Update in Diabetes Care. Exercise and Bariatric Surgery. Ted Adams, PhD, MPH Intermountain LiVe Well Center Salt Lake October 6, 2017
|
|
- Lawrence Richard
- 5 years ago
- Views:
Transcription
1 Update in Diabetes Care Exercise and Bariatric Surgery Ted Adams, PhD, MPH Intermountain LiVe Well Center Salt Lake October 6, 2017
2 There is no drug in current or perspective use that holds as much promise for sustained health as a lifetime program of physical activity. American Medical Association
3
4 Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association Benefits of exercise/physical activity in diabetic patients Improve blood glucose control in type 2 diabetes Reduced cardiovascular risk factors Contributes to weight loss Improves well-being May prevent or delay type 2 diabetes Improve cardiovascular fitness, muscle strength, insulin sensitivity, etc. Diabetes Care 2016;39:
5 R x Exercise/physical activity should be tailored to meet specific needs of each individual patient Refer to Table 3, page 2070, for specific recommendations related to types, intensity, duration and progression of exercise prescription. Refer to Table 5, page 2073, for physical activity considerations. Precautions and recommended activities for exercising with health-related complications. Be mindful of pregnancy, hypo- and hyper-glycemia, medication effects and heat-related illness Diabetes Care 2016;39:
6 ADA Abridged Standards of Care, 2017 R x Exercise/physical prescription - children and adolescents Type 1, type 2 or prediabetes 60 min/day of moderate or vigorous intensity activity, with vigorous, muscle strengthening and bonestrengthening activities included at least 3 days/week Clinical Diabetes published online 12/15/2016
7 ADA Abridged Standards of Care, 2017 R x Exercise/physical prescription - most adults, Type 1 and 2 Type 1 or type min or more of moderate-tovigorous intensity activity per week (spread out over at least 3 days/wk, not missing more than 2 days in a row 2-3 sessions/wk or resistance exercise (not in a row) Decrease time spent in sedentary behavior; interrupt prolonged sitting every 30 min Flexibility and balance training 2-3 times/wk for older adults (yoga and tai chi - flexibility, strength, balance Clinical Diabetes published online 12/15/2016
8 Prospective and retrospective observational studies in bariatric surgery Can contribute (in a unique way) to the understanding of long-term outcomes of bariatric surgery. Electronic medical record Health plans claims data Combined health plans claims data RCTs in bariatric surgery have some limitations Difficult to recruit participants May be under-powered for adequate analyses
9 Reduction of Micro- and Macrovascular Complications (Johnson BJ et al.; 2013) Pre-bariatric surgical patients (BAR) with T2DM (n=2580); surgery, Moderate and obese non-bariatric surgical patients (No-BAR) with T2DM (n=13,371) Both groups without MI, angina, CHF, stroke, or advanced microvascular disease Study outcome: First major macrovascular or microvascular event BAR to No-BAR Disease HR Macrovascular 0.39; 95% CI, Microvacular 0.22; 95% CI, Johnson BJ et al. J Am Coll Surg 2013;216:545-58
10 Multisite Study of Long-term Remission and Relapse of T2DM (Arterburn; 2013) Pre-bariatric surgical patients with T2DM (n=4,434); Initial T2DM remission within 5 years post-surgery: 68.2% (95% CI, 66-70%) Remitters who redeveloped T2DM remission within 5 years 35.1% (95% CI, 32-38%) Arterburn DE et al. Obes Surg 2013;23(1):93
11 Retrospective Pre-surgery T2DM and CVD Incidence and Mortality (Eliasson; 2015) Two large Swedish registries merged National Diabetes Registry & Scandinavian Obesity Surgery Registry 6132 RYGB patients and 6132 non-surgery control patients all patients with T2DM Matched on sex, age, BMI, calendar time 3.5 years follow-up Eliasson, B, Lancet Diabetes Endocrinol, 2015;3:847
12 Eliasson cont. all patients with T2DM (n=6132; each group, ) Events RYGB Patients (N) Non-operated (N) HR (95% CI) All-cause mortality ( ) CVD-caused mortality ( ) Fatal or non-fatal MI ( ) Eliasson, B, Lancet Diabetes Endocrinol, 2015;3:847
