MD Conference Express ADA 2011 - (Page 32)

n O T H E R N E W S rHuPH20, increases the absorption and dispersion of injected drugs. The Phase 3 Linjeta trial [NCT01067118] failed to meet criteria for noninferiority versus a comparator, and optimal temperature, timing, duration of the warming period, and the effect on infusion set age have yet to be determined for the warming device used in the study. Each of the new approaches has shown positive results, based on pharmacokinetic and pharmacodynamic studies. However, each has its own issues regarding safety and practicality, and none has been shown to have enhanced clinical efficacy for open-loop therapy. Nevertheless, the future potential of several of these approaches in providing insulin absorption and action profiles that more closely simulate that of the normal β-cell is quite promising and complement research that is directed at the development of closed-loop insulin delivery systems. 1.97 mg/dL; p<0.001) and triglycerides (-25.56 vs -19.75 mg/dL; p<0.001) [Look AHEAD Research Group et al. Arch Intern Med 2010]. Reductions in low-density lipoprotein cholesterol were greater in DSE than ILI participants (-12.84 vs -11.27 mg/dL; p=0.009), due to greater use of lipid-lowering medications in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, HbA1C levels, systolic blood pressure, and high-density lipoprotein cholesterol levels [Look AHEAD Research Group et al. Arch Intern Med 2010]. Pediatric Weight Loss Surgery: Is It Time? Written by Rita Buckley The LOOK Ahead Trial: Four-Year Outcomes of an Intensive Lifestyle Intervention in Type 2 Diabetes Written by Lori Alexander The primary objective of The Action for Health in Diabetes (Look AHEAD) Trial is to examine the long-term effects of an intensive lifestyle intervention (ILI) that is designed to achieve and maintain weight loss by decreasing caloric intake and increasing physical activity in overweight or obese volunteers with type 2 diabetes. Participants in this program will be compared with controls who are involved in diabetes support and education (DSE, usual care). A multicenter, randomized, controlled trial on the long-term (13.5 years) effects of ILI on cardiovascular morbidity and mortality (ie, the incidence of cardiovascular disease [CVD], death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization) in this population.The study includes 5145 participants and is planned through June 30, 2015. Xavier Pi-Sunyer, MD, St. Luke’s Roosevelt Hospital Columbia University, New York, New York, USA, described the study design in detail, as well as key results over 4 years [Look AHEAD Research Group et al. Diabetes Care 2007; Look AHEAD Research Group et al. Arch Intern Med 2010]. Averaged across 48 months, ILI participants had a greater percentage of weight loss than DSE participants (-6.15% vs -0.88%; p<0.001) and greater improvements in treadmill fitness (12.74% vs 1.96%; p<0.001), HbA1C level (-0.36% vs -0.09%; p<0.01), systolic (-5.33 vs -2.97 mm Hg; p<0.001) and diastolic (-2.92 vs -2.48 mm Hg; p=0.1) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 32 August 2011 Over the past 20 years, the rate of obesity or overweightedness (>95th percentile for age and gender) has doubled among children and tripled among adolescents, affecting more than 5 million of them in the United States alone [O’Brien PE et al. JAMA 2010]. This increase has been accompanied by a dramatic rise is obesity-related health complications, including illnesses that threaten life expectancy in the absence of significant weight loss [Sarwer DB, Dilks RJ. J Youth Adolescence 2011]. To date, there are no medical therapies that provide significant and durable weight loss [Barnett SJ. Curr Opin Pediatr 2011]. Paul O’Brien, MD, Monash University, Melbourne, Australia, discussed weight loss surgery in the pediatric population. The central question that he addressed was: “Is it time?” His answer was a definitive yes. In fact, he believes it is overdue. Prof. O’Brien discussed the variety of procedures that are available—including the laparoscopic adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch. Based on invasiveness, risk, complexity, and problems, he rated them on a scale of 1 to 10, with gastric banding a 5.0 (Table 1; Figure 1). According to Prof. O’Brien, the gastric band increases satiety and is a safe, effective, gentle, and cost-effective option that improves quality of life. In a recent study that compared the gastric band with an optimal lifestyle intervention, he and his colleagues found that 84% of obese adolescents in the surgery group and 12% in the lifestyle group lost >50% of excess weight, corrected for age. At entry, 36% of participants in the surgery group and 40% in the lifestyle group had metabolic syndrome. At 24 www.mdconferencexpress.com  http://www.mdconferencexpress.com http://www.mdconferencexpress.com

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