Daily Endocrinology Research Analysis

IMPORTANCE: Reports on long-term outcomes from randomized clinical trials comparing laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are scarce. OBJECTIVE: To compare long-term weight and metabolic outcomes, reoperation rates, and quality of life for patients undergoing SG vs RYGB at 10 years and beyond. DESIGN, SETTING, AND PARTICIPANTS: The SM-BOSS (Swiss Multicenter Bypass or Sleeve Study) randomized clinical trial was conducted from January 2007 to November 2011 at 4 bariatric centers in Switzerland. (The last follow-up was obtained in July 2023.) A total of 3971 patients with severe obesity were assessed, and 217 patients were enrolled and randomized to undergo SG or RYGB. INTERVENTIONS: Laparoscopic SG or RYGB. MAIN OUTCOMES AND MEASURES: The primary outcome of the SM-BOSS trial was the percentage excess body mass index loss (%EBMIL) at 5 years. The present study reports on the long-term weight and metabolic outcomes at 10 years and beyond, including changes in weight and obesity-related diseases, reoperation rates, and quality of life. RESULTS: Of 217 patients randomized to undergo SG or RYGB, mean (SD) age was 42.5 (11.1) years, mean (SD) baseline BMI was 43.9 (5.3), and 156 patients (71.9%) were female. Of 217 patients, 110 patients were randomized to RYGB and 107 to SG. Complete 10-year follow-up is available for 65.4% of patients. In the intention-to-treat population, mean (SD) %EBMIL was 60.6% (25.9) after SG and 65.2% (26.0) after RYGB (P = .29). Patients who underwent SG had significantly higher conversion rates because of insufficient weight reduction or reflux compared to RYGB (29.9% vs 5.5%; P < .001). Patients undergoing RYGB had significantly higher mean (SD) %EBMIL compared to SG after 10 years in the per-protocol (PP) population (65.9% [26.3] vs 56.1% [25.2]; P = .048). However, mean (SD) percentage total weight loss was not significantly different between groups (RYGB: 27.7% [10.8]; SG: 25.5% [15.1]; P = .37). SG patients had significantly more de novo gastroesophageal reflux (GERD) compared with RYGB (P = .02). CONCLUSIONS AND RELEVANCE: In the SM-BOSS randomized clinical trial, RYGB led to significantly higher %EBMIL in the PP population compared with SG beyond 10 years of follow-up, with better results for GERD. Patients undergoing SG experienced a significantly higher number of conversions to different anatomy compared with RYGB. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00356213.

BACKGROUND: Type 1 diabetes mellitus (T1DM) significantly affects patients' quality of life and can be life-threatening, necessitating improved monitoring strategies. Telemedicine, which leverages telecommunications technologies to deliver health care services and expertise, has the potential to enhance T1DM management. However, its effectiveness remains to be fully established. OBJECTIVE: This study aims to evaluate the effectiveness of various telemedicine-based carbohydrate-counting (CC) interventions in patients with T1DM. METHODS: This systematic review and meta-analysis searched 5 databases-PubMed, Web of Science, CINAHL, Embase, and Cochrane-as well as reference lists of retrieved articles on September 26, 2024, for randomized controlled trials (RCTs) assessing the effectiveness of telemedicine-based CC interventions in reducing glycated hemoglobin A RESULTS: From 3612 citations, we identified 18 eligible RCTs (n=1627) from 14 regions for inclusion in the meta-analysis. Participants in the telemedicine intervention group experienced a 0.35% reduction in HbA CONCLUSIONS: Compared with usual care, telemedicine-delivered CC interventions improved HbA TRIAL REGISTRATION: PROSPERO CRD42024523025; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024523025.

CONTEXT: Lipodystrophy syndromes are rare disorders characterized by deficient adipose tissue, leading to insulin resistance, dyslipidemia, and organ system abnormalities. OBJECTIVE: Our goal was to develop a lipodystrophy severity score (LDS) to holistically capture the diverse manifestations of lipodystrophy into a numerical score to aid in prediction of clinical outcomes and/or treatment impact. DESIGN: An 8-domain LDS was developed by 8 disease experts in consultation with patient organizations. The LDS was rated for feasibility and content validity by 28 additional clinicians and 9 patient representatives. LDS was compared to the Clinical Global Impression (CGI) of severity for 20 putative patient profiles, each at 2 different time points, and by comparing change in LDS to global impression of change. For external validation, LDS was calculated in 2 cohorts of patients with lipodystrophy treated with metreleptin. RESULTS: LDS domains include Diabetes/Insulin Resistance, Microvascular Complications of Diabetes, Lipids, Cardiovascular, Liver, Kidney, Reproductive, and Other. Each domain is assessed by 1 or more questions assessing both lifetime and recent complications of lipodystrophy. The LDS had high content validity and feasibility and high reliability by intraclass correlation coefficients (>0.95). Global and domain-specific LDS were strongly correlated with CGI, as were changes in scores across visits (R = 0.79-0.99, P < .001 for all). In generalized lipodystrophy, metreleptin significantly reduced LDS (from 46 to 26 at 12 months, P < .001). The reductions were smaller in partial lipodystrophy (from 65 to 61 at 12 months, P = .04). CONCLUSION: The LDS can reflect the severity of diverse manifestations of lipodystrophy and monitor changes following interventions.