IN-FLAM-MA-TION...

From whotalking.com

This might take you back.

Or date me...

Remember that Electric Company song about "-tion"?  That's when TV was exciting, even though we in our family were limited to just an hour a day. We usually chose wisely.

That's what my mind went to when I heard a recent CME Audio Digest talk on the Metabolic Syndrome.

The reason why is that the speaker, Bariatric Surgeon Dr. Sayeed Ikramuddin from the Cleveland Clinic Florida, stated that the basis of the Metabolic Syndrome and all of its associated end-organ havoc is secondary to inflammation.  Interesting concept.

Here's the breakdown, and the punchline comes in when we discuss what happens to inflammatory markers, and disease processes, after Bariatric Surgery and the associated rapid weight loss that is expected.

Metabolic Syndrome has as its hallmark insulin resistance, usually thought of as an extension of Type 2 DM.  It is heralded by increased glucose production, with elevated fasting BGs, and relatively insufficient Beta-cell secretion of insulin.  Adipose tissue, liver and muscle tissue are all effected, and as they are effected, they further impair insulin signaling and insulin sensitivity, furthering the metabolic derangement.  Inflammation increases overall via cytokines, M-1 pro-inflammatory cells, and can be measured clinically by C Reactive Protein, and Tumor Necrosing Factor (TNF).

Completing the inflammatory syndrome is central obesity, elevated serum triglycerides, and HTN.

Studies have shown that with the relatively quick reduction in adipose (inflammatory) tissue after Bariatric Surgery, TNF decreased as  measured at 3, 6, and 12 mos post op.  This reduction in inflammation, was also evident in the other paramaters in the metabolic syndrome, that is reduced LDL, Glucose, and Free Fatty Acids.

So, now the quality measures in Diabetes...the ever-elusive goals / composite measures as put out by the ADA:  

           *LDL <100
           *Glycohemoglobin <7
           *Sysytolic BP <130

Again, Dr. Ikramuddin gave a study that demonstrated a 5% to 39% success rate in getting patients to goal in a study at his institution after successful Bariatric Surgery.  And, he contrasted that with the national averages of getting Diabetic patients to those goals: 7%.

He closed by saying that the disease process of Metabolic Syndrome and insulin resistance will take care of itself if we do not. The diminished fertility rate alone, let alone the increased mortality of the syndrome, will become self-selecting.

Sobering thought... Season's Greetings...