Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

BACKGROUND AND AIMS Cardiovascular (CV) risk equations are routinely used to predict risk in nonbariatric populations, but have not been studied in depth in patients undergoing bariatric surgery and specifically those with impaired glucose regulation. The aim of this pilot study was to investigate changes in the 10-year and lifetime predicted CV risk in subjects with impaired glucose regulation before, 1 month, 6 months, and 5 years after bariatric surgery. METHOD AND RESULTS A nonrandomized prospective study was conducted of 45 participants with impaired glucose regulation undergoing temporal assessments during follow-up. Body weight, body mass index (BMI), blood pressure, lipid profile, and HbA1c were recorded preoperatively, 1 month, 6 months, and 5 years postoperatively. Preoperative and postoperative predicted CV risk was calculated using the QRISK2, QRISK lifetime, and JBS3 calculators. Follow-up rates were 93%, 91%, and 71% at 1 month, 6 months, and 5 years, respectively. The sample had a mean age of 48.8 ± 7.0 years, a mean BMI of 53.9 ± 11.1 kg/m2, and a mean HbA1c of 7.5% ± 1.7%. The predicted 10-year QRISK2 score decreased by 35%, 54%, and 24% at 1 month, 6 months, and 5 years, respectively (P < 0.001). The predicted lifetime risk also decreased with the greatest reduction (24.5% with QRISK lifetime and 26.7% with JBS3 lifetime score) observed at 5 years even though the subjects were 5 years older. CONCLUSION Bariatric surgery in patients with impaired glucose regulation is associated with a significant reduction in predicted 10-year and lifetime CV risk in a population that was 5 years older compared to baseline.

Increased body mass is directly associated with reduced cognitive function. The aim of this study was to systematically review the effect of bariatric weight loss surgery on cognitive function. A comprehensive and unrestricted literature search was conducted using the following databases: MEDLINE, EMBASE, PubMed, Scopus, Web of Sciences, and the Cochrane Library. A total of 414 publications were identified, of which 18 were included in the final review. Cognitive function as measured by a number of different assessment tools was shown to improve following surgically induced weight loss in most studies. Significant and rapid weight loss resulting from bariatric surgery is associated with prompt and sustained improvements in cognitive function including memory, executive function, and cognitive control.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Introduction: Bariatric surgery is the only evidence-based method of long-term weight control in obese individuals. The reduction in individual cardiovascular risk following bariatric surgery has not yet been quantified. QRISK2 is a United Kingdom-designed algorithm that predicts 10-year cardiovascular risk. In this study, we calculated the QRISK2 scores for patients before and after bariatric surgery in an effort to assess cardiovascular risk reduction following bariatric surgery objectively.Materials and Methods: We reviewed all patients who had undergone bariatric surgery over a 10-year period (June 2003-June 2013) at our institute. QRISK2 score was calculated pre- and postoperatively for all patients. The postoperative score was calculated at the point of longest available follow-up.Results: A total of 250 patients were included, with a median age of 36 years (interquartile range 29-44). Median follow-up postoperatively for all patients was 24 months (interquartile range 6-36). A hundred patients underwent sleeve gastrectomy, 67 (26.8%) patients had biliopancreatic diversion (BPD), 50 (20%) patients had a Roux-en-Y gastric bypass (RYG), and 33 (13.2%) were fitted with gastric bands. The median preoperative QRISK2 score was 5.6%; the median postoperative QRISK2 score was lower at 4.4% (p<0.001).Conclusion: This study is the first to use a validated scoring system to assess 10-year cardiovascular risk reduction in bariatric patients. We have demonstrated a significant reduction in cardiovascular risk following bariatric surgery.

Reductions in plasma endocannabinoids following bariatric surgery in morbidly obese females with impaired glucose homeostasis: A non-randomized prospective study • Endocannabinoids (ECs) are bioactive lipid mediators − N-arachidonyl ethanolamine (AEA) − N-palmitoyl ethanolamine (PEA) − N-oleoyl ethanolamine (OEA) − related N-acylethanolamine (NAE) derivatives − 2-arachidonyl glycerol (2-AG) • Endocannabinoid system (ECS) plays a critical role in regulation of body weight and may have a role in aetiopathogenesis of Type 2 Diabetes (T2DM) • Elevated circulating levels of AEA and 2-AG in obese people compared to non-obese controls of both genders • Little information available on the effects of extreme weight loss associated with bariatric surgery in relation to the ECS.

seen in following table.Of the 3,300 obese/overweight patients seen in 2013, 480 were randomly selected.Their information can be seen in following table.Only 29% of these patients had vitamin D levels ordered and only 30% of deficient patients were treated.Also, only 24% had any sort of follow up.Conclusions: At a single institution, most providers did not screen, treat or follow up Vitamin D deficiency in accordance with AAP guidelines.Further investigation into provider and system-level barriers to guideline compliance is warranted.

