Mean Weight Reduction Research Articles

Early growth patterns in children with autism.

Case-control studies have found increased head growth during the first year of life in children with autism spectrum disorder. Length and weight have not been as extensively studied, and there are few studies of population-based samples. The study was conducted in a sample of 106,082 children from the population-based Norwegian Mother and Child Cohort. The children were born in 1999-2009; by the end of follow-up on 31 December 2012, the age range was 3.6 through 13.1 years (mean 7.4 years). Measures were obtained prospectively until age 12 months for head circumference and 36 months for length and weight. We compared growth trajectories in autism spectrum disorder cases and noncases using Reed first-order models. Subjects included 376 children (310 boys and 66 girls) with specialist-confirmed autism spectrum disorder. In boys with autism spectrum disorder, mean head growth was similar to that of other boys, but variability was greater, and 8.7% had macrocephaly (head circumference > 97th cohort percentile) by 12 months of age. Autism spectrum disorder boys also had slightly increased body growth, with mean length 1.1 cm above and mean weight 300 g above the cohort mean for boys at age 12 months. Throughout the first year, the head circumference of girls with autism spectrum disorder was reduced-by 0.3 cm at birth and 0.5 cm at 12 months. Their mean length was similar to that of other girls, but their mean weight was 150-350 g below at all ages from birth to 3 years. The reductions in mean head circumference and weight in girls with autism spectrum disorder appear to be driven by those with intellectual disability, genetic disorders, and epilepsy. Growth trajectories in children with autism spectrum disorder diverge from those of other children and the differences are sex specific. Previous findings of increased mean head growth were not replicated.

Pulmonary function and blood gases after gastric bypass and lifestyle intervention: a comparative study.

Impaired lung function associated with obesity improves with weight loss. This is the first study to compare the effects of obesity surgery and intensive lifestyle intervention on pulmonary function and arterial blood gases. Arterial oxygenation and pulmonary function improved to a greater extent after gastric bypass than after lifestyle intervention. The superiority of surgical treatment might be mediated by greater weight loss after gastric bypass. Impaired lung function associated with obesity improves with weight loss. The effects of obesity surgery and intensive lifestyle intervention on pulmonary function and arterial blood gases have not previously been subjected to comparative examination. In this 1-year non-randomized controlled clinical trial (ClinicalTrials.gov identifier NCT00273104), 139 morbidly obese subjects (19-66 years, mean [standard deviation] body mass index [BMI] 45.1 kg m(-2) [5.6], 107 women) were treated with either Roux-en-Y gastric bypass surgery (n = 76) or intensive lifestyle intervention (n = 63). Mean weight reduction was 30 (8)% and 8 (9)%, respectively. Dynamic and static lung volumes, gas diffusing capacity and arterial blood gases were measured. Compared with lifestyle intervention, surgery resulted in a significantly greater increase in forced vital capacity (mean [95% confidence interval] between-group difference, 7 [4-10]%), forced expiratory volume in 1 s (7 [5-9]%), total lung capacity (5 [1-8]%), vital capacity (7 [4-9]%), functional residual capacity (18 [12-24]%), expiratory reserve volume (48 [30-66]%) and partial pressure of oxygen in arterial blood (0.5 [0.0-1.0] kPa). These associations either disappeared or diminished after adjusting for weight loss. Reduced central adiposity (waist circumference and waist-to-hip ratio) and systemic inflammation (C-reactive protein and adiponectin) had no effect on pulmonary function beyond the effect of reduced general adiposity (BMI). In morbidly obese subjects, gastric bypass surgery is more effective than lifestyle intervention at improving arterial oxygenation and pulmonary function. The effect might be mediated by greater weight loss after surgical treatment.

