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Jun
22nd
Cleveland Clinic Study Shows High Remission Rates of Diabetic Kidney Disease Five Years After Bariatric Surgery

 SAN DIEGO, CA – JUNE 20, 2012 – In many obese diabetic patients, one of the most dreaded complications of Type 2 diabetes can be put into remission or prevented entirely with bariatric surgery, according to a new study* from the Cleveland Clinic presented here at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

The study found that nearly 60 percent of obese patients with diabetic nephropathy, the leading cause of end-stage kidney disease, no longer had the condition five years after surgery. Additionally, only 25 percent of obese diabetics without nephropathy at the time of surgery eventually developed this complication. Researchers noted this incidence rate after surgery is about 50 percent less than what occurs in the non-surgically treated diabetes population. The five-year remission and improvement rates for Type 2 diabetes were 44 percent and 33 percent, respectively.

“When we started this study, we thought bariatric surgery may just halt the progression of diabetic nephropathy, instead over half of the patients who had diabetic nephropathy prior to undergoing bariatric surgery experienced remission. This is a remarkable finding that warrants greater consideration of bariatric surgery in this patient population,” said lead study author Helen M. Heneghan, MD, a bariatric surgery fellow at the Cleveland Clinic Bariatric and Metabolic Institute in Ohio.

About seven million Americans have diabetic kidney disease, which jumped 34 percent in the last two decades, despite a substantial increase in the use of medications to treat the disease. Diabetes is the most common cause of kidney disease, a condition that independently increases the risk of heart disease and death.[i]

The study included 52 patients, mostly female, who suffered from obesity and Type 2 diabetes for almost nine years. They had an average body mass index (BMI) of 49 before undergoing bariatric surgery, which was primarily gastric bypass surgery. Nearly 40 percent had diabetic nephropathy prior to undergoing surgery, a complication of diabetes caused by uncontrolled blood sugar which, in severe cases, can require dialysis or lead to kidney failure. In the United States, diabetic nephropathy accounts for about 40 percent of new cases of end-stage renal disease.[ii]

“No medical therapy has been as effective in achieving an effect of this magnitude on diabetic nephropathy,” said study co-author Philip R. Schauer, MD, professor of surgery and director of the Cleveland Clinic Bariatric and Metabolic Institute. Dr. Schauer published a study earlier this year in the New England Journal of Medicine that showed bariatric surgery can put Type 2 diabetes into remission even before substantial weight loss occurs. In addition to remission or improvement of Type 2 diabetes and its complications in the current study, patients were able to maintain 50 percent excess weight loss after five years, and also achieved significant improvements in blood pressure and cholesterol levels.

According to the World Health Organization, 90 percent of people with Type 2 diabetes worldwide are obese or overweight.[iii] The federal government estimates about 10.7 percent (23.5 million) of people age 20 years or older in the United States have Type 2 diabetes.[iv] According to the study authors, given these striking figures, the importance of trying to control obesity and diabetes, and prevent diabetic complications, is even more apparent.

In addition to Dr. Heneghan and Dr. Schauer, study co-authors include Neil Orzech, MD, Kalman Bencsath, MD, Derrick Cetin, DO, and Stacy A. Brethauer, MD.

About Obesity and Metabolic and Bariatric Surgery

Obesity is one of the greatest public health and economic threats facing the United States.[v] Approximately 72 million Americans are obese[vi] and, according to the ASMBS, about 18 million have morbid obesity. Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including Type 2 diabetes, heart disease and cancer.[vii],[viii] The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion,[ix] double what it was a decade ago, and projects spending to rise to $344 billion each year by 2018.[x]

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity and many related conditions and results in significant weight loss.[xi],[xii],[xiii] In the United States, about 200,000 adults have metabolic/bariatric surgery each year.[xiv] The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.[xv] The risk of death is about 0.1 percent[xvi] and the overall likelihood of major complications is about 4 percent.[xvii]

About the ASMBS

The ASMBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information, visit www.asmbs.org.

###

*PL-116: Effects of Bariatric Surgery on Diabetic Nephropathy After 5 Years Follow-up

Dr. Helen M. Heneghan; Dr. Philip R. Schauer; Neil Orzech, MD; Kalman Bencsath, MD; Derrick Cetin, DO; Stacy



REFERENCES



[i]de Boer, I. H., Rue, T. C., Hall, Y. N., et al. (2011). Temporal trends in the prevalence of diabetic kidney disease in the United States. Journal of the American Medical Association. 305(24) pp. 2532-2539. Access May 2012 from http://jama.jamanetwork.com/article.aspx?volume=305&issue=24&page=2532


