6/10/2016. Bariatric Surgery: Impact on Diabetes and CVD Risk. Disclosures BARIATRIC PROCEDURES
|
|
- Sylvia Gilmore
- 5 years ago
- Views:
Transcription
1 Bariatric Surgery: Impact on Diabetes and CVD Risk Anthony M Gonzalez, MD, FACS, FASMBS Medical Director Bariatric Surgery, South Miami Hospital Chief of Surgery, Baptist Hospital of Miami Associate Professor of Surgery, FIU College of Medicine Disclosures Intuitive Surgical- Epicenter, Proctor, Consultant, Grant Recipient Ethicon- Consultant, Proctor MID (Floshield)- Scientific Advisory Board, Grant Recipient Mallinkrodt/ Cadence- Speakers Bureau BARIATRIC PROCEDURES 1
2 Weight-loss Surgery Options 2
3 Newer Options United States 3
4 Outcomes 4
5 CMS: Inpatient Discharge Data (2010) Morbidity & mortality rates of gastric bypass are similar to other common procedures Source: Direct Research, LLC, Center for Medicare and Medicaid Services, FY 2010 MedPAR, Medicare Fee-for-Service Inpatient Discharges with Selected Procedures UHC Database: Surgery Data (2012) Morbidity & complication rates of laparoscopic bariatric surgery are similar to other laparoscopic general surgery procedures Outcomes of laparoscopic procedures in general surgical operations between 2006 and 2009 Operations N Utilization of laparoscopy LOS* (days) Complications* Mortality* Bariatric surgery 54, % 2.3 ± % 0.06% Cholecystectomy 54, % 3.3 ± % 0.18% Antireflux surgery 8, % 2.9 ± % 0.02% Appendectomy 51, % 1.6 ± % 0.02% Colectomy 21, % 5.6 ± % 0.54% Ventral hernia repair 25, % 3.2 ± % 0.24% Rectal resection 2, % 6.9 ± % 0.57% Outcome of laparoscopic operations; LOS: length of stay Source: Nguyen B, Richardson JF, Smith B et al. Utilization of laparoscopy in general surgical operations at academic centers ASMBS Abstracts. PL-106. BARIATRIC SURGERY & DIABETES 5
6 Cleveland Clinic study Schauer PR et al.: Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. NEJM 2012 Jan. 2 Cleveland Clinic study Schauer PR et al.: Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. NEJM 2012 Jan. 2 STAMPEDE Surgical treatment and medications achieved glycemic control in more patients than medical therapy alone. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med. 2012; 366:
7 STAMPEDE Study Design * As defined by ADA guidelines, including lifestyle counseling, weight management, frequent home glucose monitoring, and the use of newer drug therapies. STAMPEDE Results: Significantly More Diabetic Patients at Glycemic Control* with Bariatric / Metabolic Surgery In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Patients at Glycemic Control*, 12 months 45% 40% 35% 30% 25% 20% 15% 42% * 37% ** 10% 5% 12% 0% Medical Therapy Medical Therapy + Gastric Bypass *p=0.002 Medical Therapy + Sleeve Gastrectomy **p=0.008 *Glycemic control: HbA1c < 6.0% with or without diabetes medications, 12 mo after randomization. Figures adapted from study data. STAMPEDE Results: Average levels of HbA1c were also significantly lower after Bariatric / Metabolic Surgery Mean levels of glycated hemoglobin and fasting plasma glucose were significantly lower in each of the two surgical groups than in the medical therapy group (p<0.001). 7
8 STAMPEDE Results: Significant Decreases in Diabetic Medication Usage with Bariatric / Metabolic Surgery The average number of diabetic medications per patient per day tended to increase in the medical therapy group but decreased significantly in each surgical group (p<0.001): > 50% of patients in each surgical group used NO diabetes medications at 12 months. Italian study Mingrone G et al.: Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes. NEJM 2012 Jan. 2 Systematic Review & Meta-Analysis Buchwald (2009) T2DM resolved or improved in 87% of patients following bariatric surgery 100% 80% 60% 40% 20% 87% 87% 85% 81% 99% 0% Total Gastric Banding Resolved Gastroplasty Gastric Bypass Resolved or Improved BPD/DS Systematic review & meta-analysis reviewing 621 studies including 135,246 patients Overall, T2DM 87% resolved or improved (78% resolved) for patients after bariatric surgery Buchwald H, Estok R, Farbach K, et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. Am J Med. 2009;122(3): Figure adapted from source data. Data included includes 621 studies with 888 treatment arms & 135,246 patients; 103 treatment arms with 3188 patients reported on resolution of diabetes. 8
9 Swedish Obese Subjects (SOS) Bariatric surgery appears to be markedly more efficient than usual care in the prevention of Type 2 diabetes in obese persons. Carlsson LMS, Peltonen M, Ahlin S et al, Bariatric Surgery and Prevention of Type 2 Diabetes in Swedish Obese Subjects. N Engl J Med 2012; 367: SOS Study Carlsson et al. Study Design SOS Study Carlsson et al. Results: Significantly lower incidence of Type 2 Diabetes in Bariatric / Metabolic Surgery group 9