13 PROMISE study NIH Funded (Arterburn; 2016) Joint collaboration between 4 U.S. health care systems: Kaiser Permanente Northern California (KPNC) Kaiser Permanente Southern California (KPSC) HealthPartners Research Foundation in Minnesota (HPRF) Group Health Cooperative (GHC) Approximately 10,000 bariatric surgical patients who were diabetic prior to surgery (surgery 2001 through 2011; 40% racial/ethnic minority)
14 PROMISE study (continued) First manuscript Long-term microvascular disease (first occurrence of retinopathy, neuropathy, and/or nephropathy) Those who remitted T2DM = 29% lower risk of microvascular disease compared to never-remitted (HR 0.71 [95% CI 0.60, 0.85]) For those who remitted T2DM and later relapsed, the longer the remission time inversely related to risk for incident microvascular disease Every additional year of remittance = reduced risk of 19% (HR 0.81 [95% CI 0.67, 0.99]) Coleman KJ et al. Diab Care 2016 (online pub)
15 Geisinger Obesity Institute CVD Risk Factors and CHF (Benotti; 2017) RYGB group and matched controls, n=1724 Matched on: age, BMI, sex, Framingham Risk Score, smoking Hx, HTN meds, T2DM and date of surgery Primary end points: MI, stroke and CHF Secondary end points: CVD risk factors (risk score, lipids, SBP, and T2DM) Follow-up: 12 years post-surgery (mean = 6.3 years) Benotti PN et al. J Am Heart Assoc 2017;6:e005126
16 Geisinger Obesity Institute results Reduction in major composite CV events (63 in RYGB group and 110 in control group) HR 0.58 (95% CI: 0.42, 0.82) Groups MI (N) Stroke (N) CHF RYGB Matched Controls Reduction in CHF in RYGB compared to controls (p=0.0077) but not significantly different for MI and stroke alone Improvements in CV risk factors (p<0.0001) Benotti PN et al. J Am Heart Assoc 2017;6:e005126
17 Thereaux J et al. Retrospective Nationwide Matched Cohort Study French health care system database, SNIRAM, linked to French medical discharge database, PMSI 1633 bariatric surgery patients and 1633 matched controls Follow-up of 6 years; greatest benefit in RYGB subgroup Events Bariatric Surgery Patients Non-operated (N) Remitted T2DM 50% 9% T2DM Incidence 1% 12% Thereaux, J et al, data presented at IFSO London, 2017.
18 SOS Long-term Micro- and Macro-vascular Complications (Sjöström L et al.) Macrovascular complications of BAR vs. No-BAR BAR 20.6 per 1000 person years No-BAR 41.8 per 1000 person-years HR 0.44; 95% CI, ; p<0.001 Microvascular complications of BAR vs. No-BAR BAR 31.7 per 1000 person years No-BAR 44.2 per 1000 person-years HR 0.68; 95% CI, ; p=0.001 Sjöström L et al. JAMA 2014;311:2297
19 One RCT - Micorvascular & Macrovascular Outcomes - STAMPEDE (Schauer, P. et al.) Reduction in urinary albumin-to-creatinine ratio (UACR) of SURG vs. No-SURG (p<0.04) for both GBP and sleeve groups Patients with baseline albuminuria who returned to normal values: 62% (8 of 13; p=0.04 within group comparison) 80% (8 of 10; p=0.11 within group comparison) 25% (1 of 4; p=1.00 within group comparison) Schauer, P. et al. NEJM 2014;370:2002
20 Utah Study - Hypothesis Does Roux-en-Y gastric bypass (RYGB) surgery result in improved morbidity when severely obese non-surgical groups (population-based and denied-surgery) are compared to RYGB patients? Note: Gastric banding was not approved in US at time of study initiation (2001).
21 Recruitment Scheme: RYGB Group and Non-surgery Group 1 Patients come to surgeon s clinic to learn about RYGB and get health insurance advice. Patients informed of study. Patient agrees to participate Patient undergoes baseline testing Health plan approves RYGB or patient provides self-pay and RYGB surgery performed Health plan denies coverage of RYGB or patient chooses not to have RYGB performed Patient assigned to RYGB Group Patient assigned to Non-surgical group 1
22 Recruitment Scheme: Non-surgery Group 2 Severely obese participants not seeking bariatric surgery. Randomly selected from the Utah Health Family Tree program database: 150,000+ families (>1 million family members) Health data, including reported weight status.
