sabato, Luglio 13, 2024

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Two conferences for the price of one: sharing knowledge and intentions for diabetes and obesity

Metabolic or bariatric surgery results in superior glycemic control, less medication usage and high rates of remission of Type 2 diabetes than medical or lifestyle intervention in patients with class 1 obesity, as described in a recently published report by researchers of Pennington Biomedical Research Center and others. The study, which evaluated more than 250 participants for up to 12 years, represents the largest cohort of people assessed for the long-term durability of the two treatments. The results were presented at the 83rd Scientific Sessions Conference by the American Diabetes Association in San Diego. At the conference, Dr. Sangeeta Kashyap of the Weill Cornell Medicine New York Presbyterian introduced the study and presented “The Case for an RCT of Metabolic Surgery and Type 2 Diabetes”.

Physician-scientist Dr. Mary-Elizabeth Patti at Harvard Medical School, reviewed and shared the study design. Dr. Anita Courcoulas, Chief of the Division of Minimally Invasive Bariatric and General Surgery at the University of Pittsburgh, discussed the long-term outcomes and diabetes remission resulting from the study. Dr. Robert H. Eckel, President of the conference shared the implications of clinical management of type two diabetes.  The study represented a long-term collaboration of researchers from a variety of esteemed research centers and clinics, including the University of Pittsburgh’s Department of Surgery, the Joslin Diabetes Center, Harvard Medical School, Kaiser Permanente Washington Health Research Institute, the Department of Surgery at the Cleveland Clinic and several Brigham and Women’s Hospital Departments, to mention a couple.

The study is the longest running of its kind. From May 2007 to August of 2013, 262 participants with Type 2 diabetes were recruited and randomized into either the metabolic surgery group or medical/lifestyle intervention group. With a median follow-up of 11 years, those in the metabolic surgery group saw an increased reduction in blood sugar, great rates of diabetes remission, and significantly greater weight loss than those in the medical/lifestyle intervention group. Along with the ADA conference, another is running as well with similar or at least connected topics, the American Society for Metabolic and Bariatric Surgery (ASMBS) 2023 Annual Scientific Meeting. Indeed, diabetes and obesity are deeply connected for causality (being the one causing the other and vicecersa, depending on many factors) and diet is recognized as a common wire.

In 2018, the ASMBS updated its position on Class 1 obesity stating “bariatric surgery should be offered as an option” and access “should not be denied solely based on this outdated threshold”, referring to the prior minimum BMI requirement of 35. It further notes that current nonsurgical treatments “are often ineffective at achieving major, long-term weight reduction and resolution of co-morbidities”. In 2016, 45 professional societies, including the American Diabetes Association, issued a joint statement that metabolic surgery should be considered for patients with type 2 diabetes and a body mass index (BMI) ranging from 30 to 34.9 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications.

In 2022, ASMBS and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) representing 72 national associations and societies throughout the world, issued new evidence-based clinical guidelines that among a slew of recommendations expanded patient eligibility for weight-loss surgery; and endorsed metabolic surgery for patients with type 2 diabetes beginning at a BMI of 30. The ASMBS reports only about 1% of those who meet eligibility requirements get weight-loss surgery in any given year. In one study, University of Southern California researchers found only 3.5% of the more than one million bariatric surgery procedures performed between 2015 and 2021 were on patients with a BMI of 30 to 35, classified as Class 1 obesity.

This amounts to little more than 38,000 patients who had similar improvements in health status and underlying metabolic disorders and the same low rates of complications (less than 5%) and mortality (less than 0.1%) as their higher BMI counterparts. Sleeve gastrectomy was the most common procedure for both patient groups.In a new IRB registry study, of 30 patients with BMI 30 to 35 who underwent bariatric surgery between 2017 and 2021, researchers from New Jersey Bariatric Center found nearly 60% lost at least half their excess body weight and 56.25% saw improvements or resolution of an obesity-related disease such as type 2 diabetes or hypertension. None of the patients experienced complications.

Dr Paul Wisniowski, MD, study co-author, surgical resident at USC, stated that since the earlier the intervention on obesity or any disease, the better the outcome, patients need not wait until their obesity and related conditions become severe before seeking bariatric surgery. However, despite widespread acceptance of bariatric surgery as the most effective treatment for obesity, significant barriers to treatment still exist. Working on these barriers should be appointed on specialized teams, since the american CDC declared that, obesity affects 42.4% of Americans. Science showed the disease can cause chronic inflammation and increase the risk of many conditions including cardiovascular diseases, stroke, type 2 diabetes and certain cancers.

Beside, it can also weaken the body’s immune system and its impact on mortality due to COVID-19 has been proven as well.

  • Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.

Scientific references

Pullman JS et al. Obes Surg. 2023 Jul; 33(7):1989-1996.

Jordan K et al. Eur J Health Econ. 2023; 24(4):575-590.

van Loon SLM et al. Surg Res. 2023 May; 285:211-219.

O’Moore-Sullivan T et al. PLoS One. 2023; 18(2):e0279923.

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Dott. Gianfrancesco Cormaci
Dott. Gianfrancesco Cormaci
Laurea in Medicina e Chirurgia nel 1998, specialista in Biochimica Clinica dal 2002, ha conseguito dottorato in Neurobiologia nel 2006. Ex-ricercatore, ha trascorso 5 anni negli USA alle dipendenze dell' NIH/NIDA e poi della Johns Hopkins University. Guardia medica presso la casa di Cura Sant'Agata a Catania. In libera professione, si occupa di Medicina Preventiva personalizzata e intolleranze alimentari. Detentore di un brevetto per la fabbricazione di sfarinati gluten-free a partire da regolare farina di grano. Responsabile della sezione R&D della CoFood s.r.l. per la ricerca e sviluppo di nuovi prodotti alimentari, inclusi quelli a fini medici speciali.

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