Sustained remission of diabetes and other obesity-related conditions found a decade after weight loss surgery

Study finds that type 2 diabetes patients treated with GLP-1RAs who lowered their BMI also reduced their cardiovascular risk

A study published in the New England Journal of Medicine found that ten years after undergoing bariatric surgery during their teenage years, more than half of the participants maintained significant weight loss. Additionally, many of these individuals showed improvements in obesity-related conditions, including type 2 diabetes, high blood pressure, and high cholesterol.

“Our study demonstrates remarkable results from the longest follow-up of weight loss surgery during adolescence, confirming that bariatric surgery is a safe and effective long-term strategy for managing obesity,” stated lead author Justin Ryder, PhD. He is the Vice Chair of Research in the Department of Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and an Associate Professor of Surgery and Pediatrics at Northwestern University Feinberg School of Medicine.

Bariatric surgery is significantly under-utilized in the U.S., with only one out of every 2,500 teens with severe obesity undergoing the procedure. Based on existing recommendations, nearly five million adolescents qualify for effective weight loss interventions, such as bariatric surgery.

Hillary Fisher, now 31 years old, is glad she decided to undergo surgery at the age of 16. She was one of 260 adolescents who participated in the long-term Teen-LABS study.

“I felt overwhelmed by the daily struggles I faced due to my weight, health issues, and bullying in high school,” Ms. Fisher said. “After several unsuccessful attempts to lose weight, I weighed 260 pounds, and we decided that bariatric surgery was the solution. It changed my life; the improved health and self-esteem that came with losing 100 pounds were significant for me, and I would absolutely do it again.”

Notably, the study found that 55 per cent of the participants who had type 2 diabetes as teenagers and underwent surgery were still in remission of their diabetes at 10 years. 

“This is considerably better than the outcomes reported in people who underwent bariatric surgery as adults, a major reason why treating obesity seriously in adolescents is so important,” added Dr. Ryder. 

Indeed, a recent multi-centre randomized controlled trial found diabetes type 2 remission in adults to be 12-18 per cent at seven to 12 years after bariatric surgery.

Enhancing the accuracy of wearables that measure blood glucose levels

Diabetes is an increasingly pervasive disease, currently affecting over 500 million adults worldwide. Since there is as yet no cure for type 1 or type 2 diabetes, patients must regularly monitor their BGLs to keep them in check. Though BGL-measuring devices relying on painful finger pricks have been the gold standard for decades, modern technology is slowly opening doors to better alternatives.
Many researchers have proposed noninvasive methods to monitor BGLs using widely available wearable devices, such as smartwatches. For example, by placing the LEDs and photodetectors present in certain smartwatches against the skin, oxyhemoglobin and hemoglobin pulse signals can be measured to calculate a metabolic index, from which BGLs can be estimated. However, given the small size and limited power of smartwatches and similar wearables, the data quality of the measured signals tends to be quite low. Moreover, as these devices are worn on extremities, daily movements introduce measurement errors. These problems limit the accuracy and clinical applicability of such wearables for diabetes management.
A team from Hamamatsu Photonics K.K., Japan, has been actively researching this issue, looking for effective solutions. In a recent study led by Research and Development Engineer Tomoya Nakazawa, published in the Journal of Biomedical Optics (JBO), they conducted an in-depth theoretical analysis of the sources of errors in the metabolic-index-based method. Based on this analysis, they implemented a novel signal quality index to filter out low-quality data as a preprocessing step and thereby enhance the accuracy of estimated BGLs.
“As smartwatches are widely adopted across different regions and age groups, and with the global rise in diabetes cases, a signal quality enhancing method that is easy to implement and apply regardless of personal and individual differences is absolutely essential for meeting the increasing worldwide demand for noninvasive glucose monitoring devices,” remarks Nakazawa, explaining the motivation behind the study.
First, the researchers mathematically showed that discrepancy between the two types of phase delays in the oxyhemoglobin and hemoglobin pulse signal calculated by different methods provides a good measure of the influence of noise. They then considered two main sources of phase error, namely, a background noise level and the estimation errors introduced via sampling at discrete intervals. After formalizing these sources of errors, they calculated the effect on the estimated metabolic index.
The proposed screening approach involves implementing thresholds for the phase estimation and metabolic index errors. Data chunks that exceed the set thresholds are discarded, and the missing values are approximated using other means based on the rest of the data.
To test this strategy, the researchers conducted a long-term experiment in which the sensors in a commercial smartwatch were used to monitor the BGLs of a healthy individual during “oral challenges.” In each of the 30 tests conducted over four months, the subject would fast for two hours before consuming high-glucose foods. Their BGLs were measured using the smartwatch and a commercial continuous glucose monitoring sensor, the latter of which was used to capture the reference values.
Notably, preprocessing the data with the proposed screening method led to a notable increase in accuracy. Using the Parkes error grid technique to categorize measurement errors, a substantially higher percentage of data points ended up in Zone A when screening was applied. This refers to clinically accurate values that would lead to correct treatment decisions. “Adopting the screening process improved BGL estimation accuracy in our smartwatch-based prototype,” remarks Nakazawa, “Our technique could facilitate the integration of wearable and continuous BGL monitoring into devices such as smartwatches and smart rings, which are typically constrained in terms of size and signal quality,” he adds, highlighting the impact of the research work.
The research team also noted some of the current limitations of smartwatches that lead to inferior performance compared to smartphone camera-based techniques. Though the proposed method could certainly help enhance the performance of the former, hardware improvements in the photodetector and amplifier circuits could go a long way to make wearable electronics a more attractive and clinically acceptable option to monitor BGLs.

