Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Pivot Concepts:
Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Target Concepts:
Gene/Protein
Disease
Symptom
Drug
Enzyme
Compound
Query: UMLS:C0011860 (
type 2 diabetes
)
57,723
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
Objective:
The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.
Methods:
Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.
Results:
New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).
Conclusion:
Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
A1C
= hemoglobin A1c;
AACE
= American Association of Clinical Endocrinologists;
ABCD
= adiposity-based chronic disease;
ACE
= American College of Endocrinology;
ADA
= American Diabetes Association;
AHI
= Apnea-Hypopnea Index;
ASA
= American Society of Anesthesiologists;
ASMBS
= American Society of Metabolic and Bariatric Surgery;
BMI
= body mass index;
BPD
= biliopancreatic diversion;
BPD/DS
= biliopancreatic diversion with duodenal switch;
CI
= confidence interval;
CPAP
= continuous positive airway pressure;
CPG
= clinical practice guideline;
CRP
= C-reactive protein;
CT
= computed tomography;
CVD
= cardiovascular disease;
DBCD
= dysglycemia-based chronic disease;
DS
= duodenal switch;
DVT
= deep venous thrombosis;
DXA
= dual-energy X-ray absorptiometry;
EFA
= essential fatty acid;
EL
= evidence level;
EN
= enteral nutrition;
ERABS
= enhanced recovery after bariatric surgery;
FDA
= U.S. Food and Drug Administration;
G4G
= Guidelines for Guidelines;
GERD
=
gastroesophageal reflux disease
;
GI
= gastrointestinal;
HCP
= health-care professional(s);
HTN
= hypertension;
ICU
= intensive care unit;
IGB
= intragastric balloon(s);
IV
= intravenous;
LAGB
= laparoscopic adjustable gastric band;
LAGBP
= laparoscopic adjustable gastric banded plication;
LGP
= laparoscopic greater curvature (gastric) plication;
LRYGB
= laparoscopic Roux-en-Y gastric bypass;
LSG
= laparoscopic sleeve gastrectomy;
MetS
= metabolic syndrome;
NAFLD
= nonalcoholic fatty liver disease;
NASH
= nonalcoholic steatohepatitis;
NSAID
= nonsteroidal anti-inflammatory drug;
OA
= osteoarthritis;
OAGB
= one-anastomosis gastric bypass;
OMA
= Obesity Medicine Association;
OR
= odds ratio;
ORC
= obesity-related complication(s);
OSA
= obstructive sleep apnea;
PE
= pulmonary embolism;
PN
= parenteral nutrition;
PRM
= pulmonary recruitment maneuver;
RCT
= randomized controlled trial;
RD
= registered dietician;
RDA
= recommended daily allowance;
RYGB
= Roux-en-Y gastric bypass;
SG
= sleeve gastrectomy;
SIBO
= small intestinal bacterial overgrowth;
TOS
= The Obesity Society;
TSH
= thyroid-stimulating hormone;
T1D
= type 1 diabetes;
T2D
=
type 2 diabetes
;
VTE
= venous thromboembolism;
WE
= Wernicke encephalopathy;
WHO
= World Health Organization.
...
PMID:CLINICAL PRACTICE GUIDELINES FOR THE PERIOPERATIVE NUTRITION, METABOLIC, AND NONSURGICAL SUPPORT OF PATIENTS UNDERGOING BARIATRIC PROCEDURES - 2019 UPDATE: COSPONSORED BY AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY, THE OBESITY SOCIETY, AMERICAN SOCIETY FOR METABOLIC & BARIATRIC SURGERY, OBESITY MEDICINE ASSOCIATION, AND AMERICAN SOCIETY OF ANESTHESIOLOGISTS -
EXECUTIVE SUMMARY
. 3168 18
Metformin is the first-choice drug in uncomplicated
type 2 diabetes
(T2DM) and is effective in improving glycaemic control. It is the most widely prescribed oral antidiabetic medicine and has a good safety profile. However, there is an abundance of evidence that metformin use is associated with decreased Vitamin B12 status, though the clinical implications of this in terms of increased risk of diabetic peripheral neuropathy are debated. There is growing evidence that other B vitamins, vitamin D and magnesium may also be impacted by metformin use in addition to alterations to the composition of the microbiome, depending on the dose and duration of therapy. Patients using metformin for prolonged periods may, therefore, need initial screening with intermittent follow-up, particularly since vitamin B
12
deficiency has similar symptoms to diabetic neuropathy which itself affects 40-50% of patients with T2DM at some stage. Among patients with T2DM, 40% are reported to experience symptomatic
gastroesophageal reflux disease
(GORD), of whom 70% use oral antidiabetic medications. The most common medications used to treat GORD are proton pump inhibitors (PPIs) and antagonists of histamine selective H
2
receptors (H
2
RAs), both of which independently affect vitamin B
12
and magnesium status. Research indicates that co-prescribing metformin with either PPIs or H
2
RAs can have further deleterious effects on vitamin B
12
status. Vitamin B12 deficiency related to metformin and polypharmacy is likely to contribute to the symptoms of diabetic neuropathy which may frequently be under-recognised. This review explores current knowledge surrounding these issues and suggests treatment strategies such as supplementation.
...
PMID:Metformin and Micronutrient Status in Type 2 Diabetes: Does Polypharmacy Involving Acid-Suppressing Medications Affect Vitamin B12 Levels? 3260 68
Severe obesity is often associated with co-morbid conditions such as diabetes mellitus, hypertension, and obstructive sleep apnea. Successful weight loss can result in remission of these conditions. The authors retrospectively examined the co-morbidity profiles of pre-operative gastric sleeve adult patients from the MBSAQIP database with subjects from our adolescent bariatric program. Five conditions were compared: hypertension (HTN),
type 2 diabetes
mellitus (T2DM), dyslipidemia (DL), obstructive sleep apnea (OSA), and
gastroesophageal reflux disease
(
GERD
). Patients were matched by gender and body mass index (BMI). The prevalence of each condition was statistically more significant in the adult cohort. Successful weight loss at an earlier age may reduce the prevalence of these co-morbid conditions.
...
PMID:The Prevalence of Co-morbidities in Adult and Adolescent Bariatric Surgery Candidates. 3304 86
<< Previous
1
2
3
4
5