10 CLINICAL EVIDENCE BARIATRIC / METABOLIC SURGERY AND DIABETES MANAGEMENT IN LOW BMI (BMI 30-35) Cohen: 5-Year Study of Diabetic Patients (2012) 88% of diabetic patients without severe obesity showed diabetes remission Study of 66 consecutive diabetic patients with BMI who underwent RYGB. At median 5 years, durable diabetes remission occurred in 88% of cases, and diabetes improvement in an additional 11%. There was no recurrence of diabetes following remission during [the] six-year follow-up. Hypertension and dyslipidemia also improved, yielding 50-84% reductions in predicted 10-year cardiovascular disease risks of fatal and nonfatal coronary heart disease and stroke. Source: Cohen RV, Pinheiro JC, Schiavon CA et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care 2012; 35: Summary of Metabolic Surgery 10
11 Metabolic Surgery has. Helped Type 2 Diabetes patients achieve glycemic control more effectively than intensive medical therapy at 1 year (STAMPEDE & Mingrone) Resolved or Improved Type 2 Diabetes and other obesity related CV comorbidities for up to 5 years (STAMPEDE, Buchwald, Klein & Bolen) Reduced Medication use for Type 2 Diabetes and other CV Comorbidities for up to 3 years (STAMPEDE, AHRQ/Segal & Klein) Was more efficient than usual care for the prevention of Type 2 Diabetes in persons with obesity at 15 years (SOS) BARIATRIC SURGERY & CVD Sjostrom et al. (2012) Bariatric Surgery Prevents CV Events High insulin may be a better selection criteria for bariatric surgery than high BMI, as far as CV events are concerned Sjostrom, L et. al., Bariatric Surgery and Long-term Cardiovascular Events. JAMA 2012; 307(1):
12 Incidence of Fatal & Total CV Events Sjostrom, L et. al., Bariatric Surgery and Long-term Cardiovascular Events. JAMA 2012; 307(1):56-65 Hazard Ratio of MI, Stroke with Surgery Sjostrom, L et. al., Bariatric Surgery and Long-term Cardiovascular Events. JAMA 2012; 307(1):56-65 Segal: AHRQ 1-Year Cohort Study (2010) Significant declines in cardiovascular medication use at 12 months post-surgery Use of medication for hypertension & hyperlipidemia declined 51% and 59%, respectively, at 12 months post-surgery(p<0.0001) Patients without surgery had an increase in medications for hypertension and hyperlipidemia Source: Segal JB, Clark JM, Shore AD, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Effective Healthcare Research Report No. 28. Rockville, MD: Agency for Healthcare Research and Quality; (Fig 1, page 14) 12
13 What Should be the Focus? Bariatric / metabolic surgery can achieve better control of Type 2 diabetes with much less medication in select obese patients (BMI>35) o Focus on those patients who are at highest risk of a CV event: Younger (under 60) Treated less than 10 years Difficulty maintaining glycemic control with pharmacological agents. Having at least one other CV risk factor in addition to T2DM, e.g. elevated insulin, hypertension and/or dyslipidemia. Difficulty maintaining acceptable weight (almost all T2DM patients). o Surgery is a therapeutic intervention, not just for severely obese patients. o Mode of action of bariatric surgery is metabolically analogous to many T2DM medications with positive impact on GLP-1 & insulin sensitivity. Sjostrom, L and others. Bariatric Surgery and Long-term Cardiovascular Events. JAMA 2012; 307(1): Berry, J. and others. Lifetime Risks of Cardiovascular Disease. NEJM 2012; 366: Summary Obesity & its associated Mortality Increasing Procedure Types & Volumes Increasing Surgical Weight loss maintained at 10 years Metabolic Surgery has demonstrated Improvements in Glycemic Control in Diabetics Metabolic Surgery can Prevent Diabetes in Obese patients Bariatric Surgery has been demonstrated to reduce CV Events Thank You AnthonyG@BaptistHealth.net 13
Bariatric Surgery vs. Intensive Medical Therapy in Obese Diabetic Patients: 3-Year Outcomes
Bariatric Surgery vs. Intensive Medical Therapy in Obese Diabetic Patients: 3-Year Outcomes Results of the STAMPEDE Trial Philip R Schauer, Deepak L Bhatt, John P Kirwan, Kathy Wolski, Stacy A Brethauer,
More informationOther Ways to Achieve Metabolic Control
Other Ways to Achieve Metabolic Control Nestor de la Cruz- Muñoz, MD, FACS Associate Professor of Clinical Surgery Chief, Division of Laparoendoscopic and Bariatric Surgery DeWitt Daughtry Family Department
More information2/10/2014 CARDIOVASCULAR BENEFITS OF BARIATRIC SURGERY. Disclosures. My Background
CARDIOVASCULAR BENEFITS OF BARIATRIC SURGERY Anthony M Gonzalez, MD, FACS, FASMBS Associate Professor of Surgery, FIU College of Medicine Chief of Surgery, Baptist Hospital of Miami Medical Director Bariatric
More informationMr Jon Morrow. General Surgeon Department of Bariatric Surgery Middlemore Hospital. 16:55-17:10 Why Bariatric Surgery?
