Study Roundup

Published in April Issue             

Five-Year Outcomes of a Randomized Trial of Gastric Band Surgery in Overweight but Not Obese People With Type 2 Diabetes (Diabetes Care)

Building on previously reported 2-year outcomes of a randomized trial of laparoscopic adjustable gastric band (GB) surgery in overweight patients with type 2 diabetes of less than 5 years’ duration, the study reports 5-year outcomes for 51 participants – 22 were randomized to receive GB combined with medical care (MED) and 23 received medical care alone. The mean ± SD weight loss at the end of the study was 11.2 and 2.6 of baseline in GB and MED participants, respectively. The average weight loss over the 5 years of the study was 12.2% in GB and 1.8% in MED participants. Diabetes remission at 5 years was observed in five (23%) GB and two (9%) MED participants, equating to a relative risk of diabetes following surgery of 0.85. GB participants used fewer glucose-lowering medications and their averaged HbA1c over the 5 years of follow-up was 10.4 mmol/mol lower than that of MED participants. Blood pressure did not differ significantly between the groups. The mean HDL cholesterol was 0.24 mmol/L higher and triglycerides 0.7 mmol/L lower in GB participants, while their LDL cholesterol was 0.5 mmol/L higher in the context of less frequent use of lipid-lowering drugs. Investigators concluded sustained weight loss of 10% body weight is a therapy for overweight but not obese people with type 2 diabetes because it delivers clinically meaningful improvements in HbA1c, HDL cholesterol, and quality of life and decreases the cost of glucose-lowering drug therapy. These metabolic effects are generally comparable to those observed in patients with obesity undergoing RYGB and BPD, although long-term rates of diabetes remission appear to be higher.

Long-Term Incidence of Microvascular Disease after Bariatric Surgery or Usual Care in Patients with Obesity, Stratified by Baseline Glycaemic Status
(The Lancet Diabetes & Endocrinology)

To examine the effects of bariatric surgery on incidence of microvascular complications in patients with obesity stratified by baseline glycaemic status. Patients were recruited to the Swedish Obese Subjects (SOS) study between Sept 1, 1987, and Jan 31, 2001. Inclusion criteria were age 37–60 years and BMI of 34 or greater in men and 38 or greater in women. The surgery group (n=2,010) underwent gastric bypass (265 [13%]), gastric banding (376 [19%]), or vertical-banded gastroplasty (1369 [68%]). Participants in the control group (n=2,037) received usual care. Bodyweight was measured and questionnaires were completed at baseline and at 0·5 years, 1 year, 2 years, 3 years, 4 years, 6 years, 8 years, 10 years, 15 years, and 20 years. Biochemical variables were measured at baseline and at 2 years, 10 years, and 15 years. Participants were stratified into subgroups using baseline glycaemic status: normal fasting blood glucose concentration, prediabetes, screen-detected diabetes, and established diabetes. Data was obtained about first incidence of microvascular disease from nationwide registers and about diabetes incidence at study visits at 2 years, 10 years, and 15 years. At baseline, 2,838 patients had normal blood glucose, 591 had prediabetes, 246 had screen-detected diabetes, and 357 had established diabetes. Median follow-up was 19 years. Investigators identified 374 incident cases of microvascular disease in the control group and 224 in the surgery group. Interaction between baseline glycaemic status and effect of treatment on incidence of microvascular disease was significant. Unadjusted HRs were lowest in the subgroup with prediabetes (0·18), followed by subgroups with screen-detected diabetes (0·39), established diabetes (0·54), and normoglycaemia (0·63). Bariatric surgery was associated with reduced incidence of microvascular events in people with prediabetes regardless of whether they developed diabetes during follow-up. Bariatric surgery was associated with reduced risk of microvascular complications in all subgroups, but the greatest relative risk reduction was observed in patients with prediabetes at baseline.

