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For the week ending April 27, 2012 | |
Last week 495 articles were evaluated via DynaMed's Systematic Literature Surveillance and 261 were added to DynaMed content.
Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update. |
| Feature Article | |
Bariatric Surgery May Induce Remission of Type 2 Diabetes in Obese Patients
Type 2 Diabetes is a common complication of obesity, and the prevalence of both conditions is rapidly increasing worldwide. Though originally developed as a treatment for weight loss in obese patients, observational data suggest that bariatric surgery may have a beneficial effect on the severity of diabetes in these patients, even to the point of complete resolution, with benefits for weight loss and diabetes lasting for up to 10 years (N Engl J Med 2004 Dec 23;351(26):2683). A recent randomized trial compared 2 forms of bariatric surgery, Roux-en-Y gastric bypass and biliopancreatic diversion, to medical management of diabetes in a small group of 60 patients (mean age 43 years) in Italy.
All patients had a history of type 2 diabetes for at least 5 years and had a body mass index (BMI) ≥ 35 kg/m2. For the medical therapy group, a multidisciplinary team provided oral hypoglycemic drugs and insulin with HbA1c target < 7%, programs for diet and lifestyle modification, and increased physical activity. The surgical groups also received medical therapy adjusted by glycemic levels, and could discontinue pharmacotherapy upon normalization of glycemic profile, HbA1c or both. The primary outcome was diabetes remission defined as fasting glucose < 100 mg/dL (5.5 mmol/L) and HbA1c < 6.5% for ≥ 1 year without pharmacologic therapy.
At 2 years follow-up, no patients in the medical therapy group had achieved diabetes remission. The remission rates in the surgical groups were 75% for Roux-en-Y bypass surgery (p < 0.001 vs. medical therapy, NNT 2) and 95% for biliopancreatic diversion (p < 0.001 vs. medical therapy, NNT 1) (level 2 [mid-level] evidence). Both surgical groups had significantly greater weight loss than the medical therapy group. The most common complication of surgery was iron deficiency anemia, which occurred in 11% for each group (N Engl J Med 2012 Apr 26;366(17):1577).
Longer follow-up studies will be needed to determine both the duration of these benefits and whether the improvement in diabetes outcomes from surgery leads to fewer cardiovascular events or reduced mortality.
For more information see the Bariatric surgery and Diabetes mellitus type 2
topics in DynaMed.
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CME Information
CREDITS
Physicians: 0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: May 2, 2012
Expiration Date: May 2, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.
Program Overview
Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
Disclosures
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.
Accreditation Statements
ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AAFP: This Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each weekly update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners. Program ID 1102072I. |
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