[33] Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index.

MP111212 [Cohen,Surg Obes Relat Dis,2012,Duodenal-jejunal bypass, waist circumference, insulin sensitivity]

Surg Obes Relat Dis. 2012 Jul-Aug;8(4):375-80. doi: 10.1016/j.soard.2012.01.017. Epub 2012 Feb 2.

Cohen R, Caravatto PP, Correa JL, Noujaim P, Petry TZ, Salles JE, Schiavon CA.

Source

Department of Surgery, Center for Surgical Treatment of Morbid and Metabolic Disorders, Hospital Alemão Oswaldo Cruz, São Paulo, São Paulo, Brazil. ricardo.cohen@haoc.com.br

Abstract

BACKGROUND:

Bariatric surgery frequently results in the resolution of type 2 diabetes mellitus (T2DM). One of the many factors that could explain such findings is the duodenal exclusion of the alimentary tract. To test this hypothesis, a surgical model that induces glycemic control without significant weight loss would be ideal. In the present study, we evaluated the early metabolic changes that occur in overweight diabetic patients after laparoscopic duodenal-jejunal bypass (DJB) and determined the factors associated with success in T2DM resolution. The setting was a private practice.

METHODS:

A total of 35 patients (20 men and 15 women) were included in the present study. The mean preoperative body mass index was 28.4 ± 2.9 kg/m(2). DJB was performed in all patients, and the anthropometric data and blood samples were collected at baseline (preoperatively) and 3, 6, 9, and 12 months after surgery. Success was defined when patients reached a glycated hemoglobin level of <7% without diabetic medication.

RESULTS:

T2DM remission was observed in 14 (40%) of 35 patients. No differences in the homeostasis model assessment insulin resistance index levels and patient weight were observed before and 12 months after DJB surgery. Gender, duration of T2DM, previous use of insulin, preoperative homeostasis model assessment insulin resistance index, and C-peptide levels were not significant predictive factors of success or nonsuccess. The only factor that significantly predicted postoperative positive outcomes was a waist circumference reduction of ≥ 7% compared with baseline within the first 6 months after surgery.

CONCLUSION:

DJB improves glycemic control; however, it does not increase insulin sensitivity in overweight diabetic patients. These changes were observed without significant weight loss.

[46] Are androgen levels elevated in postnatal infant acne and sebaceous gland hypertrophy?

Postnatal androgen assoc with infant acne #MP111212
[Kuiri-Hanninen, JCEM, 2013, Acne, testosterone, 46]
http://www.ncbi.nlm.nih.gov/pubmed/23144469

J Clin Endocrinol Metab. 2013 Jan;98(1):199-206. doi: 10.1210/jc.2012-2680. Epub 2012 Nov 8.

Transient postnatal secretion of androgen hormones is associated with acne and sebaceous gland hypertrophy in early infancy.

Kuiri-Hänninen T, Haanpää M, Turpeinen U, Hämäläinen E, Dunkel L, Sankilampi U.

Source

University of Eastern Finland and Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland. ulla.sankilampi@kuh.fi.

Abstract

Context: Sebaceous gland hypertrophy (SGH) and acne-like skin eruptions are frequent during the first months of life, yet the etiology and prevalence of these conditions in infants are not clear. Objective: The objective of the study was to evaluate the association of postnatal androgens with SGH and acne in infants. Design: This was a longitudinal, monthly follow-up from 1 wk (D7) to 6 months of age (M1-M6). Patients: Patients included 54 full-term (FT; 26 boys) and 48 preterm (PT; gestational age at birth 27.7-36.6 wk, 22 boys) infants. Main Outcome Measures: The occurrence of SGH (present/absent) and acne (5-10, 10-50, and >50 papules) was registered and compared with urinary levels of dehydroepiandrosterone and its sulphate and testosterone measured by liquid chromatography-tandem mass spectrometry. Results: SGH was observed in 89% of FT and 96% of PT infants (P = 0.28). Acne (more than five papules) was observed in 91% of FT infants and in 75% of PT infants (P = 0.06). Both SGH and acne were associated with developmental rather than calendar age: SGH was limited to postmenstrual age less than 46 wk and acne was not observed less than 37 wk of postmenstrual age. Urinary androgen levels showed severalfold differences in magnitude between sexes and between the FT and PT groups. After grouping according to sex and maturity, the occurrence of SGH and the severity of acne were associated with higher urinary dehydroepiandrosterone sulphate and testosterone levels in each group. Conclusions: SGH and acne are common during the first months of life and associated with endogenous, physiologically elevated levels of androgens originating from the adrenals and gonads. These data suggest a novel role for postnatal androgen secretion in infancy.

