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Comparative Effects of Metformin versus Metformin Plus Topiramate in Treatment of Obesity With Metabolic Syndrome: Analysis from A Double-Blind Randomized Trial
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Abstracts / Can J Diabetes 37 (2013) S217eS289
THURSDAY, MAY 2: CLINIC IN FOCUS CLINICAL I 549-OR Laparoscopic Adjustable Gastric Band (LAGB) Surgery - Five Year Follow Up of a Large, Single Institution Canadian Cohort CHRISTOPHER COBOURN Medical Director, Surgical Weight Loss Centre, Mississauga, Ontario, Canada This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. Methods: Morbidly obese patients, 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic (SWLC) in Ontario, Canada between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling Methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time.
550-OR Comparative Effects of Metformin versus Metformin Plus Topiramate in Treatment of Obesity With Metabolic Syndrome: Analysis from A Double-Blind Randomized Trial GRAZIELA KALIL, WILLIAM G. HAYNES Division of Endocrinology, Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa Healthcare, Iowa City, Iowa, United States of America Hypothesis: Combining topiramate with metformin improves weight, visceral adiposity, and risk factors more than metformin alone. This abstract presents interim data from a 12-month doubleblind, randomized, parallel-group trial in obese subjects with metabolic syndrome randomized to metformin alone or metformin + topiramate (n¼24; 6 males; 55 8 yrs; weight¼10412 kg; BMI¼384 kg/m2). All received advice on calorie restriction and exercise, and half were taking orlistat. Baseline BMI was 384 kg/m2, waist 11710 cm, MAP 939 mmHg; heart rate 72 11 bpm; HBA1c 5.80.4%; triglycerides 159125 mg/dl). There were substantial weight reductions at 12 months (table). BP was significantly reduced by metformin + topiramate, and the combination also reduced waist and heart rate more than metformin alone. HBA1c and triglycerides were significantly reduced by combination therapy only, though LDL and HDL were not different. In conclusion, there is a greater effect of metformin + topiramate on waist compared to metformin alone, suggesting that topiramate improves visceral obesity independent of weight loss. Decreased heart rate after topiramate suggests that this agent may modulate the autonomic nervous system. The long-term effects of combined metformin and topiramate on CV risk factors in metabolic syndrome warrant further exploration.
551-OR Improving the Management of Psychosocial Issues in Obesity: Learnings from the Diabetes Attitudes, Wishes and Needs Study T. MICHAEL VALLIS Dalhousie University, Capital Health, Halifax, Nova Scotia, Canada In 2012 the Diabetes Attitudes, Wishes and Needs Study (DAWN2), a multinational survey across 17 countries of the world, was completed. This was a 360 degree survey of the experience of individuals living with diabetes, family members of those with diabetes, and healthcare providers. In Canada, data were collected on 902 participants, including 500 individuals with diabetes (84% type 2 diabetes, mean BMI 32.3), 121 family members, and 281 healthcare providers. Data was collected on quality of life, attitudes
and beliefs, active self-managment, care and support from the support team, care and support from family, community and society, including experience of discrimination, and future needs and improvements. Validated scales were used where possible and the same variables were assessed by persons with diabetes, family members and healthcare providers to triangulated the data. In this presentation, the Canadian DAWN2 results will be highlighted. Further, DAWN2 will be used a framework for systematically assessing psychosocial issues in those living with obesity. How can these data facilitate the management of psychosocial issues in obesity? Further, a proposal to solicit interest in replicating the DAWN approach within obesity will be presented (an Obesity Attitudes, Wishes and Needs survey). Finally, the experience of the DAWN program in knowledge translation and policy change will be summarized. Given that the majority of persons with diabetes are obese the potential for the DAWN2 study to improve quality of life in those living with obesity is high. 552-OR Phenomenological Reflections on the Lived-Meaning of Waiting for Weight-Loss Surgery NICOLE M. GLENN University of Alberta, Edmonton, Alberta, Canada The wait for weight-loss surgery may be like a wait in parts; fragmented and barely connected at all. Or perhaps it is like many waits stacked one after the other. Beyond this wait is the next and so on in a Kafta-esc spiral where what lies beyond, in