Hypoglycemia post bariatric surgery: drugs with different mechanisms of action to treat a unique disorder.

Postprandial hypoglycemia (PPH) is a complex and multifactorial complication of bariatric surgery (BS). PPH may cause severe symptoms or be asymptomatic. The treatment of this condition requires dietary changes, but severe cases require drug therapy.

SGLT2 Inhibition with Empagliflozin as a Possible Therapeutic Option for Postprandial Hypoglycemia After Bariatric Surgery.

Purpose: Since SGLT2 inhibitors may reduce postprandial hyperglycemia, this study aimed to evaluated whether empagliflozin might be useful in the treatment of postprandial hypoglycemia (PPH) postbariatric surgery (BS).

Patients And Methods: Fourteen patients who underwent BS, nine without type 2 diabetes and five with diabetes before surgery and in remission after surgery, were included. Seven of them presented symptoms of PPH (hypoglycemic group; HG) and seven were asymptomatic (nonhypoglycemic group (NHG)).

Muscle Echogenicity and Changes Related to Age and Body Mass Index.

Introduction: Muscle fibers are lost and replaced by fat- and fibrous-tissue infiltration during aging. This process decreases muscle quality and influences tissue appearance on ultrasound images over time. Increased muscle "echogenicity" represents changes caused by fat- and fibrous-tissue infiltration and can be quantified with recently developed software.

Influence of Menopausal Hormone Therapy on Body Composition and Metabolic Parameters.

The loss of estrogen with menopause is associated with an increase in central fat. The objective of this study was to evaluate the effects of menopause hormone therapy (HT) on body composition and metabolic parameters in postmenopausal women. A prospective study was conducted among postmenopausal women from the Climacteric clinic, Universidade Federal de São Paulo.

Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery.

Background: Weight regain (WR) after bariatric surgery (BS) is frequent.

Objective: The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS.

Methods: Ninety-six patients (77.

Sleep disorders in polycystic ovary syndrome: influence of obesity and hyperandrogenism.

Objective: This study aims to evaluate the sleep of subjects with polycystic ovary syndrome (PCOS), with and without hyperandrogenism, in comparison with a healthy control group and examine the effects of hyperandrogenism and obesity on sleep parameters.

Methods: A total of 44 volunteers were recruited to participate in the study. Clinical, biochemical and polysomnographic parameters were used to diagnose PCOS and hyperandrogenism.

Binge eating disorder is not predictive of alcohol abuse disorders in long-term follow-up period after Roux-en-Y gastric bypass surgery.

Introduction: Some studies have shown an increase in alcohol use disorders (AUD) after Roux-en-Y gastric bypass surgery (RYGB), but its relationship with binge eating disorder (BED) has not been fully explored. The purpose of this study was to determine the prevalence of AUD and BED after RYGB and also to evaluate if BED is predictive of late postoperative occurrence of AUD or BED.

Methods: Patients (n = 46) submitted to RYGB, in a tertiary outpatient weight management service at a Federal University of Sao Paulo, Brazil, were tested for BED and AUD using the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and AUDIT, respectively.

Association of endothelial dysfunction with cardiovascular risk factors and new-onset diabetes mellitus in patients with hypertension.

Asymmetric dimethylarginine (ADMA), which is the main endogenous inhibitor of nitric oxide synthase, plays a critical role in the process of endothelial dysfunction. The authors evaluated the association between high plasma ADMA levels in patients with hypertension and the presence of cardiovascular risk factors and the development of type 2 diabetes mellitus (DM) and cardiovascular outcomes, including death. The authors evaluated 191 patients with hypertension who were stratified into two groups according to the median value of basal ADMA: those with high levels of plasma ADMA (>0.

Relation of asymmetrical dimethylarginine levels with renal outcomes in hypertensive patients with and without type 2 diabetes mellitus.

Aim: The aim of the study was to evaluate the association between high plasma ADMA levels, a biomarker of endothelial dysfunction, with the progression of albuminuria and chronic kidney disease (CKD) in hypertensive patients, with and without type 2 diabetes mellitus.

Methods: We successfully contacted 213 of 644 patients who had been evaluated between 2004 and 2005 and for whom basal data were available. After the exclusion of 51 patients, 162 hypertensive patients who were free from albuminuria were stratified into the following 4 groups according to the presence of diabetes and plasma ADMA percentiles: general hypertensive patients with high levels of plasma ADMA (>P4 or ADMA > 0.

Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM).

Background: Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk.

The imbalance of sex-hormones related to depressive symptoms in obese men.

Obese men may present hypogonadothrofic hypogonadism, mainly related to higher insulinemia and aromatase activity. Our objectives were to evaluate the relationship of sex-hormones profiles and frequency of depressive symptoms in 43 obese men, in a cross-sectional study. They had 19-60 years, and body mass index 30-50 kg/m(2).

Present Insights on Cardiomyopathy in Diabetic Patients.

The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management.

Impact of insulin treatment in diabetic macular edema therapy in type 2 diabetes.

Objective: To evaluate the impact of insulin therapy on the outcomes of diabetic macular edema (DME) treatment with vascular endothelial growth factor (VEGF) inhibitors in people with type 2 diabetes.

Methods: A retrospective consecutive case series of 95 patients with type 2 diabetes and DME who were treated with anti-VEGF therapy. We examined 2 cohorts: patients taking only oral antidiabetic agents and patients on insulin therapy.

Adrenocortical production is associated with higher levels of luteinizing hormone in nonobese women with polycystic ovary syndrome.