Intrauterine hypervitaminosis A and lung maturation in newborn rats

Time mated adult rats were administered 100,000 IU of vitamin A daily for a period of 5 days in the 1st and 3rd trimester of the pregnancy (Days 2-6, and Days 16-20 in Group A and B respectively). The pregnant rats were allowed to litter after 21 days, and the newborn pups were collected and the lungs harvested and processed. A significantly reduced mean weight of the pup from groups A and B was observed compared to Group C which was not administered Vitamin A during pregnancy. The reduction was however more striking in the group A pups compared to the group B pups, though the weight of group B pups were significantly lower than that of the control group. In addition to the significant weight reduction, the groups A and B pups had extensive desquamation of the respiratory epithelium in the bronchiole, bronchi and alveoli. There was also associated poor delineation of the alveoli in the experimental groups. However, the cilia of the desquamated epithelium remain intact. The anomalies were worse in the group A pups than in the group B pups. The respiratory epithelial defect associated with hypervitaminosis A might explain the degree of still birth particularly in the Group A pups. The features of the anomaly are closely related to respiratory distress syndrome which is known to occur in state of low vitamin A during development. This shows that hypo and hypervitaminosis during respiratory development results in features that are similar, the only exception being the state of epithelial ciliation. Keywords : Alveolus, bronchiole, respiratory epithelium, vitamin A, atelectasis.

Adjustable Gastric Banding for Morbid Obesity; A Report from Iran

Background: Laparoscopic adjustable gastric banding (LAGB) was considered as one of the effective, less invasive methods which could help the obese patients to achieve their optimal weight without regaining the lost one. The recent article is a report of 165 patients who had undergone LAGB, while discussing the rate of their complications. Methods: Between January 2005 and February 2012, 165 obese patients had undergone LAGB in a single private surgical setting in Tehran, Iran. Patients with body mass indices (BMI) between 32 and 50 kg/m 2 were candidates for the LAGB operation. The subsequent complications were recorded during the patient's follow-up periods. Results: The patients' mean initial BMI was 37±0.3 kg/m 2 which became 29.4±0.3 kg/m 2 after LAGB. The mean weight reduction was 21.4±0.9 kg during the 16.9±0.9 months follow-up period. Morbidity rate requiring reoperation was 9% (slippage, erosion and phrenic nerve irritation. Thirty-nine patients experienced complications, including 21 slippages, 11 port infections, six erosions and one phrenic irritation. Conclusions: Despite the complications being reported, LAGB is still a safe method with an acceptable efficacy in losing weight. To our knowledge, the important factor to obtain the appropriate response is selecting cases precisely. The complications could be managed by surgeons who are experienced in upper-gastrointestinal laparoscopic surgery. Other- wise patients need to be operated through laparotomy or referred to the bariatric surgeons.

Myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes

OBJECTIVETo check the hypothesis that myo-inositol supplementation may reduce gestational diabetes mellitus (GDM) onset in pregnant women with a family history of type 2 diabetes.RESEARCH DESIGN AND METHODSA 2-year, prospective, randomized, open-label, placebo-controlled study was carried out in pregnant outpatients with a parent with type 2 diabetes who were treated from the end of the first trimester with 2 g myo-inositol plus 200 µg folic acid twice a day (n = 110) and in the placebo group (n = 110), who were only treated with 200 µg folic acid twice a day. The main outcome measure was the incidence of GDM in both groups. Secondary outcome measures were as follows: the incidence of fetal macrosomia (>4,000 g), gestational hypertension, preterm delivery, caesarean section, shoulder dystocia, neonatal hypoglycemia, and neonatal distress respiratory syndrome. GDM diagnosis was performed according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations.RESULTSIncidence of GDM was significantly reduced in the myo-inositol group compared with the placebo group: 6 vs. 15.3%, respectively (P = 0.04). In the myo-inositol group, a reduction of GDM risk occurrence was highlighted (odds ratio 0.35). A statistically significant reduction of fetal macrosomia in the myo-inositol group was also highlighted together with a significant reduction in mean fetal weight at delivery. In the other secondary outcome measures, there were no differences between groups.CONCLUSIONS myo-Inositol supplementation in pregnant women with a family history of type 2 diabetes may reduce GDM incidence and the delivery of macrosomia fetuses.

Psychoeducative groups help control type 2 diabetes in a primary care setting.

The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c), the body mass index (BMI) and cardiovascular risk factors (CVRF) compared with conventional educational measures provided individually. A quasi-experimental study (pre/post-intervention) with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m2).The beneficial effect of psychoeducational group therapy in the study group (PGT) was compared with conventional diabetes education in the control group (CG). The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003), met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005) and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002) than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05). PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care.

