Evaluation of Type 2 Diabetes Remission and Relapse Rates after Bariatric Surgery
Dilan Parmar, Samson Arokiyanathan | University of Warwick
Obesity and type 2 diabetes are pandemics intimately intertwined with the formers’ influence on the latter well documented in the literature. In recent years, bariatric surgery has presented itself not only as a tool for significant weight loss but a metabolic surgery with concurrent benefits to diabetes remission. This review aims to analyse how remission changes with time from surgery as weight recidivism is a common post-operative event.
A systematic review was performed on all eligible articles with short- and long-term data pertaining to type 2 diabetes remission after surgery. Articles were attained from a literature search of the PubMed database.
From 490 abstracts, 56 full-text articles were reviewed, of which six met inclusion criteria of this review. Except for a single study, all studies reported initial remission more than 40% with the exception reporting remission at 21% in its first follow-up. Relapse varied between studies; four studies reported relapse between 10-20% within six years follow-up; one study 41.9% relapse when follow-up was extended to 15 years; another with relapse at 24% within 12 years and the final study reporting relapse at 28% within five years.
The likelihood of relapse has been underestimated with significant clinical consequences for both patients and clinicians when considering bariatric surgery in part due to the metabolic benefits. Accompanying weight recidivism post-surgery, relapse does not mean the end of surgery’s benefits but apropos of the COVID-19 pandemic, every effort should be made to mitigate the possibility for relapse via pharmacotherapy and extended psychological support post-surgery.
Video Consultation vs Face to Face Consultation in the Management of Diabetes Mellitus
Rosie Hall | University of Warwick
With growing technology capabilities, and the COVID-19 pandemic putting pressure on health services to use remote consultation, the feasibility of using teleconsultation in regular management of chronic disease is to be considered. The popularity of teleconsultation is rising, and since the population of chronic disease sufferers in the UK is considerable, this method of consultation has, in recent years, started to be explored for various conditions. Diabetes affects 4 million people in the UK, and this review specifically focuses on the use of teleconsultation in diabetes management, in comparison to more traditional face to face consultation. If clinical outcomes are not compromised, the benefits of using a remote service could allow for the use of teleconsultation for diabetes management to be normal practice.
A systematic literature search was conducted to select published articles from web-based health databases. Data extraction and analysis of results followed.
9 studies were selected. Primary outcomes HbA1c, LDL levels and blood pressure were shown to remain, overall uncompromised, by the use of teleconsultation in comparison to face to face consultation. Patient satisfaction was also high, with few limitations of remote consultation found. Economic and time saving proved to be major advantages for patients using teleconsultation for their diabetes management.
This review identified a lack of literature on the use of teleconsultation in diabetes management, although the research reviewed did support teleconsultation use in diabetes. Future research should address the use of teleconsultation in diabetes care over a reasonable duration, with a reasonable sample size, through RCTs.
The Role of Intermittent Fasting and Exercise in the Reduction of Diabetes Risk Factors; A Narrative Review
Jade Wilmot | University of Warwick
The burden of diabetes is an ever-increasing problem for health systems worldwide. 463 million people are currently living with diabetes globally and that number has been projected to rise to near 700 million by 2045.
To explore the impact of intermittent fasting (IF) and exercise training (ET) on the known risk factors for diabetes and infer its potential effect on the prevention of, touching on its potential use for managing diabetes itself.
Systematically searching the databases Embase, Medline and Web of Science for RCT published in the last 5 years using the search terms ‘fasting’ and ‘diabetes mellitus, type 2’ or ‘prediabetic state’ or ‘metabolic syndrome’. Quality assessment performed using the CASP tool and bias assessed using the Cochrane Collaboration tool. No formal statistical analysis of the results of the included studies was performed.
13 studies were included (six used the intervention, IF, and seven studies used ET). All of which found a significant change due to the intervention – intermittent fasting or exercise training – in one or more of the outcomes measured. Of studies involved; HbA1c was reduced in 4 of 6, glycaemic indices were improved in 8 of 11, 50% saw a reduction in insulin indices, and body composition was improved in all 7 as a result of the intervention compared to the control or with change over time (from baseline to post-intervention tests).
The results from these studies would indicate that IF and ET, especially in combination should be considered in playing a role in the management of diabetes.
An Investigation into the Effect of Statins on HBA1C Levels in Pre-diabetic and Diabetic Patients
Karar Ali, Chloe Argent | University of Warwick
Growing concern about statin use and risk of developing diabetes mellitus. Some literature suggests diabetogenic effects with long term statin use (Casula et al., 2017; Kim et al., 2018; Navarese et al., 2013), especially for prediabetic patients (Kostapanos et al., 2009). Majority of prediabetics/diabetics are on statins due to age-related comorbidities or diabetic complications, with a greater than 50-fold increase in prescription prevalence between 1995 and 2013. We sought to analyse HbA1c levels over time for this patient group.
Filtered EMIS search, inclusion criteria: 1. Diabetic/prediabetic; 2. Continuous statin use for a full year; 3. HbA1c measures before, up to a month after and 9 months after statin commencement. Relevant data securely collected and analysed on Minitab 17 through paired t tests.
247 patients identified. 62 patients randomly selected for analysis. For prediabetics, mean HbA1c significantly increased (p=0.05) before statin use (41.1mmol/mol [40.2-43.9]) to after short-term statin usage (42.7mmol/mol [40.8-45.0]). There was a similar insignificant increase in diabetics.
Currently, no specific recommendations for statin use in prediabetics. Patients on long-term statins, at risk of developing diabetes, need regular HbA1c monitoring. Statins should be continued if diabetes develops, in accordance with NICE guidelines, as CVD complications pose a greater health risk and there is no evidence that statins affects glycaemic control. However, healthcare professionals should be aware of the diagnostic limitations of HbA1c, and should use it in conjunction with other tests for diagnosis.