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Journal watch - 21/03/13

Bariatric surgery for type 2 diabetes

This paper, by Professor John Dixon, Dr Carel Le Roux, Dr Francesco Rubino and Professor Paul Zimmet, examines the mechanisms by which bariatric interventions induce glycaemic control in type 2 diabetics. Finding the traditional classifications of restriction and malabsorption “inadequate”, it describes other possible mechanisms. Discovering the reason that some bariatric procedures improve glycaemic control above that associated with the lost weight, it says, could lead to new operations, devices, and drugs to treat diabetes. (Full text)

Weight loss after bariatric surgery reverses insulin-induced increases in brain glucose metabolism of the morbidly obese.

This study looked at brain glucose measurements in 22 morbidly obese patients, compared to seven subjects of healthy weight. Before surgery, the obese patients were found to have significantly higher brain glucose during a hyperinsulinemic clamp test; however, six months after the obese patients received bariatric surgery, this disparity disappeared. (Full text)

Expectations for Weight Loss and Willingness to Accept Risk Among Patients Seeking Weight Loss Surgery

Patients expect on average to lose 38% of their weight after bariatric surgery, says this survey of 654 patients seeking a weight-loss procedure. Eighty-five percent of patients were willing to accept some risk of death as a part of their operation; while the mean acceptable risk of death was 6.7%, the median risk was 0.1%. Only 57.5% of patients seeking bariatric surgery were willing to undergo a hypothetical operation that would see them losing 20% of their total weight. The paper concludes that further educational efforts may be necessary to help patients align their expectations with medical reality. (Full text)

Long-term effects of pronounced weight loss after bariatric surgery on functional and structural markers of atherosclerosis.

This study attempts to look at the long-term effects of bariatric surgery on atherosclerosis – the thickening of artery walls. After five years, the study group’s carotid intima media thickness had decreased by an average of 0.02mm, while their brachial flow-mediated dilation improved by 1.5%. The ‘improvement in both the functional and structural markers led the authors to state that the study shows further evidence for the beneficial effects of weight loss on obesity associated alterations of the vasculature.” (Full text)