Hi All,

This study proves what I have anecdotally noticed about my own patient group.  The patients who are more reliable at attending follow up appointments, either to see me, my Nutritionist (Nicola Page) or my Bariatric Nurse Specialist (Kate Berridge) are more likely to stay on track with their weight loss in the long term.  It is interesting to see that this also translates into improvements in their medical conditions associated with being overweight ie Hypertension, Hypercholesterolemia and Type 2 diabetes.  It probably follows that if you are more conscientious about attending appointments you are probably going to be more strictly adhering to nutritional and eating habit guidelines that we suggest for post-bariatric surgery life.  It is true that everything changes around eating and drinking immediately after having Bariatric surgery and these new habits should become a 'new normal' from then on to ensure the long term outcomes are good.  The better patients are at practicing their new habits, the better the outcomes they will achieve.  Anyway, plenty more to talk about when we meet in person.  An appointment to see me for a chat is the first step to take and we can take it from there!

Kind regards,

Steph Ulmer

Bariatric patients who stick to a schedule of three-, six- and 12-month follow-up visits with their doctors see greater improvements or remission of their diabetes, high blood pressure and high cholesterol than patients who skip their visits, according to research presented at ObesityWeek 2016. The paper, “The effect of close postoperative follow-up on comorbidity improvement after bariatric surgery,” was presented by researchers from the Brody School of Medicine at East Carolina University in Greenville, NC.

The study assessed the relationship between complete follow-up and improvement or remission of comorbid conditions at 12-months after surgery. The investigators obtained data from the Bariatric Outcomes Longitudinal Database (BOLD) from 2007 to 2012 and reviewed the results of 38,613 patients who had the three follow-up visits (complete follow-up) and compared them to the results of 12,468 patients who only had one or two follow-ups (incomplete follow-up). Improvement and remission of comorbid conditions were compared between the two cohorts. Specifically, changes in diabetes (T2D), hypertension, and dyslipidemia were evaluated at 12-month postoperatively.

After one year, 62.3 percent of patients with complete follow-up saw their type 2 diabetes go into remission, while those who missed a visit or two had a remission rate of 57.5 percent. The rate of improvement in diabetes was also better for those who made all three visits (74.6% vs. 68.9%). The differences between the two groups also held for high blood pressure and lipid abnormalities including high cholesterol.

“This study shows there is great value in seeing patients at routine intervals after surgery in terms of health outcomes,” said Dr Andrea Schwoerer, study co-author, currently at Carolinas Medical Center. “Unfortunately, many patients, reportedly as many as 50 percent, are lost to follow-up and therefore may not benefit as much as they can from weight-loss surgery, no matter how well it was performed.”

Hypertension improved in 63.2 percent of the patients in the complete follow-up group and 58.1 percent in the incomplete follow-up group. The difference in resolution rates in the groups was less, but still statistically significant (46.1% vs. 42%). The trend also held for lipid abnormalities, with these improving for 55 percent of patients completing follow up versus 51.1 percent for those who did not. Remission rates were,42.8% vs. 41.1% respectively, a small, but still statistically significant difference. After adjusting for baseline characteristics, complete postoperative follow-up in the first year after surgery was independently associated with a higher rate of improvement or remission of comorbid conditions.

“We cannot stress enough the importance of follow-up visits and post-operative care,” said Dr Stacy Brethauer, President-elect, ASMBS and bariatric surgeon at the Cleveland Clinic in Ohio, who was not involved in the study. “It could mean the difference between a good and a great result. The most committed patients do best, and we need to find ways to keep all patients engaged for the long-term.”

Women with a history of gestational diabetes (GD) face a heightened risk of developing yype 2 diabetes for years after giving birth, but intensive lifestyle intervention or a medication regimen can have a protective effect in this population, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

"Our long-term follow-up study found the elevated risk of developing type 2 diabetes persisted for years in women who had been diagnosed with gestational diabetes, and this long-term risk can be reduced with either intensive lifestyle intervention or the medication metformin," said one of the study's authors, Dr Vanita Aroda of the MedStar Health Research Institute in Hyattsville, MD.

The Diabetes Prevention Program Outcomes Study (DPPOS) analysed long-term metabolic health in 288 women who had a previous diagnosis of GD and 1,226 mothers who did not have a history of the condition. The women all participated in the initial Diabetes Prevention Program study, a randomised clinical trial where they were assigned to intensive lifestyle intervention, the diabetes medication metformin or a placebo. The intensive lifestyle intervention was aimed at reducing body weight by 7 percent and participating in moderate cardio exercise for 150 minutes a week.

During the DPPOS, the women continued to have their blood glucose levels measured twice a year for six years. The study looked at long-term health outcomes in Diabetes Prevention Program participants for about a decade after the women first enrolled in the study.

Over 10 years, women with a history of GD assigned to placebo had a 48% higher risk of developing diabetes compared with women without a history of GD. In women with a history of GD, lifestyle intervention and metformin reduced progression to diabetes compared with placebo by 35% and 40%, respectively. Among women without a history of GD, lifestyle intervention reduced the progression to diabetes by 30%, and metformin did not reduce the progression to diabetes.

"Medical and lifestyle interventions were remarkably effective at slowing the progression of Type 2 diabetes in this at-risk population in both the short and long term," said Aroda.