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Anchor lead: In people with type 2 diabetes, bariatric surgery can help people avoid heart attacks and strokes, Elizabeth Tracey reports

Type 2 diabetes is associated with an increased risk for heart attacks and strokes, as well as other complications like kidney or eye problems. Now a new study shows that for those people with the condition who have bariatric surgery and achieve significant weight loss, benefits in risk reduction are seen. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: Those patients who have bariatric surgery and have weight loss, those patients had a decreased incidence of developing heart disease and stroke. To have a procedure that can impact their trajectory of those complications is phenomenal. It should be noted that bariatric surgery is not for everyone, that there are long term complications particularly with vitamin deficiencies but for those who benefit from it it’s tremendously exciting.  :28

Kalyani says those with a body mass index over 30 who also have diabetes should talk with their physician if they’re considering bariatric surgery. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is fasting a good strategy for people with type 2 diabetes? Elizabeth Tracey reports

It’s a good bet that people with diabetes would rather not take insulin, and now a new report may give them hope. In this very small study of three patients with longstanding type 2 diabetes, a regimen of intermittent fasting resulted in both weight loss and the ability to stop insulin. Rita Kalyani, a diabetes expert at Johns Hopkins, says such a strategy must be approached carefully.

Kalyani: We recommend that patients with diabetes really follow an individualized multinutritional plan. When people are on medications for type 2 diabetes we really rely on them having a relatively unchanged diet from day to day, and when there is fasting intermixed with that usually that’s  when in patients who are already taking diabetes medication it puts them at risk for hypoglycemia and other side effects. It really has to be a discussion between the patient and physician whether this something they would like to try, and then a discussion about how the medication regimen might need to be modified.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can fasting help people with type 2 diabetes get off insulin? Elizabeth Tracey reports

Three people with type 2 diabetes who were taking insulin to manage their condition were able to eliminate it with a regimen of fasting, a recent study reported. Rita Kalyani, a diabetes expert at Johns Hopkins, describes the intervention.

Kalyani: In this report of three patients with type 2 diabetes who all were on insulin and oral agents, their clinicians prescribed a treatment of therapeutic fasting. And interestingly what they found was in these three patients who had alternate days of fasting, where they had one meal and followed a low carbohydrate diet, these patients had tremendous weight loss, 10 to 15 % weight loss, after a month, and all of them were able to get off insulin.  :29

Kalyani says she was surprised by this result as once people have been taking oral medications and insulin for some time their ability to make their own insulin wanes. She cautions that this is a regimen that requires medical oversight, so don’t try it on your own. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a community peer help people avoid hospitalization? Elizabeth Tracey reports

Do you know what a community health worker is? This is someone from the neighborhood who helps a person with chronic illness manage their social issues, such as coordinating their medical care, with a recent study showing their intervention reduced hospitalizations by 65%. Jeremy Greene, a social medicine expert and physician at Johns Hopkins, comments.

Greene: Part of the social science perspective in health sciences is seeing resources where often times we see lack. And moving from a space of thinking fatalistically to thinking well, what are the resources people have in their lives, my neighbor can actually be mobilized in meaningful ways to make a difference in their own lives as well as on a population basis.  :20

Since they are from the same neighborhood, community health workers have a deep understanding of the issues people may be confronting and are ideally positioned to help. Greene says its estimated that 70% of someone’s health outcomes are due to social determinants. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new series puts the social aspects of health front and center, Elizabeth Tracey reports

What are social determinants of health? A new series in the New England Journal of Medicine examines how things like education, neighborhoods, income and other factors influence someone’s health outcomes. Jeremy Greene, a physician at Johns Hopkins and one of the series founders, explains why it’s important to doctors.

Greene: The social basis of medicine is inextricable from practice. It is at the heart of medicine but we don’t do as good a job in formal medical education at providing tools. That’s why I think that this case series is a very nice recognition of that and a way of developing new teaching modalities to help students call attention to why this is actually important, really at the beginning of the medical career and we also hope these cases will be useful to physicians in practice.  :27

Greene says the temptation for both providers and patients is to think only biological mechanisms matter, but social determinants are a major factor. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Would you consider a clinical trial for your cancer care? Elizabeth Tracey reports

Only about 3% of people with cancer enroll in a clinical trial for care, with a recent large study attempting to assess people’s attitudes and beliefs regarding such trials. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: Ninety percent of the respondents thought that clinical trials were likely safe, the 10% that didn’t were really worried about adverse events associated with a new drug or a new treatment. Forty-five percent rarely considered clinical research as an option for their treatment. But as you drilled down on the folks that participated in clinical trials 93.4% said they’d participate again. The major criticism of those people was the burdensome aspect of multiple visits and the bureaucracy of having to participate in the trials.  :33

Nelson notes that clinical trials are widely available around the country and are likely to provide very comprehensive care. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Using several strategies helps people reduce the likelihood they will develop delirium while in the ICU, Elizabeth Tracey reports

Pain must be managed in those who are critically ill, a bundle of strategies called A-F for patient care in the ICU acknowledges. Dale Needham, a critical care expert and pioneer in early mobilization of patients at Johns Hopkins, says when a constellation of methods is employed, pain can be held at bay without sedation.

Needham: Where now we’ve got a patient that’s not in pain, that’s not sedated, is not delirious, and we can begin to have them engage in meaningful activity. And I always say the head bone is connected to the body bone.  When we manage sedation and delirium and have more clear thinking for our patients, then they’re able to engage in rehabilitation much more easily. There are also randomized controlled trials showing us that when patients get physical rehabilitation their duration of delirium decreases.  :32

Needham says avoidance of long term compromise because of an ICU stay is the desired outcome. At Johns Hopkins, I’m Elizabeth Tracey.

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