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Video Blog: Test Tubes Illustrate High vs Normal Blood Sugars

>> Sunday, September 26, 2010

In this video blog, Dr Sue shows you two mock test tubes, illustrating what normal blood looks like and how it flows, compared to blood when blood sugar is high. It is important to control blood sugars (keeping levels as close to normal as possible) to prevent or delay the complications of diabetes over time, including damage to the eyes, heart, kidneys, nerves in the feet, and blood vessels throughout the body.

Dr Sue Pedersen © 2010

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Avandia Use Suspended in Europe, Continued in USA

>> Thursday, September 23, 2010

It has been an absolute whirlwind week at the European Association for the Study of Diabetes Meeting in Stockholm, Sweden, and I have many interesting thing to share with my readers over a series of upcoming blogs. The week's biggest news is pretty much uncontested, however, and it regards the future of a commonly used diabetes medication called rosiglitazone, or Avandia.

Both the European Medicines Agency (EMEA) and the American FDA released statements regarding the future of Avandia on September 23, 2010. While the EMEA has suspended the use of Avandia in Europe, the FDA has allowed Avandia use to continue, while restricting access and adding additional safety labeling.

Avandia has been under mounting scrutiny since a meta analysis of data suggested that Avandia use may be associated with an increase risk of cardiovascular events. By controlling blood sugars, one of the major complications of diabetes that we are aiming to PREVENT, of course, is heart disease. While more than one such analysis of data has suggested there may be an increased cardiac risk with Avandia, no 'gold standard' randomized, controlled, clinical trial has proven this to be the case. The RECORD trial, which was a randomized clinical trial, did not demonstrate a significantly increased cardiovascular risk (though this data is subject to several criticisms).

With these analyses in hand, then, regulatory agencies have had a very difficult and controversial decision to make, and it is due to this uncertainty that the EMEA and the FDA have leaned in slightly different directions this week.

The European Medicines Agency concluded that the benefits of rosiglitazone no longer outweigh its potential risks. They indicate that Avandia will no longer be available in Europe in a few months' time, and advise patients to book an appointment with their physician to plan cessation of Avandia and to discuss other suitable medication to treat their diabetes. The suspension will remain in place unless convincing data can be provided to identify a group of patients in whom the benefits of Avandia outweigh their risks.

The FDA, on the other hand, has allowed Avandia use to continue, but has restricted its use to those who cannot control their diabetes on other medications. The FDA will also require a Risk Evaluation and Mitigation Strategy program with additional measures to ensure the safe use of the medicine. This includes a reevaluation of data from the RECORD trial mentioned above.

In addition, the FDA has put the TIDE trial on hold, which was designed to compare Avandia to a drug in the same class called Actos, with regard to effect on cardiovascular outcomes in high risk patients with type 2 diabetes.

For any patients who are taking Avandia and are either affected by it suspension (ie, living in Europe) or unsure of how to proceed, be sure to book in with your doctor to discuss before making any changes.

Dr. Sue Pedersen © 2010

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FDA Advisory Committee Rulings on Obesity Drugs Not Favorable

>> Saturday, September 18, 2010

The FDA has been busy this week, with meetings to discuss the future of two obesity drugs, one of which is currently available, and one of which is in the pre-approval phase. Overall, the future for both looks bleak.

Sibutramine (Meridia) is an obesity drug that works as an appetite suppressant, and has been available in Canada for a decade. It has come under scrunity in the past year following the results of the SCOUT trial, which was a study examining the effects of sibutramine vs placebo in over 10,000 participants who had preexisting heart disease, diabetes, or both. This study, which was published in the New England Journal of Medicine a couple of weeks ago, showed that there was a 16% increase in risk of heart attack and stroke. The increased risk was seen only in patients with known cardiovascular disease; patients with diabetes but no known history of heart disease did not have an increased risk of these events.

In response to these data, which were made available earlier this year, sibutramine was pulled from the market in Europe, but it has remained available in North America. An FDA Advisory Meeting held this week (with Alberta's own Dr Arya Sharma being one of the presenters to the committee) resulted in a 50/50 vote as to whether to recommend that the drug be pulled from the American market. Eight members voted that the drug be removed from the market, while the other 8 voted that it remain on the market with new labelling restrictions.

