Do you have diabetes and a BMI above 35? If you do and decide to get bariatric surgery to help you manage your diabetes, it could be an excellent idea.
But will you to go to your nearest hospital for the procedure? That might not be the safest thing to do.
Does your weight makes it difficult for you to manage your diabetes? Check out bariatric surgery, because it’s likely to help you to lose many pounds.
But how well will it help you manage your diabetes over the long term?
Until now, nobody knew the answer to this question. That’s why researchers have been studying a group of 120 adults with Type 2 diabetes at three teaching hospitals in the U.S. and one in Taiwan. Half of them got bariatric surgery, and half got intensive lifestyle medical management.
Metformin, the most popular diabetes medicine, figured in about 200 of the presentations at the recent annual convention of the American Diabetes Association. Two of these presentations show good news for its likely role in degenerative nerve disease and in dispelling concerns about its possible role in neuropathy. One presentation, however, brought some disturbing results, and the rest are of less interest to most people with diabetes.
This convention, which the ADA calls its 76th Scientific Sessions, attracted more than 16,000 attendees, including more than 13,000 professionals who went to New Orleans to see and hear almost 3,000 presentations about diabetes. I represented HealthCentral there.
Dr. Liu presents her poster on metformin
(Photo by David Mendosa)
A team of researchers from Tulane University’s School of Public Health and Tropical Medicine presented one poster and one oral presentation about metformin. Shuqian Liu, MD, presented the poster and told me that she designed both of these studies. The poster 570-P reported a retrospective study that examined the effect of high doses of metformin on neuropathy, a complication for 60 to 70 percent of people with diabetes.
If you have a low level of vitamin D, taking this inexpensive supplement may help you prevent diabetic retinopathy, one of the most serious complications of diabetes. This is the most common reason why some people with diabetes lose their vision.
A meta-analysis just presented at the Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists, in Orlando, Florida, from May 25 to 29, found “a statistically significant association between diabetic retinopathy and vitamin D deficiency.” Three researchers presented their findings in an abstract, “The Relationship Between Vitamin D Deficiency and Diabetic Retinopathy: A Systematic Review and Meta-Analysis.” The Canadian Journal of Ophthalmology is expected to publish the full report soon, one of the study’s authors told me.
When you have diabetes, you don’t have enough functioning beta cells. People with Type 1 diabetes have quickly lost almost all of these cells that make insulin, and if you have Type 2, you will typically experience a progressive decline in the number and size of your beta cells.
One type of diabetes drugs has been shown in animal studies to stop this progression. It may do this for humans too, but because the drug is so new researchers don’t know yet if it will work the same way for us.
The technical name for this drug class is a mouthful: glucagon-like peptide-1 receptor agonists. Researchers often shorten it to GLP-1 receptor agonist or even to GLP-1. The newest brand of these drugs is Trulicity. The others that are available in the United States are Tanzeum, Victoza, Bydureon, and Byetta, which was the first.
These drugs to help us manage Type 2 diabetes have only been available for just over 10 years. While they haven’t been approved for people with Type 1, some of these people apparently benefit from using them too, when their doctors prescribe them off-label.
Metformin is the type of pill that your doctor should prescribe for you when you begin to manage type 2 diabetes. This is the key recommendation of a huge new meta-analysis. Of the six classes of oral drugs that the U.S. Food and Drug Administration approves when people take only one drug for diabetes, metformin ranks first in overall safety and effectiveness.
“We concluded that metformin looks better for cardiovascular mortality than sulfonylureas,” says lead author Nisa Maruthur, MD, of Johns Hopkins University School of Medicine in Baltimore. “It has a long-term safety profile. Metformin is weight neutral or helps people lose weight, and its gastrointestinal side effects are avoidable or tolerable. Its effect on A1C is similar to other medications.”
Until now, researchers didn’t have any firm evidence that one class of drugs was best at reducing cardiovascular risk — heart attacks and strokes. If you have uncontrolled blood glucose, this is your the most serious diabetes risk. But the researchers concluded that metformin reduces the relative risk of a patient dying from heart disease by about 30 to 40 percent compared to its closest competitor drug, the sulfonylurea class.
The Annals of Internal Medicine, a peer-reviewed journal of the American College of Physicians, just published the study online ahead of print as “Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes.” It is comprehensive meta-analysis of more than 200 studies with more than 1.4 million people with diabetes. Those studies made head-to-head comparisons of the six drug classes: metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and SGLT-2 inhibitors.