Weight loss surgery is helping in the
reduction of Type 2 diabetes, hypertension, dyslipidemia,
cardiovascular disease, sexual dysfunction, and even the mortality
rate.
Bariatric surgery is recommended by the
National Institute of Health for Obese patients with a body mass
index (BMI) of at least 40 or less obese patients with serious
coexisting medical condition I and a BMI of at least 35. According
to National Health and Nutrition Examination Survey, 34% of Americans
have metabolic syndrome, with a waist circumference greater than or
equal to 102cm (men) or 88cm (women); triglyceride greater than or
equal to 150 mg/dl, HDL less than 40 mg/dl (men) or 50 mg/dl (women);
hypertension greater than or equal to 130/85 mmHg; and fasting
glucose greater than or equal to 100 mg/dl.
The purpose of this study is to
determine whether surgical weight loss helps in the reduction of type
2 diabetes and decreases mortality rate. Numerous prior studies have
demonstrated a connection between drastic surgical weight loss and an
improvement in type 2 diabetes, as well as a decrease in mortality
rate. The primary endpoint of bariatric surgery is weight loss. The
overall percentage of excess weight loss (EWL) is 47-70%. A
systematic review discovered EWL greater than 50 %. A meta-analysis
study also concluded that adjustable gastric banding (AGB) is
associated with less weight loss.
In another prospective observational
study, 4,776 consecutive patients undergoing a bariatric surgery
reported a low mortality rate of 0.3%. There are a number of
complications associated with surgical weight loss surgery, about
70%, such as myocardial infarction and pulmonary embolism, which are
the major causes of mortality. Those with higher mortality rate
after bariatric surgery are patients with a higher BMI, males, older
age, smokers and those with multiple comorbidities.
Observational and meta-analysis both
demonstrate that bariatric surgery is effective in controlling type 2
diabetes, decreasing anti-diabetic drug usage and a high remission
rates. Of the 135,246 subjects using meta-analysis, 78% had complete
resolution with HbA1c less than 6.5%. However, factors like shorter
duration of diabetes, greater weight loss, and former oral
antidiabetic drug usage are some of the anticipating reasons of type
2 diabetes remission. For clinical outcome, a study performed by
Brethauer et al performed between 2004 and 2007 had a mean estimated
weight loss of 55% and a mean HbA1c, which decreased from 7.5±1.5%
to 6.5±1.2%.
In another study organized at Cleveland
clinic, 150 patients with T2DM were randomized to conventional
medical therapy with HbA1c level of 7.5±1.8% in the medical therapy
group. For the mortality rate, a meta-analysis of 44,022 subjects
from eight trials demonstrated a reduced risk of global mortality
with (OR =0.58, CI 0.49-0.63).
Another study was organized to
determine whether bariatric surgery improves one’s sexual function.
Patients undergoing this procedure fill gender relevant
questionnaires, whereby their sexual performance is assessed. This
is done before the surgery and 6-7 months after surgery. A
statistical analysis test was done using SPSS 11.0 software.
Continuous variables were compared using student t-test for
independent samples. Of the 51 patients who underwent the surgery,
48 of them finished the second half after the 6-7 months post-surgery
questionnaires. With a P less than 0.001, the results were
statistically significant. Of the 43 women, 20 of them had a Female
Sexual Function Index (FSFI) score of 24.66 before surgery,
indicating a sexual dysfunction; but only 4 remained with dysfunction
after post-surgery. This indicated a P less than 0.001. For the
men, there was a baseline of 40.2 to 43.9, so they did not achieve
statistical significance. This study shows that weight loss
positively influences sexual function in the obese population. A
limitation of this study included a low response by bariatric
patients.
In conclusion, there have been a number
of studies that have broadened our knowledge on the safety and
efficacy of bariatric procedures and the effect on obesity, type 2
diabetes, and sexual dysfunction. The surgery therefore helps to
improve one’s quality of life.
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