Mr Jon Morrow General Surgeon Department of Bariatric Surgery Middlemore Hospital 16:55-17:10 Why Bariatric Surgery? Why Bariatric Surgery? Jon Morrow Bariatric Surgery Misconceptions Surgery is a cop
More informationCurrent Trends in Bariatric Surgery
Current Trends in Bariatric Surgery 9.28.2017 Abraham Krikhely, MD, FACS, FASMBS Assistant Professor of Surgery, CUMC Center of Minimal Access, Metabolic and Weight Loss Surgery Outline Why consider surgery
More informationAmerican Society for Metabolic & Bariatric Surgery
American Society for Metabolic & Bariatric Surgery April 27, 2012 Louis Jacques, MD Director, Coverage and Analysis Group Centers for Medicare and Medicaid Services Mail Stop S3-02-01 7500 Security Boulevard
More informationLong-Term Follow Up: The Burning Platform
Long-Term Follow Up: The Burning Platform John Morton, MD, MPH, FACS, FASMBS Chief, Bariatric & Minimally Invasive Surgery Stanford School of Medicine Past-President, American Society of Metabolic and
More informationBariatric Surgery: A Cost-effective Treatment of Obesity?
Bariatric Surgery: A Cost-effective Treatment of Obesity? Shaneeta M. Johnson MD FACS FASMBS 2018 NMA Professional Development Seminar Congressional Black Caucus Foundation Annual Legislative Conference
More informationBariatric Surgery Update
Bariatric Surgery Update Alexander Perez, MD, FACS Professor of Surgery Chief, Division Minimally Invasive and Foregut Surgery Speaker Disclosure Dr. Perez has disclosed that the has no actual or potential
More informationEffect of Bariatric Surgery on Cardio-Metabolic Outcomes
Effect of Bariatric Surgery on Cardio-Metabolic Outcomes Disclosure Research support from Bariatric Advantage (supplements donated for research study) Anne Schafer, MD Associate Professor of Medicine and
More informationTreating Type 2 Diabetes by Treating Obesity. Vijaya Surampudi, MD, MS Assistant Professor of Medicine Center for Human Nutrition
Treating Type 2 Diabetes by Treating Obesity Vijaya Surampudi, MD, MS Assistant Professor of Medicine Center for Human Nutrition 2 Center Stage Obesity is currently an epidemic in the United States, with
More informationBariatric Surgery Update
Friday General Session Bariatric Surgery Update Alex Perez, MD Chief, Division of Minimally Invasive and Foregut Surgery James E. Thompson, MD Family Distinguished Professor in Surgical Simulation Co Director,
More informationUse of laparoscopy in general surgical operations at academic centers
Surgery for Obesity and Related Diseases 9 (2013) 15 20 Original article Use of laparoscopy in general surgical operations at academic centers Ninh T. Nguyen, M.D. a, *, Brian Nguyen, B.S. a, Anderson
More information10/16/2014. Normal Weight: BMI Overweight: BMI >25 Obese: BMI >30 Morbidly Obese: BMI >40 or >35 with 2 comorbidities
Brinton Clark, MD, MPH Department of Medical Education Providence Portland Medical Center October 25 th, 2014 Oregon Society of Physician Assistants Fall Conference 45 yo woman with BMI=40kg/m2 (weight
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery
More informationAssociate. Professor of. Minimally. Invasive Surgery
Surgical Task Force Recommendations Ken Reed MD, FRSCS Committee Chair, and Staff Surgeon, Guelph General Hospital Clinical Associate Professor of Surgery, McMaster University Dennis Hong MD, MS.c, FRCSC,
More informationNot over when the surgery is done: surgical complications of obesity
Not over when the surgery is done: surgical complications of obesity Gianluca Bonanomi, MD, FRCS Consultant Surgeon and Honorary Senior Lecturer Chelsea and Westminster Hospital London The Society for
More informationDisclosures OBESITY. Overview. Obesity: Definition. Prevalence of Obesity is Rising. Obesity as a Risk Factor. None
Disclosures None OBESITY Florencia Halperin, M.D. Medical Director, Program for Management Brigham and Women s Hospital Instructor in Medicine, Harvard Medical School Overview Obesity: Definition Definition
More informationWhat s New in Bariatric Surgery?