[ii] American Diabetes Association. (2004). Nephropathy in diabetes. Diabetes Care. Accessed May 2012 from http://care.diabetesjournals.org/content/27/suppl_1/s79.full


[iii] Global Strategy on Diet, Physical Activity and Health – World Health Organization. (2012). Obesity and overweight. Accessed May 2012 from http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/


[iv] National Diabetes Information Clearinghouse – U.S. Department of Health and Human Services. (2008). Diabetes Overview. Accessed May 2012 from http://diabetes.niddk.nih.gov/dm/pubs/overview/DiabetesOverview_508.pdf


[v]Flegal, K. M., Carroll, M. D., Ogden, C. L., et al. (2002). Prevalence and trends in obesity among US adults, 1999-2000. Journal of the American Medical Association. 288(14) pp. 1723-1727. Accessed March 2012 from http://aspe.hhs.gov/health/prevention/


[vi]Chronic Disease Prevention and Health Promotion – Centers for Disease Control and Prevention. (2011). Obesity; halting the epidemic by making health easier at a glance 2011. Accessed February 2012 from

http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm


[vii]Office of the Surgeon General – U.S. Department of Health and Human Services. Overweight and obesity: health consequences. Accessed March 2012 from http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.html


[viii]Kaplan, L. M. (2003). Body weight regulation and obesity. Journal of Gastrointestinal Surgery. 7(4) pp. 443-51. Doi:10.1016/S1091-255X(03)00047-7. Accessed March 2012 from http://edulife.com.br/dados%5CArtigos%5CNutricao%5CObesidade%20e%20Sindrome%20Metabolica%5CBody%20weight%20regulation%20and%20obesity.pdf


[ix]Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., et al. (2009). Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs. 28(5) pp. w822-w831. Accessed February 2012 from http://www.cdc.gov/obesity/causes/economics.html


[x]Thorpe, K (2009). The future costs of obesity: national and state estimates of the impact of obesity on direct health care expenses. America’s Health Rankings. Accessed June 2012 from http://www.fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/CostofObesityReport-FINAL.pdf


[xi]Weiner, R. A. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394.


[xii]Chikunguw, S., Patricia, W., Dodson, J. G., et al. (2009). Durable resolution of diabetes after roux-en-y gastric bypass associated with maintenance of weight loss. Surgery for Obesity and Related Diseases. 5(3) p. S1


[xiii]Torquati, A., Wright, K., Melvin, W., et al. (2007). Effect of gastric bypass operation on framingham and actual risk of cardiovascular events in class II to III obesity. Journal of the American College of Surgeons. 204(5) pp. 776-782. Accessed March 2012 from http://www.ncbi.nlm.nih.gov/pubmed/17481482


[xiv]American Society for Metabolic & Bariatric Surgery. (2009). All estimates are based on surveys with ASMBS membership and bariatric surgery industry reports.


[xv]Poirier, P., Cornier, M. A., Mazzone, T., et al. (2011). Bariatric surgery and cardiovascular risk factors. Circulation: Journal of the American Heart Association. 123 pp. 1-19. Accessed March 2012 from http://circ.ahajournals.org/content/123/15/1683.full.pdf


[xvi]Agency for Healthcare Research and Quality (AHRQ). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Jan. 2007.


[xvii]Flum, D. R. et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed June 2012 from http://content.nejm.org/cgi/content/full/361/5/445

Added on 06/22/2012

by Northwest Weight Loss Surgery


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posted by raechapp on 05.27.13 at 19:23