[17] PCOS: Relationship of hyperandrogensim and hepatic steatosis

PCOS: Relat. of hyperandrogensim and hepatic steatosis #MP111212 [Jones,
JCEM, 2012, PCOS, hepatic steatosis, hyperandrogenism]
http://www.ncbi.nlm.nih.gov/pubmed/22837189

[12] How do comorbidities effect mortality in hyperthyroidism?

How do comorbidities effect mortality in hyperthyroidism? #MP111212
[Brandt, JCEM, 2012, hyperthyroid, 21%, Charlson Score]
http://www.ncbi.nlm.nih.gov/pubmed/22930783

[48] Is metabolic syndrome in adolescents associated with brain abnormalities?

Metabolic syndrome assoc with lower cognition in adolescents #MP111212
[Yau, Pediatrics, 2012, Metabolic syndrome, executive functioning, hippocampus]
http://www.ncbi.nlm.nih.gov/pubmed/22945407

Pediatrics. 2012 Oct;130(4):e856-64. doi: 10.1542/peds.2012-0324. Epub 2012 Sep 3.

Obesity and metabolic syndrome and functional and structural brain impairments in adolescence.

Yau PL, Castro MG, Tagani A, Tsui WH, Convit A.

Source

Department of Psychiatry, New York University School of Medicine, 145 East 32nd St, 8th Floor, New York, NY 10016, USA.

Abstract

BACKGROUND:

The prevalence of metabolic syndrome (MetS) parallels the rise in childhood obesity. MetS is associated with neurocognitive impairments in adults, but this is thought to be a long-term effect of poor metabolism. It would be important to ascertain whether these brain complications are also present among adolescents with MetS, a group without clinically manifest vascular disease and relatively short duration of poor metabolism.

METHODS:

Forty-nine adolescents with and 62 without MetS, matched on age, socioeconomic status, school grade, gender, and ethnicity, received endocrine, MRI, and neuropsychological evaluations.

RESULTS:

Adolescents with MetS showed significantly lower arithmetic, spelling, attention, and mental flexibility and a trend for lower overall intelligence. They also had, in a MetS-dose-related fashion, smaller hippocampal volumes, increased brain cerebrospinal fluid, and reductions of microstructural integrity in major white matter tracts.

CONCLUSIONS:

We document lower cognitive performance and reductions in brain structural integrity among adolescents with MetS, thus suggesting that even relatively short-term impairments in metabolism, in the absence of clinically manifest vascular disease, may give rise to brain complications. In view of these alarming results, it is plausible that obesity-associated metabolic disease, short of type 2 diabetes mellitus, may be mechanistically linked to lower the academic and professional potential of adolescents. Although obesity may not be enough to stir clinicians or even parents into action, these results in adolescents strongly argue for an early and comprehensive intervention. We propose that brain function be introduced among the parameters that need to be evaluated when considering early treatment of childhood obesity.

[38] New ADA Blood Pressure Targets

[ADA,Diabetes Care,2012,140,130,80]

#mp111212

http://care.diabetesjournals.org/content/36/Supplement_1/S11.full

Goals

• People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg. (B)
  
• Lower systolic targets, such as <130 mmHg, may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden. (C)
  
• Patients with diabetes should be treated to a diastolic blood pressure <80 mmHg. (B)
  

[39] Beta blockers-the old cardiac snake oil?

