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According to WHO, Indonesia ranks fourth in the largest number of patients with Diabetes Mellitus in the world. Diabetes which is also known in Indonesia by the term Kencing Manis is a metabolic disorder with symptoms such as high ratio of sugar in the blood and impaired metabolism of carbohydrates, fats and proteins. In the case of diabetes, glucose (simple sugar) level in the blood is high because the body can not release or use insulin adequately. Type 1 diabetes is often called Insulin Dependent Diabetes Mellitus (IDDM) or a Dependent Diabetes Mellitus on Insulin. Autoimmunity is when the body is allergic to one type of tissue or cell itself - in this case, is in the pancreas. Virusor chemicals that cause damage to the cell islands (groups of cells) in the pancreas where insulin is made. Type 2 diabetes is also often called Non-Insulin Dependent Diabetes Mellitus or Diabetes Mellitus Without Depending on Insulin.
A diet or an unhealthy lifestyle The number of fast food outlets (fast food) serving fatty and unhealthy foods.
Type 1 diabetes is caused by the inability of the pancreas to produce insulin, while type 2 diabetes is caused by lack of insulin due to the improper work of the pancreas. Causing loss of neurological function, causing numbness, weakness in speech, body coordination, or walking.
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Another new randomized, controlled study adds to the evidence that bariatric surgery for type 2 diabetes provides dramatically better control of the disease for people with obesity than intensive lifestyle therapy alone.
In this small, but well-controlled study, a total of 69 patients with obesity and type 2 diabetes were randomly assigned to receive either a year of intensive lifestyle weight loss therapy, a gastric band procedure, or a gastric bypass procedure. At the end of three years, none of the people who received intensive lifestyle therapy had achieved remission of their diabetes, 29% of those in the gastric band group achieved remission, and 40% of the gastric bypass patients achieved remission.
We should consider the use of bariatric (metabolic) surgery in all severely obese patients with T2DM and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago. A year ago, the UK’s National Institute for Health and Care Excellence (NICE) recommended that all people with newly diagnosed type 2 diabetes and a BMI over 35 be offered early, rapid assessment for bariatric surgery.
What will it take, we wonder, to get serious about more intensive treatment for obesity, including bariatric surgery? Click here to read more from Reuters, here to read the study, and here to read the editorial.
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy. However, it’s pretty clear that remission of type 2 diabetes is uncommon even with intensive lifestyle interventions. So yes, intensive lifestyle intervention is valuable, but it’s probably not a good bet by itself for effecting a remission of type 2 diabetes in people with obesity.
The short and simple answer is that most people experience a substantial improvement in quality of life after bariatric surgery. Another point is that health-related quality of life is not the sum total of quality of life.
In participating in a HAES group, I’ve personally met more than 5 people who either themselves have died of complications from gastric bypass surgery or have a loved one who died of complications from gastric bypass surgery.
Not withstanding that caution, I agree that we need to make good use of all the tools we can. Is the increased total mortality and sudden death risk associated with the intensive glycemic treatment strategy (ACCORD – VADT) linked to hypoglycemia ?
Although metformin is first-line therapy for patients with type 2 diabetes, glycemic control fails with metformin alone in many patients. To play the media you will need to either update your browser to a recent version or update your Flash plugin. Figure 5 shows 2 maps of the United States from the Centers for Disease Control and Prevention (CDC).[3] The upper map shows the color-coded distributions of age adjusted percentages of adults with obesity across the United States and the lower map shows the same distributions for adults diagnosed with diabetes, for the years 1994, 2000, and 2009.
Data in 2000 stated that there were approximately 5.6 million people in Indonesia who have diabetes.
It causes blood sugar level rises due to deposition of sugar from food that cannot be absorbed properly and burned into energy.


If one or both parents suffer from diabetes, then the child would be at risk of developing diabetes.
The body loses its ability to form insulin because the body's immune system destroys the cells that produce insulin. This creates imperfect metabolism in the body that leads to the improper function of insulin in the body. It is characterized by the dead tissue which turns blackish in color and smells because of the decay by the bacteria. It happens because when the body cannot distribute the sugar into the cells, the body burns its own fat and protein for energy. It happens because type 1 diabetics often wake up at night to urinate so they cannot sleep well. It contains anti-oxidants that help prevent Beta cell damage and improve cell regeneration. Anita Courcoulas and colleagues from Pittsburgh have just published this study in JAMA Surgery. People accept heart surgery for coronary disease much more readily than bariatric surgery for obesity and diabetes. I wonder, however, what happened to those who did not “achieve” remission of DM2? Lots of studies have shown how helpful intensive lifestyle interventions can be for improving the health of people with type 2 diabetes. A study of intensive lifestyle intervention versus standard diabetes education found a remission rate (complete or partial) of 11.5% in a sample that included subjects with BMI>25.
Certainly, obesity has a profound impact on quality of life and effective treatment significantly improves quality of life in people with obesity.
A considerable body of literature has been published on the impact of bariatric surgery on quality of life.
