Gestational Diabetes and the risk of developing subsequent Type 2 diabetes

16 August 2016

Gestational Diabetes and the risk of developing subsequent Type 2 diabetes

Hi All,  

This study is a longitudinal look at not only what happens to women who have been diagnosed with Gestational Diabetes and whether they go on to develop Type 2 diabetes within 10 years of diagnosis, but also the effect of non-surgical interventions on the risk of going on to develop Type 2 diabetes.  The positive news is that lifestyle changes alone can decrease this risk!! That is very encouraging.  It also holds true for my patients who have chosen to have Bariatric surgery to improve their health and minimise medical issues associated with obesity.  The message for my patients who undergo bariatric surgery is that the focus in the first post-operative year is to make lifestyle changes that can last a lifetime. This improves the chances of maintaining the weight loss that they have achieved with Bariatric Surgery (Bypass, Sleeve or Banding).  And life long weight maintenance is what we all want!!


Steph Ulmer



Women with a history of gestational diabetes (GD) face a heightened risk of developing yype 2 diabetes for years after giving birth, but intensive lifestyle intervention or a medication regimen can have a protective effect in this population, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

"Our long-term follow-up study found the elevated risk of developing type 2 diabetes persisted for years in women who had been diagnosed with gestational diabetes, and this long-term risk can be reduced with either intensive lifestyle intervention or the medication metformin," said one of the study's authors, Dr Vanita Aroda of the MedStar Health Research Institute in Hyattsville, MD.

The Diabetes Prevention Program Outcomes Study (DPPOS) analysed long-term metabolic health in 288 women who had a previous diagnosis of GD and 1,226 mothers who did not have a history of the condition. The women all participated in the initial Diabetes Prevention Program study, a randomised clinical trial where they were assigned to intensive lifestyle intervention, the diabetes medication metformin or a placebo. The intensive lifestyle intervention was aimed at reducing body weight by 7 percent and participating in moderate cardio exercise for 150 minutes a week.

During the DPPOS, the women continued to have their blood glucose levels measured twice a year for six years. The study looked at long-term health outcomes in Diabetes Prevention Program participants for about a decade after the women first enrolled in the study.

Over 10 years, women with a history of GD assigned to placebo had a 48% higher risk of developing diabetes compared with women without a history of GD. In women with a history of GD, lifestyle intervention and metformin reduced progression to diabetes compared with placebo by 35% and 40%, respectively. Among women without a history of GD, lifestyle intervention reduced the progression to diabetes by 30%, and metformin did not reduce the progression to diabetes.

"Medical and lifestyle interventions were remarkably effective at slowing the progression of Type 2 diabetes in this at-risk population in both the short and long term," said Aroda. 

The Invention That Could End Obesity

14 June 2016

The Invention That Could End Obesity

Love the enthusiasm..! This does seem too good to be true, and... But it does show how keen the world is to finding a solution to the Obesity epidemic that doesn't mean subjecting people to major surgery.  However, this, I suspect is not it.  Gastric surgery for obesity is still the best (and currently only) way of giving patients significant weight loss experiences with the chance of excellent long term results as well.  That sounds too good to be true also, but in my experience it isn't!  It does require some guidance regarding the right option for Bariatric Surgery (Gastric Banding, Gastric Sleeve and Gastric Bypass) for you and the right support pre-, during and post- surgery.  Don't look any further - we should talk!

Steph Ulmer

A Michigan surgeon invented an apparatus that he believes tricks the brain into thinking the stomach is full. His Full Sense Device could be a lifesaver for millions of obese Americans and raises questions about how hunger — our most basic human impulse — even works.

Bonnie Lauria was miserable. She was subsisting on liquids and a handful of foods her stomach could handle. Ever since she’d undergone gastric bypass surgery in the ’80s, foods like meat and bread that went down her throat in a lump would come right back up. “I knew where every bathroom was in every restaurant in the state,” Lauria says from her home in West Branch, Michigan. “It was horrendous.”