Bariatric Surgery: Update for the General Surgeon What s New in Bariatric Surgery? 2,000 B.C. 2,000 A.D. 1. America keeps getting fatter without an end in sight. 2. Bariatric surgery is not just about
More informationA Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications
A Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications Shahzeer Karmali MD FRCSC FACS Associate Professor Surgery University of Alberta
More informationType 2 diabetes remission following gastric bypass: does diarem stand the test of time?
Surg Endosc (2017) 31:538 542 DOI 10.1007/s00464-016-4964-0 and Other Interventional Techniques Type 2 diabetes remission following gastric bypass: does diarem stand the test of time? J. Hunter Mehaffey
More informationtype 2 diabetes is a surgical disease
M. Lannoo, MD, University Hospitals Leuven Walter Pories claimed in 1992 type 2 diabetes is a surgical disease Buchwald et al. conducted a large meta-analysis THE FIRST OBSERVATIONS W. Pories 500 patients
More informationClinical Practice Guidelines for the Metabolic and Nonsurgical Support of the Bariatric Surgery Patient-2014 Update
Clinical Practice Guidelines for the Metabolic and Nonsurgical Support of the Bariatric Surgery Patient-2014 Update 1.Introduction Obesity continues to be a major public health problem in Belgium, with
More informationBariatric Surgery versus Intensive Medical Therapy for Diabetes 3-Year Outcomes
The new england journal of medicine original article Bariatric Surgery versus Intensive Medical for Diabetes 3-Year Outcomes Philip R. Schauer, M.D., Deepak L. Bhatt, M.D., M.P.H., John P. Kirwan, Ph.D.,
More informationObesity and Bariatric Surgery Michel M. Murr, MD, FACS
Obesity and Bariatric Surgery Michel M. Murr, MD, FACS Director of Bariatric Center Chief of Surgery, TGH Professor of Surgery, USF Disclosure Covidien: educational grants Obesity and Bariatric Surgery
More informationObesity & Metabolic (Diabetes) Surgery
Obesity & Metabolic (Diabetes) Surgery Sherif Awad PhD, FRCS Consultant Obesity Surgeon & Clinical Lead East-Midlands Bariatric & Metabolic Institute (EMBMI), Derby Teaching Hospitals BARS Conference,
More informationMedical Policy Bariatric Surgery. Document Number: 042 Commercial and Qualified Health Plans MassHealth Authorization required X X
Medical Policy Bariatric Surgery Document Number: 042 Commercial and Qualified Health Plans MassHealth Authorization required X X No Prior Authorization Overview The purpose of this document is to describe
More informationBariatric Surgery vs. Intensive Medical Therapy in Obese Diabetic Patients. Results of the STAMPEDE Trial
ariatric Surgery vs. Intensive Medical Therapy in Obese Diabetic atients Results of the STAMEDE Trial R Schauer, SR Kashyap, K Wolski, SA rethauer, Kirwan, CE othier, S Thomas, Abood, SE Nissen and DL
More informationType 2 diabetes and metabolic surgery:
Type 2 diabetes and metabolic surgery: Shouldn't we call it again again bariatric? Josep Vidal Obesity Unit. Endocrinology and Nutrition Department Hospital Clínic, University of Barcelona (Spain) What
More information3. Metabolic Surgery and Control of Type 2 Diabetes
3. Metabolic Surgery and Control of Type 2 Diabetes Philip R. Schauer, MD Shai M. Eldar, MD Helen M. Heneghan, MD Stacy A. Brethauer, MD The rising prevalence of obesity, coupled with disappointing results
More informationORIGINAL ARTICLE. Accelerated Growth of Bariatric Surgery With the Introduction of Minimally Invasive Surgery
ORIGINAL ARTICLE Accelerated Growth of Bariatric Surgery With the Introduction of Minimally Invasive Surgery Ninh T. Nguyen, MD; Jeffrey Root, MD; Kambiz Zainabadi, MD; Allen Sabio, BS; Sara Chalifoux,
More informationSleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center
Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center 1. Safety Two Year Excess Weight Loss Two Year Weight Loss and Mortality
More informationGoals 1/9/2018. Obesity over the last decade Surgery has become a safer management strategy Surgical options for management
The Current State of Surgical Intervention in Management of Morbid Obesity Goals Obesity over the last decade Surgery has become a safer management strategy Surgical options for management 1 Goals Obesity
More informationSurgery recommendations based on BMI and glycemic control
Surgery recommendations based on BMI and glycemic control BMI (kg/m2) in type 2 diabetes patients Glycemic control Surgery guidelines 40+ (37.5+ in Asian Americans) Controlled or uncontrolled Recommended
More informationACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute
ACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute Disclosures Authors: No disclosures ACS-NSQIP Disclaimer: The American College
More informationDisclosures. Obesity and Its Challenges: Outline. Outline 5/2/2013. Lan Vu, MD Division of Pediatric Surgery Department of Surgery
Obesity and Its Challenges: Bariatric Surgery: Why or Why Not I have nothing to disclose Disclosures Lan Vu, MD Division of Pediatric Surgery Department of Surgery Outline Growing obesity epidemic Not
More informationSurgery for Obesity and Related Diseases 9 (2013) Original article
