News and Trends—April 2013

| April 12, 2013

Bariatric Times. 2013;10(4):18–20

Updated Guidelines Issued to Support Enhanced Clinical Outcomes for Bariatric Surgery Patients
JACKSONVILLE, Florida (Business Wire)—Updated clinical guidelines outlining optimal management of bariatric surgery patients’ pre- and post-surgery care have been updated by a collaborative group composed of physicians representing the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS) and the American Society for Metabolic and Bariatric Surgery (ASMBS).
The guidelines’ 74 evidence-based recommendations expand on recommendations originally published by the Task Force in 2008 and reflect recent additions to the evidence base, addressing clinical concerns such as bariatric surgery in patients with type 2 diabetes; bariatric surgery for patients with mild obesity; informed consent; and behavioral issues.
“With the number of severely obese individuals on the rise and a broader range of available surgical techniques being introduced, both surgical and endoscopic, the potentially increased need for this type of surgery demands an update of clinical best practices,” said AACE member and co-chair of the guidelines, Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU.
The following topics are among the guidelines:
•    Parameters to assist in selecting appropriate patients for bariatric surgery;
•    Best surgical options based on the patient profile;
•    Optimizing early postoperative care and long-term patient follow up;
•    Ways to recognize and manage post-operative complications;
•    Recommendations to select patients for a second bariatric surgical procedure, revision or reversal of a previous bariatric surgical procedure.

The guidelines will be published in the Volume 19, Number 2, March/April 2013 issue of Endocrine Practice; Volume 9, No. 2, March 2013 issue of Surgery for Obesity and Related Diseases; and Volume 21 Supplement 1 of Obesity.
To download an electronic version of the guidelines, please visit the following link on the Endocrine Practice website here: http://aace.metapress.com/content/53256517V45810X4
For more information about AACE, visit www.aace.com.

Major Medical Association Appeals to Diabetes Patients to Press for Congressional Action
WASHINGTON, D.C.—The American Association of Clinical Endocrinologists (AACE) is appealing to diabetes patients, their family members and friends, and other health care professionals to urge members of Congress to pass the National Diabetes Clinical Care Commission Act.
The legislation calls for the creation of a public-private commission composed of endocrinologists, other front-line diabetes health care providers, patient advocates and representatives from federal agencies involved in diabetes care activities.
The commission’s charge is to identify critical gaps in existing federal diabetes clinical care initiatives, ineffective or redundant activities that should be discontinued, and new approaches that are needed to stem the tide of the U.S. diabetes epidemic. The commission will submit its recommendations for better leveraging the federal government’s investment in diabetes-related programs to the U.S. Secretary of Health and Human Services and Congress.
AACE commends Representative Pete Olson (R-22-TX) for introducing this legislation in the U.S. House of Representatives (H.R. 1071) and Senator Jeanne Shaheen (D-NH) and Senator Susan Collins (R-ME) for introducing the legislation in the Senate (S. 539). Both bills were introduced on Tuesday, March 12.
The legislation has been endorsed by the American Diabetes Association, the Juvenile Diabetes Research Foundation, the American Academy of Ophthalmology, the American Medical Association, The Endocrine Society and the Pediatric Endocrine Society.
To signify support for the bill (H.R. 1074/S. 529), members of the public are encouraged to send a message to their Congressional representative and/or Senator. To find your representative, visit: http://www.house.gov/representatives/find/ <http://www.house.gov/representatives/find/> . To contact your Senator, visit: http://www.senate.gov/general/contact_information/senators_cfm.cfm.