The following day, the FDA held another advisory meeting, this time to discuss a new obesity medication called lorcaserin. The panel voted 9 to 5 against its approval for use in USA, stating that the modest weight loss seen did not make up for several unanswered questions about its safety.

Thus, the struggle to find effective and safe weight loss medications is still underway. A newer class of injectable medication used to treat type 2 diabetes, called GLP-1 analogs, assist with weight reduction, and are currently in trials for weight loss (though not yet approved for this purpose) in non-diabetics. In September 2010, these seem to be the brightest spot on the horizon.

Dr. Sue Pedersen © 2010

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Inspiration to Exercise!

>> Sunday, September 12, 2010

Although it seems that summer has all too rapidly come to a close in western Canada, race season is still in full swing. I competed in the bike leg of a team triathlon in Banff on Saturday (a personal first), and I spent Sunday as the physician on call for the Dinosaur Valley Half Marathon in Drumheller, AB ( During the weekend, I had the opportunity to observe and be inspired by the athletes, and to think about the variety of ways in which people motivate themselves to exercise and stay active.

One key theme was that people were often found to be competing in groups. At the marathon, I met mothers and daughters, friends, and neighbors who had banded together to train up for race day. Although triathlons are traditionally a solo sport, there were many groups who enrolled as a three person team, with one person assigned to each of the swimming, cycling, and running legs of the race. For myself, it was a great opportunity to enrol as a family and cheer each other on at our respective sports. For all of these groups, the important message that shone through each time was that having the common goal of the race in mind provided an excellent opportunity to support each other through the months of training before the race. It's true - exercise programs are often more successful in a group support setting than when a person tries to go it alone. Consider planning workouts with a group of at least 3 people, such that if one person cancels, the other two can still provide mutual motivation to burn some calories!

Another theme was the sense of accomplishment that arose from participation in these events. At the Dinosaur Valley marathon, I had the great joy of watching contestants of all ages and abilities walk or run anywhere from 5km to a full half marathon (26km). I was equally inspired by every individual who competed, because I knew that each person was challenging themselves personally to accomplish their goal. Aspiring towards a personal best provided sufficient motivation for many an athlete to train towards their goal in the preceding months. I came across a number of athletes this weekend who were going it solo, and felt that the drive to succeed was motivation enough!

One interesting theme I heard time and time again, was that people who were racing were doing it to set a good example for their children. Childhood overweight has become a serious problem, and although there are many contributory factors, a key contributor is the increase in sendentary behavior that has been noted (TV watching, internet, etc). At the Banff Triathlon, there was many a child cheering on their parents as they crossed the finish line. At the marathon, I was thrilled to see whole families running the 5km race together!

These are just a few ideas to consider to increase motivation and adherence to exercise. To all this weekend's competitors - hats off to you!

Dr. Sue Pedersen © 2010

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What We Can Learn from Elephants: The Low Energy Density Diet

>> Saturday, September 4, 2010

On a safari in Kruger National Park, South Africa, last week, I had an amazing experience learning all about the abundant wildlife we encoutered: giraffes, lions, leopards, zebras, wildebeest, hippos, crocs, and the like. One thing that stands out in my mind is the astounding eating capacity of the elephants: they eat a whopping 250 kilograms of food each day!

For an adult male elephant, weighing about 5500 kg, this equates to 1kg of food per 22kg body weight. The weight of food consumed by a human per day will vary substantially depending on what type of food is consumed, but is considerably less, proportional to body weight, compared to what an elephant consumes to maintain body weight.

So - how do the elephants do it?

The secret is in the low energy density of the food that the elephants are consuming; in other words, the caloric content of their food is very low. Elephants are herbivores, meaning that they eat only vegetation: leaves, grass, twigs, roots, bark, and small amounts of fruit, seeds, and flowers. In addition, only about 40% of their ingested food is actually digested; the remaining 60% is excreted in the stool without absorbing the caloric content. In human terms, this would be equivalent to eating a very, VERY high fiber diet - too high for human physiology - but the principle still applies.

The take home message here is that eating larger amounts of Free Veg (vegetables that have minimal calories - green leafy vegetables especially) and aiming for 25-30 grams of daily dietary fiber can decrease the overall energy density of your diet, allowing you to enjoy a more generous amount of food while maintaining a calorie-controlled diet!

Dr. Sue Pedersen © 2010

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I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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