During gastric bypass surgery, the stomach is reduced to about the size of a walnut and attached to the middle of the small intestine. Lauria’s complications from the surgery weren’t normal, so she went under the knife a second time. Still, her condition didn’t change. She switched doctors several times, but no one could help. Eventually, someone recommended bariatric surgeon Dr. Randy Baker in Grand Rapids in 2004.

Baker ran some tests and saw that the spot where Lauria’s walnut-size pouch met her small bowel was tightening. Previous doctors had tried to widen the passage so that food could pass through, but the stricture had returned. Complicating Lauria’s condition were those multiple surgeries, which left so much scar tissue that operating again would be too difficult and too dangerous.

Baker was at a loss. Then he started thinking about esophageal stents. Just like a coronary stent keeps an artery open, an esophageal stent holds the esophagus open and is often used in patients who have difficulty swallowing. What if one of those could prop open the small bowel too?

As far as Baker knew, no one had ever attempted a procedure like that before. But Lauria was out of options, so Baker told her his strategy. She agreed; he inserted the stent and hoped for the best.

“She came back to my office two weeks later and said, ‘Dr. Baker, I’m feeling great. I can eat sloppy Joes!’” Baker says. “Here’s a lady who could only do liquids, and now she can eat solids. And she’s losing weight.”

Lauria didn’t have an explanation; she told Baker she simply wasn’t hungry anymore. Baker wondered if he and other bariatric surgeons had been going at it all wrong. The stent, he theorized, was putting pressure at the top of Lauria’s pouch and sending signals to her brain saying, “I’m full.” It was doing what food does, but without actual food. Which raised some questions: What if we don’t need invasive surgeries that cut away portions of the stomach and rearrange the digestive tract and intestines? What if all we need is a device that puts pressure near the top of the stomach?

Baker set out to test his hypothesis, teaming up with a former product specialist from W.L. Gore (creators of Gore-Tex) and two surgeons at his Grand Rapids practice to create the Full Sense Device — a nitinol wire-mesh funnel coated in silicone that can be inserted through the mouth and placed in less than 10 minutes. Current plans would allow the device to remain for up to six months before removal, though in the future that time may be longer. In the company’s trials, every patient implanted with the device lost weight and continued to lose weight until the device was removed. Baker calls the phenomenon “implied satiety.” At six months, average patients lost 75% of their excess body weight — significantly more and at a faster rate than any bariatric procedure, and all, Baker says, with no “severe adverse side effects.”

The Institute for Health Metrics and Evaluation estimates that 160 million Americans — nearly half — are overweight as indicated by their body mass index, which is calculated from a person’s height and weight. (A BMI between 25 and 29.9 is considered overweight; 30-plus is obese.) Of those people, 24 million are estimated to be morbidly obese, meaning they have a BMI over 40 and are at higher risk for serious, life-threatening illnesses, including heart disease, diabetes, degenerative arthritis, and cancer. Bariatric surgeries can and often do lead to impressive weight loss, yet only 1% of obese Americans opts for the invasive and costly procedure — usually $20,000 to $30,000. (Rex Ryan, Roseanne Barr, Carnie Wilson, Al Roker, Chris Christie, Randy Jackson, and Star Jones are reported to be among the 1%.)

“There are a bunch of things that contribute to that,” says Randy Seeley, an obesity researcher and professor of surgery at the University of Michigan. “One is the ick factor — ‘someone is going to chop up my GI tract.’ Some of it is cost — it’s still not universally covered. Third is stigma. The implication is that it’s the easy way out — you’re cheating somehow by taking that option — which goes to our societal biases about obesity.”

Dr. Baker has come up with a nonsurgical device that he says will enable obese patients to lose substantial weight, and at a fraction of the cost of surgery — in the neighborhood of $5,000 at an outpatient center. A company claiming to have found a simple solution to drastic, easy weight loss is, of course, nothing new; in fact, it’s big business. (See: late-night infomercials.) Some surgeons and researchers are skeptical of Baker’s pressure theory, and at least one patient experienced chronic acid reflux after the device was inserted. But more than 10 years after the eureka moment, Baker is hopeful that doctors in Europe could begin using the Full Sense Device this year and in Canada and Mexico soon after. Americans will have to wait longer; Food and Drug Administration approval is unpredictable and likely still years away. Baker’s concern, though, is that the Full Sense Device might work too well. If it’s effective, easy, and cheap, what’s to stop people from abusing it?