[Bangalore,JAMA,12,Beta blockers,CAD, Recent MI]

#mp111212

JAMA. 2012 Oct 3;308(13):1340-9. doi: 10.1001/jama.2012.12559.

β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease.

Bangalore S, Steg G, Deedwania P, Crowley K, Eagle KA, Goto S, Ohman EM, Cannon CP, Smith SC, Zeymer U, Hoffman EB, Messerli FH, Bhatt DL; REACH Registry Investigators.

Source

Cardiovascular Clinical Research Center, New York University School of Medicine, 550 First Ave, New York, NY 10016, USA. sripalbangalore@gmail.com

Abstract

CONTEXT:

β-Blockers remain the standard of care after a myocardial infarction (MI). However, the benefit of β-blocker use in patients with coronary artery disease (CAD) but no history of MI, those with a remote history of MI, and those with only risk factors for CAD is unclear.

OBJECTIVE:

To assess the association of β-blocker use with cardiovascular events in stable patients with a prior history of MI, in those with CAD but no history of MI, and in those with only risk factors for CAD.

DESIGN, SETTING, AND PATIENTS:

Longitudinal, observational study of patients in the Reduction of Atherothrombosis for Continued Health (REACH) registry who were divided into 3 cohorts: known prior MI (n = 14,043), known CAD without MI (n = 12,012), or those with CAD risk factors only (n = 18,653). Propensity score matching was used for the primary analyses. The last follow-up data collection was April 2009.

MAIN OUTCOME MEASURES:

The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke. The secondary outcome was the primary outcome plus hospitalization for atherothrombotic events or a revascularization procedure.

RESULTS:

Among the 44,708 patients, 21,860 were included in the propensity score-matched analysis. With a median follow-up of 44 months (interquartile range, 35-45 months), event rates were not significantly different in patients with β-blocker use compared with those without β-blocker use for any of the outcomes tested, even in the prior MI cohort (489 [16.93%] vs 532 [18.60%], respectively; hazard ratio [HR], 0.90 [95% CI, 0.79-1.03]; P = .14). In the CAD without MI cohort, the associated event rates were not significantly different in those with β-blocker use for the primary outcome (391 [12.94%]) vs without β-blocker use (405 [13.55%]) (HR, 0.92 [95% CI, 0.79-1.08]; P = .31), with higher rates for the secondary outcome (1101 [30.59%] vs 1002 [27.84%]; odds ratio [OR], 1.14 [95% CI, 1.03-1.27]; P = .01) and for the tertiary outcome of hospitalization (870 [24.17%] vs 773 [21.48%]; OR, 1.17 [95% CI, 1.04-1.30]; P = .01). In the cohort with CAD risk factors only, the event rates were higher for the primary outcome with β-blocker use (467 [14.22%]) vs without β-blocker use (403 [12.11%]) (HR, 1.18 [95% CI, 1.02-1.36]; P = .02), for the secondary outcome (870 [22.01%] vs 797 [20.17%]; OR, 1.12 [95% CI, 1.00-1.24]; P = .04) but not for the tertiary outcomes of MI (89 [2.82%] vs 68 [2.00%]; HR, 1.36 [95% CI, 0.97-1.90]; P = .08) and stroke (210 [6.55%] vs 168 [5.12%]; HR, 1.22 [95% CI, 0.99-1.52]; P = .06). However, in those with recent MI (≤1 year), β-blocker use was associated with a lower incidence of the secondary outcome (OR, 0.77 [95% CI, 0.64-0.92]).

CONCLUSION:

In this observational study of patients with either CAD risk factors only, known prior MI, or known CAD without MI, the use of β-blockers was not associated with a lower risk of composite cardiovascular events.

[41] Can ARBs help or augment ED treatment?