Surgery for Obesity and Related Diseases 9 (2013) 42 47 Original article Medium-term outcomes of patients with insulin-dependent diabetes after laparoscopic adjustable gastric banding Rishi Singhal, M.R.C.S.*,
More information11/11/2011. Bariatric Surgery for Sleep Apnea. Case Presentation: Rachelle. Case Presentation: Rachelle. Case Presentation: Rachelle
Bariatric Surgery for Sleep Apnea 2,000 B.C. 2,000 A.D. 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive sleep apnea (AHI 42, on CPAP) asthma polycystic ovarian
More informationEpidemics of Obesity in the United States
Epidemics of Obesity in the United States Obesity: A Modern Epidemic It has recently become obvious that the prevalence of obesity has been rapidly increasing in the United States Obesity is definitely
More informationUpdate on Bariatric Surgery. Learning Objectives: At the end of this lecture you should be able to: Currently Available Options
Update on Bariatric Surgery Dan Bessesen, MD Chief of Endocrinology; Denver Health Medical Center Professor of Medicine, University of Colorado School of Medicine Daniel.Bessesen@ucdenver.edu Learning
More informationViriato Fiallo, MD Ursula McMillian, MD
Viriato Fiallo, MD Ursula McMillian, MD Objectives Define obesity and effects on society and healthcare Define bariatric surgery Discuss recent medical management versus surgery research Evaluate different
More informationAccess to Proven Therapies
Access to Proven Therapies Obesity is a life-threatening disease affecting 34% of adults in the U.S. Between 2000 and 2005, obesity increased by 24%, morbid obesity by 50%, and super obesity by 75%. 18%
More informationDisclosure. consultant to Ethicon Endosurgery. case mix disclosure. LRYGB sleeve BPD revisions OAGB ( minibp ), SADI: 0% 19% 55% 23%
Disclosure consultant to Ethicon Endosurgery case mix disclosure 3% 19% 23% 55% LRYGB sleeve BPD revisions OAGB ( minibp ), SADI: 0% Disclosure consultant to Ethicon Endosurgery case mix disclosure 3%
More informationBariatric Care Center Outcomes Report
Bariatric Care Center 215 Outcomes Report Since my surgery, my life is happier; I am happier with myself. Lisa Mark, Weight Loss Surgery Patient 2 Bariatric Care Center Contents Surgical Procedure Volume
More informationLaparoscopic Roux-en-Y Gastric Bypass for the Treatment of Type II Diabetes Mellitus in Chinese Patients with Body Mass Index of 25 35
OBES SURG (2011) 21:1344 1349 DOI 10.1007/s11695-011-0408-z CLINICAL RESEARCH Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Type II Diabetes Mellitus in Chinese Patients with Body Mass Index
More informationLaparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease
Laparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease Erik Peltz, D.O. April 7 th, 2008 University of Colorado Health Science Center Department
More informationWelche Operation für welchen Patienten: Sleeve, Bypass oder?
Welche Operation für welchen Patienten: Sleeve, Bypass oder?? Prof. Dr. med. Ralph Peterli Stv. Chefarzt Clarunis Leiter Forschungsplattform Viszeralchirurgie und bariatrisches Referenzzentrum Präsident
More information6/23/2011. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle
Bariatric Surgery: What the Primary Care Provider Should Know 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive
More informationDiabesita : integrazione tra terapia medica e terapia chirurgica Prof. Monica Nannipieri Dip. Medicina Clinica e Sperimentale Università di Pisa
Diabesita : integrazione tra terapia medica e terapia chirurgica Prof. Monica Nannipieri Dip. Medicina Clinica e Sperimentale Università di Pisa Dichiaro di non avere alcun conflitto d interesse Medical
More informationImpact of bariatric surgery on the management of type 2 diabetes mellitus in Singapore
Singapore Med J 2013; 54(7): 382-386 doi: 10.11622/smedj.2013138 Impact of bariatric surgery on the management of type 2 diabetes mellitus in Singapore Phong Ching Lee 1,3, MBChB, MRCP, Kwang Wei Tham
More informationDoes bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients
Surgery for Obesity and Related Diseases 9 (2013) 32 41 Original article Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients
More informationBariatric Surgery and Diabetes: Implications of Type 1 Versus Insulin-Requiring Type 2
Bariatric Surgery and Diabetes: Implications of Type 1 Versus Insulin-Requiring Type 2 Spyridoula Maraka 1, Yogish C. Kudva 1, Todd A. Kellogg 2, Maria L. Collazo-Clavell 1, and Manpreet S. Mundi 1 Objective:
More informationSURGICAL TREATMENT FOR OBESITY: WHATS THE BEST OPTION? Natan Zundel, MD, FACS
SURGICAL TREATMENT FOR OBESITY: WHATS THE BEST OPTION? Natan Zundel, MD, FACS Professor of Surgery Vice-Chairman Department of Surgery Florida International University Herbert Wertheim College of Medicine
More informationBariatric Surgery Outcomes
Bariatric Surgery Outcomes Kristoffel R. Dumon, MD a, Kenric M. Murayama, MD b, * KEYWORDS Bariatric surgery Outcomes Obesity Obesity is a global health problem and the exponential increase in obesity
More informationBARIATRIC SURGERY AND TYPE 2 DIABETES MELLITUS
