STUDY ROUNDUP

Published in June 2014 Issue             


Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications


The Swedish Obese Subjects (SOS) study reports long-term diabetes remission rates after bariatric surgery in the June 11 edition of The Journal of the American Medical Association (JAMA). Outcomes were reported on 343 patients who had nonadjustable banding (n = 61), vertical banded gastroplasty (n = 227), or gastric bypass (n = 55) and “usual obesity and diabetes care” was provided to the control group between September 1987 to January 2001. The study showed that after two years, 72.3% of surgery patients experienced remission compared to 16.4% of non-surgery patients. After 15 years, diabetes was still in remission for 30.4% of patients who had bariatric surgery and 6.5% in the control group. Additionally, 20 years after surgery, about 25 patients in the surgical group remained free of diabetes complications including eye and kidney problems. It was noted that patients who had diabetes for less than one year had the best long-term results.


Surgical vs. Medical Treatments for Type 2 Diabetes Mellitus A Randomized
Clinical Trial


Gastric bypass surgery was the most effective treatment for type 2 diabetes, according to results from a 12-month, three-arm, single center randomized clinical trial published in JAMA Surgery (June 4). The 69-patient study was done to determine feasibility of conducting a larger randomized clinical trial. University of Pittsburgh Medical Center researchers found gastric bypass patients had either partial (50%) or complete resolution (17%) of type 2 diabetes after one year and had 27% mean weight loss. Gastric band patients had mean weight loss of 17.3% and partial (27%) or complete remission (23%) of diabetes. No remission was seen in the lifestyle intervention group. The authors noted the results are preliminary and highlighted several potential challenges to successful completion of a larger trial, including difficulties associated with recruiting and randomizing patients.


Roux-en-Y Gastric Bypass Surgery or Lifestyle With Intensive Medical Management in Patients With Type 2 Diabetes Feasibility and 1-Year Results of a Randomized Clinical Trial


Another randomized study was published in JAMA Surgery (June 4) on the impact of gastric bypass or medical management on type 2 diabetes. The study showed gastric bypass patients had greater weight loss and sustained improvements in HbA1c and cardiometabolic risk factors when compared to medical management. Additionally, while both treatments improved general quality-of life measures, surgery provided greater improvement in the effect of weight on quality of life. Brigham and Women’s Hospital researchers reviewed the outcomes of 38 patients with obesity or severe obesity and type 2 diabetes. Fifty-eight percent of gastric bypass patients saw their type 2 diabetes go into remission within a year of the procedure, compared to 16% in the medical management group. Weight, waist circumference, blood pressure and blood cholesterol levels also improved after surgery, with “emergent differences” seen over one year when compared to the medical management group. The study was done to test the feasibility of methods to conduct a larger
multisite trial.


Matched Weight Loss Induced by Sleeve Gastrectomy or Gastric Bypass Similarly Improves Metabolic Function in Obese Subjects


A study of 14 non-diabetic insulin-resistant patients found Roux-en-Y gastric bypass and sleeve gastrectomy surgery resulted in similar improvements in regulating plasma glucose homeostasis, insulin sensitivity and cell function when patients were matched on weight loss. Both surgeries demonstrated comparable results in the metabolic response to meal ingestion. The study was published online in Obesity on May 28.


Obese Patients Have More Postop Problems


A new study presented at the American Academy of Physician Assistants annual meeting found patients suffering from severe obesity may experience more problems after elective hip replacement surgery than individuals with lower BMIs. Patients who had a BMI of 40 or more experienced more blood loss, longer time in surgery and more wound infections. Researchers reviewed the data of 464 patients who had hip replacement surgery at Staten Island University Hospital from January 2010 to November 2013.


Predictors of Hospital Stay Following Laparoscopic Gastric Bypass Surgery: Analysis of 9,593 Patients from the National Surgical Quality
Improvement Program


A study published online in SOARD (May 26) found length of hospital stay may be predicted prior to surgery by using certain patient characteristics and operative details. Researchers reviewed all laparoscopic gastric bypass operations reported to the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) in 2011. For the 9,593 procedures reported, the median length of stay was two days. Twenty-six percent of patients required more than three days of hospitalization. A longer hospital stay was associated with diabetes, chronic obstructive pulmonary disease, bleeding diathesis, renal insufficiency, hypoalbuminemia, prolonged operating time and a resident’s involvement with the procedure. The patient’s age, sex, BMI and other co-morbid conditions were not predictors in longer hospitalization. The study authors noted the data might be helpful in identifying which patients may not be appropriate for “fast-track protocols” aimed at reducing hospitalization to contain costs.


Incidence of Cancer Following Bariatric Surgery: Systematic Review and
Meta-Analysis


A systematic review of 13 studies with 54,257 participants showed bariatric surgery was associated with reducing the incidence of cancer in patients with severe obesity. Cancer rates in people with obesity are as high as two per 1,000 person-years. In their review, researchers from the Universidade Federal do Sul in Brazil found that 23 years following bariatric surgery cancer occurred in 1.06 cases per 1,000 person-years, which is nearly that of people with normal weight. The findings were published in the May edition of Obesity Surgery.


Gastric Band Is First Step Surgery for Morbidly Obese Teens


Teens who underwent laparoscopic adjustable gastric banding lost an average of 69% of their excess weight after three years, in what French researchers call one of the longest-term studies to date in this patient population. Researchers from Lille University Hospital also reported that metabolic syndrome and cardiovascular-risk profiles improved. After the second year, weight loss appeared to stabilized (mean BMI at two years was 34 compared with 33.7 at 3 years). One death was reported due to an abdominal hemorrhage. The findings of the 35-patient review were presented at the 2014 European Congress on Obesity.


Adolescent Laparoscopic Adjustable Gastric Banding (LAGB): Prospective Results in 137 Patients Followed for 3 Years


According to a study published online in SOARD (June 9), laparoscopic gastric banding is safe and effective in teens with severe obesity, may improve their health conditions and result of successful weight loss. Co-morbid conditions improved or resolved with weight loss in the 137 adolescent patients. Percentage reduction in BMI was reported at one (28.4%), two (35.9%), and three years (41.1%) after surgery. Thirty patients underwent one or more additional operations as a result of complications, and 27 patients underwent band-removals or had revisional procedures.


Study Provides Snapshot of Recent Bariatric Demographics, Outcomes


A study examining the demographics of patients who had bariatric surgery found no changes in gender, age or number of patients presenting with diabetes since 2007. Additionally, patient safety outcomes, measured in terms of morbidity and mortality, remain “virtually unmoved.” A change was observed in ethnicity, with the percentage of African American patients rising from 10.11% in 2007 to 13.43% in 2011, and the percentage of Hispanic patients increasing from 5.84% to 8.44%. The study of more than 364,000 bariatric surgery patients reported major complications around 2% and deaths in 0.1%. Within the first 30 days, 1.75% of patients experienced a serious adverse event (AE) and within one year 2.02% experienced a serious AE. For the individual procedures, researched reported one-year mortality rates for biliopancreatic diversion with duodenal switch (0.84%), Roux-en-Y gastric bypass (26%), sleeve gastrectomy (0.11%) and gastric banding (0.05%). The study was presented by Dr. Ranjan Sudan on behalf of the research committee and executive council of the ASMBS at ObesityWeek 2013.