Wednesday, November 14, 2012

World Diabetes Day

Today is World Diabetes Diabetes. Somebody would probably like it if you wore blue (I am wearing blue myself, but it's a coincidence- I wore blue yesterday and the day before too). World Diabetes Day was established in 1991 by the International Diabetes Federation. To "raise awareness and advocacy." This year's theme is prevention and education.
As you all know, I believe that type 1 diabetes probably can be avoided in some way or another (because it isn't wholly genetic), and that that way has not yet been discovered.
Right now, if you are newly diagnosed with type 1 diabetes, 12 or older, never been in DKA, antibody positive, your best shot at being nondiabetic is probably an autologous bone marrow transplant. This will have many possible side effects, including death (more probably including infertility), and it is not at all guaranteed to work. I think this is a reasonable option.

But haha, let's go back to things the IDF says. Here is what they say in their position paper on bariatric surgery and type 2 diabetes.
-15% of type 2 diabetics of European descent are not overweight (in the United States, for comparison purposes, 40% of all adults are not overweight).
- Type 2 diabetes risk goes up with increasing BMI such that it is a larger risk at greater degrees of obesity, and in the most obese groups of women, the risk is increased 93 fold (this seems hard to believe because I thought the risk was already more than 1%)
-people rarely sustain large weight losses through lifestyle alone (my grandfather did)
- Type 2 diabetics whose blood sugar control does not improve despite taking more and more medications are at higher risk of death both compared to those whose blood sugar does improve on medications and compared to those on fewer medications with the same blood sugars.
- After bariatric surgery in obese type 2 diabetics, 62-72% are in remission two years later. Remission from diabetes means using no medications but having an A1c below 6%, having normal fasting blood sugar, and keeping that up for a year. Notably, without surgery, the remission rate two years after a diagnosis of type 2 diabetes can be over 25%.
-36% were still in remission ten years after bariatric surgery. To break that down, 1/3 don't have a remission lasting even two years, 1/3 have a remission lasting 2 to 10 years, and 1/3 have a remission lasting more than 10 years.
-Most diabetes groups recommend bariatric surgery for diabetics with a BMI of 40 or greater, as well as for those whose BMI is 35-40 with some other disease where weight loss matters (such as arthritis).The different organizations had different opions about whether or not bariatric surgery was appropriate for people with BMIs below 35.
- This is recommended for type 2 diabetics as young as 15 years old.
-Although the IDF says risk for bariatric surgery are as low as those for elective cholecystectomy, I can tell you complication rates for cholecystectomy (and I had complications after elective chole) are lower than what they report for four different bariatric surgeries- they report one year complication rates of f 4.6%, 10.8%, 14.9% and 25.7%.
-A number of these surgeries can create a high risk of vitamin deficiency (a book I once read by a neurologist described a patient he saw in the hospital who was dying of unrecognized vitamin deficiencies following bariatric surgery).
-The IDF recommends bariatric surgery as a treatment for type 2 diabetes when BMI is greater than 35 and A1c greater than 7% despite metformin and weight loss efforts, and when BMI is greater than 40 no matter the A1c.
-The IDF's position is that only 2% of the number of bariatric surgeries that should be performed, are.

Personally, I'd like to raise a little awareness of the fact that being obese does not by any means prevent a person from having autoimmune diabetes only responsive to insulin. I wouldn't go so far as to say that being overweight can cause autoimmune diabetes as a fact, because studies on the topic have had mixed results. But at least a few studies have shown higher antibody rates (among nondiabetics) in obese kids, and a higher rate of obesity among type 1 diabetics (despite the fact that our median weight is very slightly below average). You are not going to get medication free diabetes control if your diabetes is autoimmune.

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