Can ARBs help or augment ED treatment?
#MP111212
[Chen, International Journal of Impotence Research, 12, losartan, cavernous local renin-angiotensin system, severe ED]
http://www.medscape.com/viewarticle/774868_1

International Journal of Impotence Research

Losartan Improves Erectile Dysfunction in Diabetic Patients

A Clinical Trial

Y Chen, S Cui, H Lin, Z Xu, W Zhu, L Shi, R Yang, R Wang, Y Dai

 Disclosures

Int J Impot Res. 2012;24(6):217-220.

Abstract

The activation of cavernous local renin-angiotensin system has an important role in pathogenesis of diabetic erectile dysfunction (ED). In our primary study, we found that angiotensin Type 1 receptor blocker improved the erectile function of diabetic rats. Therefore we explored the losartan in clinical treatment for diabetic patients suffering with ED. A total of 124 diabetic patients with ED were included in this study and treated with losartan or tadalafil or losartan plus tadalafil or watch for waiting as control for 12 weeks. Erectile function was assessed by International Index of Erectile Function (IIEF-5) questionnaire, the percentage of positive responses to sexual encounter profile questions 2 (SEP2), 3 (SEP3) and the global assessment question (GAQ). Losartan or tadalafil or losartan plus tadalafil significantly improved the mean IIEF-5 scores, the percentage of successful penetrations (SEP2), the successful intercourse completions (SEP3) and GAQ ( P<0.05). The combination of losartan and tadalafil is more effective than the single-use of losartan or tadalafil ( P<0.05). The patients with moderate and mild ED had better response rates to losartan than patients with severe ED. This is the first clinical trial in losartan therapy on diabetic patients suffering from ED. Losartan seems to be effective and well-tolerated in diabetic ED patients, especially for mild to moderate ones. The combination therapy of losartan and tadalafil appeared to be more effective than monotherapy.

[35] Intermediate risk papillary thyroid carcinoma and selective use of RAI

Selective use of RAI in PTC. #MP111212
[Nixon, Arch Otolaryngol Head Neck Surg, 2012, intermediate-risk PTC,
nodal metastases, DSS 100%]
http://archotol.jamanetwork.com/article.aspx?articleid=1392530

[10] Mortality risk in non-hypertensive renal disease

Mortality risk in non-hypertensive renal disease #MP111212
[Mahmood,Lancet,2012,Mortality,eGFR,hypertension]
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61272-0/abstract

[8] Femur strength vs bmd

Michael Laidlaw MD (@drlaidlaw) 11/17/12 1:47 PM #MP111212 Femur strength vs BMD/ethnicity for predicting fracture:[Ishii,JCEM,2012,strength indices,fracture,ethnicity] ncbi.nlm.nih.gov/pubmed/22865903

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[16] M2 metabolite for glargine.

Andy Lee (@drandylee) 11/22/12 10:16 AM Lantus kinetics [Bolli,DiabetesCare,12,glargine,M2,metabolic effect] #mp111212 m.care.diabetesjournals.org/content/35/12/…

#ddiabetes

#llantus

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[47] Are bisphosphonates associated with an increased risk of GI cancers?

Bisphosphonates not associated with increased risk of GI cancers #MP111212
[Vinogradova, BMJ, 2013, bisphosphonates, GI cancer, adjusted odds ratio]
http://www.ncbi.nlm.nih.gov/pubmed/23325866