23 Recruitment Hypothesis Denied surgery patients (Non-surgical Group 1) represent characteristics associated with seeking surgery (potentially self-selected for significant comorbidities and other conditions). Population-based severely obese participants (Non-surgical Group 2) represent characteristics associated with severely obese subjects in the general population.
24 Long-term Prospective Utah Study (NIH-funded ) Exam 1 Exam 2 Exam 3 Exam 4 Surgical Center RYGB 418 RYGB Surgery Utah Health Family Tree Program No RYGB Non-Surgery Non-Surgery Baseline 2 Years 6 Years Adams et al. Obesity 2010;18: Adams et al. JAMA 2012;308: Years
25 12-year Results Follow-up End Point RYGB Surgery Group Non-surgery Group 1 Non-surgery Group 2 (minus deaths) (minus deaths) (minus deaths) Potential Participation, n Any data source, n (%) 388 (98.7%) 364 (96.3%) 301 (99.3%) Minimum of Weight, SBP, and either glucose or HbA1c, n (%) Later had bariatric surgery, n (%) 353 (90.1%) 342 (90.5%) 285 (94.1%) (35%) 39 (12%) Adams, T. et al. NEJM 2017;377:
26 12-year Results Mortality End Point RYGB Surgery Group Non-surgery Group 1 Non-surgery Group 2 (minus deaths) (minus deaths) (minus deaths) All-cause, n (%) 26 (6.2%) 39 (9.4%) 18 (5.6%) CVD, (n) (%) Cancer, n (%) Suicide, n (%) 5 (1.2%) 2 (0.5%) 0 Poisoning, n (%) 4 (1.0%) 2 (0.5%) 0 = Death subsequent to bariatric surgery Adams, T. et al. NEJM 2017;377:
27 % Change % Change in Baseline Body Weight (mean adjusted) Control 2 Control 1 Surgery -50 BL 2 Years 6 Years 12 Years = Surgery group differs significantly from non-surgery groups; p<0.001 Adams, T. et al. NEJM 2017;377:
28 Percent weight change from baseline 20 % Change in Baseline Body Weight RYGB Group Baseline 2-yr 6-yr 12-yr % weight lost # of participants Baseline 2 Years 6 Years 12 Years RYGB patients Deaths Total
29 Percent weight change from baseline % Change in Baseline Body Weight Non-Surgery Group # of participants Baseline 2 Years 6 Years 12 Years Non-surgery group Had surgery later Deaths Total Baseline 2-yr 6-yr 12-yr 2-yr surgery 6-yr surgery 12-yr surgery Non-surgical controls All controls including surgeries
30 Percent weight change from baseline % Change in Baseline Body Weight Non-Surgery Group yr 10 6-yr # of participants Baseline 2 Years 6 Years 12 Years Non-surgery group Had surgery later Deaths Total Baseline 12-yr 2-yr surgery 6-yr surgery 12-yr surgery Population controls All controls including surgeries
31 Weight Loss Maintenance at 12 Years: RYGB Group 360 of 387 RYGB patients (93%) maintained at least a 10% weight loss from baseline to year (70%) maintained at least 20% weight loss 155 (40%) maintained at least 30% weight loss Only 4 of 387 (1%) had regained all postsurgical weight loss Adams, T. et al. NEJM 2017;377:
32 Diabetes remission after RYGB Group 2 years 6 years 12 years Surgery, % 74% 62% 51% Surgery, n 66/88 54/87 43/84 Adams, T. et al. NEJM 2017;377:
33 Diabetes and Hypertension: 12-year Remission End Point Surgery % NS 1, % NS 2, % Adj. OR S vs NS 1 Adj. OR S vs NS 2 T2D 51% 10% 5% HTN 36% 10% 14% 8.9 (2.0, 40.0) 5.1 (1.7, 15.6) 14.8 (2.9, 75.5) 2.4 (0.9, 5.9) = P<0.001 Adams, T. et al. NEJM 2017;377:
