Journal watch - review of the latest clinical papers 20/10/2021

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 of papers including the role of bariatric surgery and type 1 diabetes, five-year outcomes of sleeve gastrectomy for patients with T2DM and class I obesity, a RCT that found exercise post-RYGB counteracts the post-surgical loss of muscle mass and function from surgery, a meta-analysis of drug supplements for obesity treatment, and that obesity and nutrition-focused professional organisations need to increase the diversity of membership and leadership at the presidential level in the US (please note, log-in maybe required to access the full paper).

Is there a Role for Bariatric Surgery in Patients with Severe Obesity in Type 1 Diabetes Mellitus?

Researchers from the Geisinger Medical Center have reported that bariatric surgery may be a viable treatment within patients that have type I diabetes mellitus. Writing in SOARD, their small study evaluated insulin and diabetic medication requirements in patients with type I diabetes mellitus two years after bariatric surgery.

In total, 38 bariatric surgery patients with type I diabetes mellitus were included in the study, with a mean Hb A1c of 8.4% before surgery. During follow-up the insulin requirements improved from 114 units preoperatively to 60 units at one year postoperatively (p=0.0018) and 60 units at two-years postoperatively (p=0.0033).

In addition, the number of patients on more than one diabetic medication decreased from 66% preoperatively to 53% one-year postoperatively (p=0.343) and 52% at two-years (p=0.149), although this was not significant.

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Five-Year Outcomes of Sleeve Gastrectomy in Patients with Class I Obesity and Type 2 Diabetes Mellitus

Laparoscopic sleeve gastrectomy is a reasonable option as a metabolic procedure for patients with T2DM and class I obesity, according to researchers from India, writing in Obesity Surgery.

The small study reported the five-year results of 20 patients with class I obesity and T2DM, who had undergone LSG between March 2012 and March 2015. Seventeen patients were available for follow-up at five years - 52.9% achieved HbA1c < 6.5% without medication, while 41.2% patients had improvement of their glycaemic status. However, one patient had recurrence of diabetes after initial remission.

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A randomized clinical trial on the effects of exercise on muscle remodelling following bariatric surgery

International team of researchers have examined the impact of muscle atrophy and strength loss after bariatric surgery. They conducted a randomised, controlled trial to examine investigated the effects of exercise training on bariatric surgery-induced loss of muscle mass and function, and the effects of the intervention on molecular and histological mediators of muscle remodelling.

Reporting their findings in the Journal of Cachexia, Sarcopenia and Muscle, the trial included 80 women with obesity who were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n=40) or RYGB plus exercise training group (RYGB + ET: n=40). Clinical and laboratory parameters were assessed at baseline, and three (POST3) and nine months (POST9) after surgery. The six month, three-times-a-week, exercise intervention (resistance plus aerobic exercise) was initiated three months post-surgery (for RYGB + ET). In addition, a healthy, lean, age-matched control group was recruited to provide reference values for selected variables.

The results showed that:

  • Surgery resulted in a similar (p=0.66) reduction in lower-limb muscle strength in RYGB and RYGB+ET (−26% vs. −31%), which was rescued to baseline values in RYGB + ET (P = 0.21 vs. baseline) but not in RYGB (P < 0.01 vs. baseline).

  • Patients in RYGB+ET had greater absolute (214 vs. 120 kg, p< 0.01) and relative (2.4 vs. 1.4 kg/body mass, p< 0.01) muscle strength vs. with RYGB alone at POST9.

  • Exercise resulted in better performance in timed-up-and-go (6.3 vs. 7.1 s, p= 0.05) and timed-stand-test (18 vs. 14 repetitions, p< 0.01) compared with RYGB.

  • RYGB + ET resulted in increased capillarization (p< 0.01) and satellite cell content (p< 0.01) than RYGB at POST9.

They concluded that the results support the incorporation of exercise into the recovery algorithm for bariatric patients so as to counteract the post-surgical loss of muscle mass and function.

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The best drug supplement for obesity treatment: a systematic review and network meta-analysis

The most effective drugs for weight loss are phentermine and topiramate, pramlintide, naltrexone, bupropion, and liraglutide vs. placebo treatment, according to researchers from Iran. Writing in BMC Diabetology & Metabolic Syndrome, they performed a meta-analysis of 11 studies that contained 14 different drug supplements.

The results revealed that there were significant mean effects in people intervened with Phentermine 15.0mg + Top