BMJ. 2013 Jan 16;346:f114. doi: 10.1136/bmj.f114.
Exposure to bisphosphonates and risk of gastrointestinal cancers: series
of nested case-control studies with QResearch and CPRD data.
Vinogradova Y, Coupland C, Hippisley-Cox J.
Source
Division of Primary Care, University Park, Nottingham NG2 7RD, UK.
Abstract
OBJECTIVE:
To investigate the association between use of bisphosphonates estimated
from prescription information and risk of gastrointestinal cancers.
DESIGN:
Series of nested case-control studies.
SETTING:
General practices in the United Kingdom contributing to the QResearch
primary care database (660) and the Clinical Practice Research Datalink
(CPRD) (643).
PARTICIPANTS:
Patients aged ≥50 with a diagnosis of a primary gastrointestinal cancer
in 1997-2011, each matched with up to five controls by age, sex,
practice, and calendar year.
MAIN OUTCOME MEASURES:
Odds ratios for incident gastrointestinal cancers (colorectal,
oesophageal, gastric) and use of bisphosphonates, adjusted for smoking
status, ethnicity, comorbidities, and use of other drugs.
RESULTS:
20 106 and 19 035 cases of colorectal cancer cases, 5364 and 5135 cases
of oesophageal cancer cases, and 3155 and 3157 cases of gastric cancer
were identified from QResearch and CPRD, respectively. Overall
bisphosphonate use (at least one prescription) was not associated with
risk of colorectal, oesophageal, or gastric cancers in either database.
Adjusted odds ratios (95% confidence interval) for QResearch and CPRD
were 0.97 (0.79 to 1.18) and 1.18 (0.97 to 1.43) for oesophageal cancer;
1.12 (0.87 to 1.44) and 0.79 (0.62 to 1.01) for gastric cancer; and 1.03
(0.94 to 1.14) and 1.10 (1.00 to 1.22) for colorectal cancer. Additional
analyses showed no difference between types of bisphosphonate for risk
of oesophageal and colorectal cancers. For gastric cancer, alendronate
use was associated with an increased risk (1.47, 1.11 to 1.95; P=0.008),
but only in data from the QResearch database and without any association
with duration and with no definitive confirmation from sensitivity analysis.
CONCLUSIONS:
In this series of population based case-control studies in two large
primary care databases, exposure to bisphosphonates was not associated
with an increased risk of common gastrointestinal cancers.
PMID: 23325866 [PubMed - in process] PMCID: PMC3546625 Free PMC Article

[29] Comparing machine learning techniques for genomic selection

Effectiveness of ML techniques for genomic selection

[Ogutu, BMC Proceedings, 2011, random forests, gradient boosting, support vector machines]

http://www.biomedcentral.com/1753-6561/5/S3/S11

#MP111212

[37] How does metformin reduce cancers?

[Akin,Clin Endocrinology, 12,Metformin, Pigment epithelium derived factor, insulin resistance]

Clin Endocrinol (Oxf). 2012 Dec;77(6):852-6. doi: 10.1111/j.1365-2265.2012.04341.x.

#mp111212

Pigment epithelium-derived factor increases in type 2 diabetes after treatment with metformin.

Akın S, Aksoy DY, Cınar N, Aydın K, Karaağaoğlu E, Arıyürek M, Gülçelik NE, Usman A, Gürlek A.

Source

Section of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Hacettepe University.

Abstract

OBJECTIVE:

Pigment epithelium-derived factor (PEDF) has anti-angiogenic, immunomodulatory and anti-inflammatory properties. In addition to the significant role it plays in reducing diabetic complications, PEDF is now used in the treatment of certain cancers. It possibly plays a role in insulin resistance cases, too. However, whether metformin treatment has any significant effects on PEDF levels is not known. In this study, we investigated the regulation of PEDF in type 2 diabetes in relation to fat mass and insulin resistance before and after the use of metformin for treatment.

DESIGN:

Prospective cohort study.

SUBJECTS:

Thirty-six patients with newly diagnosed type 2 diabetes and 33 healthy individuals.

MEASUREMENTS:

Baseline weight, waist circumference (WC), fasting (FPG) and postprandial (PPPG) glucose, insulin, HbA1c, HOMA, PEDF and total/truncal fat mass were determined both in the diabetic and control subjects. Procedures were repeated in the diabetic group after a 6-month metformin treatment.

RESULTS:

Baseline FPG, PPPG, HbA1c, HOMA, weight, WC and truncal fat mass were higher in patients with diabetes whereas PEDF levels were found to be comparable with the controls. We completed the study with 31 of the 36 patients with diabetes we had selected for the study. We observed a decrease in the weight, WC, FPG, PPPG, HOMA, total and truncal fat mass of the patients while there was a significant rise in the PEDF levels (P = 0·002) after the metformin treatment. On the other hand, no significant correlation was observed between the change in PEDF levels and the clinical and laboratory findings.