Evolution of Exenatide as a Diabetes Therapeutic

Type 2 diabetes (T2DM) is a disease of epidemic proportion associated with significant morbidity and excess mortality. Optimal glucose control reduces the risk of microvascular and possibly macrovascular complications due to diabetes. However, glycemic control is rarely optimal and several therapeutic interventions for the treatment of diabetes cause hypoglycemia and weight gain; some may exacerbate cardiovascular risk. Exenatide (synthetic exendin-4) is a glucagon-like peptide-1 receptor (GLP-1R) agonist developed as a first-in-class diabetes therapy. This review presents an overview of the evolution of exenatide as a T2DM treatment, beginning with the seminal preclinical discoveries and continuing through to clinical pharmacology investigations and phase 3 clinical trials. In patients with T2DM, exenatide enhanced glucose-dependent insulin secretion, suppressed inappropriately elevated glucagon secretion, slowed gastric emptying, and enhanced satiety. In controlled phase 3 clinical trials ranging from 12 to 52 weeks, 10-mcg exenatide twice daily (ExBID) reduced mean HbA1c by -0.8% to -1.7% as monotherapy or in combination with metformin (MET), sulfonylureas (SFU), and/or thiazolidinediones (TZD); with mean weight losses of -1.2 kg to -8.0 kg. In controlled phase 3 trials ranging from 24 to 30 weeks, a 2-mg once-weekly exenatide formulation (ExQW) reduced mean HbA1c by -1.3% to -1.9%, with mean weight reductions of -2.3 to -3.7 kg. Exenatide was generally well-tolerated. The most common side effects were gastrointestinal in nature, mild, and transient. Nausea was the most prevalent adverse event. The incidence of hypoglycemia was generally low. By building upon early observations exenatide was successfully developed into an effective diabetes therapy.

Difference in weight loss based on ethnicity, age and comorbidity status in a publicly funded adult weight management centre: 1-year results.

Limited evidence is available on the effectiveness of publicly funded weight loss (WL) clinics. We examined the 1-year WL outcomes and investigated predictors of WL and discontinuation of 1566 overweight and obese adults, who attended the Wharton Medical Clinic (WMC) weight management centre for at least 6 months. Overall, 42.7% (n = 669) of the entire sample achieved a ≥5%WL over the entire follow-up period from July 2008 to February 2012. On average, patients lost 5.6 ± 7.2 kg (5.0 ± 6.3%) of initial body weight (BW), while a subsample of patients attending the clinic for at least 1 year had a mean weight reduction of 6.6 ± 7.9 kg (5.9 ± 7.2%) of BW. Older patients were more likely to achieve a greater WL in comparison with young patients while White patients and those without type 2 diabetes (T2D) lost almost twice as much weight and %BW in comparison with Asian patients and patients with T2D, respectively (P < 0.05). Discontinuing patients did not differ in terms of sex, body mass index, education and smoking status from those who continued treatment (P > 0.05). Results of this study demonstrate that the WMC provides a practical model for clinically effective lifestyle-based treatment, accessible to a wide range of demographically diverse adults.

The role of sibutramine in weight reduction

The effectiveness of pharmacologic support with sibutramine along with the preservation of dietary and regimen measures is shown in a group of long-term treated patients at the Metabolic Clinic of the University Hospital in Hradec Králové. In ambulatory patients, basic anthropometric parameters as body weight, BMI, waist circumference and the total amount of adipose tissue were compared before substitution with 10 mg sibutramine and after a four-month therapy. This group included 94 patients who were administered the same dose of sibutramine for the whole period of time. This group consisted of 37 men and 57 women. After a four-month therapy with sibutramine there was a mean reduction in weight by 7.9 ± 3.8 kg in the monitored group of patients. Their BMI was reduced by 2.3 ± 1.5 kg/height2 and the waist circumference by 4.4 ± 3.8 cm. The decrease in the percentage of the total body lipid was 2.9 %. Despite a surprising decision of the European Drug Agency to suspend the registration of sibutramine in the whole of Europe since January 2010 we can state that in our patients we have proven a positive effect of sibutramine substitution on their weight reduction (Tab. 1, Ref. 19).

