Published in April Issue             

Final Stampede Results: Glycemic Beneftis of Bariatric Surgery Persist Over Time
(Cleveland Clinic)

In the final, five-year follow-up report from the STAMPEDE trial, Cleveland Clinic research shows that bariatric surgery’s beneficial effects on blood glucose control in mild and moderately obese patients with type 2 diabetes may persist for up to five years, with the advantage over diabetes medications-only approach widening over time. The five-year follow-up also reported that:

  • Over 88% of gastric bypass and sleeve gastrectomy patients maintained healthy blood glucose levels without the use of insulin
  • 29% of gastric bypass patients and 23 percent of sleeve gastrectomy patients achieved and maintained normal blood glucose levels, compared to just 5 percent of those on medication alone
  • Weight loss was significantly greater with gastric bypass and sleeve gastrectomy than medications and was primary driver for glucose control

The effects of both surgical procedures to normalize glucose levels did however diminish overtime and some late complications were noted with surgery. The study results were presented at the American College of Cardiology’s 65th Annual Scientific Session.

Worldwide Trends in Diabetes since 1980: A Pooled Analysis of 751 Population-based Studies with 4·4 million Participants (The Lancet)

Since 1980, age-standardized diabetes prevalence in adults has increased, or at best remained unchanged, in every country. This rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Data was pooled from population-based studies that had collected data through measurement of diabetes biomarkers. Data was used from 751 studies including nearly 4.4 million adults from 146 countries. Global prevalence increased from 4.3% in 1980 to 9% in 2014 in men, and from 5% to 7.9% in women. The number of adults with diabetes globally increased from 108 million in 1980 to 422 in 2014.

Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity (JAMA)

Researchers used the Longitudinal Assessment of Bariatric Surgery-2, an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported. Of 2458 participants, 2221 completed baseline and follow-up assessments. 70.4% had RYGB; 25.0% had LAGB. At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not. Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3.

Effect of Sibling Birth on BMI Trajectory in the First 6 Years of Life (Pediatrics)

Study examines longitudinal association between birth of a sibling and changes in BMIz score trajectory during the first six years of life. Across 1- sites in U.S., 697 children were recruited at time of birth. Children whose sibling was born when they were 24 to 36 months or 36 to 54 months old, compared with children who did not experience the birth of a sibling by first grade, had a lower subsequent BMIz trajectory and a significantly lower BMIz at first grade (0.27 vs 0.51, P value = 0.04 and 0.26 vs 0.51, P value = 0.03, respectively). Children who did not experience the birth of a sibling by the time they were in first grade had 2.94 greater odds of obesity (P value = 0.046) at first grade compared with children who experienced the birth of a sibling when they were between 36 to 54 months old.

Gastric bypass Surgery vs. Intensive Lifestyle and Medical intervention for Type 2 Diabetes: the CROSSROADS Randomized Controlled Trial (Diabetologia)

Study screened 1,808 adults meeting inclusion criteria (age 25–64, with type 2 diabetes and a BMI 30–45 kg/m2). Of these, 43 were allocated via concealed, computer-generated random assignment in a 1:1 ratio to RYGB or ILMI. The latter involved >=45 min of aerobic exercise 5 days per week, a dietitian-directed weight- and glucose-lowering diet, and optimal diabetes medical treatment for 1 year. The primary outcome was diabetes remission at 1 year (HbA1c < 6.0% [< 42.1 mmol/mol], off all diabetes medicines). Compared with the most rigorous ILMI yet tested against surgery in a randomized trial, RYGB yielded greater type 2 diabetes remission in mild-to-moderately obese patients recruited from a well-informed, population-based sample.