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Journal watch - review of the latest clinical papers 10/08/2021

Updated: Aug 25, 2021

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview from pharmacotherapies, clinical trials, COVID-19 and bariatric surgery, and more (please note, log-in maybe required to access the full paper).

Pharmacotherapies for Post-Bariatric Weight Regain: Real-World Comparative Outcomes

The week’s round up of researcher papers begins with an interesting paper in Obesity by researchers form University of Texas Southwestern Medical Center, Dallas, TX, who compared the outcomes of pharmacotherapies for weight regain after bariatric surgery. The paper, ‘Pharmacotherapies for Post-Bariatric Weight Regain: Real-World Comparative Outcomes’, published in Obesity, looked the outcomes form 207 individuals who were treated for post-bariatric weight regain with the following treatments:

  • Intensive lifestyle modification (ILM) group

  • A non–glucagon-like-1 receptor agonist (GLP-1-RA)-based weight-loss pharmacotherapy (WLP) group and;

  • A GLP-1-RA-based WLP group (the latter two groups in conjunction with ILM).

They found that the percentage body weight loss greatest in the GLP-1-RA-based WLP group at six and nine months and there was a significant difference in the percentage of individuals achieving ≥5% weight loss after three, six and nine months, most from the GLP-1-RA-based WLP group.

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Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes

Writing on behalf of the SURPASS-2 Investigators in the New England Journal of Medicine, the researchers provide an update from a study that compared the efficacy and safety of once-weekly tirzepatide (a dual glucose-dependent insulinotropic polypeptide) with semaglutide (glucagon-like peptide-1 (GLP-1) receptor agonist) in patients with type diabetes. In this 40-week, phase 3 trial, 1,879 patients were randomly assigned to receive tirzepatide at a dose of 5 mg, 10 mg or 15 mg or semaglutide at a dose of 1 mg. The primary end point was the change in the glycated haemoglobin level from baseline to 40 weeks.

The estimated mean change from baseline in the glycated hemoglobin level was −2.01 percentage points, −2.24 percentage points, and −2.30 percentage points with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and −1.86 percentage points with semaglutide. Reductions in body weight were greater with tirzepatide than with semaglutide (−1.9 kg, −3.6 kg, and −5.5 kg, respectively; p<0.001 for all comparisons). Serious adverse events were reported in 5 to 7% of the patients who received tirzepatide and in 3% of those who received semaglutide.

This study was funded by Eli Lilly.

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Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial

Staying with Tirzepatide, outcomes from the SURPASS-3 trial were also published this week in The Lancet by researchers who assessed the efficacy and safety of tirzepatide vs titrated insulin degludec in type 2 diabetics inadequately controlled by metformin with or without SGLT2 inhibitors.

A total of 1,437 participants were randomly assigned (1:1:1:1) to once-weekly subcutaneous injection of tirzepatide (5, 10, or 15 mg) or once-daily subcutaneous injection of titrated insulin degludec. The primary efficacy endpoint was non-inferiority of tirzepatide 10 mg or 15 mg, or both, vs insulin degludec in mean change from baseline in HbA1c at week 52.

The non-inferiority margin of 0.3% was met.The proportion of participants achieving a HbA1c of less than 7.0% (<53 mmol/mol) at week 52 was greater (p<0·0001) in all three tirzepatide groups (82%–93%) versus insulin degludec (61%).

Authors concluded that in patients with type 2 diabetes, tirzepatide (5, 10, and 15 mg) was superior to titrated insulin degludec, with greater reductions in HbA1c and bodyweight at week 52 and a lower risk of hypoglycaemia.

This study was funded by Eli Lilly.

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Prior Bariatric Surgery in COVID-19 Positive Patients May Be Protective

Researchers from NYU Langone Health, New York, examined if prior bariatric surgery correlates with increased risk of hospitalisation and outcome severity after COVID-19 infection. They reported their findings in SOARD.

A cohort of COVID-19 positive patients with a history of bariatric surgery (n=124, 36% Roux-en-Y Gastric Bypass (RYGB, n=45), 35% laparoscopic adjustable gastric banding (LAGB, n=44), and 28% laparoscopic sleeve gastrectomy (LSG, n=35) were matched in a 1:4 ratio to a control cohort of COVID-19 positive patients who were eligible for bariatric surgery (BMI >40 kg/m2 or BMI >35 kg/m2 with a comorbidity at the time of COVID-19 diagnosis) (n=496).

The reported that patients with a history of bariatric surgery were less likely to be admitted through the emergency room (p=0.0001), less likely to require a ventilator during the admission (p=0.028), had a shorter length of stay in both the ICU (p=0.033) and overall (p=0.0002), and were less likely to be deceased at discharge compared to the control group (p=0.028).

Therefore, they concluded that history of bariatric surgery significantly decreases the risk of emergency room admission, mechanical ventilation, prolonged ICU stay, and death in patients with COVID-19.

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Comparing a Short Biliopancreatic Limb to a Long Biliopancreatic Limb in Patients with a Roux-en-Y Gastric Bypass with 4 Years Follow-up

Writing in Obesity Surgery, researchers from The Netherlands compared weight loss after a short and long biliopancreatic limb (BPL) in patients who underwent a RYGB with a minimum of four years follow-up. In total, 574 patients underwent a primary RYGB procedure and were divided in two groups: a short BPL group (BPL of 50 cm with an AL of 150 cm, n=286) and long BPL group (BPL of 150 cm with an AL of 75 cm, n=288). The percentage total weight loss (%TWL) between groups was compared up to four years after surgery.

They found that patients in the long BPL group showed significantly more %TWL compared to the short BP limb group starting at six months (p= 0.004) until four years after surgery (p<0.001).

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The Effect of Laparoscopic Sleeve Gastrectomy on Glycemic Control in Type 2 Diabetic Patients

Reporting in Cureus, researchers from Kuwait report the outcomes a retrospective study that examined the impact of laparoscopic sleeve gastrectomy (LSG) on the glycaemic control of 70 type 2 diabetic patients. Fasting plasma glucose (FPG) was taken pre- and post-operatively in all patients who were followed up to monitor the change in diabetic medications in terms of quantity, type and dose.

The mean reduction of FPG after surgery was 2.94+3.66 (p<0.001) over a mean interval of eight days (range, 0-34 days). Immediate reduction in FPG was reported in 61 patients (87%) and the greatest reduction was seen in the age group <40 years. In total, 49 patients (70%) had diabetes remission, while 20 (29%) had reduction in their diabetes medication.

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