STUDY ROUNDUP

Published in September/October 2015 Issue             


Bariatric–Metabolic Surgery Versus Conventional Medical Treatment in Obese Patients with Type 2 diabetes: 5 year Follow-up of an Open-Label, Single-Center, Randomized Controlled Trial (The Lancet)

According to a study in The Lancet, bariatric surgery is more effective than medical treatment for the long-term control of patients with obesity and Type 2 diabetes, and should be considered in the treatment of this disease. The open-label randomized controlled trial lasting 5 years grouped 20 patients to receive medical treatment, 20 to receive gastric bypass and 20 to receive biliopancreatic diversion. Overall, 50% of the surgery patients (37% gastric bypass, 63% biliopancreatic) maintained diabetes remission at 5 years, compared with none of the medically treated patients. Surgical patients lost more weight than medically treated patients, but weight changes did not predict diabetes remission or relapse after surgery. While five major complications of diabetes and one death arose in the medical group, compared to only complication in the surgery groups, there were no late complications or deaths in the surgery groups.

Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012 (JAMA)


According to a new study in JAMA, In 2011-2012, the estimated prevalence of total diabetes rose to 14.3% among US adults, with a higher prevalence among those who were non-Hispanic black, non-Hispanic Asian, and Hispanic and among those with diabetes 9.1 were diagnosed while 36.5% were undiagnosed. The study found 38% had prediabetes. In 1998, the estimate prevalence was 9.8%, in 2001 it was 10.8% and 2001 it was 12.4%. The data comes from an analysis of the National Health and Nutrition Examination Survey (NHANES). The increase was significant in every age group, in both sexes, and every racial/ethnic group by all education levels and poverty income ratios.


The Impact of Bariatric Surgery on Retinopathy in Patients with Type 2 Diabetes: A Retrospective Cohort Study (SOARD)


A retrospective study of 152 patients assessed the impact of bariatric surgery on progression to sight threatening retinopathy (STDR) in patients with Type 2 diabetes (T2DM) in comparison to patients with diabetes who had bariatric surgery at a single center. The study only included patients who had retinal images within a year prior to surgery, and at least one post-surgery. Following bariatric surgery, patients with diabetes remained at risk of developing STDR, even in those who did not have evidence of STDR prior to surgery. However, compared to a matched group for age, HbA1 and follow-up duration, bariatric surgery was associated with a lower progression with 5.7% developing STDR by study-end, and 5.6% developing maculopathy. More than 12% of non-surgical patients with routine care developed STDR and 15.4% developed maculopathy. The researchers called for clinical trials to ascertain the impact of bariatric surgery on DR.


Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass (JAMA Surgery)


A retrospective study compared the impact of LAGB and RYGB on health care use and costs during the period between 2005 and 2011 using a national claims data set. Quarterly and yearly total health care costs, ED visits, hospital days and prescription drug costs were propensity score matched between 4935 LAGB patients and 4935 RYGB patients. Both procedures were associated with downward trends in costs, however by the third year, LAGB patients had total annual costs that were 16% higher. The first and second year after surgery, LAGB patients had 27% to 29% fewer ED visits, but by year three there was no difference and postoperative annual hospital days were not significantly different between the two groups. Both procedures lowered prescription cost but annual postoperative prescription costs were 17% to 32% higher for LAGB patients. The researchers from Kaiser Permanente, Harvard and Group Health Research concluded both procedures flattened total health care cost trajectories and suggested clinicians and policymakers weigh the differences that were discerned when making recommendations or shaping regulatory guidance about these procedures.


Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery  (Obesity Surgery)


The Johns Hopkins Center for Bariatric Surgery studied the nutritional status of 58 candidates for Roux-en Y gastric bypass, and found 1 in 5 patients had three or more deficiencies prior to surgery. Seventy-seven percent of patients were female, with a median age of 42 and BMI of 46. Vitamin D was deficient in 92.9% and 36% to 56% were deficient in iron before surgery. Blacks had a higher rate of multiple micronutrient deficiency at 50%, compared to 39.7% overall. The researchers concluded pre-operative supplementation, especially of vitamin D and iron, should be explored.


Bariatric–Metabolic Surgery Versus Conventional Medical Treatment in Obese Patients with Type 2 Diabetes: 5 year Follow-up of an Open-Label, Single-Centre, Randomized Controlled Trial (The Lancet)


A five-year randomized clinical study out of Italy (Catholic University of Rome), published in the journal The Lancet, finds bariatric surgery is more effective than medical treatment for the long-term control of patients with obesity. Sixty patients were randomly assigned into three groups of 20. Patients had either medical treatment, gastric bypass or biliopancreatic diversion (BPD). Overall half of the surgical patients (7 of the gastric bypass and 12 of the BPD patients) maintained diabetes remission at 5 years, compared with none of the medically treated patients. Surgical patients lost more weight than medically treated patients, but weight changes did not predict diabetes remission or relapse after surgery. Five major complications of diabetes and one death arose in the medical group, compared to only complication in the surgery groups. There were no late complications or deaths in the surgery groups. Researchers concluded surgery should be “considered in the treatment algorithm” of obesity. “However, continued monitoring of glycaemic control is warranted because of potential relapse of hyperglycaemia.


Laparoscopic Sleeve Gastrectomy Leads the U.S. Utilization of Bariatric Surgery at Academic Medical Centers (SOARD)


This study is a case series of the first 16 patients who had laparoscopic sleeve gastrectomy (LSG) at the Anschutz Medical Campus of University of Colorado, Aurora, Colorado. Patients enrolled in this study had a mean BMI of 43.5 kg/m2 and a mean age of 49. At 7-year follow-up, 14 of these 16 patients had a mean %WL of 29.6%±8.95 and a mean %EWL of 59.6%±19.9% based on self-report. Eleven of 14 patients achieved>50% EWL. Three patients did not meet the treatment goal of less than 50% EWL, and 2 of these patients had less than 30% EWL. One-year follow-up data revealed a mean EWL of 72%±20%, which was significantly greater than EWL at 7 years. Each patient who met the goal of 50% EWL at 1 year still met that goal by 7 years. Complications included 1 patient with a partial obstruction and leak at the gastric incisura angularis presenting with vomiting 4 months postoperative and diagnosed on upper gastrointestinal (GI) series. She was managed with endoscopic stent placement. There were no reoperations and no deaths. The authors concluded that LSG is a durable and successful operation.


Health-care Costs over 15 Years After Bariatric Surgery for Patients with Different Baseline Glucose Status: Results from the Swedish Obese Subjects Study (The Lancet Diabetes & Endocrinology)


A 15-year prospective study suggests patients with obesity and Type 2 diabetes should be prioritized for bariatric surgery over those without diabetes, given the long-term cost savings from possible disease reversal following surgery. Researchers from the Karolinska Institute in Sweden and colleagues evaluated data from the Swedish Obese Subjects (SOS) study, and compared 2,010 adults who had bariatric surgery with 2,037 who were treated conventionally. The patients were divided into three groups: 2,836 who were euglycaemic; 591 who had prediabetes and 603 who had diabetes. The total health-care costs were higher for patients in the surgery group with euglycaemia ($71,059 vs. $45,542) or prediabetes ($78,151 vs. $54,864), but did not differ between the surgery and conventional treatment group for patients with diabetes ($88,572 vs. $79,967). The authors noted the study showed that for patients with obesity and Type 2 diabetes, “the upfront costs of bariatric surgery seem to be largely offset by prevention of future health-care and drug use.”