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Original Article
A Clinical Trial to Maintain Glycemic Control in Youth with Type 2 Diabetes
Increases in childhood obesity have been accompanied by an increased incidence of type 2 diabetes in youth. Because the risk of microvascular and macrovascular complications in adults increases with both the duration of diabetes and lack of glycemic control,, it is imperative to achieve and sustain…
- April 29, 2012
- TODAY Study Group
- 10.1056/NEJMoa1109333
- Free Full Text
Increases in childhood obesity have been accompanied by an increased incidence of type 2 diabetes in youth.¹,² Because the risk of microvascular and macrovascular complications in adults increases with both the duration of diabetes and lack of glycemic ...
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Editorial
TODAY — A Stark Glimpse of Tomorrow
Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined with conflicts between individual freedom and…
- April 29, 2012
- Allen D.B.
- 10.1056/NEJMe1204710
- Free Full Text
Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined ...
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Editorial
Surgery or Medical Therapy for Obese Patients with Type 2 Diabetes?
Type 2 diabetes is one of the fastest growing epidemics in human history and is closely associated with obesity. Furthermore, the disease has multiple manifestations and is associated with progressive beta-cell failure. Although lifestyle measures, including weight loss and physical activity,…
- April 26, 2012
- Zimmet P. and Alberti K.G.M.M.
- N Engl J Med 2012; 366:1635-1636
Type 2 diabetes is one of the fastest growing epidemics in human history and is closely associated with obesity.¹ Furthermore, the disease has multiple manifestations and is associated with progressive beta-cell failure.² Although lifestyle measures, ...
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Original Article
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
The growing incidence of obesity and type 2 diabetes mellitus globally is widely recognized as one of the most challenging contemporary threats to public health. Uncontrolled diabetes leads to macrovascular and microvascular complications, including myocardial infarction, stroke, blindness,…
- April 26, 2012
- Schauer P.R., Kashyap S.R., Wolski K., et al.
- N Engl J Med 2012; 366:1567-1576
- CME
In this randomized, controlled study of obese patients with type 2 diabetes, those who received medical therapy plus bariatric surgery had significantly better glycemic control at 12 months than did those who received medical therapy alone.
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Original Article
Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes
The prevalence of type 2 diabetes mellitus is rapidly increasing worldwide, in parallel with the current obesity epidemic. In 2010, the global prevalence of type 2 diabetes was estimated at 8.3% of the adult population, a proportion that is projected to increase to 9.9% by 2030. As many as 23% of…
- April 26, 2012
- Mingrone G., Panunzi S., De Gaetano A., et al.
- N Engl J Med 2012; 366:1577-1585
In this study involving severely obese patients with type 2 diabetes, Roux-en-Y gastric bypass and biliopancreatic diversion achieved better glucose control than conventional medical therapy as assessed at 2 years.
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Clinical Practice
Glycemic Management of Type 2 Diabetes Mellitus
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 39-year-old…
- April 5, 2012
- Ismail-Beigi F.
- N Engl J Med 2012; 366:1319-1327
- CME
- Full Text Audio
This article provides a framework for establishing glycemic targets for patients with type 2 diabetes, taking into account both psychosocial and clinical factors, and discusses strategies to achieve the targets. First-line treatments and additional therapies are discussed.
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Original Article
Lifestyle Change and Mobility in Obese Adults with Type 2 Diabetes
The growing prevalence of type 2 diabetes mellitus is an ominous health threat in the United States, and globally. Surveillance data from the Centers for Disease Control and Prevention cite type 2 diabetes as largely a disease of aging, and its prevalence may escalate as the population gets older.…
- March 29, 2012
- Rejeski W.J., Ip E.H., Bertoni A.G., et al.
- N Engl J Med 2012; 366:1209-1217
This trial investigated whether an intensive lifestyle intervention to produce weight loss and increased fitness would slow loss of mobility among obese patients with type 2 diabetes. Both weight loss and improved fitness were associated with a decline in the rate of mobility loss.
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Editorial
Obesity Treatment in Primary Care — Are We There Yet?
