptions for two medications were on metformin and another diabetes medication. And patients on three medications were on metformin and pioglitazone and another diabetes medication, including exenatide and liraglutide.

So clinicians should be aware that predicting diabetes is possible. And delaying or avoiding type 2 diabetes is also possible. Knowing this can help clinicians better treat patients who are at high risk of type 2 diabetes.

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