Diablo 3 : Literacy: Blue strange, elite strange and rare and strange

After night the in purgatory A1 a mode detailed experience, including the single player mode and cooperation mode, encountering a variety of elite strange and rare and strange, and whether killing off according to the specific team situation; can not kill resolutely notice teammate pass out next through direct SKIP. Goldwto sell many game gold,such as : diablo 3 gold d3 gold runescape gold rs gold diablo 3 gold d3 gold diablo3 gold blade and soul gold wow gold tibia gold aion gold rom gold runes of magic gold age of wushu gold aion kinah dofus kamas cabal gold cabal alz eve isk atlantica gold dfo gold guild wars 2 gold gw2 gold tera gold c9 gold rappelz gold rappelz rupees second life linden mabinogi gold maple story mesos rift gold dragon nest gold itunes gift card App Store Gift Card Rare and strange: with a rare name (usually blue, but at the same time may also be gold elite), it is difficult to find, but to get rid of, there is often a special surprise, because fixed and affixes equipment, regardless of the blue-loaded or yellow equipment, are to the edge, in fact, is the best SP produced strange fortune depends on it. Open the list of your accomplishments, an achievement which lists the most rare and strange, but not all! In addition, rare and strange fall the best equipment is not 100% drop, but if you want, you could do nothing but find them, rs gold because they can. If you encounter, but you can not beat , please hurry to invite your friends list into your game together to engage it, and to drop more than a goodly portion of luck, but also a way of getting money to the Friends of the base! Daobao Wizard: Drop equipped with everything falling energy saving in this chapter, in addition to rare and strange part of falling! Drop the game settings, through research nethack (known as the originator of the Diablo setting items randomly drop) settings, blade and soul gold in fact, a setting is as follows: Rare and strange list of rare and strange list: this figure may be possible, each unique drop list of rare and strange, usually the main producing strange Need rings and necklaces; Blue strange list: this picture ordinary strange, it may appear strange blue, just blue strange installed it must be out of the blue, drop list is the list of the world fall in each of the sections that, that does not beyond the the chapter drop the other chapters will be out equipment. (FARM A1 friend Note, A4 was a good blue-loaded, drag a drag the corpse into the A4.) 3 golden elite list: mainly wow gold used to increase this figure a bit of a challenge and entertainment, to be honest, not farm their significance, and this strange basically impossible to be done FARM their fall list and blue The strange world drop, as limited by chapter, but the yellow loading a relatively high probability it wants. So, I'll give you advice: Careful and meticulous to a certain figure, the difficulty is not great, you can complete single FARM again, all the blame, all the stones, all the local touch it again, and then reset it again, and so forth NNNN times and times, you can put this figure there might be rare and strange touch, we also know this "specialty". Another supplement on suits and legendary equipment drop set: part of the world falling, broken jar and trash mobs and the like can be a goodly portion of luck, but the mobs die so much, the opportunity is always there; portion of the fixed BOSS out drop, multi-brush it, the opportunity is always there, after all, is fixed drop FARM when a lot of bad street but in the end is inevitable; part fall by rare and strange, the same can not be met seeking to encourage you and diligent traveled to every corner of the map; also part of falling exists only in the advanced chest, face. About rare and strange location: each figure with surface and underground (cave) in two parts, this strange wandering the entire surface of each figure, that might be buried in the ground, but mainly present in the underground; each figure has a fixed number of underground cave spawn points, and each picture to refresh the total number of points is fixed, but each time the refresh only a few points, to refresh a few point and which point to refresh are random; Members diligent little more effort, run a race map, summarize the law, there will always be the outcome! ! ! ! ! Random number paradox: while the computer is set between 1-100 random samples of any single chance, from long statistical point of view, are the same, but in a short period of time during the actual operation, you extracted to a 1 and 100 chance is very small; the improved random numbers, often using double-random number divided by the ratio rounded, for example, taken from 1-100 where two duplicate number, and then divided by 2 rounded . Refer to the above extract random set model of random numbers, each picture looks much spawn points, but a subset of locations and 1 or 100 is actually more difficult to be able to get from another point of view, mean that other spawn points easily be able to get refreshed, this rule can be found by summing. My last most important conclusion: Some rare and strange appears only in the rare spawn points, this setting is also normal, everyone can sum up, there is always the law to be investigated!

posted by raechapp on 05.28.13 at 06:41

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)
Who says bridesmaid dresses have to be ugly and unflattering?
Designers brought their A-game to the Spring/Summer 2014 runways in New York recently, showing bridesmaid gowns that attendants will definitely want to wear again.
Click through the below photos to see 8 gorgeous new styles, then tell us in the comments: would you choose one of these looks for your 'maids'?







posted by raechapp on 06.01.13 at 06:20

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)
Who says bridesmaid dresses have to be ugly and unflattering?
Designers brought their A-game to the Spring/Summer 2014 runways in New York recently, showing bridesmaid gowns that attendants will definitely want to wear again.
Click through the below photos to see 8 gorgeous new styles, then tell us in the comments: would you choose one of these looks for your 'maids'?







posted by raechapp on 06.01.13 at 23:19

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)
Who says bridesmaid dresses have to be ugly and unflattering?
Designers brought their A-game to the Spring/Summer 2014 runways in New York recently, showing bridesmaid gowns that attendants will definitely want to wear again.
Click through the below photos to see 8 gorgeous new styles, then tell us in the comments: would you choose one of these looks for your 'maids'?







posted by raechapp on 06.03.13 at 03:50

Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)

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Who says bridesmaid dresses have to be ugly and unflattering?
Designers brought their A-game to the Spring/Summer 2014 runways in New York recently, showing bridesmaid gowns that attendants will definitely want to wear again.
Click through the below photos to see 8 gorgeous new styles, then tell us in the comments: would you choose one of these looks for your 'maids'?







posted by raechapp on 06.03.13 at 23:30

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Bridesmaid Dresses: Spring/Summer 2014 Styles From Top Designers (PHOTOS)

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