The Effect of Weight Loss in Obese Patients with Chronic Stable Plaque-Type Psoriasis

Background. Chronic plaque psoriasis is frequently associated with obesity. The effect of a low-calorie diet on psoriasis has not been investigated. Objective. The objective was to investigate whether moderate weight loss increases the therapeutic response to topical treatment in obese patients with chronic stable plaque-type psoriasis. Material and Method. A 24-week clinical trial was conducted in 10 patients. The efficacy of a low-calorie diet with topical treatment was compared with baseline in obese patients with chronic stable plaque-type psoriasis. The primary measure of clinical response was the Psoriasis Area and Severity Index at weeks 12 and 24. Results. At week 12, the mean reduction in body weight was 9.6 percent. There was an improvement from baseline of 50 percent or more in the Psoriasis Area and Severity Index in 50 percent of the patients. The responses as measured by improvements in the Psoriasis Area and Severity Index were paralleled by improvements in global assessments by the physician and the patients and in the Dermatology Life Quality Index. Conclusion. Obese patients with chronic stable plaque-type psoriasis increase their response to a low-calorie diet. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients.

Mechanisms of right heart failure-A work in progress and a plea for failure prevention.

Mechanisms of right heart failure-A work in progress and a plea for failure prevention.

True Bug (Heteroptera) Impact on Cocoa Fruit Mortality and Productivity

The real impact of true bug damage on cocoa pods has never been assessed precisely. We conducted a 2-yr study on 1,080 cocoa trees on 36 farms in Cameroon to assess the contribution of true bugs to fruit mortality and production loss. The cocoa fruiting cycle, fruit mortality, and damage caused by true bugs as well as other pests and diseases were monitored on a weekly basis. True bug damage also was described on 2,500 ripe pods per year. Pod weight, bean number, and bean weight were measured and compared for different degrees and types of damage on the ripe pods. Our results showed that true bugs were the main external cause of young fruit abortion. They reduced the abundance of young fruit by up to 10%. In contrast, although one-third of the ripe pods sampled had true bug lesions, only 4% were moderately to heavily damaged. The mean weight of ripe pods was reduced by 12% when there was medium to heavy damage. While the mean weight of wet beans was reduced significantly (by 3-10%), the number of beans per pod was not changed by damage. Despite the reduction in mean weight, the overall weight of beans for the pods sampled was reduced by <2%. Therefore, our study confirmed the common assumption that the economic impact of true bug damage on mature pods is negligible on cocoa farms in Cameroon. However, true bugs have a significant impact on young fruit mortality.

Dapagliflozin monotherapy in drug‐naïve patients with diabetes: a randomized‐controlled trial of low‐dose range

Many patients with type 2 diabetes are suboptimally managed with currently available therapies. Dapagliflozin, a sodium-glucose co-transporter-2 inhibitor, has shown efficacy in reducing diabetic hyperglycaemia. This study assessed efficacy of three lower doses in recently diagnosed patients. This phase 3, randomized, double-blind, placebo-controlled study assigned treatment-naïve patients to placebo or dapagliflozin monotherapy (1, 2.5 or 5 mg) daily for 24 weeks. Patients were antidiabetic drug-naïve with inadequate glycaemic control [haemoglobin A1c (HbA1c) ≥7.0 and ≤10.0%]. The primary efficacy endpoint was change in HbA1c from baseline. Secondary endpoints included changes in body weight and fasting plasma glucose (FPG), and proportions achieving HbA1c <7%. A total of 282 patients with type 2 diabetes were randomly assigned to one of four treatment groups. Baseline characteristics were similar across groups. At week 24, mean HbA1c reduction was significantly greater with dapagliflozin: -0.68% for 1 mg, -0.72% for 2.5 mg, -0.82% for 5 mg, versus 0.02% for placebo (p < 0.0001); compared to mean baseline values of 7.8-8.1%. Mean FPG reduction was significantly greater for all dapagliflozin groups versus placebo (p < 0.02), as was mean weight reduction (p < 0.003). During the treatment period, 19.1% of placebo-treated patients received rescue medication or discontinued because of poor glycaemic control versus 6.9, 4.1 and 5.9% for dapagliflozin 1, 2.5 and 5 mg, respectively. Percentages of patients experiencing ≥1 adverse event were similar across groups. Dapagliflozin at doses of 1, 2.5 and 5 mg/day is effective in reducing glycaemic levels and body weight in treatment-naïve patients with type 2 diabetes. Dapagliflozin was generally well tolerated. This insulin-independent mechanism suggests a new treatment for type 2 diabetes.