Background and Aims. Bariatric surgery results in the remission of type 2 diabetes mellitus (T2DM) in morbidly obese subjects. The aim of the study was to investigate the predictive value of both static and dynamic measures of C-peptide in relation to T2DM resolution 6 months after bariatric surgery regardless of the operation type.Methods and Results. A non-randomized prospective study of 24 participants with T2DM undergoing bariatric surgery. Measurements of fasting and 2-hour plasma glucose, insulin, C-peptide and measures of insulin sensitivity were recorded temporally during an oral glucose tolerance test pre-operatively and 6 months post-operatively. A responder was defined with a fasting glucose <5.6 mmol/L and HbA(1c) <6.0% postoperatively. Within the sample there were 11 responders and 13 non-responders at 6 months. There was a significant difference in the duration of diabetes between the groups. Fasting C-peptide (P <= 0.05) and 2-hour C-peptide (P <= 0.05) were higher in responders compared to non-responders. Significantly higher C-peptide levels were observed preoperatively at all time points for responders, with significantly higher area under the curve (AUC(0-60) and AUC(0-120)). Using the lower quartiles for C-peptide levels, both fasting C-peptide (>2.5 ng/mL [0.83 nmol/L]) and 2-hour C-peptide (>5.2 ng/mL [1.73 nmol/L]) had a sensitivity and negative predictive value of 100% to predict T2DM remission. Logistic regression showed that C-peptide, duration of diabetes and BMI were associated with response. The area under the ROC curve was 0.94 and a regression model predicted diabetes remission with a sensitivity of 85.7% and a specificity of 88.9%.Conclusions. This study demonstrated that static (fasting) and dynamic (AUC, 2-hour) C-peptide measurements predict T2DM resolution 6 months following bariatric surgery. This work provides insight into C-peptide dynamics as a predictor of response to bariatric surgery. (C) 2015 Elsevier Inc. All rights reserved.

AIM:We examined endocannabinoids (ECs) in relation to bariatric surgery and the association between plasma ECs and markers of insulin resistance.METHODS:A study of 20 participants undergoing bariatric surgery. Fasting and 2-hour plasma glucose, lipids, insulin, and C-peptide were recorded preoperatively and 6 months postoperatively with plasma ECs (AEA, 2-AG) and endocannabinoid-related lipids (PEA, OEA).RESULTS:Gender-specific analysis showed differences in AEA, OEA, and PEA preoperatively with reductions in AEA and PEA in females postoperatively. Preoperatively, AEA was correlated with 2-hour glucose (r = 0.55, P = 0.01), HOMA-IR (r = 0.61, P = 0.009), and HOMA %S (r = -0.71, P = 0.002). OEA was correlated with weight (r = 0.49, P = 0.03), waist circumference (r = 0.52, P = 0.02), fasting insulin (r = 0.49, P = 0.04), and HOMA-IR (r = 0.48, P = 0.05). PEA was correlated with fasting insulin (r = 0.49, P = 0.04). 2-AG had a negative correlation with fasting glucose (r = -0.59, P = 0.04).CONCLUSION:Gender differences exist in circulating ECs in obese subjects. Females show changes in AEA and PEA after bariatric surgery. Specific correlations exist between different ECs and markers of obesity and insulin and glucose homeostasis.

