STUDY ROUNDUP

Published in July/August 2015 Issue             


Roux-en-Y Gastric Bypass for Diabetes (the Diabetes Surgery Study): 2-Year Outcomes of a 5-Year, Randomized, Controlled Trial
(The Lancet Diabetes & Endocrinology)


Two-year follow-up data of 120 patients participating in the Diabetes Surgery Study, an ongoing 5-year randomized trial assessing outcomes of diabetes control, showed that gastric bypass coupled with intensive lifestyle intervention and medical management resulted in significantly more patients achieving better control of their Type 2 diabetes than lifestyle intervention and medical management alone (45 patients [75%] vs 14 [24%]). All study participants had poorly controlled Type 2 diabetes for at least 6 months and a BMI between 30 and 39kg/m2.


Urinary Incontinence Before and After Bariatric Surgery (JAMA Internal Medicine)


Results from the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study demonstrate that among both women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over three years. In the study, 1,987 patients with a median BMI of 46 kg/m2 had first-time bariatric surgical procedures between March 14, 2006 and April 24, 2009 and were followed for three years. Urinary incontinence was more prevalent among women (49.3%) than men (21.8%). After a mean 1-year weight loss of 29.5% in women and 27.0% in men, year-one urinary incontinence prevalence dropped among women (18.3%) and men (9.8%). The 3-year prevalence was higher than the one-year prevalence for both sexes, 24.8% among women and 12.2% among men, but was substantially lower than baseline. Weight loss was independently related to urinary incontinence remission per 5% weight loss, as were younger age and the absence of a severe walking limitation.


Three-Year Outcomes of Bariatric Surgery vs. Lifestyle Intervention for Type 2 Diabetes Mellitus (JAMA Surgery)


A randomized clinical trial comparing intensive lifestyle weight loss intervention to bariatric surgery (gastric bypass or gastric banding) for the treatment of Type 2 diabetes showed surgery with two years of an adjunctive low-level lifestyle intervention resulted in more disease remission than did lifestyle intervention alone. Three year follow-up data was assessed in 61 obese participants ages 25 to 55 years. Partial or complete remission was achieved by 40% of RYGB patients, 29% of LAGB patients, and none of the intensive lifestyle weight loss intervention participants. The use of diabetes medications was reduced more in the surgical groups than the lifestyle intervention–alone group, with 65% of RYGB, 33% of LAGB, and none of the intensive lifestyle weight loss intervention participants going from using insulin or oral medication at baseline to no medication at year three. Mean reductions in percentage of body weight at three years were the greatest after RYGB at 25.0%, followed by LAGB at 15.0% and lifestyle treatment at 5.7%.


Prevalence of Overweight and Obesity in the United States, 2007-2012
(JAMA Internal Medicine)


A nationally representative data set from the National Health and Nutrition Examination Survey (NHANES) was used to analyze the U.S. chronic disease burden associated with BMI, updating the prior analysis from 1988 to 1994. The results demonstrated that adult Americans with obesity now outnumber those who are merely overweight. The data included over 15,000 participants from 2007 to 2012, which showed nearly 75% of men and 67% of women are overweight or obese. Data collected from the 1988-1994 study found 63% of men and 55% of women were overweight or obese at that time. Results also showed African Americans have the highest rates of obesity among both men at 39%, and women at 57%, and 7% of black men and 17% of black women were extremely obese.


Reoperative Surgery for Management of Early Complications After Gastric Bypass  (Obesity Surgery)


A retrospective analysis of 52 patients examined outcomes in patients who underwent reoperative surgery within 30 days of laparoscopic gastric bypass (LRYGB). Over a 5-year period, 52 out of 1,769 (2.9 %) patients had reoperations within 30 days. The 30-day reoperative surgery rate was 2.5% for primary and 7.1% for revisional LRYGB. The most common indications for reoperation included bleeding (n = 16), followed by bowel obstruction (n = 14), leak (n = 14), and diagnostic exploration for tachycardia and abdominal pain (n = 4). Forty-nine reoperations were started laparoscopically and six required conversion to laparotomy. The most common sources of bleeding were the mesenteric vessels (n = 6); the most common cause of obstruction was adhesion (n = 5), and the most common site of leak was the gastric pouch and gastrojejunal anastomosis (n = 9). Twenty (38%) patients developed further complications that led to a third surgery in nine (17%) patients. There were no significant differences as far cause for reoperation noted between patients undergoing primary surgery versus revisional surgery. The 90-day readmission and mortality rates were 29 % and zero, respectively.