The efficacy of manual toothbrushes following a brushing exercise: a systematic review

To determine the efficacy of manual tooth brushing with respect to toothbrush design and brushing duration. The PubMed-MEDLINE and Cochrane CENTRAL were searched through October 2010 to identify appropriate studies. The outcome measurement was dental plaque removal following subject brushing. The search yielded 2119 titles and abstracts. Ultimately, 59 papers with 212 brushing exercises as separate legs of the experiments and meeting the eligibility criteria were selected. Overall, a brushing exercise provides a 42% (21) plaque score reduction (95% CI: 41.23; 42.03). Of the brushing studies providing data as assessed according to the Quigley and Hein plaque index, the weighted mean reduction from baseline in plaque scores was 30% (95% CI: 26.79; 33.21). A weighted mean plaque score reduction of 53% (95% CI: 49.51; 56.49) was observed in the experiments using the Navy plaque index. Subanalysis between the different bristle tuft configurations illustrated variation in plaque removal ability (24-61%). The angled bristle design numerically showed the highest mean plaque reduction with either index. A subanalysis of brushing duration revealed after 1 min, a mean reduction of 27% and after 2 min, 41%. The efficacy in plaque removal following a brushing exercise is a reduction from baseline plaque scores of 42% on average, with a variation of 30-53% dependent on the plaque index used. The available evidence indicates that bristle tuft arrangement (flat trim, multilevel, angled) and brushing duration are factors that contribute to the variation in observed efficacy.

Abstract 5057: Gene expression profile of chemoresponse of microdissected papillary serous tumors of the ovary identifies POLH and REV3L as potential therapeutic targets

Abstract Treatment of advanced stage ovarian carcinoma often involves cytoreductive surgery followed by adjuvant chemotherapy with paclitaxel and either cisplatin or carboplatin. Most tumors have either inherent or develop acquired resistance to chemotherapy, resulting in patient demise from their cancer. The mechanism of drug nonresponse (refractory/resistance) remains unknown and currently there is no clinically useful molecular predictor of response. Here, we determined the gene expression profile of 52 microdissected advanced stage papillary serous ovarian cancer and identified gene expression signatures predictive for nonresponse to chemotherapy. To generate a predictive gene signature, class prediction algorithms were applied to genes differentially expressed between resistant and sensitive tumors (p&amp;lt;0.001) using leave-one-out cross-validation. We developed a predictive 96-gene signature for tumor refractory and 29-gene signature for tumor resistance to chemotherapy. Real-time quantitative RT-PCR validated the results of the cDNA microarray analysis. To further validate our array results and demonstrate therapeutic value of these targets, we pursued several novel genes to determine whether over expression will render ovarian cancer cell lines resistance to chemotherapeutic drugs. Overexpression of EDIL3, GNA13 and POLH genes imparted cisplatin resistance to the ovarian cancer cell lines. As DNA Polymerases contribute to cell survival and the emergence of resistant cells by allowing cells to replicate beyond cisplatin adducts to avoid replication arrest and cell death, we decided to evaluate the potential therapeutic value of the genes POLH (DNA polymerase eta) and REV3L (DNA polymerase zeta) using short interfering RNA (siRNA) approach. Reduced gene expression via gene specific siRNA molecules renders ovarian cancer cell lines (A2780-CP20 and UCI 107) sensitive to cisplatin in vitro. Further, we validated these results in an orthotopic mouse model of ovarian cancer using liposomal (DOPC) siRNA approach as these nanoscale liposomes can penetrate deeply into the tumor. A combination of siREV3L/siPOLH-DOPC with cisplatin resulted in a significant reduction in mean tumor weight compared to mice treated with nonspecific control siRNA (77% reduction; Mann Whitney test, P=0.0140), compared to mice treated by nonspecific control siRNA with cisplatin (72% reduction; Mann Whitney test, P=0.0108), and compared to those mice treated with combination siREV3L/siPOLH-DOPC (68% reduction; Mann Whitney test, P=0.0070). In conclusion, here we report gene profile signatures of the chemoresponse of ovarian cancer. POLH and REV3L identified as potential therapeutic targets which can serve as targets for specific molecular therapeutic molecules that can increase the sensitivity of ovarian cancer to standard chemotherapy. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5057. doi:1538-7445.AM2012-5057