34 Diabetes and Hypertension: 12-year Incidence End Point Surgery % NS 1, % NS 2, % Adj. OR S vs NS 1 Adj. OR S vs NS 2 T2D 3% 26% 26% 0.08 (0.03, 0.24) HTN 16% 41% 47% 0.23 (0.11, 0.49) 0.09 (0.03, 0.24) 0.09 (0.11, 0.51) = P<0.001 Adams, T. et al. NEJM 2017;377:
35 mg/dl Unadjusted Mean HDL-Cholesterol BL 2 Years 6 Years 12 Years Surgery Group Non-S Group 1 Non-S Group 2 Surgery group mean (adjusted for medication use) differs significantly from non-surgery groups; p<0.05 Adams et al. JAMA 2012;308: Adams et al. Obesity 2010;18: Adams, et al. NEJM 2017;377:
36 grams 250 Left Ventricular Mass BL 2 Years 6 Years 12 Years Surgery Group Non-S Group 1 Non-S Group 2 Adams et al. JAMA 2012;308: Adams et al. Obesity 2010;18: Adams, et al. NEJM 2017;377:
37 Conclusions Long-term durability of weight loss after RYGB with minimal weight increase between the 6- and 12-year follow-up Very minimal incidence of T2DM Remission rate 51% at the 12-year follow-up Marked improvement in systolic hypertension and lipid levels
38 Acknowledgement: Funding from NIH-NIDDK
39 Thank You
40 There is no drug in current or perspective use that holds as much promise for sustained health as a lifetime program of physical activity. Journal of the American Medical Association
41
42 Benefits of Physical Activity Lower death rates Prevents or reduces risk of: High blood pressure Osteoporosis Overweight and obesity Depression and anxiety Diabetes Some cancers (i.e. colon)
43 Benefits of Physical Activity Improves structure and function of ligaments, tendons and joints Improves: Muscular strength Sleep patterns Health-related quality of life Independent living with increasing age
44 R x Structured Exercise Program Frequency: 3-5 days/week Intensity: 55/65% - 90% max heart rate
45 R x Structured Exercise Program continued Duration: min (continuous or intermittent - minimum 10 min. bouts accumulated over the day) Mode: Large muscle groups, continuous, aerobic in nature
46 Modes for Structured Exercise Walking-hiking Running-jogging Cycling-bicycling Aerobic dance Stair climbing Swimming Endurance games
47 R x Structured Exercise Program continued Resistance training: One set, 8-10 exercises, 8-12 reps, 2-3 days/wk
48 Examples of Using Your Own Weight
49 R x Structured Exercise Program continued Flexibility training: 2-3 days/wk of stretching major muscle groups
50 Flexibility Exercises
51 R x Lifestyle Physical Activity Accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all days of the week. Resistance training 2 times per week
52 Examples: Moderate Intensity Activities Walking Yard Work Stair Climbing Housework Dancing
53 Resting Metabolic Rate (RMR) Indirect calorimetry using a Parvomedics TrueOne 2400 metabolic cart. Measurements taken in the morning after a 12-hour fast, minimal exercise in prior 24 hours, and participants having rested in a supine position for at least 30 minutes. 24-hour estimates based on at least 10 minutes of stable resting values. 986 participants had at least one assessment Mixed model regression was used to determine group-wise differences at each time point.
