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WEDNESDAY, June 18 (HealthDay News) -- Weight loss plays a major role in improving diabetes after obese patients have stomach-reduction surgery, say Duke University Medical Center researchers.

Previous studies have suggested that gastric bypass surgery -- which re-routes how food is sent from the stomach to the small intestine -- helps improve diabetes by causing changes in the way hormones are secreted from the gut and pancreas.

But the metabolic effects shouldn't overshadow the importance of losing weight after surgery, the Duke team said.

"Yes, there are physiologic changes related to the restructuring of the gastrointestinal or GI tract that appear to influence the rapid improvement in diabetes following gastric bypass. But our study shows the patients who were able to get off medications completely and go into remission were the ones who lost the most weight," Dr. Eric DeMaria, director of bariatric surgery at Duke University Medical Center, said in prepared statement.

The more weight patients lost, the higher the likelihood of diabetes improvement, DeMaria and colleagues found.

They studied 314 obese diabetic patients who had gastric bypass surgery. Of those patients, 71 had severe diabetes that required insulin therapy because oral medications weren't sufficient to control the disease.

Overall, gastric bypass surgery had a beneficial effect on diabetes. After 12 months, all the patients were able to reduce the dose or number of their diabetes-related medications. Of the 71 patients with severe diabetes, 48 percent achieved remission of their disease.

Losing weight during the first three weeks to six months after gastric bypass surgery was critical for patients who achieved diabetes remission, DeMaria said.

To achieve long-lasting diabetes improvement following weight-loss surgery, "we need to tell patients to pay attention to their weight and to do things that enhance weight loss. That can only be accomplished by changing patient behavior and lifestyle," he said.

The study was expected to be presented Wednesday at a meeting of the American Society for Metabolic and Bariatric Surgery.

More information

The U.S. Centers for Disease Control and Prevention has more about diabetes.

TUESDAY, June 17 (HealthDay News) -- The relationship between diabetes and depression apparently cuts both ways: Not only are people with treated type 2 diabetes at a heightened risk for developing depression, individuals with depression are also at risk for developing diabetes.

The research revelation suggests that both doctors and patients need to be more aware of the dual risks.

"Doctors should have their sensitivity increased toward picking up on the potential for more of their diabetes patients and more of their depression patients having susceptibility to the other disorder," said Dr. Stuart Weiss, assistant clinical professor of medicine at New York University School of Medicine.

Type 2 diabetes and clinical depression tend to go hand in hand, the study authors said, although the question has been, which comes first?

"There have been studies that show people with diabetes are twice as likely to have symptoms of depression as those who don't, and it could either be because depression itself leads to the development of type 2 diabetes or it could be that having diabetes leads to the development of depression," said study lead author Dr. Sherita Hill Golden, an associate professor of medicine and epidemiology at Johns Hopkins University School of Medicine.

"There are several studies showing that depression and depressive symptoms lead to the development of type 2 diabetes, but only a couple of studies showing that diabetes itself leads to depression. We wanted to look to see whether or not we could tease out the chicken-and-egg situation," she said.

Previous studies have also found that treating depression can help extend the lives of people with diabetes.

The authors of the new study performed two analyses, both using information from participants in the Multi-Ethnic Study of Atherosclerosis trial.

The first analysis involved 5,201 individuals without type 2 diabetes at the start of the trail and found that treated type 2 diabetes was associated with a 54 percent increased risk of developing depressive symptoms over 3.2 years. Persons with untreated diabetes were not at risk of developing depression.

Interestingly, people with pre-diabetes or untreated diabetes were about 25 percent less likely to develop depressive symptoms than people with normal fasting blood sugar levels, the researchers said.

"That was a little bit of a surprise," Golden said. The study authors aren't sure why this was so, but suggest that maybe the monitoring associated with treating diabetes might contribute to depression.

The second analysis included 4,847 participants and found that elevated depressive symptoms were associated with a 42 percent greater likelihood of developing diabetes during the follow-up period. The stronger the depressive symptoms, the higher the chance of developing diabetes. After adjusting for such factors as being overweight, not exercising and smoking, the risk of developing diabetes was still 34 percent higher in patients with depression.

"Those with depression are more likely to consume more calories, be less physically active and are more likely to smoke, so they just have poor overall health behaviors in general," Golden said. "That seems to be one component of treating depression that needs to be addressed."

The findings, published in the June 18 issue of the Journal of the American Medical Association, indicate that integration of care may be helpful to these patients, Golden said.

"For people who are being treated for symptoms of depression, it's important also to think about some treatment modalities that can also help them adopt healthy behaviors," she said. "And certainly among people who have treated diabetes and who are at risk of developing depression, we need to be aware of that increased risk."

Golden serves on the Merck & Co.'s clinical diabetes advisory board; the study was supported by the U.S. National Institutes of Health.

More information

Visit the American Diabetes Association   for more on type 2 diabetes and depression.

SATURDAY, June 7 (HealthDay News) -- People with type 2 diabetes can help control the disease by taking better care of their teeth and gums.

That's the case dentists were expected to make at the American Diabetes Association's annual meeting in San Francisco this weekend.

"Several recent studies have shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control, and puts them at much greater risk of end-stage kidney disease and death," George W. Taylor, an associate professor of dentistry at the University of Michigan schools of Dentistry and Public Health, said in a prepared statement. "Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," he said.

Intensive periodontitis intervention, for example, can significantly lower one's levels of A1C, a measure of long-term glucose control.

"We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C," dentist Maria E. Ryan, director of clinical research at the Stony Brook University School of Dental Medicine in New York, said in a prepared statement.

Periodontal, or gum, disease is an infection and chronic inflammatory disease of the tissues surrounding and supporting the teeth. As it is painless, most people don't know they have it, yet it is a major cause of tooth loss in adults.

Among the studies to be discussed linking gum disease and diabetes are:

• A 1988-1994 U.S. population data study that found having periodontal disease put a person at twice the risk of having insulin resistance as those without such disease.
• An unpublished Stony Brook University study of people displaying pre-diabetic insulin resistance that links the severity of a periodontal disease with their degree of insulin resistance. "We think periodontitis may adversely affect glycemic control, because the pro-inflammatory chemicals produced by the infection -- such as IL-1 beta, IL-6 and TNF-alpha -- could transfer from the gum tissue into the bloodstream and stimulate cells to become resistant to insulin," Taylor said. "Then insulin resistance prevents cells in the body from removing glucose from the bloodstream for energy production."
• A set of studies of the Pima Indians in the Southwest, a population with a very high rate of type 2 diabetes. One found those with periodontitis were more than four times as likely to develop worsened glycemic control; another showed that those with severe gum disease had more than triple the risk of dying from diabetic nephropathy or ischemic heart disease than those with less severe periodontal disease.
• A study, funded by the National Institutes of Health, that found a "statistically significant reduction" in A1C levels in people with type 2 diabetes after 15 months after routine periodontal treatment, Taylor said.

"When glycemia has been difficult to control, the physician might consider asking patients when they last saw their dentist, whether periodontitis has been diagnosed and, if so, whether treatment has been completed," Ryan said. "A consultation with the dentist may be appropriate, to discuss whether periodontal treatment has been successful or whether a more intensive approach with oral or sub-antimicrobial antibiotics is in order because, just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums."

More information

The American Academy of Periodontology has more about gum disease  .