Monday, October 28, 2019

Body Fat Percentage May Be Better in Identifying Prediabetes and Diabetes

Obesity is viewed as a “major risk factor for the development of prediabetes and type 2 diabetes.” Body mass index or BMI is probably the most frequently used measurement of obesity. However, BMI is also viewed as an imperfect measurement of excess body fat. Based on BMI, an individual may appear to have a normal weight -- a BMI < 25 -- but actually have a body fat percentage (BF%) that raises the individual’s risk for prediabetes and type 2 diabetes.

Therefore, accurate measurements of BF% are sought. One of the more accurate methods may be the air-displacement plethysmography, or ADP. Further, it appears that ADP for BF% may be better at identifying those with a high risk of prediabetes and diabetes.

Air-displacement plethysmography (ADP) is defined as “A technique for measuring body composition (body volume and percentage of body fat) that relies on the relative volume and pressure of gas displaced by the body when it is placed inside a plethysmograph.” A plethysmograph is “a device for measuring and recording changes in the volume of the body or of a body part or organ.”

One study looked at a total of 4,828 participants to determine the effectiveness of ADP in measuring body fat percentage for the diagnosis of diabetes and prediabetes. Three groups were created using BMI classifications for normal weight, overweight and obesity. These groups were described as follows: 587 lean participants, 1,320 overweight participants, and 2,921 obese participants.

The investigators concluded that there was “a higher than expected number of subjects with prediabetes or type 2 diabetes” in the lean and obese groups, using BF% cutoff points, than what would be expected using BMI cutoff points. The most often used cutoff points for BF% are as follows: overweight men, 20.1-24.9%; overweight women, 30.1-34.9%; obese men, >= 25% and obese women, >= 35%.

At any rate, BF% does a better job of identifying subjects with a high risk of prediabetes or type 2 diabetes than BMI.

Wednesday, October 23, 2019

The Metabolically Healthy Obese and Diabetes

Past research has shown that there are obese people who are metabolically healthy. And while the idea that one can be obese and healthy is counterintuitive, apparently, these people exist. They are referred to as metabolically healthy obese or MHO. Although MHOs do exist, there are reasons to believe that the healthy state may not be long-lasting. And recent research has shown that metabolically healthy obese individuals have a higher risk of diabetes compared to normal weight individuals.

One scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging suggested that MHOs may be healthier than one might expect because they have a healthier level of inflammation. And that this healthier level of inflammation may actually protect the MHOs from disease. This is an interesting conclusion, since one of the problems with excess body fat is inflammation. Inflammation appears to play a role in insulin resistance which can lead to type 2 diabetes.

The connection between excess body fat and diabetes was highlighted in a recent study done in China. The investigators looked at the connection between MHOs and diabetes incidence in middle-aged and elderly people. They were also interested in knowing whether or not nonalcoholic fatty liver disease (NAFLD) played a role in that Association.

The investigators looked at over 17,000 individuals who did not have diabetes at the beginning of the study. The investigators defined metabolically healthy individuals as those with a BMI of 28 and zero or one of four metabolic comorbidities. These comorbidities were high blood pressure, increased triglycerides, hyperglycemia and low-cholesterol. The healthy MHOs were compared to metabolically healthy normal weight persons.

The investigators concluded that the MHO condition “was associated with increased incidence of diabetes in a middle-aged and elderly population, and the association did not differ by the presence or absence of NAFLD.” And in another study, researchers concluded that the MHO state is relatively unstable.

So, while some obese individuals may be healthy, in general, the healthy state may not last as long as a person of normal weight. The excess, harmful body fat may be detrimental in the long run.

Wednesday, September 25, 2019

Primary Care Organizations Are Not Paying Enough Attention to Prediabetes

Having prediabetes puts a person at a high risk for type 2 diabetes. Type 2 diabetes can lead to kidney problems, heart problems, strokes and other comorbidities. Thus, both healthcare and community organizations are offering programs to combat prediabetes so that type 2 diabetes may be delayed or prevented. However, primary care organizations need to play a bigger role in prediabetes treatment. And currently, these organizations are not participating as much as they could in the treatment.

One study concludes “that few patients with undiagnosed prediabetes are even told that they are at high risk for diabetes.” Further, the study indicates “that diabetes prevention requires improved patient-centered care, which likely begins with the delivery of adequate information to patients.” There are reasons, however, why primary care organizations are reluctant to give a diagnosis and treatment for prediabetes. There is, at most, vague agreement on what prediabetes is, and some don’t think it is really a disease. And some feel that since there are other health conditions that are known to be serious, it is not a good idea to overburden the patient with more to worry about.