“When this hits the market, there’s not going to be just 10,000 to 15,000 people having it,” says Fred Walburn, president and sole employee of Full Sense Device’s parent company, BFKW. “There’s going to be hundreds of thousands. Millions per year.”

For diabetes in obesity, weight-loss surgery beats medication

5 May 2016

For diabetes in obesity, weight-loss surgery beats medication

This truly is a remarkable study, as Dr Schauer says. It is as close as you can get to answering a scientific question with the use of a study. The question being, does Bariatric surgery cure diabetes? Whilst cure is a very strong word, this 5year data gives a very powerful indication that surgery is able to alter the course of diabetes significantly and over the longer term. This is big news and should definitely be suggested to people who develop type 2diabetes with increasing weight. Worth a visit to your GP to discuss whether bariatric surgery is right for you!


Half of the patients treated with weight-loss surgery in the study were diabetes-free at five years, said Dr. Francesco Rubino of Kings College London in the UK and colleagues in a report in The Lancet.

“The five-year mark is an important mark in many diseases,” Dr. Rubino told Reuters Health by phone. “The fact that some patients at five years are basically disease-free is a remarkable finding.”

In 2009, he and his colleagues randomly assigned 20 obese patients with type 2 diabetes to receive medical treatment, 20 to receive a type of weight-loss surgery called a gastric bypass, and another 20 to undergo a weight-loss operation called a biliopancreatic diversion.

Eighty percent of patients who had surgery had their blood sugar under good long-term control, versus about 25 percent of patients treated with drugs only.

All of the study groups had a reduction in cardiovascular risk. But the surgery-treated patients had a 50 percent lower risk of heart and blood vessel disease than those treated with drugs only, and they needed fewer drugs for treating high blood pressure or high cholesterol.

The improvements in blood sugar control and heart disease risk weren’t related to how much weight patients lost.

“What really is causing the remission of diabetes after surgery remains mysterious,” Dr. Rubino said. What is known, he added, is that the intestines produce a host of hormones involved in regulating metabolism. Reconstructing the gastrointestinal tract so that food bypasses the stomach and small intestine may help restore normal metabolic control, he explained.

Like any surgery, weight loss operations carry risks. An international study published earlier this, for example, found that after two years, people randomized to have gastric bypass surgery had better control of their type 2 diabetes than people assigned to a medication group, but they also had a higher risk for infections and bone fractures. (See Reuters Health story of May 21, 2015.)

And some patients may gain back some of the weight they lost.

Still, doctors are increasingly referring to this type of surgery as “diabetes surgery,” rather than obesity surgery, said Dr. Philip Schauer, the director of the Cleveland Clinic Bariatric and Metabolic Institute and a bariatric surgeon, in a telephone interview with Reuters Health. Dr. Schauer did not participate in the new study.

There are some people, this study shows, that can go into remission for up to five years or more,” he said. “We hesitate to use the word ‘cure,’ but it’s pretty darn close to a cure, about as close to a cure as you can get.’

Dr. Schauer pointed out that about half of patients with type 2 diabetes are unable to control their blood sugar with medication and lifestyle measures. Based on the new findings, he said, bariatric surgery should be offered to these patients if they are moderately obese, for example with a body mass index (BMI) of 35. (BMI is a measure of weight in relation to height.)

Currently the National Institutes of Health states that patients should have a BMI of 40, or a BMI of 35 with obesity-related illness, such as type 2 diabetes, in order to be eligible for weight loss surgery.

“There are still many insurance companies today that will not pay for this surgery for any reason, whether it’s for obesity or diabetes. It means that they are denying people effective treatment,” Dr. Schauer said. “This study is going to make insurance carriers and third party payers rethink their coverage policies regarding bariatric or diabetes surgery, as we prefer to call it.”


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