The U.S. Preventive Services Task Force recommends that clinicians arrange for their obese patients to receive intensive, multicomponent behavioral weight-loss counseling. However, less than 50% of primary care physicians (PCPs) report that they consistently provide diet and weight-control advice…
- November 24, 2011
- Yanovski S.Z.
- N Engl J Med 2011; 365:2030-2031
The U.S. Preventive Services Task Force recommends that clinicians arrange for their obese patients to receive intensive, multicomponent behavioral weight-loss counseling.¹ However, less than 50% of primary care physicians (PCPs) report that they ...
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Original Article
A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice
Investigators are searching for new approaches to the treatment of obesity during routine medical visits.– Trials in which primary care providers (PCPs) offer counseling about diet and activity (i.e. lifestyle counseling) have led to weight loss of 2.5 kg or less over study periods ranging from 6…
- November 24, 2011
- Wadden T.A., Volger S., Sarwer D.B., et al.
- N Engl J Med 2011; 365:1969-1979
- Free Full Text
This trial compared three weight-loss interventions (usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling) in primary care practice. Enhanced brief lifestyle counseling was most effective, resulting in significant weight loss in about one third of patients.
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Original Article
Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice
Obesity is an important and growing public health problem around the world. In the United States, approximately one third of adults are obese. Obesity adversely affects each of the major cardiovascular risk factors — blood pressure, lipid profile, and diabetes. As a consequence, obese persons…
- November 24, 2011
- Appel L.J., Clark J.M., Yeh H.-C., et al.
- N Engl J Med 2011; 365:1959-1968
- Free Full Text
- CME
This trial showed that two types of behavioral interventions, one based on remote, call-center support and the other on in-person support, resulted in significant weight loss among obese patients. These results provide templates for effective weight-loss programs in primary care practices.
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Original Article
Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors
During the past three decades, the prevalences of overweight and obesity in the pediatric population have increased substantially. Childhood obesity is a predictor of an increased rate of death, owing primarily to an increased risk of cardiovascular disease.– Forecasts suggest that the "obesity…
- November 17, 2011
- Juonala M., Magnussen C.G., Berenson G.S., et al.
- N Engl J Med 2011; 365:1876-1885
- Free Full Text
- CME
In four prospective cohort studies, obese adults who were overweight or obese in childhood had increased rates of cardiovascular risk factors. Those who were overweight or obese as children but not as adults had risks similar to the risks among those who were never obese.
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Editorial
Childhood Obesity and Coronary Heart Disease
Obesity is the most common nutritional problem among children in both developed and underdeveloped countries. Despite efforts over the past decade to prevent and control obesity, data from the 2003–2006 National Health and Nutrition Examination Surveys (NHANES) show that 16.3% of children and…
- November 17, 2011
- Rocchini A.P.
- N Engl J Med 2011; 365:1927-1929
Obesity is the most common nutritional problem among children in both developed and underdeveloped countries. Despite efforts over the past decade to prevent and control obesity, data from the 2003–2006 National Health and Nutrition Examination Surveys (...
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Review Article
Mechanisms of Disease: The Human Plasma Lipidome
Cholesterol and triglyceride levels are now assessed routinely, and physicians regularly prescribe lipid-lowering drugs to patients found to have dyslipidemia. However, the increase in the number of patients with metabolic diseases (including type 2 diabetes and obesity, which are associated with…
- November 10, 2011
- Quehenberger O. and Dennis E.A.
- N Engl J Med 2011; 365:1812-1823
Biochemical analyses reveal that plasma contains over 600 structural forms of lipid molecules. This review summarizes known correlations between levels of lipid moieties and disease and describes potential therapeutic targets relevant to CVD, cancer, and neurologic disease.
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Original Article
Long-Term Persistence of Hormonal Adaptations to Weight Loss
Worldwide, there are more than 1.5 billion overweight adults, including 400 million who are obese. Although dietary restriction often results in initial weight loss, the majority of obese dieters fail to maintain their reduced weight. Understanding the barriers to maintenance of weight loss is…
- October 27, 2011
- Sumithran P., Prendergast L.A., Delbridge E., et al.
- N Engl J Med 2011; 365:1597-1604
- Free Full Text
In this study, the levels of circulating mediators of appetite that change after weight loss and promote weight regain did not revert to the values recorded before weight loss. Long-term strategies to counteract these changes may be needed to prevent obesity relapse.
