Lower estimated insulin sensitivity was associated with risk for hyperfiltration over time, whereas increased albumin excretion was associated with hyperglycemia in youth-onset T2DM.
rate increased after RYGB to 28% at 1 year (21 patients), 31% at 5 years (23 patients), and 47% at 10 years (35 patients) (Figure 1).At 10 years after RYGB, the anemia rate in the cohort without bariatric specialist follow-up (n = 58) increased to 33 patients (57%), from 13 (22%) before surgery (P < .001). The rate of anemia in the cohort with bariatric specialist follow-up (n = 16) did not increase significantly after 10 years (3 [19%] vs 2 [13%]; P = .07) (Figure 2). Compared with patients with bariatric specialist follow-up, patients without bariatric specialist follow-up had significantly higher odds of anemia at 10 years (odds ratio, 6.1; 95% CI, 1.4-27.6; P = .02) after adjusting for preoperative anemia.Discussion | Long-term complications of RYGB, such as anemia, may go unrecognized by nonbariatric specialists. Causes include iron, vitamin B 12 , and folate deficiency; less common causes include copper, vitamin A, and selenium deficiency and bleeding marginal ulcers. We found high anemia rates 10 years after RYGB; these rates may reflect a mixed vitamin and mineral deficiency, because patients had normocytic anemia. Our study suggests that follow-up with bariatric specialists more than 5 years after surgery, rather than with specialists with no bariatric expertise, can decrease long-term anemia risk. This finding may demonstrate the bariatric specialist's specific understanding of the long-term risk for nutritional deficiency after RYGB and the importance of vitamin and mineral supplementation. All patients receiving iron supplements who still had anemia at 10 years were in the group without bariatric specialist follow-up (n = 11), a finding suggesting an inappropriate choice of treatment or inadequate follow-up. No similar effect of follow-up was observed for other long-term outcomes, such as excess weight loss and medication requirements.This study emphasizes the importance of long-term specialty-specific follow-up for bariatric surgery. The major limitation of this study was the size of the cohort with bariatric specialist follow-up, which may be too small to identify a significant difference in the 10-year anemia rates compared with preoperative rates. Nonetheless, the significant difference observed in the cohort without bariatric specialist follow-up suggests an opportunity for an intervention to improve follow-up and decrease anemia rates and other long-term complications. Long-term follow-up should be an integral part of bariatric programs, and additional studies are needed to identify potential barriers to successful follow-up. In the VA population, such barriers include distance from a bariatric center and lower socioeconomic status. We implemented a hub-andspoke model for bariatric care, including health care specialist education, in which the bariatric team communicates regularly with the patient's primary care clinician before and after surgery. 6 This model may prove to be an effective tool to overcome such barriers and improve outcomes.
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