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Should We Be Treating Type 2 Diabetes With Bariatric Surgery?

Should We Be Treating Type 2 Diabetes With Bariatric Surgery?

Should We Be Treating Type 2 Diabetes With Bariatric Surgery?

I'm resurrecting and tweaking this piece, for the third time now, consequent to the publication in the New England Journal of Medicine of the 12 year data that continues to strongly support the use of bariatric surgery to treat type 2 diabetes.
In case you missed the news, a recent study published in the New England Journal of Medicine demonstrated dramatic benefits of bariatric surgery in the treatment of type 2 diabetes.
Now I'm not going to get into the study here in great detail, but it followed 1,156 patients from for 12 years and divided them into 3 groups. Those who sought and chose not to have bariatric surgery. Those who sought and had bariatric surgery. And those who did not seek nor have bariatric surgery. Researchers examined all of them at baseline, 2 years, 6 years, and 12 years in terms of whether they had type 2 diabetes, hypertension, or hyperlipidemia.
The results were striking.
With a follow up rate of 90% at 10 years researchers demonstrated that not only were patients 12 years post bariatric surgery maintaining an average loss of 77lbs/26.9% (the non-surgical groups at 12 years lost an average of nothing), but that amoung those patients who had diabetes pre-surgically, 12 years later, 51% were in remission. And for those who are curious about such things as odds ratios, the odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus the non-surgery group.
(and though they weren't quite as striking, the surgery group at 12 years also had markedly higher remission rates and lower incidences of b Continue reading

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Diabetes Snacks: Best for Office

Diabetes Snacks: Best for Office


8 Delicious Diabetes-Friendly Office Snacks
Medically reviewed by Peggy Pletcher, MS, RD, LD, CDE on March 14, 2017 Written by Lori Zanini, RD, CDE
Almonds, pistachios, popcorn your office desk drawer is probably already an arsenal of lower-carb snack foods. With diabetes, these healthy snacks are crucial to combat hunger and control your blood sugar.
If youre bored of the same old snacks, on the other hand, it might be time to mix it up. Snack and meal planning help is the number one request that I receive from clients. Below are eight great ideas to step up your snack game with fresh foods that are satisfying and delicious.
Your guide to diabetes-friendly snacking at work
Remember, planning ahead is especially helpful for the workplace. Its so easy to become engulfed in meetings, projects, and deadlines that we can suddenly go from a little hungry to ravenous. Having diabetes-friendly snacks on hand will give you a go-to when your co-worker brings in those dreaded morning donuts, afternoon pastries, or the always-present candy bowl.
When it comes to choosing your snacks, think about when, how, and what you will be eating.
Ideally, you will be hungry for snacks about two to three hours after your main meals. If you are hungry less than two hours after a meal, this might be a reason to evaluate if you are eating balanced meals. Foods high in carbohydrates and low in protein and fat tend to digest more quickly, raise our blood glucose levels, and leave us wanting more too soon.
Being mindful of what you eat, really thinking about what and why you are eating, make Continue reading

28 Experts Answer Questions About Diabetes T2 & Prediabetes

28 Experts Answer Questions About Diabetes T2 & Prediabetes


A1: Diabetes is not on the decline, but rather type 2 diabetes is on the increase. The increase in T2DM correlates with our populations increase in obesity. Now, more than 2/3 of Americans are overweight or obese, and while the rate of rise may have plateaued a bit, incidence of T2DM has not. In addition, T2DM increases with age. As we are living longer, we are likely to see more diabetes.
A2: I think the biggest diet mistake patients make is thinking by refraining from eating sugar, their diabetes will get better.
While eating sugar or sugary products isnt great, the most important factor is weight loss. While there is varying evidence on different types of diets, in general, a calorie is a calorie. For example, a patient might eat a few pieces of candy a day, and think that if she stops this, it will improve her diabetes.
In fact, it is unlikely that refraining from a few pieces of candy a day will promote enough weight loss to improve diabetes. Patients need to know that they should both eat healthy, and decrease portions . You can have an extremely healthy diet, but if your calorie content is too high because of portion sizes, then you are unlikely to lose weight and improve diabetes.
I think one of the biggest management mistakes made is use of finger stick glucose monitors. The public seems to generally know about diabetics checking their sugar, and because insurance usually covers glucose monitors, they are often highly promoted by the industry. However, if you are Type 2 diabetic and are not taking insulin or a sulfonylurea, then there is no need to check your Continue reading

The Juicy Bits of the CBO Report for People with Diabetes

The Juicy Bits of the CBO Report for People with Diabetes

We’ve highlighted three passages from the report, which appraises the Senate bill that would repeal and replace the Affordable Care Act.
Today, you are probably seeing a slew of headlines that include the words “CBO score”. That’s because the Congressional Budget Office (CBO) released its report on the impact of the Senate bill to repeal and replace the Affordable Care Act. The bill in question, known as the Better Care Reconciliation Act of 2017, is the Senate’s version of the Affordable Health Care Act, which the House of Representatives passed in May. The Senate has been expected to vote on its health care bill this week.
Read more: What the CBO Grade of the AHCA means for people with diabetes.
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After a CBO score is released, it becomes the prize in a tug of war of spin between politicians for and against the bill being graded. We thought it might be helpful to focus on what the CBO report actually says, and so we’ve pulled out three passages that might be particularly important to people with diabetes.
Passage #1 – “CBO and JCT* estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increa Continue reading

Bowls Full of Diabetes-Compatible Goodness

Bowls Full of Diabetes-Compatible Goodness

As I sit here writing to you there is, simmering on the stove, a huge French country pot roast. My local “stupidmarket” had a sale on the one of the cuts of meat that I like for slow cooking.
It is cool and I crave something hearty and with a stick to your ribs goodness. Yesterday I made a big pot of my favorite (which child do I love most?) soup for dinner tonight and three buckets full for the freezer.
For many of you, cooking is a chore. Something you have to do. Many of you have realized that the best way to control the carbohydrates in your meals is by preparing them yourselves. But all that work. All that chopping. Who wants to do that? Other than me, I mean.
For those of you that don’t really enjoy cooking as much as I do, I want to share with you that it takes no more work to make a big pot roast, stew, pot pie filling, or batch of soup than it does to make it for one or two servings. Cooking these kinds of foods in advance and in big batches has the benefit of you having it ready to re-heat when you need it.
Another thing is that letting this foods sit overnight in your fridge enhances their flavor. Want a scientific explanation? I am not sure that I have one. There are a few theories about this. One is (and it is the one I favor) that the flavors have a chance to meld into one another. The tomato gives some of its flavor to the stock and vice versa. Another theory is that reheating reduces the liquid a bit more and concentrates the flavors. Both make sense, but who cares? It works and makes life a lot easier.
Soup is one of my favorite foods. Unless you are Continue reading

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