Surgery News - August 2008 - (Page 11) AUGUST 2008 • SURGERY NEWS GENERAL SURGERY 11 Gastric Bypass Lowers HbA1c Levels in Type 2 Diabetes B Y J E F F E VA N S Else vier Global Medical Ne ws N A T I O N A L H A R B O R , M D . — Patients with type 2 diabetes who have undergone laparoscopic Roux-en-Y gastric bypass surgery might experience a significant drop in hemoglobin A1c levels to below the cutoff value recommended in guidelines, according to a retrospective study. The procedure maintained its effect through 3 years of follow-up, during which the patients significantly lowered their use of oral hypoglycemic agents and insulin. Remission of diabetes occurred in more than half (53%) of the gastric bypass patients available for follow-up after 3 years. But an age- and gender-matched cohort of medically managed patients with type 2 diabetes who did not undergo surgery developed worsening hemoglobin A1c (HbA1c) levels and significantly increased use of oral hypoglycemic agents and insulin during a similar time frame. “Based on our findings, we feel that bariatric surgery should be considered a first-line treatment option for obese patients with type 2 diabetes,” Dr. Daniel E. In the current study, the surgical patients lost a mean of 103 pounds, or 68% of their excess weight, at 1 year. The body mass index (BMI) of surgical patients dropped from a mean of 48 kg/m2 before surgery to a BMI of 31 after 1 year. Nonsurgical patients had a mean BMI of 45 initially. Among surgical patients, the use of oral hypoglycemic agents significantly declined from 77% at baseline to 18% at 1 year and 22% at 3 years. In comparison, oral hypoglycemic use in conventionally treated patients rose from 67% at baseline to 82% at 1 year, remaining stable to 3 years. In both groups, insulin use followed the same trends as oral hypoglycemic agents. At 3 years, 26% of gastric bypass patients used oral hypoglycemic agents and/or insulin, compared with 82% of conventionally treated patients. Remission of diabetes (defined as an HbA1c less than 6% and off diabetic medications) occurred at 1 year in 59% of surgical patients and in 35% of conventionally treated patients. Of the 51 surgical cohort patients, the 31 who had gone into remission at some point during the 3 years of follow-up had had diabetes for a mean of 4.1 years. That was significantly shorter than the mean duration of disease for the 20 patients who never remitted (7.9 years). Overall, the surgical patients had a slightly longer mean duration of diabetes than did the nonsurgical patients, according to Dr. Mumme, who did not have any disclosures to make for himself or his coinvestigators. ■ New from the American College of Surgeons and Thomson Healthcare I Need an Operation Now What? A Patient’s Guide to a Safe and Successful Outcome I Need an Operation…Now What? gives patients the information they need to boost their chances of having a successful surgical experience, with the best possible results. Written in patient-friendly, nontechnical language, this book is designed to help patients understand the process of having an operation from start to finish. Inside they’ll learn: » How to find a qualified surgeon—one who’s right for them » When to get a second opinion about their treatment—and how to go about finding one » How to ask about the risks and benefits of having an operation » How to prepare for an operation—from what to pack and what to wear to when to stop eating » What to expect, including advice from patients who’ve had various operations, from major gastrointestinal procedures to back surgery—and who will care for them—while in the hospital » Numerous "insider's" tips, such as how to help prevent infection and the best times to schedule an operation » All the costs of the operation » How to ensure a comfortable recovery period The experts agree “Along with your love and support, the greatest gift you can give a loved one or friend facing or weighing the benefits and risks of surgery is a copy of this book. With his thoughtful, clear, very accessible writing, Dr. Russell, with the American College of Surgeons, provides a wealth of informational resources that every patient can draw on. He gives excellent advice on how to ask good questions and become an informed, empowered consumer. Most importantly, he urges you, the patient, to ‘take control and become fully informed about your options.’ This book will help you do that, prepare you for the effects of surgery and how to deal with them and give you confidence as you navigate through the health care system.” Helen Darling, president of the ISBN 13: 978156363-700-1 Pub. Jan 2008 • Paperback $19.95 • 125 pp National Business Group on Health AN AGE- AND GENDER-MATCHED COHORT OF MEDICALLY MANAGED DIABETIC PATIENTS DEVELOPED WORSENING HEMOGLOBIN A1C LEVELS. Mumme said at the annual meeting of the American Society for Metabolic and Bariatric Surgery. The study that Dr. Mumme, a general surgery resident, presented for his colleagues at Gundersen Lutheran Medical Center, La Crosse, Wis., compared the outcomes of 51 patients with type 2 diabetes who underwent laparoscopic Rouxen-Y gastric bypass at the center during 2001-2005 and 51 medically managed patients with type 2 diabetes who were identified within a family practice database. Patients in both groups had a mean age of 48 years and 78% were female. Among 48 surgical patients with HbA1c values recorded after 1 year of follow-up, mean HbA1c levels significantly dropped from 7.5% before surgery to 5.8%. The 29 patients who had 3-year follow-up data experienced a significant drop in mean HbA1c levels from 7.8% before surgery to 6.1%. HbA1c levels increased from 7% to 7.8% over a 3-year period in 39 patients of the medically managed comparison cohort. The current treatment guidelines of the American Diabetes Association recommend lowering HbA1c levels below 7%. Data from a study investigating the association of HbA1c with cardiovascular disease and mortality in adults showed that a percentage point increase in HbA1c was associated with a 20%-30% increase in cardiovascular events or total mortality (Ann. Intern. Med. 2004;141:413-20). And in another study, each percentage point drop in HbA1c was associated with a 37% decline in the risk of microvascular complications (BMJ 2000;321:405-12). “Like a true professional, Dr. Russell gives surgical patients-to-be all the information and support needed to make decisions that meet their needs as only they can know them. This book is not only practical, but also highly respectful, most educational. Patients can use this book to navigate through their surgical experience while we all push for a better-organized health care delivery system.” Richard J. Umbdenstock, president and CEO of the American Hospital Association “Research shows that people who are well informed about their treatment options enjoy better surgical outcomes and are more satisfied with their results.” To order or for further information visit http://www.facs.org/public_info/patientguidebook.html or call 312/202-5474 http://www.facs.org/public_info/patientguidebook.html http://www.facs.org/public_info/patientguidebook.html
Table of Contents Feed for the Digital Edition of Surgery News - August 2008 Surgery News - August 2008 Contents The 20/20 Vision: Making Amends News From the College: Dedicated Effort Opinion: NOTESworthy? Pediatric Surgery: Burn Remedy Surgery News - August 2008 Surgery News - August 2008 - Contents (Page 1) Surgery News - August 2008 - Contents (Page 2) Surgery News - August 2008 - Contents (Page 3) Surgery News - August 2008 - Contents (Page 4) Surgery News - August 2008 - Contents (Page 5) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 6) Surgery News - August 2008 - The 20/20 Vision: Making Amends (Page 7) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 8) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 9) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 10) Surgery News - August 2008 - News From the College: Dedicated Effort (Page 11) Surgery News - August 2008 - Opinion: NOTESworthy? (Page 12) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 13) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 14) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 15) Surgery News - August 2008 - Pediatric Surgery: Burn Remedy (Page 16)
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