BARIATRIC SURGERY AND TYPE 2 DIABETES MELLITUS George Vl Valsamakis European Scope Fellow Obesity Visiting iti Associate Prof Warwick Medical School Diabetes is an increasing healthcare epidemic throughout
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
More informationSubstantial Decrease in Comorbidity 5 Years After Gastric Bypass
Substantial Decrease in Comorbidity 5 Years After Gastric Bypass A Population-based Study From the Scandinavian Obesity Surgery Registry Sundbom, Magnus; Hedberg, Jakob; Marsk, Richard; Boman, Lars; Bylund,
More informationUpdate in Diabetes Care. Exercise and Bariatric Surgery. Ted Adams, PhD, MPH Intermountain LiVe Well Center Salt Lake October 6, 2017
Update in Diabetes Care Exercise and Bariatric Surgery Ted Adams, PhD, MPH Intermountain LiVe Well Center Salt Lake October 6, 2017 There is no drug in current or perspective use that holds as much promise
More informationMorbid Obesity A Curable Disease?
Morbid Obesity A Curable Disease? Piotr Gorecki, M.D. F.A.C.S. Associate Professor of Clinical Surgery Weill Medical College of Cornell University Chief of Laparoscopic Surgery New York Methodist Hospital
More informationOverview. Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco
GASTROINTESTINAL COMPLICATIONS AFTER BARIATRIC SURGERY Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco UCSF DEPARTMENT OF SURGERY Original Article
More informationCurrent Status of Bariatric Surgery in Asia
Emerald hall A, 1:2-1:5, November 7, 213 Current Status of Bariatric Surgery in Asia Go Wakabayashi, MD, PhD, FACS Professor and Chairman Department of Surgery Iwate Medical University Numbers of bariatric
More informationDiabetes control and lessened cerebral cardiovascular risks after gastric bypass surgery in Asian Taiwanese with a body mass index <35 kg/m2
Diabetes control and lessened cerebral cardiovascular risks after gastric bypass surgery in Asian Taiwanese with a body mass index
More informationBariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018
Bariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018 Disclosures None Objectives Review expected weight loss from
More informationType 2 diabetes and metabolic surgery:
Type 2 diabetes and metabolic surgery: Shouldn't we call it again Surgery for Type 2 DM again bariatric? Is it Metabolic or Bariatric surgery? Josep Vidal Obesity Unit. Endocrinology and Nutrition Department
More informationControversies in Obesity Management Public Meeting
Controversies in Obesity Management Public Meeting July 14, 2015 1 Agenda Public Meeting Convened, Topic Overview 9:30 am Presentation of the Evidence and Economic Modeling, Q&A 9:35 10:40 am (Dr. Dan
More informationDiabetes and Weight in Comparative Studies of Bariatric Surgery vs Conventional Medical Therapy: A Systematic Review and Meta-Analysis
OBES SURG (2014) 24:437 455 DOI 10.1007/s11695-013-1160-3 REVIEW ARTICLE Diabetes and Weight in Comparative Studies of Bariatric Surgery vs Conventional Medical Therapy: A Systematic Review and Meta-Analysis
More informationThe Changing Shape of Bariatric Surgery
Measuring Obesity The Changing Shape of Bariatric Surgery D. Scott Diamond, MD FACS Determined by height and weight Comparison to ideal body weight/height BMI = weight(kg) height(m) 2 BMI = weight(lb)*
More informationSession 6B Appropriate Treatment of Obesity Demonstrates Clinical & Economic Success
Session 6B Appropriate Treatment of Obesity Demonstrates Clinical & Economic Success Part 2 John Dawson, FSA, MAAA Appropriate Treatment of Obesity Demonstrates Clinical & Economic Success SOA Asia-Pacific
More informationMid-term results of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy compared results of the SLEEVEPASS and SM-BOSS trials
Editorial Page 1 of 5 Mid-term results of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy compared results of the SLEEVEPASS and SM-BOSS trials David Benaiges 1,2,3, Elisenda
More informationIntroduction ARTICLE. and 3.4%, respectively. In both the medium- and majorweight-reduction
Diabetologia (2015) 58:1448 1453 DOI 10.1007/s00125-015-3591-y ARTICLE Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese
More informationBariatric surgery. KHALAJ A.R. M.D Obesity Clinic Mostafa Khomini Hospital Shahed University Tehran
Bariatric surgery KHALAJ A.R. M.D Obesity Clinic Mostafa Khomini Hospital Shahed University Tehran WWW.IRANOBESITY.COM Why Surgery? What is Indication of Surgery? What is ContraIndication of surgery? What
More informationBariatric Surgery MM /11/2001. HMO; PPO; QUEST 05/01/2012 Section: Surgery Place(s) of Service: Outpatient; Inpatient
Bariatric Surgery Policy Number: Original Effective Date: MM.06.003 09/11/2001 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 05/01/2012 Section: Surgery Place(s) of Service: Outpatient;
More informationCommonly Performed Bariatric Procedures in Singapore. Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital
Commonly Performed Bariatric Procedures in Singapore Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital Scope 1. Introduction 2. Principles of bariatric surgery
More informationWhy is Earlier and More Aggressive Treatment of T2 Diabetes Better?
