Prevalence of Undiagnosed and Inadequately Treated Type 2 Diabetes Mellitus, Hypertension, and Dyslipidemia in Morbidly Obese Patients Who Present for Bariatric Surgery

Mostaedi, Rouzbeh; Lackey, Denise E.; Adams, Sean H.; Dada, Stephen; Hoda, Zahid A.; Ali, Mohamed R.

doi:10.1007/s11695-014-1196-z

Cited by 12 publications

(12 citation statements)

References 38 publications

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“…Um quarto da nossa amostra era de pacientes diabéticos no pré-operatório, sendo que, em outros trabalhos relevantes na área, a prevalência da morbidade variou de 7,4% a 22,3% 9,10,17,18 . Entre esses pacientes, a grande maioria (85,71%) apresentava glicemia de jejum maior que 100 e apenas 14,28% tinham glicemia controlada.…”

Section: Discussionunclassified

“…A partir desse resultado pode-se avaliar que a grande maioria dos pacientes estudados estava em uso de medicação antidiabética e mesmo assim apresentava glicemia de jejum não controlada. Como sugere o estudo de Mostaedi et al 18 , não é possível delinear uma relação causal direta entre a obesidade e o descontrole da doença, mas é pertinente que seja alertado para o status não controlado pré-operatório dos pacientes.…”

Section: Discussionunclassified

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Desfechos Metabólicos De Pacientes Submetidos a Bypass Gástrico Em Y De Roux Em Um Hospital Universitário

Becker¹,

Ronsoni²,

Hohl³

et al. 2014

cbr

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RESUMO: A obesidade é uma doença relevante nos dias atuais e de grande impacto na saúde da população mundial, sendo o Bypass Gástrico em Y-de-Roux amplamente utilizada no tratamento cirúrgico da obesidade mórbida, entretanto esta técnica não é isenta de complicações. A úlcera duodenal perfurada no segmento excluso em pacientes submetidos ao Bypass Gástrico em Y-de-Roux é uma patologia rara sendo encontrado na literatura apenas 21 casos no mundo. Existem evidências que o segmento excluso mantem-se produtor de ácidos gástricos sem a neutralização do alimento, Este relato de caso trata-se de uma paciente com história de Bypass Gástrico em Y-de-Roux hà 5 anos, que apresentou quadro de dor abdominal após uso prolongado de AINE, sendo encaminhada para videolaparoscopia. Foi diagnosticado úlcera duodenal perfurada em segmento excluso e o tratamento definitivo procedeu em seguida, sendo realizado ulcerorrafia e omentoplastia. Palavras-chave: Obesidade mórbida. Bypass gástrico em Y-de-Roux laparoscópico. Úlcera duodenal perfurada. Úlcerorrafia. Reparo laparoscópico. ABSTRACT: Obesity is an important disease in the present day and of great impact on the health of the world population, being the Roux-en-Y gastric bypass widely used in the surgical treatment of morbid obesity, however this technique is not without complications. The perforated duodenal ulcer in the excluded segment in patients undergoing Roux-en-Y gastric bypass is a rare disease being found worldwide in the literature only 21 cases. There is evidence that the excluded segment keeps producing gastric acid without food neutralization. This case report it is a patient with a history of Roux-en-Y gastric bypass 5 years before, who presented abdominal pain after prolonged use of NSAIDs, being referred to laparoscopy. It was diagnosed perforated duodenal ulcer in excluded segment and thereafter definitive treatment, being fulfilled ulcerorrafia and omentoplasty.

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Section: Discussionunclassified

Desfechos Metabólicos De Pacientes Submetidos a Bypass Gástrico Em Y De Roux Em Um Hospital Universitário

Becker¹,

Ronsoni²,

Hohl³

et al. 2014

cbr

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“…( 11 ) Bariatric surgery lowers body weight markedly and reduces the severity of comorbidities associated with obesity, as well as reducing that of OSA. ( 12 , 13 ) Worldwide, the accepted criteria for bariatric surgery include the following ( 14 , 15 ) : being 18-65 years of age and having a BMI ≥ 40 kg/m 2 or ≥ 35 kg/m 2 and having any obesity-related comorbidity (resistant hypertension, established heart disease, severe degenerative osteoarthritis, or respiratory failure). Although the exact pathophysiology of OSA in obese patients remains poorly understood, it is thought that the deposition of fatty tissue in the neck narrows the lumen of the upper airway, thereby inducing its collapse.…”

