Endo Blog

Bariatic Surgery

St. Luke's Regional Medical Center has recently been touting in the local media it's Bariatric Center. Using radio buys with anecdotes about the success of bariatric surgery (the early ad run was extremely hyperbolic and actually contained the word "cure").

While there is little doubt that many patients benefit, Dr. Alan Garber offers a counter-point argument:

The unproven issue with bariatric surgery is the durability of the antidiabetic effect. Since we know that there is a progressive loss of beta cell function after the diagnosis of diabetes, could the disease re-emerge after time when further loss of beta cell function led to the re-appearance of hyperglycemia? This happens with almost all current medications for diabetes and there is no reason to suppose that surgery is any different.

A long-term durability trial similar to ADOPT is required to differentiate surgery from medications in this regard. The surgeons omit an additional possibility to explain the almost immediate effect of surgery on glucose control. Almost all hyperglycemic, recently diagnosed diabetic patients have reversible glucose toxicity at the level of the beta cell. Thus, acutely lowering food intake reduces prandial glucose excursions and improves endogenous insulin secretion by overcoming this glucose toxicity. This effect of surgery is no different than starvation, which will effectively treat most forms of diabetes, at least in the near term.

What is frequently seen in this office is an amelioration of dysglycemia but the development of vitamin and mineral disorders.  Secondary hyperparathyroidism, iron deficiency, and zinc deficiency are not uncommon.  If you decide to have this surgery, please remember the following:

• It is possible to eat around the surgery.  Several patients failed to apply modification of their lifestyle, decreasing food intake and increasing carbohydrate intake, and gained all of their weight back with a return of their diabetes.
• You will still need endocrine and metabolic follow-up. Failure to recognize and treat the post-operative co-morbidities described above can seriously effect your health in the end.

Contaminated baby food story just gets worse

Yahoo News reports:

Probe finds 20 percent of China milk companies in scandal

By Ben Blanchard

SHIJIAZHUANG, China (Reuters) - Twenty percent of Chinese dairy firms probed in the wake of a baby milk health scare have been found to have produced melamine-tainted formula, state media reported on Tuesday.

Chinese quality officials last week ordered a nationwide probe into all baby milk powders after it was reported that dozens of children had developed kidney stones after drinking tainted formula produced by the Sanlu Group.

Two infants have since died and more than 1,200 diagnosed with kidney illness in a growing scandal that authorities have warned may be yet to peak.

The head of the state-owned company has been sacked.

The results of the government-led probe announced on Tuesday showed that Sanlu Group, which has been the focus of public anger over the scandal, is by far from the only offending company.

The rest of the story is here.

Update on Chinese goods......

More bad new from China expounding on my previous story.

China warns of 'possibly rising' toll from tainted baby formula

The Associated Press

Tuesday, September 16, 2008

BEIJING: The Chinese Health Ministry warned Tuesday of a possible rise in the number of babies affected by the contaminated milk powder that has already been linked to the deaths of two infants and to health problems in more than 1,200 others.

The official Xinhua news agency quoted the ministry as saying Tuesday that medical agencies were prepared for a "possibly rising" number of cases and that the country was setting up a "multilevel treatment system" for infants who drank the contaminated milk product.

The company at the heart of the widening scandal, Sanlu Group, apologized Monday for the tainted milk powder, which the Health Ministry said had been spiked with the industrial chemical melamine.

Sanlu said that the suppliers of the raw milk used in the product were responsible for adding the chemical, which is typically used in plastics, to make the milk appear to have a higher protein content.

Zhang Zhenling, vice president of Sanlu, apologized Monday but did not explain why the company took so long to inform the public about the contamination. The company allegedly received complaints about the product as early as March and confirmed the presence of melamine in the milk product during tests conducted in early August.

Sanlu went public with the information after Fonterra, a New Zealand company that owns a 43 percent share in the company, told the New Zealand government about the contaminated product. New Zealand officials then informed the Chinese government.

"The serious safety accident of the Sanlu formula milk powder for infants has caused severe harm to many sickened babies and their families," Zhang said. "We feel really sad about this."

Dog food and heparin as well.  Caveat emptor as they say.

See you at ten......

see you then.

This news from Los Angeles:

Former Los Angeles television news anchor George Putnam, whose booming, iconic voice famously inspired the character of Ted Baxter on the classic sitcom "The Mary Tyler Moore Show," died in his sleep Friday at a Chino hospital where he was being treated for liver and kidney ailments. He was 94.

Born in Minnesota, Putnam first worked in radio in Minneapolis before coming to Los Angeles in 1951 and moving to television. He served as news anchor at a number of Los Angeles TV stations for a quarter of a century, working from the early 1950s until 1975 at KTTV 11, KCOP 13, KTLA 5 and KHJ (now KCAL 9).

"The thing I remember most is that George had this personal contact with the viewers at home - they really would listen to him," recalls Stan Chambers, who was news director at KTLA during Putnam's tenure there and still works as a reporter for the station today.

I was a huge listener to Putnam in my younger days when I lived in Los Angeles.  Makes me wonder what happened to Vin Scully, the other big media voice of my time.  Here's the answer. Alive and well as they say.

Don't text and drive

Now this is horrifying.

LOS ANGELES - Federal officials investigating a commuter rail collision that killed 25 people said they want to review cell phone records to determine if an engineer blamed for running a stop signal before the crash may have been text messaging at the time.

25 killed because the driver of a train was not paying attention.  I'm to the point where my soon to be 15 year old daughter will be driving and she is an inveterate texter.  Looks like texting is the next drinking.

Uh, oh.........

China Suspects Bad Milk Powder Sickened Babies

By Loretta Chao

BEIJING -- Chinese health officials said contaminated baby formula could be responsible for an unusual spate of kidney-stone cases that are afflicting dozens of infants across China, rekindling concern about safety problems with the country's products.

And some of the patients wonder why I'm a stickler for drugs made in the States.

9/11 Remembrance

Lest we forget........

Good News for T2DM

This is good news:

Published at www.nejm.org September 10, 2008 (10.1056/NEJMoa0806470)

10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

Rury R. Holman, F.R.C.P., Sanjoy K. Paul, Ph.D., M. Angelyn Bethel, M.D., David R. Matthews, F.R.C.P., and H. Andrew W. Neil, F.R.C.P.

Abstract PDF Supplementary Material Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes. 

Methods Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories. 

Results Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea–insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). 

Conclusions Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number, ISRCTN75451837

Once again, it has been shown that early tight control of diabetes makes a difference.  What is interesting about this study is that macrovascular complications of the disease are now shown to be positively affected by treatment.