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Diabetes remission occurred in 60% of adults who had gastric bypass surgery compared with 6% of patients who received a lifestyle and medical intervention according to the CROSSROADS study published in Diabetologia online on March 17th 2016. This study analysed a cohort of 32 patients with type 2 diabetes and mild to moderate obesity, and also found those in the surgical group reduced their mean A1C from 7.7% to 6.4% and lost more weight and used fewer diabetes medications at 12 months than those in the lifestyle/intervention group. Surgery is certainly an effective means of improving diabetes, however long-term side-effects, such as malabsorption or surgical complications are unclear.
The results are promising but it must be noted that follow-up was only for 1 year and this was a very small study including a select group of patients. Results may not be generalisable to everyone in the community but gastric bypass is a potential option to consider in the treatment options for type 2 diabetes and obesity.
Cardiovascular disease was reduced by 30% in type 1 diabetes patients who had intensive therapy during the Diabetes Control and Complications Trial 30 years ago. At 30 years of follow-up, a study published online February 9th 2016 in Diabetes Care involving 1441 patients, found a 30% reduction in the incidence of any cardiovascular disease and a 32% reduction in the incidence of major cardiovascular disease events (nonfatal myocardial infarction, stroke or cardiovascular death) in type 1 diabetes patients who were in the intensive therapy group, compared with those in a conventional therapy group. This was despite the intensive therapy period only lasting an average of 6.5 years.
It is reassuring to see that type 1 diabetes patients who were taught intensive therapy to manage their diabetes, have long-term beneficial effects on the incidence of cardiovascular disease that persist for up to 30 years.
The Endocrine Society of Australia (ESA) has published its top 5 list of interventions and practices to avoid.
The list was developed by Endocrinologists as part of a Royal Australian College of Physicians initiative that encouraged each medical specialty to think about the clinical circumstances in which some of their practices (medical tests, procedures or interventions) should be questioned and discussed by physicians.
The ESA’s top 5 practices and interventions to avoid:
1. Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.
2. Don’t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency.
3. Do not measure insulin concentration in the fasting state or during an oral glucose tolerance test to assess insulin sensitivity
4. Avoid multiple daily glucose self-monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycaemia.
5. Don’t order a total or free T3 level when assessing thyroxine dose in hypothyroid patients.
Sitting for long stretches might boost your risk for type 2 diabetes, even if you exercise, researchers report. An extra 40 minutes of couch potato behaviour was found to dramatically increase the risk of developing type 2 diabetes in a new study published online in Diabetologia. HealthDay reports that “each extra hour in a sedentary position – whether working on the computer or lounging in the recliner – seems to increase” the “odds of type 2 diabetes by 22 percent, the study authors”. That risk remained even if people undertook high intensity exercise such as running or swimming, researchers found after collecting “data on nearly 2,500 adults, average age 60.”
It should be noted however, that the link between sitting and diabetes is only an association based on cross-sectional data, and doesn’t prove that sitting causes type 2 diabetes. Why sedentary behavior may play a role in the development of type 2 diabetes is not clear from the study.
Overall, sitting for long periods is not a good thing!
The caffeine in a cup of coffee may help people reduce the “perception of effort” involved in exercising, so it is easier for them to stick with their workout plan, UK researchers reported in Sports Medicine. Researchers said the perception of effort required for exercise is one reason why people choose sedentary activities in their free time, and psychoactive drugs such as caffeine may help reduce the physical exertion associated with exercise and motivate more people to stick to their fitness plans. For more, see Business Standard (India) (14th January 2016)
Reducing stress could help people lose weight, according to a University of Florida study in the journal BBA Molecular and Cell Biology of Lipids. Chronic stress promotes production of betatrophin, a protein that reduces the body’s ability to break down fat. These findings were found in this study involving animal metabolism, and further research is needed to study the effect of betatrophin in humans. This however provides an interesting insight into how reducing chronic stress might help people lose weight. Also reported in HealthDay News.