wait, may be completely unknown to the one who is waiting. One may wonder where does this wait begin? According to clinic metrics the wait for surgery begins with surgical approval. However, many people wait years for this moment to arrive, if it arrives at all. If one were to consider the time from referral to surgery as the wait, the average waiting time in Canada would be just over five years. Five years. That is over five times longer then the next longest, publically funded, surgical queue in the country. What might it be like, then, to wait for weight-loss surgery? How is this experienced lived by those who wait? Taking a human science phenomenological approach I consider these questions and reflect upon aspects of the wait for bariatric surgery including experiences of the body, self, space, time and other within this context. I conducted multiple interviews with the seven study participants to collect experiential data. With this work I aim to explicate the possible experiential meanings of this wait for weight loss surgery and bring about a greater depth of understanding of the phenomenon as it is lived. This understanding, in turn, may elicit a tacit response, a moment of pause, of re/consideration leading to more ethical, tactful ways of being within this particular clinical space. 553-OR Changes in Body Composition and Bone Mineral Density in Severely Obese Patients Following Metabolic Surgery TAMARA CARVER, OLIVIER BABINEAU, HANNAH LEMKE, OLIVIER COURT, NICHOLAS V. CHRISTOU, ROSS E. ANDERSEN McGill University, Montréal, Québec, Canada Metabolic surgery is the most effective treatment for severe obesity. Rapid weight loss leads to changes in lean tissue (LT), fat tissue (FT), and bone mineral density (BMD). Therefore, the aims of this study were to evaluate the short-term (3 and 6 months) changes in body composition, android fat (AF); and BMD of the lumbar spine, femoral-neck (FNBMD), and total-hip (THBMD) using the GE Lunar iDXA in severely obese patients after Roux-en-Y gastric bypass surgery. A longitudinal study of 29 severely obese participants (7 males, 22 females) with a mean age of 4411yrs, BMI of 49.46.1kg/m2, and body mass of 135.521.4kg took part in the study. At 3 months, total body mass was reduced by 27.8kg (46.413.1%EWL) with fat and lean mass representing 68.3% (19kg) and 31.7% (8.8kg) of the lost weight respectively. Between 3 and 6 months, body mass was reduced a further 10.5kg giving a %EWL at
Abstracts / Can J Diabetes 37 (2013) S217eS289
THURSDAY, MAY 2: CLINIC IN FOCUS CLINICAL I 549-OR Laparoscopic Adjustable Gastric Band (LAGB) Surgery - Five Year Follow Up of a Large, Single Institution Canadian Cohort CHRISTOPHER COBOURN Medical Director, Surgical Weight Loss Centre, Mississauga, Ontario, Canada This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years. Methods: Morbidly obese patients, 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic (SWLC) in Ontario, Canada between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling Methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time.
550-OR Comparative Effects of Metformin versus Metformin Plus Topiramate in Treatment of Obesity With Metabolic Syndrome: Analysis from A Double-Blind Randomized Trial GRAZIELA KALIL, WILLIAM G. HAYNES Division of Endocrinology, Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa Healthcare, Iowa City, Iowa, United States of America Hypothesis: Combining topiramate with metformin improves weight, visceral adiposity, and risk factors more than metformin alone. This abstract presents interim data from a 12-month doubleblind, randomized, parallel-group trial in obese subjects with metabolic syndrome randomized to metformin alone or metformin + topiramate (n¼24; 6 males; 55 8 yrs; weight¼10412 kg; BMI¼384 kg/m2). All received advice on calorie restriction and exercise, and half were taking orlistat. Baseline BMI was 384 kg/m2, waist 11710 cm, MAP 939 mmHg; heart rate 72 11 bpm; HBA1c 5.80.4%; triglycerides 159125 mg/dl). There were substantial weight reductions at 12 months (table). BP was significantly reduced by metformin + topiramate, and the combination also reduced waist and heart rate more than metformin alone. HBA1c and triglycerides were significantly reduced by combination therapy only, though LDL and HDL were not different. In conclusion, there is a greater effect of metformin + topiramate on waist compared to metformin alone, suggesting that topiramate improves visceral obesity independent of weight loss. Decreased heart rate after topiramate suggests that this agent may modulate the autonomic nervous system. The long-term effects of combined metformin and topiramate on CV risk factors in metabolic syndrome warrant further exploration.