Blood glucose (mmol/l) Why is Earlier and More Aggressive Treatment of T2 Diabetes Better? Disclosures Dr Kennedy has provided CME, been on advisory boards or received travel or conference support from:
More informationBNORC: Contribution over 25 years to evidence on obesity and cancer
BNORC: Contribution over 25 years to evidence on obesity and cancer Graham A Colditz, MD DrPH Niess-Gain Professor Chief, Boston July 10, 2017 https://tinyurl.com/ybmnqorq Economic costs of diabetes:
More informationRobotic Bariatric Surgery. Richdeep S. Gill, MD Research Fellow Center for the Advancement of Minimally Invasive Surgery (CAMIS)
Robotic Bariatric Surgery Richdeep S. Gill, MD Research Fellow Center for the Advancement of Minimally Invasive Surgery (CAMIS) Background Over 500 million obese individuals worldwide Bariatric surgery
More informationCan Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus
PAPERS OF THE 133RD ASA ANNUAL MEETING Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus Stacy A. Brethauer, MD, Ali Aminian, MD, Héctor Romero-Talamás, MD,
More informationThis letter is to request that BCBS-ND revisit its bariatric surgery policy in the area of Type 2 Diabetes Mellitus (T 2 DM).
March 29, 2016 Jacquelyn Walsh V.P. for Clinical Excellence and Quality Blue Cross/Blue Shield North Dakota 4510 13 th Ave. S. Fargo, ND 58121 Dear Ms. Walsh: This letter is to request that BCBS-ND revisit
More informationObesity Who is suitable for surgery? Professor Rob Andrews University of Exeter / Taunton NHS trust
Obesity Who is suitable for surgery? Professor Rob Andrews University of Exeter / Taunton NHS trust Investigator on BYBAND study Conflict of interest 3 Diet and Exercise studies (ACTID, EXTOD, STAMP2)
More informationOBESITY AND WEIGHT LOSS SURGERY FOR THE PRIMARY CARE PHYSICIAN
OBESITY AND WEIGHT LOSS SURGERY FOR THE PRIMARY CARE PHYSICIAN Nicole Basa, M.D., F.A.C.S., F.A.S.M.B.S Assistant Professor of Surgery Texas A&M Medical School Bariatric Medical Director- Cedar Park Regional
More informationDiabetes Mellitus: A Cardiovascular Disease
Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular
More informationGlycemic control a matter of life and death
Glycemic control a matter of life and death Linda Garcia Mellbin MD PhD Specialist in Cardiology & Internal medicine Dep of Cardiology Karolinska University Hospital /Karolinska Institutet Mortality (%)
More informationChoice Critria in Bariatric Surgery. Giovanni Camerini
Choice Critria in Bariatric Surgery Giovanni Camerini Surgical vs Medical treatment Indications for Bariatric Surgery (WHO 1992) BMI of at least 40; BMI of 35 in case of serious diseases related to obesity;
More informationObesity and Weight Loss Surgery for the Primary Care Physician
Saturday General Session Obesity and Weight Loss Surgery for the Primary Care Physician Nicole Basa, MD Bariatric and General Surgeon Cedar Park Surgeons, PA Cedar Park, Texas Educational Objectives By
More informationBariatric surgery: has anything changed in the last few years?