Metabolic outcomes of matched patient populations initiating exenatide BID vs. insulin glargine in an ambulatory care setting

This observational study evaluated the clinical effectiveness of exenatide BID (exenatide) vs. insulin glargine (glargine) in patients with type 2 diabetes mellitus in ambulatory clinical practice. Retrospective analyses were conducted using an electronic medical record (EMR) database among adult patients with type 2 diabetes mellitus initiating exenatide or glargine between 1 November 2006 and 30 April 2009. The cohorts were propensity-score matched to control baseline demographics, clinical measures, health status and medication use. The changes from baseline to a 12-month follow-up period for A1C (primary outcome), weight, body mass index (BMI), blood pressure and lipid levels were compared between the matched cohorts using paired tests. Propensity-score matching between the exenatide (n = 4494) and glargine (n = 5424) cohorts led to 2683 matched pairs with comparable characteristics, including age, gender and baseline clinical values. The exenatide cohort achieved a greater mean reduction in A1C (-0.6% vs. -0.4%, p < 0.01), weight (-2.6 kg vs. -0.2 kg, p < 0.01), BMI (-0.8 kg/m(2) vs. -0.04 kg/m(2) , p < 0.01) and systolic blood pressure (SBP) (-1.8 mmHg vs. -0.1 mmHg, p < 0.01) in the follow-up period. The changes in diastolic blood pressure and lipid levels were not significantly different between cohorts. Compared to glargine, exenatide-treated patients experienced significant reductions in A1C, weight, BMI and SBP. Acknowledging the limitations of observational research, exenatide showed greater clinical effectiveness than glargine from a large EMR database in the ambulatory care setting.

Clinical Use of Liraglutide in Type 2 Diabetes and its Effects on Cardiovascular Risk Factors

To assess whether liraglutide, a glucagon-like peptide-1 receptor agonist, has cardioprotective properties in addition to its glycemic effects. We performed a retrospective analysis of medical records of 110 obese patients with type 2 diabetes mellitus treated with liraglutide for at least 6 months between March 2010 and April 2011 at our tertiary care referral center. The variables analyzed were body mass index, hemoglobin A(1c) (A1C), systolic blood pressure (SBP), plasma C-reactive protein (CRP) concentrations, and serum lipids. In our overall study cohort, we noted a reduction in mean weight from 120 ± 5 kg to 115 ± 3 kg and a decrease in mean A1C from 7.8% ± 0.6% to 7.2% ± 0.2%. The mean triglyceride concentration decreased from 173 ± 19 mg/dL to 151 ± 15 mg/dL, the mean SBP was reduced from 132 ± 6 mm Hg to 125 ± 4 mm Hg, and the mean CRP concentration declined from 4.7 ± 0.8 mg/L to 3.2 ± 0.4 mg/L after treatment with liraglutide for a minimal duration of 6 months and a mean duration of 7.5 months (for all the foregoing changes, P<.05). These variables decreased whether these patients were previously treated with orally administered hypoglycemic agents alone or in combination with insulin or exenatide. Our findings in a clinical practice show that liraglutide is a potent antidiabetes drug, whether given in combination with orally administered agents or insulin or as a substitution for exenatide. It lowers body weight, A1C levels, SBP, and CRP and triglyceride concentrations.

Intentional Weight Loss and Dose Reductions of Anti-Diabetic Medications – A Retrospective Cohort Study

