- Email: [email protected]
SOARD Category 1 CME Credit Featured Articles, Volume 9, July–August 2013
SOARD Category 1 CME Credit Featured Articles, Volume 9, July–August 2013 Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N. Surg Obes Relat Dis 2013;9;498-502.
Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M. Surg Obes Relat Dis 2013;9;569-573. Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with three to five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational
activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are:
Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N. Surg Obes Relat Dis 2013;9;498-502.
Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M. Surg Obes Relat Dis 2013;9;569-573.
1550-7289/13/$ – see front matter r 2013 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery. http://dx.doi.org/10.1016/j.soard.2013.06.018
592
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 591–594
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 591–594
593
ARTICLE 1
Question 3
Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy.
Is recurrence of T2DM after bariatric surgery reported in the literature?
Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N.
A. No, there are no data about it. B. Yes, only in patients with greater weight loss failure rate after gastric bypass. C. Yes, the recurrence or worsening, after gastric bypass, was only associated with a lower preoperative BMI. D. Yes, the recurrence or worsening, after gastric bypass, was associated with a lower preoperative BMI, or regain of a greater percentage of lost weight, or greater weightloss failure rate.
Surg Obes Relat Dis 2013;9;498-502. Learning Objectives Bariatric surgery is currently being evaluated as a potential treatment for type 2 diabetes. Laparoscopic sleeve gastrectomy (LSG) is becoming popular as a stand-alone procedure for the treatment of morbid obesity and related diseases. The aim of this study was to evaluate the long-term effects of LSG on type 2 diabetes and other related comorbidities in morbidly obese patients. LSG can result, in a significant percentage of treated patients, in a prolonged remission (60 months) of type 2 diabetes, maintaining euglycaemia without medication, and significant remission of hypertension and dyslipidemia, consequently diminishing the cardiac risk factor (Framingham score). The long-term remission of type 2 diabetes observed in our study prevents the occurrence of diabetic retinopathy in these patients. Question 1 Which are the parameters to consider for a complete remission of type 2 diabetes, according to the consensus group definitions drawn in 2009? A. HbA1c in the normal range and fasting plasma glucose o100 mg/dL for at least 1 year’s duration. B. HbA1c in the normal range and fasting plasma glucose 100–125 mg/dL for at least 1 year’s duration. C. HbA1c in the normal range and fasting plasma glucose o100 mg/dL for at least 1 year’s duration without active pharmacologic therapy or ongoing procedures. D. HbA1c in the normal range and fasting plasma glucose 100–125 mg/dL for at least 1 year’s duration without active pharmacologic therapy or ongoing procedures.
Question 4 Can bariatric surgery reduce the number of microvascular and macrovascular T2DM complications and consequently fatal cardiovascular events? A. There are no data in the literature about lower cardiovascular death after bariatric surgery. B. There are only a few data about reduction of mortality from heart disease after gastric bypass. C. Yes, studies reported a lower incidence of total cardiovascular events after bariatric surgery by significantly reducing the Framingham risk score. D. There are only a few data about reduction of mortality from heart disease after biliopancreatic diversion with duodenal switch. ARTICLE 2 Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M. Surg Obes Relat Dis 2013;9;569-573. Learning Objectives
Severe obesity is associated with reduced mental wellbeing (i.e., depression, perceived stress).
Patients undergoing bariatric surgery often show disturbed eating behaviors before surgery.
Question 2 Which is the preoperative negative prognostic factor of type 2 diabetes mellitus (T2DM) remission? A. B. C. D.
There is no negative prognostic factor. T2DM diagnosis 41 year before surgery. T2DM diagnosis 410 years before surgery. BMI 450 kg/m² before surgery.
After a mid-term follow-up one year after laparoscopic sleeve gastrectomy, depression and perceived stress generally improve. Patients with persistent abnormalities in eating behavior (e.g., low cognitive restraint) may need special support after surgery to cope with their new anatomic conditions. It is essential to identify patients at risk (persistent psychological burden) in order to provide the support needed and to improve the overall outcome.
594
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 591–594
Question 1 Psychological conditions after bariatric surgery: Which is the correct answer? A. All patients do well psychologically one year after laparoscopic gastric banding. B. Addressing psychological symptoms in treatment strategies may help improve the surgical outcome. C. Any disturbances of eating behaviors represent a contraindication for bariatric surgery. D. Disordered eating stops completely after sleeve gastrectomy. E. Bariatric surgeons do not need to address psychological issues.
D. Deficits in concentration. E. Improvement in body image Question 3 Eating behavior is not influenced by: A. the extent an individual needs to control her/his food intake cognitively. B. metabolic pathways. C. the percentage of excess weight loss. D. food craving. E. perceived feelings of hunger. Question 4
Question 2 Depression is a relevant psychiatric comorbidity in patients with severe obesity. Which symptom is not a primary relevant symptom of a depressive episode? A. Sleep disturbances. B. Reduced self-confidence. C. Mood disturbances.
What is not helpful when identifying patients with mental burdens following bariatric surgery? A. Slight excess weight loss in follow-up visits after bariatric surgery. B. Feelings of loss of control. C. Non-compliance to nutritional recommendations. D. Inadherence to regular surgical follow-up visits. E. Improvement of diabetes symptoms.
Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M. Surg Obes Relat Dis 2013;9;569-573. Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with three to five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational
activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are:
Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N. Surg Obes Relat Dis 2013;9;498-502.
Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M. Surg Obes Relat Dis 2013;9;569-573.
1550-7289/13/$ – see front matter r 2013 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery. http://dx.doi.org/10.1016/j.soard.2013.06.018
592
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 591–594
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 591–594
593
ARTICLE 1
Question 3
Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy.
Is recurrence of T2DM after bariatric surgery reported in the literature?
Abbatini F, Capoccia D, Casella G, Soricelli E, Leonetti F, Basso N.
A. No, there are no data about it. B. Yes, only in patients with greater weight loss failure rate after gastric bypass. C. Yes, the recurrence or worsening, after gastric bypass, was only associated with a lower preoperative BMI. D. Yes, the recurrence or worsening, after gastric bypass, was associated with a lower preoperative BMI, or regain of a greater percentage of lost weight, or greater weightloss failure rate.
Surg Obes Relat Dis 2013;9;498-502. Learning Objectives Bariatric surgery is currently being evaluated as a potential treatment for type 2 diabetes. Laparoscopic sleeve gastrectomy (LSG) is becoming popular as a stand-alone procedure for the treatment of morbid obesity and related diseases. The aim of this study was to evaluate the long-term effects of LSG on type 2 diabetes and other related comorbidities in morbidly obese patients. LSG can result, in a significant percentage of treated patients, in a prolonged remission (60 months) of type 2 diabetes, maintaining euglycaemia without medication, and significant remission of hypertension and dyslipidemia, consequently diminishing the cardiac risk factor (Framingham score). The long-term remission of type 2 diabetes observed in our study prevents the occurrence of diabetic retinopathy in these patients. Question 1 Which are the parameters to consider for a complete remission of type 2 diabetes, according to the consensus group definitions drawn in 2009? A. HbA1c in the normal range and fasting plasma glucose o100 mg/dL for at least 1 year’s duration. B. HbA1c in the normal range and fasting plasma glucose 100–125 mg/dL for at least 1 year’s duration. C. HbA1c in the normal range and fasting plasma glucose o100 mg/dL for at least 1 year’s duration without active pharmacologic therapy or ongoing procedures. D. HbA1c in the normal range and fasting plasma glucose 100–125 mg/dL for at least 1 year’s duration without active pharmacologic therapy or ongoing procedures.
Question 4 Can bariatric surgery reduce the number of microvascular and macrovascular T2DM complications and consequently fatal cardiovascular events? A. There are no data in the literature about lower cardiovascular death after bariatric surgery. B. There are only a few data about reduction of mortality from heart disease after gastric bypass. C. Yes, studies reported a lower incidence of total cardiovascular events after bariatric surgery by significantly reducing the Framingham risk score. D. There are only a few data about reduction of mortality from heart disease after biliopancreatic diversion with duodenal switch. ARTICLE 2 Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control. Rieber N, Giel KE, Meile T, Enck P, Zipfel S, Teufel M. Surg Obes Relat Dis 2013;9;569-573. Learning Objectives
Severe obesity is associated with reduced mental wellbeing (i.e., depression, perceived stress).
Patients undergoing bariatric surgery often show disturbed eating behaviors before surgery.
Question 2 Which is the preoperative negative prognostic factor of type 2 diabetes mellitus (T2DM) remission? A. B. C. D.
There is no negative prognostic factor. T2DM diagnosis 41 year before surgery. T2DM diagnosis 410 years before surgery. BMI 450 kg/m² before surgery.
After a mid-term follow-up one year after laparoscopic sleeve gastrectomy, depression and perceived stress generally improve. Patients with persistent abnormalities in eating behavior (e.g., low cognitive restraint) may need special support after surgery to cope with their new anatomic conditions. It is essential to identify patients at risk (persistent psychological burden) in order to provide the support needed and to improve the overall outcome.
594
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 591–594
Question 1 Psychological conditions after bariatric surgery: Which is the correct answer? A. All patients do well psychologically one year after laparoscopic gastric banding. B. Addressing psychological symptoms in treatment strategies may help improve the surgical outcome. C. Any disturbances of eating behaviors represent a contraindication for bariatric surgery. D. Disordered eating stops completely after sleeve gastrectomy. E. Bariatric surgeons do not need to address psychological issues.
D. Deficits in concentration. E. Improvement in body image Question 3 Eating behavior is not influenced by: A. the extent an individual needs to control her/his food intake cognitively. B. metabolic pathways. C. the percentage of excess weight loss. D. food craving. E. perceived feelings of hunger. Question 4
Question 2 Depression is a relevant psychiatric comorbidity in patients with severe obesity. Which symptom is not a primary relevant symptom of a depressive episode? A. Sleep disturbances. B. Reduced self-confidence. C. Mood disturbances.
What is not helpful when identifying patients with mental burdens following bariatric surgery? A. Slight excess weight loss in follow-up visits after bariatric surgery. B. Feelings of loss of control. C. Non-compliance to nutritional recommendations. D. Inadherence to regular surgical follow-up visits. E. Improvement of diabetes symptoms.