Diabetes is a growing global issue, currently affecting over 500 million adults. As there is still no cure for either type 1 or type 2 diabetes, patients need to regularly monitor their blood glucose levels (BGLs) to manage their condition. While traditional BGL-measuring devices that require painful finger pricks have been the standard for many years, modern technology is beginning to offer better alternatives.

Many researchers have proposed noninvasive methods to monitor blood glucose levels (BGLs) using commonly available wearable devices, such as smartwatches. For instance, by positioning the LEDs and photodetectors found in certain smartwatches against the skin, it is possible to measure the pulse signals of oxyhemoglobin and haemoglobin. This data can then be used to calculate a metabolic index, which can help estimate BGLs. However, due to the small size and limited power of these smartwatches and similar wearables, the quality of the measured signals is often low. Additionally, daily movements can introduce measurement errors because these devices are typically worn on the extremities. These issues hinder the accuracy and clinical applicability of wearables for managing diabetes.

A team from Hamamatsu Photonics K.K. in Japan has been actively researching solutions to a pressing issue. In a recent study led by Research and Development Engineer Tomoya Nakazawa and published in the Journal of Biomedical Optics (JBO), they conducted a thorough theoretical analysis of the errors associated with the metabolic index-based method. Based on their findings, they developed a novel signal quality index to filter out low-quality data as a preprocessing step, which enhances the accuracy of estimated blood glucose levels (BGLs).

“As smartwatches are widely adopted across different regions and age groups, and with the global rise in diabetes cases, a signal quality enhancing method that is easy to implement and apply regardless of personal and individual differences is essential for meeting the increasing worldwide demand for noninvasive glucose monitoring devices,” remarks Nakazawa, explaining the motivation behind the study.

First, the researchers mathematically showed that the discrepancy between the two types of phase delays in the oxyhemoglobin and haemoglobin pulse signal calculated by different methods provides a good measure of the influence of noise. They then considered two primary sources of phase error: a background noise level and the estimation errors introduced via sampling at discrete intervals. After formalizing these sources of errors, they calculated the effect on the estimated metabolic index.

The proposed screening approach involves implementing thresholds for the phase estimation and metabolic index errors. Data chunks that exceed the set thresholds are discarded, and the missing values are approximated using other means based on the rest of the data.

To test this strategy, the researchers conducted a long-term experiment in which the sensors in a commercial smartwatch were used to monitor the BGLs of a healthy individual during “oral challenges.” In each of the 30 tests conducted over four months, the subject would fast for two hours before consuming high-glucose foods. Their BGLs were measured using the smartwatch and a commercial continuous glucose monitoring sensor, which was used to capture the reference values.

Notably, preprocessing the data with the proposed screening method led to a notable increase in accuracy. Using the Parkes error grid technique to categorize measurement errors, a substantially higher percentage of data points ended up in Zone A when screening was applied. This refers to clinically accurate values that would lead to correct treatment decisions. “Adopting the screening process improved BGL estimation accuracy in our smartwatch-based prototype,” remarks Nakazawa, “Our technique could facilitate the integration of wearable and continuous BGL monitoring into devices such as smartwatches and smart rings, which are typically constrained in terms of size and signal quality,” he adds, highlighting the impact of the research work.

The research team also noted some of the current limitations of smartwatches that lead to inferior performance compared to smartphone camera-based techniques. Though the proposed method could certainly help enhance the former’s performance, hardware improvements in the photodetector and amplifier circuits could go a long way toward making wearable electronics a more attractive and clinically acceptable option for monitoring BGLs.

