Published in April 2014 Issue             

Changes in Diabetes-Related Complications in the United States, 1990–2010

A new study published April 17 in The New England Journal of Medicine found that while diabetes is becoming increasingly common in the United States, the risks of diabetic complications have fallen since 1990. Better preventive care for adults with diabetes contributed to a 68% drop in their risk of heart attacks and a 64% drop in deaths from high blood sugar. The risks of strokes and lower-limb amputations both fell by about one half and there was a 28% drop in cases of severe kidney disease. The study was funded by the Centers for Disease Control and Prevention (CDC).

The Effectiveness and Risks of Bariatric Surgery An Updated Systematic Review and Meta-analysis, 2003-2012

An updated meta-analysis showed bariatric surgery provides “substantial and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patient.” The findings were published in the March edition of JAMA Surgery. The systematic review and meta-analysis included 164 studies with a combined population of 161,756 patients. In randomized clinical trials, the mortality rate within 30 days was 0.08%; the mortality rate after 30 days was 0.31%. BMI loss at five years was 12 to 17. The complication rate was 17% and the reoperation rate was 7%. Gastric bypass was more effective in weight loss but associated with more complications. Adjustable gastric banding had lower mortality and complication rates but the reoperation rate was higher and weight loss was less substantial than gastric bypass. Sleeve gastrectomy appeared to be more effective in weight loss than adjustable gastric banding and comparable with gastric bypass. Researchers reported the mortality rate was lower than previous meta-analyses.

Long-term Outcomes of Laparoscopic Sleeve Gastrectomy as a Primary
Bariatric Procedure

According to a study published online in SOARD (April 16), laparoscopic sleeve gastrectomy as a primary procedure is a reliable surgery with positive long-term results of excess weight loss and resolution of co-morbid conditions. Researchers from the Clinical Hospital in Chile conducted a retrospective analysis of 161 patients who had surgery between 2005-2007 (70% of patients completed follow up at five years). The median preoperative BMI was 34.9 kg/m2. After five years, the median BMI and %EWL was 28.5 kg/m2 and 62.9% respectively. The resolution of dyslipidemia and insulin resistance was also found (80.7% and 84.7% respectively). At five years, 26.7% of patients reported new-onset GERD symptoms. Researchers reported patients in their series with a preoperative BMI < 40 kg/m2 experienced the best results.

Influence of Median Surgeon Operative Duration on Adverse Outcomes in
Bariatric Surgery

A study published online in SOARD (March 31) found the median surgeon operative duration was independently associated with adjusted rates of certain adverse outcomes after laparoscopic gastric bypass and that improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery. Researchers reviewed the data of 16,344 laparoscopic Roux-en-Y gastric bypass patients who had the procedure from 2006 to 2012. Surgeons categorized as slow took 53 additional minutes to complete the surgery, compared to faster surgeons [median (Interquartile range) 139 (133-150) vs.
86 (69-91), p<0.001].