54 kcals/day Resting Metabolic Rate (RMR) Non-Surgery 2 Non-Surgery 1 Surgery BL 2 Years 6 Years 12 Years RMR has an expected drop with weight loss in Surgery group Long-term rate of RMR decrease mirrors age-related drop in controls // Within-group change from previous assessment is significant (p<0.05) Surgery value differs significantly from Non-Surgery 1 group (p<0.05) Surgery value differs significantly from Non-Surgery 2 group (p<0.05)
55 kcals/day Resting Metabolic Rate (RMR) per kg body weight Non-Surgery 2 Non-Surgery 1 Surgery BL 2 Years 6 Years 12 Years Per kilogram RMR remains improved long-term, perhaps explaining maintenance of post-op weight loss Difference begins to wane by 12 years // Within-group change from previous assessment is significant (p<0.05) Surgery value differs significantly from Non-Surgery 1 group (p<0.05) Surgery value differs significantly from Non-Surgery 2 group (p<0.05)
56 kilograms RYGB: influence of Fat and FFM on RMR FFM FM Weight RMR BL 2 yrs 6 yrs 12 yrs 0 RMR does not decrease as much as expected with weight loss FFM constitutes 1/3 rd of weight loss, but is only 11% of regain /// Change is significant (p<0.05) compared with previous assessment
57 kilograms Kcals/kg/day RYGB: influence of Fat and FFM on RMR/kg FFM FM Weight RMR/kg BL 2 yrs 6 yrs 12 yrs 0 RMR/kg changes reflect increased FFM relative to FM /// Change is significant (p<0.05) compared with previous assessment
58 Cardiorespiratory fitness: time on treadmill Graded exercise test with 12-lead ECG Submaximal tests at baseline and 12 years (maximal tests at 2 and 6 years) Means are seconds to test completion Time Test type RYGB Baseline Submax (80%) (seconds) NS 1 (seconds) NS 2 (seconds) 602±13 593±14 582±13 2 years Maximal 873±13 623±16 586±14 6 years Maximal 828±14 641±17 679±13 12 years Submax (80%) 643±14 598±16 556±17 After surgical weight loss, RYGB patients are able to last significantly longer on the treadmill years after surgery The effect is lost when controlling for weight = (p<0.05) = (p<0.0001)
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 informationStandards of Medical Care in Diabetes 2016
Standards of Medical Care in Diabetes 2016 Care Delivery Systems 33-49% of patients still do not meet targets for A1C, blood pressure, or lipids. 14% meet targets for all A1C, BP, lipids, and nonsmoking
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 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 informationOBESITY 2008: DIET, EXERCISE, DRUGS, AND SURGERY
OBESITY 2008: DIET, EXERCISE, DRUGS, AND SURGERY Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest CLASSIFICATION OF OVERWEIGHT
More information6/10/2016. Bariatric Surgery: Impact on Diabetes and CVD Risk. Disclosures BARIATRIC PROCEDURES
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
More informationImplications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes?
Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes? Boston, MA November 7, 213 Edward S. Horton, MD Professor of Medicine Harvard Medical School Senior Investigator
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 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 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 informationAdvanced Concepts of Personal Training Study Guide Answer Key
Advanced Concepts of Personal Training Study Guide Answer Key Lesson 22 Working with Special Populations LESSON TWENTY TWO Lesson Twenty Two Working with Special Populations WORKING WITH SPECIAL POPULATIONS
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 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 Exercise on Patients with Diabetes Mellitus. Learning Objectives. Definitions Physical Activity and Health
Impact of Exercise on Patients with Diabetes Mellitus Bret Goodpaster, Ph.D. Exercise Physiologist Assistant Professor of Medicine University of Pittsburgh Division of Endocrinology and Metabolism Learning
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 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 informationThe role of exercise in diabetes care
The role of exercise in diabetes care Eun-Jung Rhee Endocrinology and Metabolism, Kangbuk Samsung Diabetes and Vascular Center, Sungkyunkwan University School of Medicine Contents Why do we exercise?
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 informationLearning Objectives. Impact of Exercise on Patients with Diabetes Mellitus. Definitions: Physical Activity and Health.
Impact of Exercise on Patients with Diabetes Mellitus Bret Goodpaster, Ph.D. Exercise Physiologist Professor of Medicine University of Pittsburgh Division of Endocrinology and Metabolism Learning Objectives
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationEdward Melanson, Ph.D., Associate Professor, Division of Endocrinology, Metabolism, and Diabetes University of Colorado Denver
Edward Melanson, Ph.D., Associate Professor, Division of Endocrinology, Metabolism, and Diabetes University of Colorado Denver 45 y/o man Medications: none Social Hx: moderate alcohol intake (1-2 cans
More informationBenefits of exercise: a review of the research and a plan for prescribing exercise programs
Benefits of exercise: a review of the research and a plan for prescribing exercise programs How many of your patients would take a pill that would do the following Christine Kramer, ANP Decrease their
More informationPrediabetes 101. What is it and what can I do about it? Intermountainhealthcare.org/diabetes
Prediabetes 101 What is it and what can I do about it? Patient Education Intermountainhealthcare.org/diabetes What do you already know about prediabetes? Fact or Fiction? There are often no symptoms of
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 informationEnergy balance. Changing rate of energy expenditure
Energy balance Changing rate of energy expenditure 2 Physical activity and exercise Physical activity Occupational activity Physical Activity Exercise (business, work) Leisure activity (Recreational activities,
More informationMicrovascular Disease in Type 1 Diabetes
Microvascular Disease in Type 1 Diabetes Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine The Course
More informationThe Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
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 informationObesity Management in Patients with Diabetes Jamy D. Ard, MD Sunday, February 11, :15 a.m. 11:00 a.m.