In that study, I was disturbed to see that people with obesity who did NOT have obesity-related disease (problematic in and of itself, given that the conditions the researchers regard as obesity-related diseases also occur in people without obesity. It is absolutely a significant component of overall QoL, but we should take care not to conflate the two. Your comments about stigma, guilt, shame, and dissatisfying healthcare encounters are very important. In the context of health, exercise has effects on bone, muscle, fat, function, mood, cognition and inflammation. The surgical study also defined success as partial or complete remission, so the intensive lifestyle intervention (ILI) study supports my point that the zero percent finding in the surgical study likely due to either the desire for surgery among those randomized to the control group, or the control intervention being sub-optimal. No doubt you know the importance of taking care when comparing across studies in different patient populations.
Bernard Charbonell (University of Nantes, France) discussed new options in diabetes management.
An open-label randomized controlled trial was conducted, which compared add-on exenatide with add-on glimepiride in patients who had failed to achieve glycemic control with metformin alone.
We recognised that there was underlying moderate-severe insulin resistance affecting muscle and the liver, and this, coupled with beta cell failure, formed the classical triumvirate (1). We examined the restoration of first-phase and total insulin response as well as hepatic and peripheral insulin sensitivity. In 2009, this number reached 8 million people and is predicted to increase to more than 21 million people in 2025. So, this type of diabetes is often associated with the damage or impaired function of the pancreas to produce insulin. Surgery, particularly surgery that alters absorption of nutrients, should be used only as a last resort. In this study, they showed that people in the lifestyle group lost almost 6% of body weight and improved their lipid profiles and blood pressure. Sure, the data show they occur more frequently in people with obesity, but obesity is not obligatory for any of these conditions mentioned) reported equal health-related quality of life as people with obesity who did have obesity-related diseases.
As someone with obesity, I am concerned that too great a focus on surgery for obesity conflates health with weight, interacts with societal weight stigma in problematic ways, and will begun to be pushed as a recommendation before other high quality, non-invasive interventions have been offered in good faith.
It’s tough to make any progress in reducing the impact of obesity until we first treat people with respect regardless of their health and size. The ILI study included people down to a BMI of 25 while the surgery study was only people who actually had obesity.
The insulin resistance in muscle primarily was responsible for the excessive postprandially rise in plasma glucose concentration, while insulin resistance in the liver, in combination with accelerated gluconeogenesis, resulted in an excessive rate of hepatic glucose production which led to an increase in the fasting plasma glucose concentration (2-4). Additionally, to examine the mechanistic basis of observed outcomes, we quantified the change in fat content of the pancreas and liver The data are consistent with the hypothesis that the abnormalities of insulin secretion and insulin resistance that underlie type 2 diabetes have a single, common aetiology, i.e. This fact makes Indonesia ranks fourth as the country with the highest number of diabetics in the world.


In type 1 diabetes, the pancreas cannot produce enough insulin because the body's immune system disorders that destroy cell that produce insulin, or due to virus infection so that the insulin hormone in the body is reduced and resulting in accumulation of sugar in the bloodstream.
While the pancreas cannot produce enough insulin to overcome insulin deficiency, the level of blood sugar will rise. While surgery successfully reduces adiposity via energy restriction, it does not address the preservation of muscle and bone mass, both lost through surgery and inactivity. It would be good to compare their zero percent success rate with what is seen in studies where the interventions were all non-surgical.
I suspect stigma from society at large, guilt, shame, and dissatisfying health care encounters play a large role in this.
There may be individuals who have less regenerative potential in the beta cell due to factors other than the effects of excess adipose tissue.
This provides a unified hypothesis to explain a common disease that previously appeared to require separate disease processes affecting the pancreas and insulin-sensitive tissues. It would be unfortunate if the take-away from this study was that lifestyle intervention is completely ineffective.
Facing obesity is a long, hard slog and bariatric surgery is one of the best tools available. If so, why is surgery the answer, rather than something less invasive but with excellent health outcomes such as Health At Every Size? I applaud the work you and your organization do to bring attention to the issue of access to health management for people with obesity.
With all risk factors associated with diabetes, those who exercise have reduced mortality and morbidity. In addition to covering bariatric surgery for those individuals for whom it is truly the best option, all people with obesity should also have access to non-invasive evidence-based treatment approaches. Prior to the onset of spontaneous diabetes in rodents, both total pancreatic fat and islet triacylglycerol content increase sharply. In vitro, chronic saturated fatty acid exposure of beta cells inhibits the acute insulin response to glucose, and removal of fatty acids allows recovery of this response. The present data provide clear evidence that decreasing total pancreatic fat is associated with a return of beta cell function. However, it is probable that the negative effect on beta cell function is exerted by toxic intermediaries such as diacylglycerol and ceramides, which change rapidly in response to acute metabolic changes, rather than by stored triacylglycerol per se, which acts as an index of fatty acid intermediary concentration.
Endless access to abundant calories from carbohydrate may be an evolutionarily novel, and thus pathology-inducing, situation.
And yet everything happens only a certain number of times, and a very small number really Leave a Reply Cancel reply You must be logged in to post a comment.
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