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Special Article
Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment
Many observational studies have shown that neighborhood attributes such as poverty and racial segregation are associated with increased risks of obesity and diabetes, even after adjustment for observed individual and family-related factors.– In response, the U.S. surgeon general has called for…
- October 20, 2011
- Ludwig J., Sanbonmatsu L., Gennetian L., et al.
- N Engl J Med 2011; 365:1509-1519
- Free Full Text
- CME
In this study, women with children were enabled to move from poor neighborhoods to neighborhoods with lower poverty rates. The moves were associated with modest but potentially important reductions in the prevalence of extreme obesity and diabetes.
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Case Records of the Massachusetts General Hospital
Case 32-2011 — A 19-Year-Old Man with Recurrent Pancreatitis
Presentation of Case. Dr. Christopher J. Moran (Pediatric Gastroenterology): A 19-year-old man was admitted to this hospital because of recurrent pancreatitis. The patient had been well until approximately 6 months earlier, when lethargy and epigastric pain developed, associated with a dry throat,…
- October 20, 2011
- Shah U. and Shenoy-Bhangle A.S.
- N Engl J Med 2011; 365:1528-1536
A 19-year-old man was admitted to this hospital because of recurrent pancreatitis, associated with alcohol use, beginning 6 months earlier. On examination, he was obese and had upper abdominal tenderness. Imaging studies showed normal pancreatobiliary anatomy.
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Perspective
Bariatric Surgery in Adolescents
In this electronic age, we have become increasingly sedentary, while food, much of it prepackaged and of high nutrient density, is available in abundance. That overweight and obesity rates have reached epidemic proportions among children and adolescents in industrialized society is no longer news,…
- October 13, 2011
- Ingelfinger J.R.
- N Engl J Med 2011; 365:1365-1367
Is the possibility that a minimally invasive surgical procedure might cure a child's obesity and its complications an appealing solution? Or does a surgical approach to this complex problem constitute a misguided application of technology to a societal disorder?
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Original Article
General and Abdominal Obesity and Risk of Death among Black Women
The prevalence of overall and abdominal obesity has increased rapidly in the United States, with the greatest increases reported among black women. By 2020, overall obesity (body-mass index [BMI, the weight in kilograms divided by the square of the height in meters] ≥30.0) and abdominal obesity…
- September 8, 2011
- Boggs D.A., Rosenberg L., Cozier Y.C., et al.
- N Engl J Med 2011; 365:901-908
- Free Full Text
This study assessed the relation of BMI and waist circumference to the risk of death among black women participating in the Black Women's Health Study. The risk of death from any cause increased with increasing BMI above 25.0, a pattern similar to that observed in whites.
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Perspective
Front-of-Package Nutrition Labeling — An Abuse of Trust by the Food Industry?
On January 24, 2011, two major food-industry trade associations, the Grocery Manufacturers of America (GMA) and the Food Marketing Institute, announced a new and voluntary nutrition-labeling system that major food and beverage companies would use on the front of packages to "help busy consumers…
- June 23, 2011
- Brownell K.D. and Koplan J.P.
- N Engl J Med 2011; 364:2373-2375
- Free Full Text
On January 24, two food-industry trade associations announced a new voluntary nutrition-labeling system that major food and beverage companies would use on the front of packages to “help busy consumers make informed choices.” But is the program good for public health?
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Original Article
Adolescent BMI Trajectory and Risk of Diabetes versus Coronary Disease
Although obesity in adulthood is a well-documented risk factor for both type 2 diabetes and coronary heart disease, it remains unclear whether a longer history of relative overweight, starting earlier in life, poses an additional risk. Furthermore, whereas the trajectory of weight and height from…
- April 7, 2011
- Tirosh A., Shai I., Afek A., et al.
- N Engl J Med 2011; 364:1315-1325
- Free Full Text
- CME
This study followed healthy young men, with repeated measures of height and weight over a mean of 17.4 years. Elevated BMI in adolescence, even within the normal range, was found to be a substantial risk factor for later obesity-related disorders, including type 2 diabetes and CHD.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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