Obesity Management in Patients with Diabetes Jamy D. Ard, MD Sunday, February 11, 2018 10:15 a.m. 11:00 a.m. Type 2 diabetes mellitus (T2DM) is closely associated with obesity, primarily through the link
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 informationWhy Do We Care About Prediabetes?
Why Do We Care About Prediabetes? Complications of Diabetes Diabetic Retinopathy Leading cause of blindness in adults 1,2 Diabetic Nephropathy Leading cause of Kidney failure Stroke 2- to 4-fold increase
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 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 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 informationPhysical Activity: Impact on Morbidity and Mortality
Physical Activity: Impact on Morbidity and Mortality International Congress of Nutrition September 17, 2013 Steven N. Blair Departments of Exercise Science & Epidemiology/Biostatistics Arnold School of
More informationKidney and heart: dangerous liaisons. Luis M. RUILOPE (Madrid, Spain)
Kidney and heart: dangerous liaisons Luis M. RUILOPE (Madrid, Spain) Type 2 diabetes and renal disease: impact on cardiovascular outcomes The "heavyweights" of modifiable CVD risk factors Hypertension
More informationAging and Exercise 8/7/2014. Effects of Aging and Exercise
Aging and Exercise Dave Enzler Director of Recreation, Fitness and Wellness University of Southern Indiana Effects of Aging and Exercise Normal Changes Body Composition (muscle mass decreases, fat increases)
More informationMicrovascular Complications in Diabetes:
Microvascular Complications in Diabetes: Perspectives on Glycemic Control to Prevent Microvascular Complications Discussion Outline: Glycemia and Microvascular Compliations Clinical Trials - A Brief History
More informationThe Benefits of Physical Activity for Older Adults. A Wellness Module
The Benefits of Physical Activity for Older Adults A Wellness Module Benefits of Regular Physical Activity Reduces blood pressure Reduces cholesterol Helps maintain body weight Prevents further bone loss
More information7/6/2012. University Pharmacy 5254 Anthony Wayne Drive Detroit, MI (313)
University Pharmacy 5254 Anthony Wayne Drive Detroit, MI 48202 (313) 831-2008 Be able to identify the signs of a heart attack or stoke Identify what puts you at a higher risk for cardiovascular disease,
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 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 informationDiabetes Treatment Update
Diabetes Treatment Update Timothy C. Evans, MD PhD FACP University of Washington Department of Medicine Disclosure: Dr. Evans has no significant financial interest in any of the products or manufacturers
More informationEnergy, Health, Resilience what has F.I.T.T got to do with it?