Section: Introductionmentioning

confidence: 99%

Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography

Duarte

Magalhães-da-Silveira

2015

J. bras. pneumol.

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Objective: To identify the main predictive factors for obtaining a diagnosis of obstructive sleep apnea (OSA) in patients awaiting bariatric surgery. Methods: Retrospective study of consecutive patients undergoing pre-operative evaluation for bariatric surgery and referred for in-laboratory polysomnography. Eight variables were evaluated: sex, age, neck circumference (NC), BMI, Epworth Sleepiness Scale (ESS) score, snoring, observed apnea, and hypertension. We employed ROC curve analysis to determine the best cut-off value for each variable and multiple linear regression to identify independent predictors of OSA severity. Results: We evaluated 1,089 patients, of whom 781 (71.7%) were female. The overall prevalence of OSA-defined as an apnea/hypopnea index (AHI) ≥ 5.0 events/h-was 74.8%. The best cut-off values for NC, BMI, age, and ESS score were 42 cm, 42 kg/m2, 37 years, and 10 points, respectively. All eight variables were found to be independent predictors of a diagnosis of OSA in general, and all but one were found to be independent predictors of a diagnosis of moderate/severe OSA (AHI ≥ 15.0 events/h), the exception being hypertension. We devised a 6-item model, designated the NO-OSAS model (NC, Obesity, Observed apnea, Snoring, Age, and Sex), with a cut-off value of ≥ 3 for identifying high-risk patients. For a diagnosis of moderate/severe OSA, the model showed 70.8% accuracy, 82.8% sensitivity, and 57.9% specificity. Conclusions: In our sample of patients awaiting bariatric surgery, there was a high prevalence of OSA. At a cut-off value of ≥ 3, the proposed 6-item model showed good accuracy for a diagnosis of moderate/severe OSA.

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“…7,8 This is lower than the >70% preoperative prevalence of diabetes and prediabetes in patients presenting for bariatric surgery. 9 Thus, there is indirect evidence to suggest that failure of bariatric surgery, most commonly due to failure to lose weight, or weight regain does not universally lead to recurrence of metabolic problems.…”

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confidence: 99%

Failed Surgical Weight Loss Does Not Necessarily Mean Failed Metabolic Effects

Aminian

Jamal

Augustin

et al. 2015

Diabetes Technology & Therapeutics

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The metabolic profile of patients after a failed surgical weight loss procedure is unknown. Long-term clinical outcomes of 31 obese diabetes patients with post-bariatric surgery excess weight loss of ≤25% were assessed. At a median follow-up of 6 years (range, 5-9 years) after surgery, remission and clinical improvement of diabetes occurred in seven (23%) and 13 (42%) patients, respectively. A long-term mean total weight loss of 7.0±4.7% and excess weight loss of 13.7±8.5% were associated with a mean reduction in fasting blood glucose level, from 158.9±66.7 to 128.4±35.3 mg/dL (P=0.03), and a significant decrease in diabetes medication requirements (P<0.001). A significant decrease in systolic blood pressure (11.1±23.4 mm Hg, P=0.01) and level of circulating triglycerides (35.7±73.4 mg/dL, P=0.04) was also observed after surgery. A modest surgical weight loss in the range of 5-10% of initial weight was associated with significant improvement in cardiometabolic risk factors of morbidly obese diabetes patients. The markedly improved glycemic control (65% remission or clinical improvement) may be partly explained by weight-independent antidiabetes mechanisms of certain bariatric surgical procedures.

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Prevalence of Undiagnosed and Inadequately Treated Type 2 Diabetes Mellitus, Hypertension, and Dyslipidemia in Morbidly Obese Patients Who Present for Bariatric Surgery

Abstract: In this patient group, DM, HTN, and DYS were poorly compensated, even when pharmacotherapy was consistent with published GL. This may be due to disease burden in bariatric surgery candidates or to inadequate medical management prior to presentation.

Cited by 12 publications

References 38 publications

Desfechos Metabólicos De Pacientes Submetidos a Bypass Gástrico Em Y De Roux Em Um Hospital Universitário

Desfechos Metabólicos De Pacientes Submetidos a Bypass Gástrico Em Y De Roux Em Um Hospital Universitário

Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography

Failed Surgical Weight Loss Does Not Necessarily Mean Failed Metabolic Effects

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