June 11, 2009 (EurekAlert) - In teenagers, laparoscopic gastric banding surgery for treatment of extreme obesity can significantly improve and even reverse the metabolic syndrome, a new study found. The results were presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.An increasing number of obese adolescents have the metabolic syndrome, said a study co-author, Ilene Fennoy, MD, MPH, a pediatric endocrinologist at New York City's Columbia University Medical Center.

The metabolic syndrome is a cluster of metabolic risk factors that increase the chance of later developing diabetes and cardiovascular disease. Weight loss can reduce the risk factors that are part of the syndrome: abdominal obesity as shown by a large waist circumference (waistline), low HDL ("good") cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood sugar.

"Few treatments, however, have succeeded in achieving major weight loss or greatly improving adolescents' medical complications of obesity-until now," Fennoy said.

In the new study, 24 morbidly obese teens between the ages of 14 and 17 years underwent laparoscopic gastric banding, also called the "Lap-Band" procedure. This minimally invasive weight loss surgery uses a band that can repeatedly be adjusted to make the stomach smaller.

Six months after the operation, patients had a statistically significant decrease in their body mass index (BMI, a measure of body fat) as well as their waist circumference and blood levels of C-reactive protein, a measure of inflammation that is linked to increased risk of cardiovascular disease. These improvements continued to 1 year in the 12 patients whose follow-up was that long.

Other features of the metabolic syndrome improved rapidly in the first 6 months and continued to a year, but with "less dramatic" changes, the authors reported in their abstract.

Five patients with 12-month follow-up met the criteria for a diagnosis of the metabolic syndrome before surgery. Only two still had this diagnosis a year later, a decrease in prevalence from 41.7 to 16.7 percent.

"Laparoscopic gastric banding surgery may be a useful intervention for morbidly obese teenagers to decrease the risk of early development of cardiovascular disease and other illnesses related to obesity," Fennoy said.

Currently approved for use only in adults, the Lap-Band procedure is being studied in teenagers under age 18. Long-term studies are needed to confirm that this procedure effectively improves the metabolic syndrome in adolescents, Fennoy said.

June 11, 2009 (EurekAlert) - Researchers have discovered a reason why smoking greatly increases the risk of heart disease and stroke. Nicotine promotes insulin resistance, also called prediabetes, which is a risk factor for cardiovascular disease, according to the new study, which was presented at The Endocrine Society's 91st Annual Meeting in Washington, D.C.Additionally, the study authors were able to partially reverse this harmful effect of nicotine in mice by treating them with the nicotine antagonist mecamylamine, a drug that blunts the action of nicotine.

The study, which the National Institutes of Health funded, was conducted by researchers at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona, Calif.

Their results may explain why cigarette smokers have a high cardiovascular death rate, even though "smoking causes weight loss, which should protect against heart disease," said the study's lead author, Theodore Friedman, MD, PhD, chief of the endocrinology division at Charles Drew University.

Prediabetes and diabetes are known risk factors for cardiovascular disease. Past studies show that cigarette smokers tend to be insulin resistant, meaning that their hormone insulin does not work properly. To compensate, their blood glucose (sugar) levels become higher than normal but not yet high enough for diabetes. Smokers also have higher rates of diabetes, but it is not clear whether smoking is the cause, because they could have other risk factors, Friedman explained.

Some studies demonstrate that nicotine and cigarette smoking induce high levels of the stress hormone cortisol. "As cortisol excess is known to induce insulin resistance, it has been suggested that glucocorticoids, such as cortisol, are the missing [causative] link between cigarette smoking and insulin resistance," Friedman said.

The new study results suggest this theory is correct, he said. The researchers studied the effects, on 24 adult mice, of twice-daily injections of nicotine for 2 weeks. The mice ate less food than control mice that received injections without nicotine, and they also lost weight and had less fat. Despite this, the mice receiving nicotine developed prediabetes (insulin resistance), which subsequent mecamylamine treatment improved somewhat. These mice also had high cortisol levels in their blood and tissues, and mecamylamine blocked this effect.

"Our results suggest that reducing tissue glucocorticoid levels or decreasing insulin resistance may reduce the heart disease seen in smokers," Friedman said. "We anticipate that in the future there will be drugs to specifically block the effect of nicotine on glucocorticoids and insulin resistance."

Currently available nicotine antagonists are not specific enough to completely block nicotine's effects or they have bothersome side effects, so better drugs are needed for this purpose, he said.