Energy, Health, Resilience what has F.I.T.T got to do with it? 15 March 2012 Maretha Delport: Executive Heath Promotion If we could give every individual the right amount of nourishment and exercise, not
More informationThe Obesity Epidemic: Its Impact in the Workplace and What Employers Can Do
1 The Obesity Epidemic: Its Impact in the Workplace and What Employers Can Do Dr. Monali Misra, MD, FRCS(C), FACS Assistant Professor Department of Surgery, St. Joseph s Healthcare, McMaster University
More informationUpdate on CVD and Microvascular Complications in T2D
Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine
More informationPrevention of complications: are we winning or losing the battle. Naveed Sattar Professor of Metabolic Medicine
Prevention of complications: are we winning or losing the battle Naveed Sattar Professor of Metabolic Medicine Duality of Interest Declaration Consultant or speaker for: Amgen, AstraZeneca, Boehringer
More informationChapter 37: Exercise Prescription in Patients with Diabetes
Chapter 37: Exercise Prescription in Patients with Diabetes American College of Sports Medicine. (2010). ACSM's resource manual for guidelines for exercise testing and prescription (6th ed.). New York:
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 informationLesson 7 Diet, Exercise and Sports Nutrition
Lesson 7 Diet, Exercise and Sports Nutrition Physical inactivity has been identified by WHO as the 4 th leading risk factor for global mortality. Physical activity is any movement that burns calories whereas
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 informationDiabetes and the Heart
Diabetes and the Heart Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 6, 2012 Outline Screening for diabetes in patients with CAD Screening for CAD in patients with
More information9 th Grade Physical Education
NAME: Class Period: 9 th Grade Physical Education Sheboygan North High School Physical Fitness Definition of Physical Fitness: All though this is a widely accepted definition of Physical Fitness most experts
More informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
More informationStandards of Medical Care In Diabetes
Standards of Medical Care In Diabetes - 2017 Robert E. Ratner, MD, FACP, FACE Professor of Medicine Georgetown University School of Medicine Disclosed no conflict of interest Standards of Care Professional.diabetes.org/SOC
More informationChairman s Rounds, 02/15/2011
Chairman s Rounds, 02/15/2011 Edward Lipkin, MD Associate Professor, Department of Medicine Division of Metabolism, Endocrinology and Nutrition University of Washington Predictive factors in patient s
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 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 informationSTATE OF THE STATE: TYPE II DIABETES
STATE OF THE STATE: TYPE II DIABETES HENRY DRISCOLL, MD, CHIEF of ENDOCRINOLOGY MARSHALL U, CHERTOW DIABETES CENTER, HUNTINGTON VAMC HEATHER VENOY, RD, LD, CDE DIETITIAN, DIABETES EDUCATOR, CHERTOW DIABETES
More informationPhysical Activity/Exercise Prescription with Diabetes
Physical Activity/Exercise Prescription with Diabetes B R AD H I NTERMEYER C E P A C SM S A NFORD H E ALTH C A RDIAC R E H AB A N D D I ABE TES E XE RCISE The adoption and maintenance of physical activity
More informationMacrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?
Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists
More informationThe Metabolic Syndrome: Is It A Valid Concept? YES
The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA
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 informationDiabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?
Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of
More informationBenefits of Physical Activity. Health 1
Benefits of Physical Activity Health 1 Mental and Social Benefits Exercise has a positive effect on your mental, physical and emotional health Stress Relief Mood Enhancement Better Sleep Improved Self-Esteem
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 informationSlide 1. Slide 2. Slide 3. A Fork in the Road: Navigating Through New Terrain. Diabetes Standards of Care Then and Now
Slide 1 A Fork in the Road: Navigating Through New Terrain Carol Hatch Wysham, MD Clinical Associate Professor of Medicine University of Washington School of Medicine Section Head, Rockwood Center for
More informationA Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass
OBES SURG (2013) 23:93 102 DOI 10.1007/s11695-012-0802-1 CLINICAL RESEARCH A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass David E. Arterburn &
More informationStandards of Medical Care in Diabetes 2018
Standards of Medical Care in Diabetes 2018 Eric L. Johnson, M.D. Associate Professor University of North Dakota School of Medicine and Health Sciences Assistant Medical Director Altru Diabetes Center Grand
More informationComplications of Diabetes: Screening and Prevention
Complications of Diabetes: Screening and Prevention Dr Steve Cleland Consultant Physician GGH and QEUH Diabetes Staff Education Course June 17 Diabetic Complications Microvascular: Retinopathy Nephropathy
More informationExercise prescription in primary care setting
Exercise prescription in primary care setting Mohamad Shariff A Hamid MBBS (Adelaide), MMed Sports Med (UM), PhD (UM) Sports Medicine Unit University of Malaya Summary Introduction Screening Goal setting
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 informationPrevalence of Obesity (Adults) Prevalence of Obesity (Children) CURRENT STRATEGIES IN. Obesity: 33.8% Men: 32.2% Women: 35.5%
CURRENT STRATEGIES IN OBESITY Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Prevalence of Obesity (Adults) Obesity:
More informationPRESENTED BY BECKY BLAAUW OCT 2011
PRESENTED BY BECKY BLAAUW OCT 2011 Introduction In 1990 top 5 causes of death and disease around the world: Lower Respiratory Tract Infections Diarrhea Conditions arising during pregnancy Major Depression
More informationRecommended levels of physical activity for health
Recommended levels of physical activity for health Children (5 17 years old) For children and young people of this age group physical activity includes play, games, sports, transportation, recreation,
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 informationJAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial
JAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial Daniel DeUgarte, MD Division of Pediatric Surgery Surgical Director, UCLA FIT Program Bariatric
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 informationAmerican Academy of Insurance Medicine
American Academy of Insurance Medicine October 2012 Dr. Alison Moy Liberty Mutual Dr. John Kirkpatrick Thrivent Financial for Lutherans 1 59 year old male, diagnosed with T2DM six months ago Nonsmoker
More informationOptimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden
Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD
More informationExercise means being ACTIVE
Section Eight This section will tell you: EXERCISE The benefits of exercise How to exercise safely Effects of exercise on blood glucose levels How to prepare to exercise How to balance exercise with nutrition
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 informationDiabetes Mellitus: Implications of New Clinical Trials and New Medications
Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October
More informationACCORD, ADVANCE & VADT. Now what do I do in my practice?