CONCLUSION:

Our study is the first to identify a metformin-related increase in PEDF levels in diabetes. The increase observed in PEDF levels after the metformin treatment does not seem to be related to the changes in insulin resistance, fat mass or glycemic control. Hence, our results suggest that further investigation is necessary to determine the direct effects of metformin on PEDF gene and protein expression in vitro.

[50] New Beta-Cell Paradigm?

mp111212 [Dor,NEJM,13,beta-cell dedifferentiation, Foxo1,alpha-cell mass]

http://www.nejm.org/doi/full/10.1056/NEJMcibr1214034

[43] Impact of food insecurity on Diabetes self management

Impact of food insecurity on Diabetes self management

#MP111212
[Lyles, Diabetes Care, 12, food insecurity, diabetes self management, 0.38%]
http://www.ncbi.nlm.nih.gov/pubmed/23275354

Diabetes Care. 2012 Dec 28. [Epub ahead of print]

Food Insecurity in Relation to Changes in Hemoglobin A1C, Self-Efficacy, and Fruit/Vegetable Intake During a Diabetes Educational Intervention.

Lyles CR, Wolf MS, Schillinger D, Davis TC, Dewalt D, Dahlke AR, Curtis L, Seligman HK.

Source

University of California San Francisco Center for Vulnerable Populations, Division of General Internal Medicine at San Francisco General Hospital, San Francisco, California.

Abstract

OBJECTIVE Food insecurity is hypothesized to make diabetes self-management more difficult. We conducted a longitudinal assessment of food insecurity with several diabetes self-care measures.RESEARCH DESIGN AND METHODSWe conducted a secondary, observational analysis of 665 low-income patients with diabetes, all of whom received self-management support as part of a larger diabetes educational intervention. We analyzed baseline food insecurity (measured by the U.S. Department of Agriculture Food Security module) in relation to changes in hemoglobin A1C (HbA(1c)) as well as self-reported diabetes self-efficacy and daily fruit and vegetable intake. We examined longitudinal differences using generalized estimating equation linear regression models, controlling for time, age, sex, race, income, and intervention arm.RESULTSOverall, 57% of the sample had an income <$15,000. Participants who were food insecure (33%) were younger, had less income, and were more likely to be unemployed compared with participants who were food secure. At baseline, those who were food insecure had higher mean HbA(1c) values (8.4% vs. 8.0%) and lower self-efficacy and fruit and vegetable intake than those who were food secure (all P < 0.05). Compared with food-secure individuals, participants who were food insecure had significantly greater improvements in HbA(1c) over time (0.38% decrease compared with 0.01% decrease; P value for interaction <0.05) as well as in self-efficacy (P value for interaction <0.01). There was no significant difference in HbA(1c) by food security status at follow-up.CONCLUSIONSParticipants experiencing food insecurity had poorer diabetes-related measures at baseline but made significant improvements in HbA(1c) and self-efficacy. Low-income patients who were food insecure may be particularly receptive to diabetes self-management support, even if interventions are not explicitly structured to address finances or food security challenges.

[22] Should obesity be considered a brain disorder?

Should obesity be considered a brain disorder? #MP111212
[Volkow, AM J Psychiatry, 2007, obesity, addiction, hypothalamus]
http://ajp.psychiatryonline.org/article.aspx?articleID=98310

[27] debunked the weight independent effect of RYGB?

jci.org/articles/view/64895#.UME2jdJg-AU.twitter … #jci

#MP111212[bradley, JCI, 2012, RYGB, Insulin secretion rate, weight loss–independent effects]

[5] Drug eluding stents

Andy Lee (@drandylee) 11/15/12 8:11 PM nej.md/SZggfc [Farkouh,NEJM,12,multivessel CAD,drug-eluding stents, Strokes] are new stents better than CABG? #MP111212

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