Bariatric Surgery in Young Adults: A Multicenter Study Into Weight Loss, Dietary Adherence and Quality of Life (SOARD)

To evaluate weight loss, dietary adherence and quality of life in a multicenter young adult sample in the first six years after bariatric surgery, data was collected from 184 patients ages of 18-24 that had bariatric surgery. Patients were interviewed by phone, and sent questionnaires assessing postoperative weight, quality of life and lifestyle behaviors including dietary adherence. Mean percent weight loss was 30.2 for sleeve gastrectomy and 35.6 for gastric bypass. Adherence to postoperative dietary recommendations declined over the years and explained 8.3% of the variance in weight loss. Quality of life scores lagged behind national norms for young adults and were largely unrelated to weight loss. A quarter of patients (25%) turned out to be Not in Education, Employment or Training (NEET) and 38% consumed mental healthcare since surgery, which occurred independent of weight loss, and concurred with poorer quality of life. Investigators concluded young adult patients achieve weight loss comparable to adult patients following bariatric surgery. However, post-operative adherence to behavioral recommendations and psychosocial functioning clearly demonstrate room for improvement and require adjunctive interventions.

Definition Determines Weight Regain Outcomes Following Sleeve Gastrectomy (SOARD)

Retrospective data from a cohort of patients followed up at five years was used to illustrate how the lack of a standard definition for weight regain significantly alters reported sleeve gastrectomy (SG) outcomes and to contribute to the discussion of how weight regain should be defined. The data demonstrated how the presence of multiple definitions in the literature significantly affects outcome reporting for weight regain. Applying six definitions of weight regain to the cohort, resulted in six different rates ranging from 9-91%. Post hoc analyses revealed significant associations between weight change and the Bariatric Analysis Reporting Outcome System (BAROS) score as well as patient opinion. The non-uniform reporting of weight regain appears to significantly affect SG outcome reporting. Investigators recommended development of consensus statements and guidelines from research groups with access to large robust databases.

Impact of Laparoscopic Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Postoperative Lipid Values (SOARD)

To evaluate the postoperative lipid values after Roux-en-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG) at a community hospital, a retrospective review of a prospective database was completed for patients having surgery from 2001 through 2013. Lipid values available at 6–18 months postoperative were evaluated. There were 1,326 and 121 patients who underwent LRYGB and LSG during the study period, respectively. Of these patients, 644 LRYGB and 67 LSG patients had pre- and postoperative lipid values available and included in the final analysis. Postoperative mean total cholesterol and LDL values were significantly lower in LYRGB versus LSG patients. Postoperatively, 10% and 30% of LRYGB and LSG patients had a total cholesterol values>=200 mg/dL; 4% and 24% had LDL values>=130 mg/dL; and 8% and 9% had triglyceride levels>130 mg/dL, respectively. HDL values were within the recommended range in 52% and 57% of LRYGB and LSG patients, respectively. Patients who underwent LRYGB had a greater postoperative reduction in total cholesterol, LDL, and triglycerides. Investigators concluded LRYGB may be the more appropriate procedure for patients with significant preoperative hypercholesterolemia.

Thirty-Day Outcomes for Children and Adolescents Undergoing Laparoscopic Sleeve Gastrectomy at a Free-Standing Children's Hospital (Clinical Obesity)

To assess perioperative outcomes of paediatric patients undergoing laparoscopic sleeve gastrectomy (LSG) at a single-center, free-standing children's hospital, data was retrospectively reviewed for demographics, comorbidities and 30-day outcomes for all patients who had LSG from 2010 to 2015. A total of 105 patients underwent 107 LSG procedures (two revisions). Mean age was 17.2 years. The majority of patients were black (57.1%), followed by white (21.0%) and hispanic (18.1%). The mean BMI was 51.0 ± 9.8 kg/m2. Comorbidities included obstructive sleep apnea (59.0%), hypertension (15.2%), polycystic ovarian disease (16.7% of females only), depression (12.4%) and diabetes (11.4%). Median length of stay was 2.0 days. There were no deaths. Major complications occurred in four patients (3.8%); three required reoperation. Four patients (3.8%) experienced minor complications. Investigators concluded LSG can be safely performed for children and adolescents at a free-standing children's hospital.