Tuesday, May 25, 2021

Prediabetes Can Shorten a Person's Life

The CDC estimates that 88 million adult Americans have prediabetes. And most persons with prediabetes are not aware that they have the condition. The CDC’s diabetes prevention program trial that took place between 1996 and 2001 showed that lifestyle intervention could reduce the risk of progression from prediabetes to diabetes by 58% compared to people with prediabetes who were receiving usual care. And a recent study suggests that prediabetes can shorten a person’s life.

The investigators studied 2844 subjects to determine how the “years of potential life lost,” or YPLL, for persons with prediabetes compared with the YPLL of persons with diabetes and the YPLL of persons with normoglycemia. The subjects were male and female with an average age of 52. From 1976 to 1982 the participants were given oral glucose tolerance tests. Also, anthropometric measurements were made during the study period.

The researchers concluded “that adjusted life expectancy of middle-aged individuals with prediabetes” was two years shorter than the life expectancy of individuals with normoglycemia, and the expectancy of individuals with diabetes was eight years shorter than individuals with normoglycemia.  The researchers went on to say that “YPLL was greater in women, younger individuals (less than 16 year) and in those with moderate overweight.” The researchers indicated that both the intrinsic risk associated with prediabetes and the risk of progressing from prediabetes to diabetes could be factors impacting lifespan.

The study confirms the importance of addressing prediabetes, especially in middle-aged adults. Healthcare providers should endeavor to work with at-risk prediabetes patients. They should work with the patients, if appropriate, to get them into a diabetes prevention program. These programs can delay or prevent diabetes which could increase the lifespan of a person with prediabetes. Delaying or preventing diabetes can not only increase a person’s lifespan. It could also lower the person’s healthcare costs.


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Sunday, May 23, 2021

Predicting Bariatric Surgery Outcomes

Bariatric surgery is the most effective obesity treatment in use today. However, the surgery does have associated failures and related side effects. Therefore, it would be useful to have methods in place to predict the bariatric surgical success so that risks could be weighed against the probable outcomes. This would benefit patients and physicians. A recent study was done to determine if bariatric surgery outcomes could be predicted.

The two most common forms of bariatric surgery are gastric bypass and sleeve gastrectomy. For many years gastric bypass surgery was the most popular form of weight loss surgery. However, more recently, sleeve gastrectomy has gained in popularity because it is an effective weight loss method, and it is typically accompanied by less severe  side effects than gastric bypass. At any rate, in general, bariatric surgery predictive methods focus on gastric bypass and sleeve gastrectomy.

Indeed, there are failures in bariatric surgery. Researchers in Sweden concluded that in the case of laparoscopic gastric bypass surgery, there is “a marked and sustained weight loss with improvement of obesity-related comorbidity in most patients. However, 23% met at least one definition of surgical treatment failure…” So, predictive methods would be useful.

A recent retrospective study looked at 760 patients who underwent bariatric surgery. Approximately 66% of the patients experienced sleeve gastrectomy and approximately 34% of the patients experienced gastric bypass surgery. Linear regression methods were used to predict the weight loss after one year following the surgery. Twelve predictive models were developed and used to predict the weight loss for each patient.

The investigators determined that while "predicted BMI had reasonable correlation with observed values, none of evaluated models presented acceptable accuracy. All models tend to overestimate the outcome.” Therefore, more research is needed to improve bariatric surgical outcomes predictions.

With good predictive models for bariatric surgical outcomes, healthcare providers could improve the selection of bariatric surgical candidates. For those candidates that are not expected to have good outcomes, another, less expensive and risky weight loss method could be recommended. And for those candidates who are likely to have positive outcomes, the surgery could proceed. This would lower risks and save money, benefiting both the patient and physicians.


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