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Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes
Mini-Oral Abstracts (p < 0.05) in weight loss were observed between the Basic and Enhanced programs at 3 or 6 months. Therefore, the patterns of weight loss in men and women were examined regardless of program. Assessments included objectively measured height and weight. An Intention-to-Treat (ITT) analysis was performed for weight using repeated measures ANOVA and paired t-tests. Results: After 3 months, males had lost significantly more weight (−4.5 ± 4.6 kg) than females (−2.4 ± 3.0 kg) (p = 0.004). In terms of weight loss success at 3 months, 32% of men lost >5% of body weight compared to 21% of women. After 6 months, there was no significant difference in weight loss between men and women; 30% of men had lost >5% of body weight whereas 36% of women had achieved this goal. Conclusion: Both males and females can lose weight using online programs. The time course of weight loss appears to differ and this may have implications for sex-specific weight loss program design. Programs for men should consider providing weight loss maintenance information after 3 months for those who have achieved their target weight. Programs for women may need the active weight loss phase to be at least 6 months long before shifting the focus to weight loss maintenance. http://dx.doi.org/10.1016/j.orcp.2012.08.120 M118 Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes J. Dixon 1,2,∗ , L. Chuang 3,4 , K. Chong 5 , S. Chen 6 , G. Lambert 1 , N. Straznicky 1 , E. Lambert 1 , W. Lee 6 1 Baker
IDI Heart & Diabetes Institute, Melbourne, Australia 2 School of Primary Health Care, Monash University, Melbourne, Australia 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei 4 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 5 Department of Internal Medicine, Min-Sheng General Hospital, Taiwan, Republic of China 6 Department of Surgery, Min-Sheng General Hospital, Taiwan, Republic of China Aim: To find clinically meaningful preoperative predictors of diabetes remission, and inadequate glycemic control or improvement following gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes
59 following bariatric surgery may help in patient selection and counseling. Method: Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1year. Remission was defined as HbA1c ≤6%. Analysis involved binary logistic regression to identify predictors and receiver operator characteristics to determine clinically useful cut-off values. Results: Remission was achieved in 107 (69.5%) subjects at 12 months. Diabetes duration of <4 years, body mass index >35 kg/m2 and fasting Cpeptide concentration >2.9 ng/ml provided three independent preoperative predictors and three clinically useful cut-points. A combination of 2 or 3 of these predictors allows a sensitivity of 82% and specificity of 87% for remission. Duration of diabetes (with different cut-points) and C-peptide also predicted those not achieving HbA1c ≤7% and a poor glycemic response to surgery. Percentage weight loss following surgery was also predictive of remission and less satisfactory outcomes. Conclusion: In those with type 2 diabetes the glycemic response to gastric bypass is related to BMI, duration of diabetes, fasting C-peptide (influenced by insulin resistance and residual beta-cell function) and weight loss. These data support and refine the findings in non-Asian populations and for other bariatric procedures. Specific ethnic and procedural cut-points may vary. http://dx.doi.org/10.1016/j.orcp.2012.08.121 M119 Body fat increases throughout pregnancy despite no significant changes in 24-h energy expenditure and caloric intake J. Morris ∗ , T. O’Sullivan Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia Aim: Optimising weight gain is important in promoting a healthy pregnancy for good maternal and infant outcomes. Dietary advice in pregnancy is generally based on research of nonpregnant women, not taking into account potential metabolic changes during pregnancy. The aim was to evaluate longitudinal changes in body composition, energy expenditure and macronutrient intake during a healthy pregnancy. Method: A longitudinal study was performed. Fat mass (FM), lean body mass (LBM), 24 h energy expenditure (TEE), caloric and macronutrient intake were measured in 12 healthy women at 12—14, 24—26 and 34—36 weeks gestation. Body
IDI Heart & Diabetes Institute, Melbourne, Australia 2 School of Primary Health Care, Monash University, Melbourne, Australia 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei 4 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 5 Department of Internal Medicine, Min-Sheng General Hospital, Taiwan, Republic of China 6 Department of Surgery, Min-Sheng General Hospital, Taiwan, Republic of China Aim: To find clinically meaningful preoperative predictors of diabetes remission, and inadequate glycemic control or improvement following gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes
59 following bariatric surgery may help in patient selection and counseling. Method: Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1year. Remission was defined as HbA1c ≤6%. Analysis involved binary logistic regression to identify predictors and receiver operator characteristics to determine clinically useful cut-off values. Results: Remission was achieved in 107 (69.5%) subjects at 12 months. Diabetes duration of <4 years, body mass index >35 kg/m2 and fasting Cpeptide concentration >2.9 ng/ml provided three independent preoperative predictors and three clinically useful cut-points. A combination of 2 or 3 of these predictors allows a sensitivity of 82% and specificity of 87% for remission. Duration of diabetes (with different cut-points) and C-peptide also predicted those not achieving HbA1c ≤7% and a poor glycemic response to surgery. Percentage weight loss following surgery was also predictive of remission and less satisfactory outcomes. Conclusion: In those with type 2 diabetes the glycemic response to gastric bypass is related to BMI, duration of diabetes, fasting C-peptide (influenced by insulin resistance and residual beta-cell function) and weight loss. These data support and refine the findings in non-Asian populations and for other bariatric procedures. Specific ethnic and procedural cut-points may vary. http://dx.doi.org/10.1016/j.orcp.2012.08.121 M119 Body fat increases throughout pregnancy despite no significant changes in 24-h energy expenditure and caloric intake J. Morris ∗ , T. O’Sullivan Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia Aim: Optimising weight gain is important in promoting a healthy pregnancy for good maternal and infant outcomes. Dietary advice in pregnancy is generally based on research of nonpregnant women, not taking into account potential metabolic changes during pregnancy. The aim was to evaluate longitudinal changes in body composition, energy expenditure and macronutrient intake during a healthy pregnancy. Method: A longitudinal study was performed. Fat mass (FM), lean body mass (LBM), 24 h energy expenditure (TEE), caloric and macronutrient intake were measured in 12 healthy women at 12—14, 24—26 and 34—36 weeks gestation. Body