Diet Critical to Improving Type 2 Diabetes After Bariatric Surgery
DALLAS, Texas—Patients with type 2 diabetes mellitus (T2DM) who consume a diet identical to the strict regimen followed after bariatric surgery are just as likely to see a reduction in blood glucose levels as those who undergo surgery, researchers at UT Southwestern Medical Center have found.
“For years, the question has been whether it is the bariatric surgery or a change in diet that causes the diabetes to improve so rapidly after surgery,” said Dr. Ildiko Lingvay, assistant professor of internal medicine and first author of the study published online in Diabetes Care. “We found that the reduction of patients’ caloric intake following bariatric surgery is what leads to the major improvements in diabetes, not the surgery itself.”
The study followed 10 patients in a controlled, inpatient setting during two distinct periods. Initially they were treated only with the standard diet given to patients after bariatric surgery, while researchers measured effects on blood glucose levels. Several months later, the patients underwent the Roux-en-Y gastric bypass bariatric surgery and followed the same diet while the UT Southwestern research team again examined blood glucose levels. Patients received less than 2,000 calories total during each of these 10-day periods, which is the customary diet after gastric bypass surgery.
Fasting blood glucose levels dropped 21 percent on average during the diet-only phase, and 12 percent after combining the diet with surgery. Patients’ overall blood glucose levels after a standard meal decreased by 15 percent in the diet-only phase and 18 percent after combining diet with surgery. The scientists said the results demonstrate that the extremely restrictive diet imposed after bariatric surgery is responsible for the rapid diabetes remission, which occurs within days of the procedure normally.
The study was performed with support from the National Institutes of Health.
Visit www.utswmedicine.org/conditions-specialties/weight-loss-obesity/ to learn more about weight loss and obesity clinical services at UT Southwestern.

After Weight-loss Surgery, New Gut Bacteria Keep Obesity Away
NEW YORK (Reuters)—The logic behind weight-loss surgery seems simple: rearrange the digestive tract so the stomach can hold less food and the food bypasses part of the small intestine, allowing fewer of a meal’s calories to be absorbed. Bye-bye, obesity.
A study of lab mice, published recently, begs to differ. It concludes that one of the most common and effective forms of bariatric surgery, called Roux-en-Y gastric bypass, melts away pounds not—or not only—by re-routing the digestive tract, as long thought, but by changing the bacteria in the gut.
Or, in non-scientific terms, the surgery somehow replaces fattening microbes with slimming ones.
If that occurs in people, too, then the same bacteria-changing legerdemain achieved by gastric bypass might be accomplished without putting obese patients under the knife in an expensive and risky operation.
“These elegant experiments show that you can mimic the action of surgery with something less invasive,” said Dr. Francesco Rubino of Catholic University in Rome and a pioneer in gastric-bypass surgery. “For instance, you might transfer bacteria or even manipulate the diet” to encourage slimming bacteria and squelch fattening kinds,” said Rubino, who was not involved in the study.
To read the full article, visit http://www.reuters.com/article/2013/03/27/us-obesity-surgery-bacteria-idUSBRE92Q0ZQ20130327?irpc=932

CareFusion Launches New Take-Apart Laparoscopic Scissors
SAN DIEGO, California (PRNewswire)—CareFusion, a global medical technology company, launched its new Snowden-Pencer® take-apart laparoscopic scissors.
The scissors are the latest in CareFusion’s line of take-apart laparoscopic surgical instruments and provide sterile, sharp blades and a new insulated shaft for each procedure. Designed for easy assembly and disassembly, the scissors feature an ergonomic, reusable ring-handle that also fits Snowden-Pencer take-apart clamps, dissectors and graspers. The handle is designed to more evenly distribute pressure than traditional handles and accommodates a variety of hand positions for comfort and precision during surgery.
For more information, call 800-323-9088 or visit http://www.carefusion.com/SnowdenPencer.

Steris Corporation Launches Orthopedic Surgical Table
MENTOR, Ohio—Steris Corporation launched the STERIS OT 1000 Orthopedic Surgical Table with SWAN technology, a unique buoyant articulation capability that allows virtually effortless movement of the patient for anterior approach total hip arthroplasty (AATHA) fracture reduction and many other orthopedic procedures. Slide, traction and rotation of the boot are controlled with one hand, and fluid movement of the leg spar is managed by the other hand. This allows full gross and fine traction positioning and a full range of motion without interference from the equipment. In addition, special features enhance the access of anesthesiologists , surgeons and staff to their patient s during surgery
For more information, visit www.steris.com

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