Diabetes Core Update 12/10/2012 – Detailed Summary

Podcast: Diabetes Core Update
Date: December 10, 2012
Presented by: Dr. Neil Skolnik & Dr. John J. Russell
Purpose:
To discuss and synthesize the latest clinically relevant research published in the American Diabetes Association’s journals, focusing on practical implications for diabetes care.

Main Theme

The episode explores recent research findings from ADA journals with direct applications in diabetes management, concentrating on exercise modalities for youth obesity, hypoglycemia post-bariatric surgery, genetic influences on weight loss diets, comparisons of bariatric procedures for diabetes remission, new ADA consensus on managing diabetes in older adults, and the relationship between metabolic syndrome and cancer risk.

Key Discussion Points & Insights

1. Aerobic vs. Resistance Exercise in Obese Adolescent Boys

(Starts at 01:48)

• Study: Randomized controlled trial (Diabetes, Nov 2012) comparing effects of aerobic vs resistance exercise (without caloric restriction) on abdominal fat, intrahepatic lipid, and insulin sensitivity in 45 obese adolescent boys.
• Findings:
  • Both exercise modalities prevented significant weight gain seen in controls.
  • Both reduced total and visceral fat, and intrahepatic lipid.
  • Resistance exercise additionally led to significant improvements in insulin sensitivity (27% increase), unlike aerobic exercise.
  • Adolescents reported greater enjoyment of resistance training.
• Clinical Insight:
  • Reinforces benefits of including both aerobic and resistance training for youth as per ADA guidelines.
  • Suggests patient preference and enjoyment are key for adherence (“things that work are the things that we do” – Dr. Skolnik, 05:23).
• Notable Quote:

  “This clearly puts resistance exercise strongly on the map as a point of emphasis for intervention with youth.”
  — Dr. Neil Skolnik (05:25)

2. Hypoglycemia After Bariatric Surgery

(Starts at 06:11)

• Overview: Hypoglycemia is a rare but noteworthy complication after gastric bypass. Must differentiate between early/late dumping syndrome and true hyperinsulinemic hypoglycemia.
  • Early Dumping: Vasomotor/GI symptoms soon after eating simple sugars, common soon after surgery, improves over time.
  • Late Dumping: 1–3 hours post-meal, due to exaggerated insulin response.
  • Hyperinsulinemic Hypoglycemia: Rare, severe, neurological symptoms several months to years post-surgery.
• Prevalence: About 1 in 500 gastric bypass patients.
• Clinical Relevance:
  • Symptoms are often vague, important for PCPs to recognize in post-bariatric patients—even those not on diabetes meds.
• Notable Quote:

  “I think as our patients have bariatric surgeries...they are just following up with us and having some very kind of vague symptoms. So it is something we might be thinking about at some point as a rare thing that’s different from the dumping syndrome…”
  — Dr. John Russell (09:17)

3. Genetics & Weight Loss Diets: The FTO Genotype

(Starts at 10:15)

• Study: POUNDS LOST trial (Diabetes, Nov 2012) looking at FTO genotype and body composition over two years with varied dietary macronutrient content.
• Findings:
  • FTO risk allele carriers responded better to high protein diets (greater fat and weight loss).
  • Suggests genetic differences can affect dietary success.
• Clinical Insight:
  • Early evidence for personalized, genotype-based dietary recommendations. Not ready for routine clinical use but points to a future of personalized nutrition.
• Notable Quote:

  “It’s clear clinically that some people do better on a high protein diet, some people do better on a low protein diet...what this study suggests is there are genetic reasons why some people may actually achieve better weight loss on one diet than another.”
  — Dr. Neil Skolnik (12:03)

4. Comparison of Bariatric Procedures for Diabetes Remission

(Starts at 13:16)

• Procedures Discussed:
  • Restrictive: Gastric banding, vertical sleeve gastrectomy.
  • Diversionary: Roux-en-Y, biliopancreatic diversion with duodenal switch.
• Findings & Trends:
  • Sleeve gastrectomy is supplanting gastric banding due to better outcomes.
  • Roux-en-Y and biliopancreatic diversion yield greater weight loss and diabetes remission, but diversionary procedures have higher risk and need for lifelong nutritional monitoring.
  • Diabetes remission/cure rates range from 45% to ~90% depending on procedure type.
• Patient Selection:
  • Best remission rates in patients not on insulin, shorter diabetes duration, less insulin resistance.
• Notable Quote:

  “So, you know, diabetes, we've never really used the term cure before...With some of these procedures now, we can actually have a cure for diabetes for folks.”
  — Dr. John Russell (16:58) “We need to let people know that they're not all the same...”
  — Dr. John Russell (19:01)

5. ADA Consensus on Diabetes Care in Older Adults

(Starts at 19:44)

• Summary of Consensus Points:
  1. Individualize A1C Goals:
     • Tighter control for healthy, younger older adults; relaxed goals for those with comorbidities/limited life expectancy.
  2. Lipid Management:
     • Treat as aggressively as with younger adults due to short time to see benefit.
  3. Blood Pressure Goals:
     • Similar to younger adults if achievable easily (systolic BP 130–140 acceptable in older adults).
• Relevance:
  • Acknowledges higher risks of hypoglycemia, institutionalization, and comorbidity burden in the elderly.
• Upcoming:
  • Special episode for a detailed discussion with one of the consensus authors.

6. Metabolic Syndrome and Risk of Cancer

(Starts at 23:45)

• Meta-analysis: 116 studies, >38,000 cancer cases.
  • Men: Metabolic syndrome increases risk of liver, colorectal, and bladder cancer.
  • Women: Increased risk of endometrial, pancreatic, breast, rectal, and colorectal cancers.
• Clinical Relevance:
  • Metabolic syndrome is widespread—about 25% of Americans, 40% of seniors.
  • Not only increases MI risk (as seen in WOSCOPS trial: 3x MI risk) but now also linked to certain cancers.
• Prevention Message:
  • Preventing metabolic syndrome components (obesity, impaired fasting glucose, hypertension) has benefits beyond cardiovascular risk.
• Notable Quote:

  “Metabolic syndrome really is the quintessential American disease.”
  — Dr. John Russell (24:03)

Notable Quotes & Moments

• “The things that work are the things that we do.” — Dr. Neil Skolnik [05:23]
• “It’s clear clinically that some people do better on a high protein diet...” — Dr. Neil Skolnik [12:03]
• “We can actually have a cure for diabetes for folks.” — Dr. John Russell [16:58]
• “Metabolic syndrome really is the quintessential American disease.” — Dr. John Russell [24:03]

Timestamps for Key Segments

• Aerobic vs Resistance Exercise in Adolescents – 01:48–06:11
• Hypoglycemia after Bariatric Surgery – 06:11–10:15
• FTO Genotype & Weight Loss Diets – 10:15–13:16
• Comparing Bariatric Surgical Procedures – 13:16–19:44
• ADA Consensus on Older Adults – 19:44–23:45
• Metabolic Syndrome and Cancer Risk – 23:45–26:41

Tone and Takeaways

The hosts maintain a practical, clinical, and optimistic tone, consistently highlighting both the excitement and caution required as new evidence emerges. They encourage focusing on intervention strategies that are realistic and patient-centered, and underscore the importance of ongoing learning with evolving research.

For More Information:
Visit www.diabetesjournals.org for articles and further resources.