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Can Silicon Valley Cure Diabetes With Low Carbs And High Tech?

Can Silicon Valley Cure Diabetes With Low Carbs And High Tech?

Can Silicon Valley Cure Diabetes With Low Carbs And High Tech?

Imagine a treatment for Type 2 diabetes that requires neither surgery, medication nor calorie restriction, but rather relies on adherence to a low-carbohydrate, high-fat diet, tracked by regular finger-stick checks of blood chemistry and guided remotely by a team of physicians, coaches and algorithms.
That’s the premise of Virta Health, a San Francisco-based digital health company formed in 2014 and launched officially today, with $37M in the bank from investors including Dr. Robert Kocher of Venrock. The kickoff follows Tuesday’s publication of the results of an uncontrolled clinical study of several hundred patients in Indiana, who will be treated and followed for two years; the just-published data--an interim report of sorts--represent the first 10 weeks of study, sponsored by Virta.
(Disclosure: I am Chief Medical Officer of a genomics data management company, DNAnexus, and do not have a personal, professional or financial relationship with Virta Health; I trained in endocrinology and have previously written about therapeutic approaches to diabetes, including surgery and prevention.)
The number of patients with A1c levels below 6.5% (a measure of diabetic control) increased from 52/262 when the study began to 147/262 after 10 weeks. The majority of patients had one or more diabetes medications reduced or eliminated by the end of the study, and the average patient lost 7.2% of his or her starting weight. 90% of patients who started the study remained enrolled after 10 weeks. Finally, the average beta-hydroxybutyrate level (a measure of degree of dietary carbohydrate Continue reading

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Low-Carb Diet vs. Bariatric Surgery for People With Diabetes

Low-Carb Diet vs. Bariatric Surgery for People With Diabetes

A September 2016 commentary in The New York Times called for a trial of low-carb diets before committing to bariatric surgery. This has an immediate, superficial appeal to those of us committed to lifestyle as medicine. Here’s to remedies in the kitchen, rather than the operating room! Unfortunately, however, this commentary is misleading. There is no basis for a selective argument for low-carb diets; they are just about as apt to work in the short term, and fail over time, as any other.
While there is quality coverage of diet and health out there, there is much that perpetuates misconceptions and fallacies; it would be impossible to tackle them all here. But this particular New York Times piece is worth exploration and clarification, particularly because of the larger, important conversation it prompts.
Garth Davis, MD, is a True Health Initiative Council member and is uniquely qualified to reveal how the authors of this article misrepresented the role of surgery for weight loss, which is quite effective when applied judiciously. He practices medical and surgical weight loss in Houston, where he is medical director of weight loss surgery at Memorial City Hospital. He is also the author of the books Proteinaholic: Why Our Obsession With Meat Is Killing Us, and An Expert's Guide to Weight Loss Surgery.
Dr. Davis looks from altitude and provides a reality check about the dietary patterns most reliably and consistently linked to lasting control of weight and lifelong promotion of health.
A Weight Loss Surgeon’s Perspective: Garth Davis, MD
As a weight loss surgeon and spec Continue reading

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited.
We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications.
Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P=0.01, adjusted P=0.03, P=0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P=0.03, adjusted P=0.07, P=0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P=0.003). At 5 years, changes from baseline observed in Continue reading

Psoriasis severity may influence type 2 diabetes risk

Psoriasis severity may influence type 2 diabetes risk

People living with psoriasis are not only at higher risk of type 2 diabetes, but their risk also rises in line with the skin disease's severity, according to recent research from the University of Pennsylvania Perelman School of Medicine in Philadelphia.
The team — led by Joel M. Gelfand, a professor of dermatology and epidemiology — reports the findings in a paper that was published recently in the Journal of the American Academy of Dermatology.
"We know psoriasis is linked to higher rates of diabetes," Prof. Gelfand explains, "but this is the first study to specifically examine how the severity of the disease affects a patient's risk."
He and his team suggest that the findings support the idea that there is a biological connection between psoriasis and type 2 diabetes.
Psoriasis and diabetes
Psoriasis is a serious medical condition that affects around 7.5 million people in the United States. It develops from a fault in the immune system that disrupts the normal biology of the skin and joints.
About 80–90 percent of people with psoriasis have plaque psoriasis, an inflammatory condition in which the immune system sends faulty signals that make skin cells grow too fast.
As the cells reach the surface of the skin and die, they form lesions that appear as thick red patches covered with silvery scales. The patches typically develop on the elbows, palms, face, scalp, lower back, knees, and soles of the feet, but they can also affect the mouth, nails, genitals, and other places.
Around 40 percent of people with psoriasis have psoriatic arthritis, which is a form of the dise Continue reading

Why Aren’t There More People of Color at Diabetes Conferences?

Why Aren’t There More People of Color at Diabetes Conferences?

Opinion
I grew up in a small town in Northeast Georgia with a fairly large African American population, but a lot of the things I was interested in wasn’t popular with most of the black kids in my community. As a kid, I was usually the only black kid into something, whether it was band, 4H, or chorus.
I was diagnosed with Type 1 diabetes around 1989 when I was 25 years old. I had all the typical symptoms but didn’t think much of it, since I knew nothing about diabetes. Eventually, my roommate set me up with an appointment with the urologist (you read that right) who diagnosed me.
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Back in my day, there was no Meetup or Myspace, and definitely no Facebook, so meeting others who lived with diabetes was pretty much a crapshoot. When I found a group, it turned out to be made up mostly of seniors; as a 25-year-old guy, that was not my idea of a party.
It would be many years before I found groups and organizations that helped people with diabetes connect and support each other. I basically had to wait until I had internet access to find these groups.
By the time I transitioned all my friends from Myspace to Facebook, I had my first insulin pump. I also had my first experience with diabetic retinopathy in one eye. By the time my other eye became damaged, I had begun taking my diabetes more seriously than I had in years past. I tried to learn more about how I could save my vision and my overall health.
Facebook helped me connect with several advocates, and others with diabetes. Through those connections I was able to learn more about the effects of diabetes, not just on Continue reading

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