There are other reasons why primary care organizations are not participating in prediabetes treatment. A recent study suggested that providers may not be aware of how effective interventions are in reducing the risk of diabetes. And there may be a “lack of access to providers of dietary and exercise advice.”

At any rate, the study concluded: “most patients with confirmed prediabetes do not receive appropriate care.” And “that the approach of primary care toward prediabetes needs to change if we are to effectively prevent diabetes.”

More attention should be given to the diagnosis and treatment of prediabetes in order to prevent or delay type 2 diabetes. And the Centers for Disease Control and Prevention’s Diabetes Prevention Program (DPP), or National DPP, is a good place to start. 

Friday, September 20, 2019

Lifestyle Habits and Alzheimer's Disease

According to the Centers for Disease and Control and Prevention (CDC), the chief causes of chronic diseases are smoking, overuse of alcohol, poor diet, and lack of physical activity. Among the chronic diseases that the CDC lists are heart disease, stroke, cancer, diabetes, obesity and Alzheimer’s disease. And a recent study shows that lifestyle habits can lower the risks of Alzheimer’s disease a greater amount than the researchers had anticipated.

The study was described at the Alzheimer’s Association international conference in Los Angeles. The researchers concluded that if a person employs a healthy diet, engages in physical activity, stops smoking, does not overindulge in alcohol use, and participates in “cognitive stimulation activities,” the individual could lower his or her risk of Alzheimer’s disease by 60%.

The study included 2765 participants who were tracked over a ten-year period. There were two parts of the study: one part was called the Chicago Health and Aging Project (CHAP), and the other was called the Rush Memory and Aging Project (MAP). The study consisted of older adults with an average age of the CHAP participants being 73 years and the average age of the MAP participants being 81 years. The participants were both male and female, who were either black or non-Hispanic whites.

The participants evaluated the behavior of the participants using a scoring method involving healthy habits. The researchers gave the participants a "0" if they did not engage in one of the five above mentioned healthy habits or a "1" if the participants did engage in the one of the healthy habits. And it was concluded that if an individual earned four or five in the rating system, that individual’s risk of Alzheimer’s was lowered by 60% compared to subjects in the study who earned a total score of "0" or "1".

Further, another study presented at the conference indicated that healthy lifestyle choices could even lower the risk of Alzheimer’s for people who are genetically predispositioned for the disease. The investigators concluded that “people with a high genetic risk of Alzheimer’s are less likely to develop the disease if they pursue a healthy lifestyle.”

The above-referenced studies confirm what research continues to show: A healthy lifestyle is one of the best ways to reduce the risk of chronic illnesses. So healthcare providers ought to work to induce patients to embrace healthy living. It could lower our healthcare costs while improving population health.

Thursday, August 29, 2019

Personalizing the Treatment for Patients with Type 2 Diabetes

Personalized medicine is something that's being talked about a lot today. In personalized medicine, a provider customizes a patient's treatment, based on a specific set of characteristics associated with the patient. Customization can be used when it comes to type 2 diabetes. To customize the treatment, the provider should have knowledge of different type 2 diabetes treatment options. For example, for some individuals, focusing on excess body weight may be the best approach in the diabetes treatment. And for others, high intensity interval training (HIIT), as a key tool in the treatment of type 2 diabetes, may make the most sense.

A study done in Japan indicated that when men or women gain weight, there is an increase in type 2 diabetes and prediabetes. And when there is a decrease in weight, there is an associated decrease in type 2 diabetes and prediabetes. The investigators therefore concluded that “the BMI level was likely to contribute to trends in the prevalence of T2DM, and thus the management of obesity may be important to reduce the prevalence of T2DM.”

HIIT “is a training technique in which you give all-out, one hundred percent effort through quick, intense bursts of exercise, followed by short, sometimes active, recovery periods. This type of training gets and keeps your heart rate up and burns more fat in less time.”

And according to one study, for obese persons, HIIT can increase hormones, like ghrelin, that lead to weight gain, and HIIT can decrease hormones, such as GLP-1(Glucagon-like peptide-1), that lead to weight loss .

The investigators concluded that “appetite hormones differ between lean and obesity participants. The finding also suggested HIIT is more likely to elicit appetite hormones responses in obesity than in lean individuals with type 2 diabetes. Therefore, with caution, it is recommended that the high intensity interval training can be beneficial for these patients.”

Therefore, viewing the patient as an individual is worth the effort. If the patient with type 2 diabetes is obese, treat the obesity as well as the diabetes. And consider HIIT for those obese patients with type 2 diabetes who might benefit from the more intense physical activity.



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. 


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