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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.
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)
31/10/2015
Researchers found patients with type 2 diabetes had significantly larger reductions in HbA1c and cholesterol levels three months after participating in high-intensity bursts of exercise, compared with those in the conventional sustained-exercise program group. The findings, presented at the 2015 Canadian Cardiovascular Congress and based on 76 patients with newly diagnosed diabetes, also showed that the burst-exercise group had better adherence to the program than the sustained exercise group.
02/11/2015
A double-blind study, presented last week at the 2015 International Thyroid Congress and Annual Meeting of the American Thyroid Association which involved 32 adults with primary hypothyroidism, showed that the combination of T4 (thyroxine) and T3 (liothyronine) was of no significant clinical benefit compared to thyroxine alone. However, there is still need for future studies with longer follow-up to evaluate the effects of T3 in select patients who have ongoing symptoms of hypothyroidism.
October 20th annually is world osteoporosis day which brings awareness to this condition which affects 1 in 3 women and 1 in 5 men over 50 years of age. Fragile or thin bones are common and can lead to fractures and other health complications. To improve bone health, a healthy diet full of calcium, protein and vitamin D can certainly help and regular weight-bearing exercise is very beneficial. Sunshine is the main source of vitamin D, however caution should be taken to prevent over-exposure. For more information see
New research presented at the American Society for Bone and Mineral Research 2015 Annual Meeting shows that aging postmenopausal women who received denosumab (Prolia) over 10 years continued to gain bone mineral density and had low incidences of fracture. Particularly “striking” was the lumbar spine bone density which increased 21.7% over the 7 year study.
Leading research demonstrates that in the US, 23000 people visit hospital emergency departments and more than 2100 are hospitalized due to dietary supplements, particularly weight loss and sexual enhancement supplements. Vitamins, dietary supplements and herbal medications have no monitoring of their safety and are not in any way regulated. Supplements do not require rigorous research trials to prove efficacy like pharmaceutical medications, which puts consumers at significant risk, who often believe that such produces are “natural and safe”. Ingredients in such supplements vary significantly and may contain hidden ingredients and untested chemicals that are often different to the packaging. Whilst many are safe, it is important to discuss any supplements with your doctor. The Food and Drug Administration has “repeatedly warned about the dangers of such products”.
WWW.NEJM.ORG