Objective. Insulin resistance (IR) and ovarian and adrenal hyperandrogenism are a common finding in women with polycystic ovary syndrome (PCOS). The aim of the present study was to access possible differences in insulin resistance, gonadotropins, and androgens production in obese and nonobese PCOS women.

Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia.

Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease.

The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema.

Aims: Evaluate the role of systemic factors on the functional and anatomic outcomes of anti-VEGF therapy for diabetic macular edema (DME).

Methods: A retrospective consecutive case series of 124 patients with DME treated with anti-VEGF therapy was collected. The main outcome measures were change in best corrected visual acuity (BCVA) and change central subfield macular thickness (CST) measured with spectral-domain ocular tomography coherence (SD-OCT); and their correlation with clinical findings.

Postprandial adiponectin levels are associated with improvements in postprandial triglycerides after Roux-en-Y gastric bypass in type 2 diabetic patients.

Background: Postprandial hypertrygliceridemia is a known factor for cardiovascular disease and is often observed in patients with type 2 diabetes mellitus (T2DM) and visceral adiposity. Adiponectin is a hormone with antiatherogenic and anti-inflammatory effects, which decreases in obesity and T2DM subjects. The weight loss induced by diet or bariatric surgery could be restoring adiponectin levels.

[Efect of short term glycemic control on microalbuminuria and glomerular filtration rate in type 2 diabetic patients with poor glycemic control].

Introduction: The intensive glucose control significantly reduces the risk of microvascular complications, including nephropathy.

Objectives: We assess the impact of glycemic control through calculation of weekly mean glycemia (WMG) and glycemic variability (GV) on 24 hours ambulatory blood pressure (ABPM), urinary albumin excretion (UAE) and glomerular filtration rate (GFR).

Methods: 53 patients with type 2 diabetes mellitus (DM2) were randomly divided into two groups to receive conventional or intensive treatment, which included weekly visits for medication adjustments and implementation of an educational plan for six weeks.

[Importance of nutritional counseling and dietary fiber content on glycemic control in type 2 diabetic patients under intensive educational intervention].

Objective: To evaluate the importance of nutritional counseling within a set of multidisciplinary interventions.

Subjects And Methods: Forty-seven patients with type 2 diabetes and hyperglycemia (A1C ≥ 8%), treated conventionally (n = 19, GC) or intensively in six weekly visits (n = 28, GI) were analyzed. We evaluated mean weekly blood glucose (MWG) at baseline and after 6 weeks in both groups.

Cholesterol goal attainment in hypertensive patients: the impact of metabolic syndrome components.

Background: Hypertension and dyslipidemia are potentially modifiable cardiovascular risk factors.

Methods: We studied hypertensive outpatients regarding goal attainment in controlling dyslipidemia, according to individual cardiovascular risk profile, following the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Factors of goal attainment for low-density lipoprotein cholesterol (LDL-C) were determined.

Impaired abdominal skin sensory function in morbid obesity and after bariatric surgery.

Background: Bariatric surgery reduces body weight, but creates the need for surgical correction of the patient's body shape, especially of the abdomen. The abdominal skin of the ex-obese has a lower quantity of fibrous and non-fibrous components; however, its functional status has not yet been studied. This study quantified, at different depths, the neurological function of the abdominal skin of the obese and morbidly ex-obese.

Rapid improvement of glycemic control in type 2 diabetes using weekly intensive multifactorial interventions: structured glucose monitoring, patient education, and adjustment of therapy-a randomized controlled trial.

Background: We evaluated intensive intervention in poorly controlled patients with type 2 diabetes mellitus involving weekly clinic visits and adjustment of therapy with analysis of three seven-point glucose profiles and intervention from an interdisciplinary staff.

Methods: Sixty-three patients were randomized to an intensive treatment group that obtained self-monitoring of blood glucose (SMBG) profiles (six or seven values per day, 3 days/week) and were seen in the clinic at Weeks 1-6 and 12. SMBG results were downloaded, analyzed using Accu-Chek(®) 360° software (Roche Diagnostics, Indianapolis, IN), and used to adjust therapy.

Is mandatory screening for obstructive sleep apnea with polysomnography in all severely obese patients indicated?

Purpose: The study aims to assess the risk factors for the presence and severity of obstructive sleep apnea (OSA) among severely obese patients evaluated for bariatric surgery.

Patients And Methods: Polysomnography recordings were performed in consecutive patients undergoing Roux-en-Y gastric bypass from January 2004 to January 2007. Sleep apnea was noted as present or absent and graded from mild to severe according to the apnea/hypopnea index.

Early improvement in glycemic control after bariatric surgery and its relationships with insulin, GLP-1, and glucagon secretion in type 2 diabetic patients.

Background: The surgical treatment of obesity ameliorates metabolic abnormalities in patients with type 2 diabetes. The objective of this study was to evaluate the early effects of Roux-en-Y gastric bypass (RYGB) on metabolic and hormonal parameters in patients with type 2 diabetes (T2DM).

Methods: Ten patients with T2DM (BMI, 39.

Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment.

Overweight and obesity in youth is a worldwide public health problem. Overweight and obesity in childhood and adolescents have a substantial effect upon many systems, resulting in clinical conditions such as metabolic syndrome, early atherosclerosis, dyslipidemia, hypertension and type 2 diabetes (T2D). Obesity and the type of body fat distribution are still the core aspects of insulin resistance and seem to be the physiopathologic links common to metabolic syndrome, cardiovascular disease and T2D.