Background and AimIntentional weight loss, primarily by improving insulin resistance, is known to decrease the need for anti-diabetic medications. In this study, we assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment.MethodsCase records of 50 overweight or obese patients with DM who successfully decreased dosage or discontinued diabetes medications after losing weight via attendance at two University-based, outpatient weight management centers were analyzed. Follow-up visits, weight reduction interventions, and decisions for dose reductions or discontinuation of medications were individualized to patient needs by the treating physician.ResultsMean starting BMI was 35 kg/m2, mean age 53.4 years, and 58% were male. All 50 used at least one anti-diabetic medication (30 metformin, 39 sulfonylureas, 31 insulin, 21 sitagliptin) to manage blood sugar. Mean duration of follow-up was 30.2 months. Mean weight loss was 10.8±4.1 kgs (11.1% of initial body weight ±4.7%). 22/50 patients (44%) discontinued anti-diabetes medications (14 sulfonylureas [36%], 7 insulin [23%], 4 sitagliptin [19%]). The mean percentage weight loss achieved at the point of successful discontinuation of medication was 11.2%±3.5% (14% for sulphonylureas, 11% for insulin, and 7.1% for sitagliptin). Mean percentage weight loss of 5.6%±2.8% (5.1% for sulphonylureas, 4.3% for insulin, and 7.1% for sitagliptin) was required for initial dose reduction. For every 5% weight loss, predicted dose reductions were sulphonylureas, 39%; insulin, 42%; and any anti-diabetic medications, 49%.ConclusionAmong overweight or obese patients with type 2 diabetes, intentional weight loss of 7–14% was typically required for full discontinuation of at least one anti-diabetic medication. Discontinuation of insulin was achieved at a mean weight reduction of 11% of initial body weight.

The Effect of Prolonged Physical Activity Performed during Extreme Caloric Deprivation on Cardiac Function

BackgroundEndurance exercise may induce transient cardiac dysfunction. Data regarding the effect of caloric restriction on cardiac function is limited. We studied the effect of physical activity performed during extreme caloric deprivation on cardiac function.MethodsThirty-nine healthy male soldiers (mean age 20±0.3 years) were studied during a field training exercise lasted 85–103 hours, with negligible food intake and unlimited water supply. Anthropometric measurements, echocardiographic examinations and blood and urine tests were performed before and after the training exercise.ResultsBaseline VO2 max was 59±5.5 ml/kg/min. Participants' mean weight reduction was 5.7±0.9 kg. There was an increase in plasma urea (11.6±2.6 to 15.8±3.8 mmol/L, p<0.001) and urine osmolarity (692±212 to 1094±140 mmol/kg, p<0.001) and a decrease in sodium levels (140.5±1.0 to 136.6±2.1 mmol/L, p<0.001) at the end of the study. Significant alterations in diastolic parameters included a decrease in mitral E wave (93.6 to 83.5 cm/s; p = 0.003), without change in E/A and E/E′ ratios, and an increase in iso-volumic relaxation time (73.9 to 82.9 ms, p = 0.006). There was no change in left or right ventricular systolic function, or pulmonary arterial pressure. Brain natriuretic peptide (BNP) levels were significantly reduced post-training (median 9 to 0 pg/ml, p<0.001). There was no elevation in Troponin T or CRP levels. On multivariate analysis, BNP reduction correlated with sodium levels and weight reduction (R = 0.8, p<0.001).ConclusionsExposure to prolonged physical activity performed under caloric deprivation resulted in minor alterations of left ventricular diastolic function. BNP levels were significantly reduced due to negative water and sodium balance.

Effects of exenatide in poorly controlled type 2 diabetes*

The aim of this retrospective analysis was to assess the clinical effectiveness of exenatide in patients with type 2 diabetes in routine clinical practice. Patients with type 2 diabetes mellitus and inadequate glycemic control were commenced on exenatide in an out-patient setting. Effects on Hba1c, weight and BMI at 3- and 6-month intervals were recorded by a retrospective review of medical records. We examined a cross-section of 61 patients. The mean weight at treatment initiation was 114 kg and baseline Hba1c was 9.8% (84 mmol/mol). Mean reduction in Hba1c at 3 months was 0.8% (10 mmol/mol, P < 0.01) and mean reduction at 6 months was 0.5% (6 mmol/mol, P < 0.05). Mean weight loss at 3 months was 4.2 kg (P < 0.0001) and at 6 months was 6.6 kg (P < 0.0001). Seventeen patients were prescribed exenatide in addition to insulin, against current guidelines. This cohort of patients showed a greater mean reduction in weight (7.4 vs 6.2 kg) as compared to the group on exenatide without insulin, but mean Hba1c increased at 6 months by 0.35% (4 mmol/mol). Adjunctive exenatide treatment in patients with suboptimally controlled type 2 diabetes on oral hypoglycaemic medications, achieved reductions in Hba1c and weight, in line with published studies. However, in patients already on insulin, favourable results can be achieved by the addition of exenatide by careful patient selection and follow-up.