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. 
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