BACKGROUND:Bariatric surgery is an effective treatment for morbid obesity. Obesity and type 2 diabetes are associated with chronic inflammation. There is lack of data examining the effects of sleeve gastrectomy (SG) on inflammatory biomarkers. Our aim was to study the effects of SG on specific cytokines associated with obesity including interleukin-6 (IL-6), interleukin-10 (IL-10), leptin, adiponectin, and C-reactive protein (CRP) preoperatively, 1 and 6 months after surgery.METHODS:A nonrandomized prospective study comprising of 22 participants with impaired glucose homeostasis and type 2 diabetes undergoing SG (body mass index 50.1 kg/m(2), glycated hemoglobin [HbA1c] 53 mmol/mol). Serial measurements of IL-6, IL-10, leptin, adiponectin, and CRP were performed during oral glucose tolerance testing preoperatively, 1 and 6 months postoperatively.RESULTS:We observed significant improvements at 1 and 6 months in leptin (P≤.001) and CRP (P = .003) after SG. We also observed a significant reduction in IL-6 at 6 months (P = .001). No statistically significant differences were observed for adiponectin and IL-10.CONCLUSION:This study is the first to examine the detailed changes in the inflammatory cytokines after SG. Our study shows significant improvements in the inflammatory biomarkers after SG in patients with impaired glucose homeostasis and type 2 diabetes.

BACKGROUND:Bariatric surgery is an effective treatment for morbid obesity. Current literature reports significant improvements in glucose homeostasis after malabsorptive surgery. There is limited evidence on the effects of laparoscopic sleeve gastrectomy (SG) on glucose-insulin homeostasis and postoperative incretin hormone response. The objective of this study was to examine the metabolic effects of SG on temporal changes in insulin and glucose homeostasis, incretin hormones and hepatic insulin clearance in patients with impaired glucose tolerance (IGT) and type 2 diabetes (T2 DM). METHODS:A nonrandomized prospective study comprising 22 participants undergoing SG (body mass index [BMI] 50.1 kg/m(2), glycated hemoglobin [HbA1c] 53 mmol/mol) and 15 participants undergoing biliopancreatic diversion (BPD) (BMI 62.1 kg/m(2), HbA1c 58 mmol/mol). Serial measurements of glucose, insulin, C-peptide, glucagon like peptide-1 (GLP-1) and glucose-dependent insulinotropic hormone (GIP) were performed during oral glucose tolerance testing preoperatively and 1 and 6 months postoperatively. Areas under the curve (AUC) were examined at 30, 60, and 120 minutes. RESULTS:Within the SG group, significant improvements were observed respectively at 1 and 6 months in glucose control (HbA1c: -0.9%, -1.3%), measures of insulin sensitivity (fasting insulin: -4.8 mU/L, -8.5 mU/L; fasting C-peptide: -0.6 pmol/L, -1.1 pmol/L; Homeostasis Model Assessment [HOMA-IR]: -0.144, -0.174; HOMA %S:+29.6,+92.4), hepatic insulin clearance (+0.07,+0.13) and postprandial GLP-1 response (AUC0-30 pmol h L(-1):+300,+331, AUC0-60:+300,+294, AUC0-120:+316,+295). These results were comparable to the BPD group. CONCLUSIONS:SG is associated with significant early improvements in insulin sensitivity and incretin hormone response and results in significant improvements in IGT/T2 DM.

AimsTo assess the incidence and progression of diabetic retinopathy (DR) 12months post bariatric surgery in persons with morbid obesity and type 2 diabetes.MethodsA retrospective pilot analysis of electronic hospital records between 1998 and 2012.Results40 of 148 subjects had pre- and post-surgery DR screening. Of those without DR pre-surgery 1.5% (n=26) progressed to minimum background DR (BDR) post surgery. Those with minimum BDR (n=9) pre-surgery revealed no progression, with 55.6% (n=5) showing evidence of regression. One person with moderately severe BDR and two with pre-proliferative DR (PPDR) prior to surgery experienced progression. Two persons with PPDR prior to surgery remained under the hospital eye services and were therefore not eligible to be re-assessed by the screening service.ConclusionsThere was a low incidence of new DR and progression of DR in those either without evidence of retinopathy or with minimal BDR prior to surgery with some subjects showing evidence of regression. There was however a risk of progression of DR in those with moderate BDR or worse, and should therefore be monitored closely post-surgery.

This is a case report of an 85-year old patient who presented with abdominal pain, nausea and vomiting associated with altered liver function test.The plain X-rays and CT scan showed pneumobilia with an ectopic gallstone.The patient was diagnosed with Bouveret syndrome and managed surgically.The report is followed by a discussion about Bouveret syndrome.