Understanding how mutations affect diseases such as diabetes

Natália Ružičková Institute of Science and Technology Austria

PhD student Natália Ružičková

Many statistical models and algorithms scientists use can be imagined as a “black box.” These powerful models give accurate predictions, but their internal workings are not easily understood. In an era dominated by deep learning, where an ever-increasing amount of data can be processed, Natália Ružičková, a physicist and PhD student at the Institute of Science and Technology Austria (ISTA), chose to take a step back at least in the context of genomic data analysis.

Ružičková, along with recent ISTA graduate Michal Hledík and Professor Gašper Tkačik, has proposed a model to analyze polygenic diseases—conditions where multiple regions of the genome contribute to dysfunction. This model also aids in understanding the role of these identified genomic regions in developing these diseases. Their research provides valuable findings by integrating advanced genome analysis with fundamental biological insights. The results have been published in the Proceedings of the National Academy of Sciences (PNAS).

Decoding the human genome

In 1990, the Human Genome Project was launched to decode human DNA fully—the genetic blueprint that defines humanity. By 2003, the project was completed, leading to numerous scientific, medical, and technological breakthroughs. By deciphering the human genetic code, scientists aimed to learn more about diseases linked to specific mutations and variations in this genetic map. The human genome comprises approximately 20,000 genes and even more base pairs, which are the letters of the blueprint. This complexity made ample statistical power essential, resulting in the development of “genome-wide association studies” (GWAS).

GWAS approach the issue by identifying genetic variants potentially linked to organismal traits such as height. Notably, they also include the propensity for various diseases. The underlying statistical principle is relatively straightforward: participants are divided into two groups—healthy and sick individuals. Their DNA is then analyzed to detect variations—changes in their genome—that are more prominent in those affected by the disease.  

An interplay of genes

When genome-wide association studies emerged, scientists expected to find just a few mutations in known genes linked to a disease that would explain the difference between healthy and sick individuals. The truth, however, is much more complicated. “Sometimes, hundreds or thousands of mutations are linked to a specific disease,” says Miss Ružičková. “It was a surprising revelation and conflicted with our understanding of biology.”

Each individual mutation contributes only minimally to the risk of developing a disease. However, when combined, these mutations can provide a better—though not complete—understanding of why some individuals develop the disease. Such diseases are known as “polygenic.” For instance, type 2 diabetes is considered polygenic because it cannot be attributed to a single gene; rather, it involves hundreds of mutations. Some of these mutations influence insulin production, insulin action, or glucose metabolism, while many others are found in genomic regions that have not been previously linked to diabetes or have unknown biological functions.

The omnigenic model

In 2017, Evan A. Boyle and colleagues from Stanford University proposed a new conceptual framework called the “omnigenic model.” They proposed an explanation for why so many genes contribute to diseases: cells possess regulatory networks that link genes with diverse functions.

“Since genes are interconnected, a mutation in one gene can impact others, as the mutational effect spreads through the regulatory network,” Ružičková explains. Due to these networks, many genes in the regulatory system contribute to a disease. However, until now, this model has not been formulated mathematically and has remained a conceptual hypothesis that was difficult to test. In their latest paper, Ružičková and her colleagues introduce a new mathematical formalization based on the omnigenic model named the “quantitative omnigenic model” (QOM).

Combining statistics and biology

To demonstrate the new model’s potential, they needed to apply the framework to a well-characterized biological system. They chose the typical lab yeast model Saccharomyces cerevisiae, better known as the brewer’s yeast or the baker’s yeast. It is a single-cell eukaryote, meaning its cell structure is similar to that of complex organisms such as humans. “In yeast, we have a fairly good understanding of how regulatory networks that interconnect genes are structured,” Miss Ružičková says.

Using their model, the scientists predicted gene expression levels—the intensity of gene activity, indicating how much information from the DNA is actively utilized—and how mutations spread through the yeast’s regulatory network. The predictions were highly efficient: The model identified the relevant genes and could clearly pinpoint which mutation most likely contributed to a specific outcome.

The puzzle pieces of polygenic diseases

The scientists’ goal was not to outdo the standard GWAS in prediction performance but rather to go in a different direction by making the model interpretable. Whereas a standard GWAS model works as a “black box,” offering a statistical account of how frequently a particular mutation is linked to a disease, the new model also provides a chain-of-events causal mechanism for how that mutation may lead to disease.

In medicine, understanding the biological context and such causal pathways has huge implications for finding new therapeutic options. Although the model is far from any medical application, it shows potential, especially for learning more about polygenic diseases. “If you have enough knowledge about the regulatory networks, you could also build similar models for other organisms. We looked at the gene expression in yeast, which is just the first step and proof of principle. Now that we understand what is possible, one can start thinking about applications to human genetics,” says Miss Ružičková.