551-OR Improving the Management of Psychosocial Issues in Obesity: Learnings from the Diabetes Attitudes, Wishes and Needs Study T. MICHAEL VALLIS Dalhousie University, Capital Health, Halifax, Nova Scotia, Canada In 2012 the Diabetes Attitudes, Wishes and Needs Study (DAWN2), a multinational survey across 17 countries of the world, was completed. This was a 360 degree survey of the experience of individuals living with diabetes, family members of those with diabetes, and healthcare providers. In Canada, data were collected on 902 participants, including 500 individuals with diabetes (84% type 2 diabetes, mean BMI 32.3), 121 family members, and 281 healthcare providers. Data was collected on quality of life, attitudes
and beliefs, active self-managment, care and support from the support team, care and support from family, community and society, including experience of discrimination, and future needs and improvements. Validated scales were used where possible and the same variables were assessed by persons with diabetes, family members and healthcare providers to triangulated the data. In this presentation, the Canadian DAWN2 results will be highlighted. Further, DAWN2 will be used a framework for systematically assessing psychosocial issues in those living with obesity. How can these data facilitate the management of psychosocial issues in obesity? Further, a proposal to solicit interest in replicating the DAWN approach within obesity will be presented (an Obesity Attitudes, Wishes and Needs survey). Finally, the experience of the DAWN program in knowledge translation and policy change will be summarized. Given that the majority of persons with diabetes are obese the potential for the DAWN2 study to improve quality of life in those living with obesity is high. 552-OR Phenomenological Reflections on the Lived-Meaning of Waiting for Weight-Loss Surgery NICOLE M. GLENN University of Alberta, Edmonton, Alberta, Canada The wait for weight-loss surgery may be like a wait in parts; fragmented and barely connected at all. Or perhaps it is like many waits stacked one after the other. Beyond this wait is the next and so on in a Kafta-esc spiral where what lies beyond, in wait, may be completely unknown to the one who is waiting. One may wonder where does this wait begin? According to clinic metrics the wait for surgery begins with surgical approval. However, many people wait years for this moment to arrive, if it arrives at all. If one were to consider the time from referral to surgery as the wait, the average waiting time in Canada would be just over five years. Five years. That is over five times longer then the next longest, publically funded, surgical queue in the country. What might it be like, then, to wait for weight-loss surgery? How is this experienced lived by those who wait? Taking a human science phenomenological approach I consider these questions and reflect upon aspects of the wait for bariatric surgery including experiences of the body, self, space, time and other within this context. I conducted multiple interviews with the seven study participants to collect experiential data. With this work I aim to explicate the possible experiential meanings of this wait for weight loss surgery and bring about a greater depth of understanding of the phenomenon as it is lived. This understanding, in turn, may elicit a tacit response, a moment of pause, of re/consideration leading to more ethical, tactful ways of being within this particular clinical space. 553-OR Changes in Body Composition and Bone Mineral Density in Severely Obese Patients Following Metabolic Surgery TAMARA CARVER, OLIVIER BABINEAU, HANNAH LEMKE, OLIVIER COURT, NICHOLAS V. CHRISTOU, ROSS E. ANDERSEN McGill University, Montréal, Québec, Canada Metabolic surgery is the most effective treatment for severe obesity. Rapid weight loss leads to changes in lean tissue (LT), fat tissue (FT), and bone mineral density (BMD). Therefore, the aims of this study were to evaluate the short-term (3 and 6 months) changes in body composition, android fat (AF); and BMD of the lumbar spine, femoral-neck (FNBMD), and total-hip (THBMD) using the GE Lunar iDXA in severely obese patients after Roux-en-Y gastric bypass surgery. A longitudinal study of 29 severely obese participants (7 males, 22 females) with a mean age of 4411yrs, BMI of 49.46.1kg/m2, and body mass of 135.521.4kg took part in the study. At 3 months, total body mass was reduced by 27.8kg (46.413.1%EWL) with fat and lean mass representing 68.3% (19kg) and 31.7% (8.8kg) of the lost weight respectively. Between 3 and 6 months, body mass was reduced a further 10.5kg giving a %EWL at