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Obesity has long been linked to type 2 diabetes, but many patients have trouble sustaining long-term weight loss with conventional methods. A recent Australian study has shown that bariatric surgery using the BioEnterics LAP-BAND System offers new hope for morbidly obese patients with type 2 diabetes.
In a study of 50 obese diabetic patients, 64% had remission of their diabetes 1 year after surgery, and 26% had major improvement. Patients also experienced improvements in blood pressure, cholesterol, sleep patterns, depression, and overall quality of life.
All the patients had tried unsuccessfully to lose weight for at least 5 years. Before the surgery, their average weight was 300 pounds. A year later, their average weight was 242 pounds, and they continued to lose weight after the study. The study was reported in the February 2002 issue of Diabetes Care. A recent study in Clinical Diabetes states that lap-band surgery requires no stapling, cutting, or opening of the stomach; is reversible; and allows tailoring of the system based on patient's needs.
The surgical procedure, which involves placing a gastric band to limit food entering the stomach, was approved in the United States in June 2001 but isn't widely used here. In Australia, however, it's the most common surgical weight-loss method in use. It's safe for patients with latex allergies because no latex is used in the system or accessories.
The FDA has approved EstroGel (estradiol gel) to treat moderate to severe vasomotor symptoms and menopause-associated vulvar and vaginal atrophy. A clear, odorless, hydroalcoholic gel, it's been available in Europe for 25 years.
EstroGel is applied once a day on one arm, from wrist to shoulder, to ensure that the woman receives a consistent and continuous estrogen dose. This delivery method avoids first-pass metabolism in the liver and minimizes skin irritation. The daily dose of EstroGel is 1.25 grams, which delivers 0.75 milligrams of estradiol.
According to the Women's Health Initiative study, using unopposed estrogens in postmenopausal women who haven't had hysterectomies increases their risk of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, deep vein thrombosis, and endometrial cancer. Studies were done with oral conjugated estrogens and medroxyprogesterone acetate; other drugs and combinations of estrogens and progestins weren't studied but the risks should be assumed to be similar. Estrogens should be prescribed for the shortest time and lowest dose possible to meet the needs of the women being treated.
Estrogen shouldn't be used by women who are pregnant or suspect they may be, or for those with breast cancer, active thrombophlebitis, or thromboembolic disorders. See the package insert for complete information.
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