March 4, 2009 (Newswire) - Not only do teens with type 1 diabetes have the normal adolescent concerns of school, work and social activities, but they are responsible for taking insulin, monitoring blood glucose (blood sugar) levels and keeping doctor visits, too. Now, a new study suggests that feelings such as anger or sadness could interfere with teens' diabetes management."Adolescence is a difficult time to manage diabetes, for multiple reasons: some of them are physiological, like puberty; some are psychological, such as increasing autonomy. Also, there's a rise during adolescence of negative emotions," said Cynthia Berg, Ph.D., chairperson of the psychology department at the University of Utah in Salt Lake City.

Berg, a study co-author, and colleagues had 62 adolescents with type 1 diabetes complete daily diaries for two weeks, detailing their mood, average blood glucose levels, overall confidence in their ability to manage their diabetes and ability to manage daily diabetes tasks, such as eating healthy foods and taking insulin.

The findings appear in the latest issue of the Annals of Behavioral Medicine.

During the two-week study period, when teens reported more positive feelings, such as happiness or excitement, they tended to have lower - nearer normal - blood glucose levels. In contrast, when teens reported negative feelings, daily diary entries revealed a tendency toward higher blood glucose levels.

Researchers measured positive and negative emotions on a one- to five-point scale. "The important issue is that for every one-point change in emotion, there is a rather sizeable change in blood glucose," Berg said.

Ann Goebel-Fabbri, Ph.D., a psychologist at Joslin Diabetes Center in Boston, cautioned that the act of entering the blood glucose number in journals might cloud teens' moods. As a result, "they may feel negatively or positively charged from that result," she said.

"The take-home message for health care providers, parents and teens is that both emotions can potentially influence their confidence in blood sugar management," Goebel-Fabbri said. "At the same time, it can go in the opposite direction - the actual outcomes can also influence their emotions. It's a bidirectional relationship."

Fortenberry KT, et al. Perceived diabetes task competence mediates the relationship of both negative and positive affect with blood glucose in adolescents with type 1 diabetes. Annals of Behavioral Medicine 31(1), 2009.

March 3, 2009 (EurekAlert) - The study, published in the Journal of Clinical Endocrinology & Metabolism, was led by Jill P. Crandall, M.D., associate professor of clinical medicine and director of the Diabetes Clinical Trials Unit at Einstein.Diabetes becomes increasingly common with age. An estimated 37 million Americans over the age of 65 have diabetes, almost one-quarter of that population. Another 20 to 30 percent of seniors, an estimated 7.5 to 11.1 million, are not clinically diabetic but have impaired glucose tolerance, which is considered a form of "pre-diabetes."

"In most cases, this mild form of high blood glucose causes no symptoms and is often overlooked by both doctors and patients, but studies have shown that it may be associated with increased risk of heart disease," says Dr. Crandall. "The purpose of this study was to explore the cardiovascular risk profile of older adults with pre-diabetes."

The study looked at 58 older adults with an average age of 71, half with normal glucose tolerance and half with post-challenge hyperglycemia (PCH). PCH is characterized by a temporary spike in blood glucose levels that occurs immediately after a meal. Various measures were taken before and after study participants consumed a standard high carbohydrate meal.

The researchers found that the adults with PCH not only had higher glucose and insulin levels after the meal, but also higher levels of triglycerides (a type of blood fat considered an independent risk factor for cardiovascular disease). They also had higher levels of a protein that promotes blood clotting, and more inflammation of blood vessels, compared to controls. In addition, a test of blood vessel function after the meal showed impairment only in the PCH group. Studies show that increases in each of these measures raise one's risk for heart disease.

Routine glucose screening of the elderly, using the standard oral glucose tolerance test (OGTT), could be used to identify these high-risk individuals, the researchers note. The OGTT measures the body's ability to use glucose, the body's main source of energy. The test begins with a measure of one's fasting blood glucose level, providing a baseline for comparing other glucose values. The patient then drinks a sweet liquid containing a specific amount of glucose. Blood samples are collected at several intervals over the next two or three hours.

Despite the results of this study, it has not been established whether treatment aimed at reducing mild hyperglycemia will lower their risk for heart disease. "Consequently, other interventions designed to reduce the risk of cardiovascular disease, including the use of statins and aspirin, should be strongly considered for older adults with PCH," says Dr. Crandall.