ACCORD, ADVANCE & VADT Now what do I do in my practice? Richard M. Bergenstal, MD International Diabetes Center Park Nicollet Health Services University of Minnesota Minneapolis, MN richard.bergenstal@parknicollet.com
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 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 information1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria
1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage
More informationExercise to Prevent and Treat Diabetes
Exercise to Prevent and Treat Diabetes Karen Kemmis, PT, DPT, MS, GCS, CDE, FAADE Joslin Diabetes Center SUNY Upstate Medical University kemmisk@upstate.edu July 18, 2016 Objectives Review the benefits
More informationMacrovascular Management. What s next beyond standard treatment?
Macrovascular Management What s next beyond standard treatment? Are Lifestyle Modifications Still Relevant in Diabetic Patients? Diet Omega-6 and omega-3 fatty acids have been shown to improve CVD risk
More informationModern Management of Hypertension
Modern Management of Hypertension Robert B. Baron MD Professor of Medicine Associate Dean for GME and CME Declaration of full disclosure: No conflict of interest Current Status of Hypertension Prevalence
More informationProgram Overview. Risk Factors for T2D. Risk Factors for T2D. Harnessing the Power of Exercise to Prevent Type-2 Diabetes
Harnessing the Power of Exercise to Prevent Type-2 Diabetes Program Overview Gary Scheiner MS, CDE Owner/Clinical Director Integrated Diabetes Services LLC gary@integrateddiabetes.com (610) 642-6055 T2D
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 informationProgram Overview. Risk Factors for T2D. Harnessing the Power of Exercise to Prevent Type-2 Diabetes
Harnessing the Power of Exercise to Prevent Type-2 Diabetes Gary Scheiner MS, CDE Owner/Clinical Director Integrated Diabetes Services LLC gary@integrateddiabetes.com (610) 642-6055 Program Overview T2D
More informationNEW DEVELOPMENTS IN ASSESSMENT AND TREATMENT OF OBESITY
Prevalence of Obesity (Adults)! Obesity: 33.8% Men: 32.2% Women: 35.5% Overweight + obesity: 68% Men: 72.3% Women: 64.1% Severe Obesity: 6% Flegal JAMA 2010 Men and Women Aged 40 to 59 Years in 1999-2000
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 informationType 2 Diabetes in Adolescents
Type 2 Diabetes in Adolescents Disclosures Paid consultant, Eli Lilly, Inc, Pediatric Type 2 Diabetes Clinical Trials Outline The burden of diabetes Treatment and Prevention Youth Diabetes Prevention Clinic
More informationThe Role of Physical Activity in Cardiometabolic Health
The Role of Physical Activity in Cardiometabolic Health Understanding the Connection Between Physical Activity and Health Robert E. Sallis, MD, FAAFP, FACSM Co-Director, Sports Medicine Fellowship Kaiser
More informationDiabetes Mellitus: Evaluation and Care Management
Diabetes Mellitus: Evaluation and Care Management Michael King, MD Assistant Professor Residency Program Director University of Kentucky Dept. of Family & Community Medicine Learning Objectives 1. Review
More information