People with type 2 diabetes who eat low-carb may be able to discontinue medication

Study finds low-carbohydrate diet may improve beta-cell function in people with type 2 diabetes
The study finds that a low-carbohydrate diet may improve beta-cell function in people with type 2 diabetes.

Adults with type 2 diabetes on a low-carbohydrate diet may see benefits to their beta-cell function, allowing them to manage their disease better and possibly discontinue medication, according to new research published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.


Beta-cells are endocrine cells in the pancreas that produce and release insulin, the hormone that controls blood sugar levels.

More than 38 million Americans have diabetes, and over 90% of them have type 2 diabetes. Type 2 diabetes most often develops in people 45 or older, but more and more children, teens and young adults are also developing the disease.

People with type 2 diabetes have a compromised beta-cell response to blood sugar, possibly due in part to eating too many carbohydrates. Beta-cell failure or insufficiency on top of insulin resistance is responsible for the development and progression of type 2 diabetes.


“This study shows people with type 2 diabetes on a low-carbohydrate diet can recover their beta-cells, an outcome that cannot be achieved with medication,” said lead study author Barbara Gower, PhD, of the University of Alabama at Birmingham in Birmingham, Ala. “People with mild type 2 diabetes who reduce their carbohydrate intake may be able to discontinue medication and enjoy eating meals and snacks that are higher in protein and meet their energy needs.”

The researchers gathered data from 57 white and Black adults with type 2 diabetes, half on a low-carbohydrate diet and the other half on a high-carbohydrate diet. They examined their beta-cell function and insulin secretion at baseline and after 12 weeks.

All of the participants’ meals were provided. People on the carbohydrate-restricted diet ate 9% carbohydrates and 65% fat, and participants on the high-carbohydrate diet ate 55% carbohydrates and 20% fat.

The researchers found that those on a low-carbohydrate versus a high-carbohydrate diet saw improvements in the acute and maximal beta-cell responses, which were 2-fold and 22% greater, respectively. Within each race group, Black adults on a low-carbohydrate diet saw 110% greater improvements in the acute beta-cell response and White adults had improvements in the maximal beta-cell response that was 48% greater than their respective counterparts on the high-carbohydrate diet.

“Further research is needed to determine if a low-carbohydrate diet can restore beta-cell function and lead to remission in people with type 2 diabetes,” Gower said.

Ultra-processed foods pose huge dangers for people with diabetes

Researchers found ultra-processed foods, even diet ones, bring distinct risks for people with diabetes.
Researchers found that ultra-processed foods, even diet ones, bring distinct risks for people with diabetes.

A team of researchers in nutritional sciences, kinesiology, and health education at the University of Texas at Austin has found that eating more ultra-processed foods—from diet sodas to packaged crackers to certain cereals and yoghurts—is closely linked with higher blood sugar levels in people with Type 2 diabetes.

In a recent paper published in the Journal of the Academy of Nutrition and Dietetics, the team describes how, more than just the presence of sugar and salt in the diet, consuming more ultra-processed foods loaded with additives can lead to higher average blood glucose levels over several months, as measured by HbA1C.

“We wanted to understand the impact of different types of foods on blood sugar control in people with Type 2 diabetes,” said Marissa Burgermaster, assistant professor of nutritional sciences at UT and the senior author of the study. “Our findings showed that individuals who consumed more ultra-processed foods had poorer blood sugar control, while those who included more minimally processed or unprocessed foods in their diet had better control.”

The researchers examined the diet recalls and scored them against three widely used indexes that look at the overall quality or nutrition in a person’s diet. Still, those tools were not associated with blood glucose control. Instead, how many grams of ultra-processed food the participants ate or drank was linked to worse control, and a correspondingly better control occurred in participants who ate more whole foods or foods and drinks with minimal processing.

Recent studies have indicated that eating more ultra-processed foods is linked to higher rates of cardiovascular disease, obesity, sleep disorders, anxiety, depression and early death. Ultra-processed foods are typically higher in added sugars and sodium. Still, the researchers concluded that the A1C increases were not about merely added sugar and sodium, or they would have correlated with the tools that measure overall nutritional quality in the diet. Synthetic flavours, added colours, emulsifiers, artificial sweeteners and other artificial ingredients may be in part to blame, hypothesized Erin Hudson, a graduate student author of the paper, and this would suggest that dietary guidelines may need to begin to place more emphasis on ultra-processed foods.