Vitamin D is a common treatment used in the community, particularly in the elderly to improve bone health and the risk of falls and fractures. Adequate Vitamin D levels are required to help the body absorb calcium which is important for bone health amongst other functions. A study has just been published online on January 4th in JAMA Internal Medicine that shows “high doses” defined as 2,000 IU daily (or typically 2 capsules a day) may actually increase the risk for falls among certain seniors. Those that took standard doses approximately 800 IU daily had the best benefit in falls and fractures in 200 Swiss seniors followed for one-year. These group of seniors (70 years or older) who had already had falls were divided into three groups. One took the standard, currently recommended 24,000 IU of vitamin D a month, another took 60,000 IU a month and a final group took 24,000 IU of vitamin D plus 300 micrograms of calcifediol, a broken down form of vitamin D. The group that took the lowest dose of the vitamin at 24,000 IU monthly, had falls (about 48%) while more of those taking the two higher doses (about 66.5%) fell during the year.
Not only did the people taking 24,000 IU monthly have fewer falls, but they also showed better muscle strength in their lower extremities, an indication that they might be better protected against falls and potential fractures. It should be noted that this study used a large monthly dose of Vitamin D, whereas the majority of the Australian population would be taking a smaller daily dose.
Vitamin D supplementation is a controversial area and there will be more research to come regarding optimal Vitamin D dosing and levels. Patients should be cautious not to take excessive amounts of Vitamin D and be guided by their doctor when commencing vitamin supplements for bone health.
Research presented at the Genitourinary Cancers Symposium suggests that “an experimental blood test designed to analyze circulating tumor cells may be able to predict which patients with prostate cancer could benefit from hormone therapies. In a press release, Sumanta K. Pal, MD, said, “It’s remarkable that a blood test could help us profile cancers in real time, gleaning insights that directly affect patient care decisions.”
The non-invasive liquid biopsy involves taking a blood test and staining it with special dyes to distinguish normal blood cells from tumour cells in the bloodstream which are released from cancers, including any areas of the body where the cancer has metastasised to. The cells are then analysed for genetic abnormalities and researchers noted that specific genomic features responded well to hormone therapies, whereas other features such as higher heterogeneity suggested resistance to androgen receptor therapies. If this test is validated, it may pave the way for personalised selection tool for treatments in prostate cancer and is a much simpler method of sampling tumours through a simple blood test, rather than an invasive biopsy.
Greater consumption of potatoes, especially french fries, was shown in a new study published online in Diabetes Care December 17th, to be associated with a higher risk of developing type 2 diabetes, independent of body mass index and other risk factors. Replacement of potatoes with whole grains was associated with a lower risk of Type 2 diabetes. This study analysed data in three large cohorts of US health professionals involving nearly 200,000 individuals. Potato consumption was assessed using validated food frequency questionnaires. Higher consumption of total potatoes (including baked, boiled, or mashed potatoes and french fries) was significantly associated with an elevated risk for type 2 diabetes (up to 33% if ≥7 servings/week after adjustment for demographic, lifestyle, and dietary factors) and was highest for french fries. Replacing 3 servings/week of total potatoes with the same amount of whole grains was estimated to reduce the risk of developing type 2 diabetes.
Lack of physician knowledge about transgender medicine is a barrier to care. Transgender patients report difficulty finding knowledgeable providers and transgender medicine is not covered by conventional medical curricula. A study published in the journal Endocrine Practice (2015;21(10):1134-1142), demonstrated that a simple change in the training curriculum to include a single lecture about transgender medicine can improve care. This intervention was given to junior doctors in Boston, USA in 2014 who were training in internal medicine and family medicine. An anonymous survey assessed the doctors’ knowledge and willingness to assist with hormonal therapy before and after the lecture and found that the lecture significantly increased doctor’s knowledge and willingness to assist with hormonal therapy for transgender patients from 5% to over 70% and improved understanding that gender identity has a biologic basis that remains constant and that hormonal and surgical therapies should be offered. This type of intervention is simple and has the ability to significantly improve access to care and outcomes for transgender individuals. As such, training in transgender medicine should be made available in all doctors-in-training and medical students who may be involved in transgender care.