S.O.S.

The concept that type 2 diabetes mellitus (T2DM) can be reversed with an intestinal operation is counterintuitive. How could our costliest disease be forced into full, durable, and safe remission with the bypass of a few inches of intestine? Counterintuitive or not, it’s true. Accordingly, we take notice when Sjöström and colleagues (1) in the Swedish Obese Subjects (SOS) study, the longest and most complete bariatric surgery outcome study in the world, document in this issue that bariatric surgery reduces the incidence of heart attacks. The SOS is a prospective, nonrandomized, controlled interventional trial on the effect of bariatric surgery on mortality and morbidity compared with conventional treatment that enrolled 4,047 obese individuals from 1 September 1987 to 31 January 2001. Of these, 2,010 underwent bariatric surgery, and a contemporary matched group of 2,037 did not. The current report compared the 345 diabetic patients who underwent bariatric surgery with the 262 who did not. The authors found that “bariatric surgery was associated with a reduced myocardial infarction incidence� (38/345 [11.0%] in the surgery vs. control group 43/262 [16.4%] [P = 0.017]). The effect was stronger in individuals with higher serum cholesterol and triglycerides at baseline. Not surprising, since the bariatric surgery was associated with significant decreases in body weight, blood glucose, serum triglycerides, systolic and diastolic blood pressure, and an increase in HDL-cholesterol

Hair radioactivity as a measure of exposure to radioisotopes

Since many radioisotopes accumulate in hair, this tropism was investigated by comparing the radioactivity of shaved with plucked hair collected from rats at various time intervals up to 24 hrs after intravenous injection of the ecologically important radioisotopes, iodine-131, manganese-54, strontium-85, and zinc-65. The plucked hair includes the hair follicles where biochemical transformations are taking place. The data indicate a slight surge of each radioisotpe into the hair immediately after injection, a variation of content of each radionuclide in the hair, and a greater accumulation of radioactivity in plucked than in shaved hair. These results have application not only to hair as a measure of exposure to radioisotopes, but also to tissue damage and repair at the hair follicle

Outcomes of Roux-en-Y gastric bypass surgery for severely obese patients with type 1 diabetes: a case series report

Roux-en-Y gastric bypass surgery (RYGB) reverses type 2 diabetes (DM2) in approximately 83% of patients with morbid or severe obesity. This procedure has been performed in small numbers of severely obese patients with type 1 diabetes (DM1), but the impact on glycemic control and insulin requirement in this population has not been widely described. We report three patients with DM1 and severe obesity that underwent RYGB. Weight, glycemic control, and insulin requirements before and one year after the procedure were compared. Significant weight loss was achieved by all three patients but insulin requirements decreased in only 2 patients. In contrast, glycemic control (A1C) remained suboptimal in all three patients up to one year after the surgery. These findings suggest that RYGB leads to important weight loss and positively affects insulin sensitivity. However, reaching optimal glycemic control in patients with DM1 diabetes remains challenging due to persisting insulin deficiency