Bariatric surgery: has anything changed in the last few years? Mauro Toppino University of Turin Digestive and Colorectal Surgery Minimal Invasive Surgery Center (Head:Prof. Mario Morino) XIV Annual Conference
More informationRobotics in General Surgery. Objectives
Robotics in General Surgery Jennifer S. Schwartz, MD Assistant Professor of Surgery Department of Surgery Division of General & Gastrointestinal Surgery The Ohio State University Wexner Medical Center
More informationAdjustable Gastric Band Surgery: Review of Current Practice. Dr. Chris Cobourn The Surgical Weight Loss Centre Mississauga, Ontario Canada
Adjustable Gastric Band Surgery: Review of Current Practice Dr. Chris Cobourn The Surgical Weight Loss Centre Mississauga, Ontario Canada March 31, 2012 Disclosures Allergan Canada Unrestricted Research
More informationENTRY CRITERIA: C. Approved Comorbidities: Diabetes
KAISER PERMANENTE OHIO BARIATRIC SURGERY (GASTROPLASTY) Methodology: Expert Opinion Issue Date: 12-05 Champion: Surgery Review Date: 4-10, 4-12 Key Stakeholders: Surgery, IM Depts. Next Update: 4-14 RELEVANCE:
More informationPage 2: Baker IDI. Page 4: Baker IDI. Global & Regional Obesity. High income English speaking Light Blue. Global & Regional Severe obesity
Metabolic Surgery Update Patients selection and choice of procedure Professor John B Dixon MBBS, FRACGP, FRCP Edin, PhD NHMRC Senior Research Fellow Head of Clinical Obesity Research, Baker IDI Heart and
More informationBenefits of Bariatric Surgery
Benefits of Bariatric Surgery Dr Tan Bo Chuan Registrar, Department of Surgery GP Forum 27 May 2017 Improvements of Co-morbidities Type 2 diabetes mellitus Hypertension Hyperlipidemia Degenerative joint
More informationLONG TERM OUTCOMES OF SLEEVE GASTRECTOMY (LSG) Jacques Himpens, Gustavo Arman The European School of Laparoscopic Surgery Brussels Belgium
LONG TERM OUTCOMES OF SLEEVE GASTRECTOMY (LSG) Jacques Himpens, Gustavo Arman The European School of Laparoscopic Surgery Brussels Belgium DISCLOSURE DR HIMPENS IS A CONSULTANT WITH ETHICON ENDOSURGERY
More informationSURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS
SURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS Professor of Surgery Vice-Chairman Department of Surgery Florida International University Herbert Wertheim College
More informationPredictors of Short-Term Diabetes Remission After Laparoscopic Roux-en-Y Gastric Bypass
Predictors of Short-Term Diabetes Remission After Laparoscopic Roux-en-Y Gastric Bypass Gianluca Iacobellis, Chengyu Xu, Rafael E. Campo & Nestor F. De La Cruz- Munoz Obesity Surgery The Journal of Metabolic
More informationSINGLE INCISION ENDOSCOPIC SURGERY (SIES)
EAES CONSENSUS CONFERENCE SINGLE INCISION ENDOSCOPIC SURGERY (SIES) STATEMENTS AND RECOMMENDATIONS EAES appreciates your input! Please give your opinion on the below statements and recommendations of the
More information* Assit. prof., *** Prof. & Head of deptt., Deptt. of Surgery, MGIMS ** Asstt prof Deptt. of Medicine. REVIEW ARTICLE
REVIEW ARTICLE TYPE 2 DIABETES MELLITUS - EXPLORING THE AVENUE OF BARIATRIC SURGERY. S RAO*, JAIN VV**, GUPTA DO***. Diabetes is a growing public health problem world-wide and especially in India which
More informationBariatric Surgery: The Primary Care Approach
The 8 th Annual Conference of the Lebanese Society of Family Medicine October 25 th 2009 Bariatric Surgery: The Primary Care Approach Bassem Y. Safadi, MD, FACS Associate Professor of Clinical Surgery
More information(Who and) When should patients with obesity and impaired glucose regulation undergo metabolic surgery?
(Who and) When should patients with obesity and impaired glucose regulation undergo metabolic surgery? Alex Miras Senior Clinical Lecturer in Endocrinology Disclosures Fractyl Novo Nordisk Astra Zeneka
More informationFive Things a Family Physician Needs to Know about Baritric Surgery.
Five Things a Family Physician Needs to Know about Baritric Surgery. Dr. J Kenneth Reed MD FRCS(C) Guelph General Bariatric Centre of Excellence May 2014 Five Things to Know About Bariatric Surgery Presenter
More informationPage 2: Baker IDI. Page 4: Baker IDI. Global & Regional Obesity. High income English speaking Light Blue. Global & Regional Severe obesity
Metabolic Update Patients selection and choice of procedure Professor John B Dixon MBBS, FRACGP, FRCP Edin, PhD NHMRC Senior Research Fellow Head of Clinical Obesity Research, Baker IDI Heart and Diabetes
More informationSleeve Gastrectomy: Harmful. John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10
Sleeve Gastrectomy: Harmful John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10 Background Obesity: Body Mass Index >30 Risk factor for CAD, DM, Cancers Obesity Trends*
More information