scope school dublin - david haslam
DESCRIPTION
TRANSCRIPT
Results: primary careResults: primary care
Figure. Mean total GP and nurse visits over six weeks by BMI (post-discharge)
Nanchahal K et al Int J Obes 2005 29; 317-323
-6
-5
-4
-3
-2
-1
0
1
2
3
3m 6m 12m 24 m
Wei
ght C
hang
e kg
-2.3
-4.2
-3.3 -3.0
One in 6 achieve >5% weight loss at 12 or 24 months
Counterweight mean weight change
n (12m) = 642 attending from total possible 1419 (45%)n (24m) = 357 attending from total possible 825
Expected weight change without intervention
Heitmann BL & Garby L (1999) Int J Obes
Br J Gen Pract. 2008; 58: 548-554
Mean Counterweight effect size: 4 kg below expected weight at 12-24 months
Weight change attending population
MA
TER
NA
L OB
ES
ITY
Shai et al for the DIRECT study group
Case 1Case 1
Week
–6.1%
–10.2%*Mea
n w
eigh
t lo
ss (
%)
Adapted from Sjöström et al. Reprinted with permission from Elsevier. Lancet 1998; 352: 167–72
52–4 0 3624120
–12
–8
–2
–4
–6
–10
Orlistat produces greater weight loss Orlistat produces greater weight loss than diet alonethan diet alone
*p<0.001 vs placebo
Placebo + diet (n=340)
Orlistat + diet (n=343)
Active treatment begins
*Reduction in risk of progressing to type 2 diabetes vs placebo
Cumulative incidence of type 2 diabetes based on Cumulative incidence of type 2 diabetes based on 2-hour oral glucose tolerance test – all patients2-hour oral glucose tolerance test – all patients
Inci
den
ce (
%)
p=0.0032*
0 26 52 78 104 130 156 182 208
9.0%
6.2%
0
10
4
8
2
6
Week
RR37.3%
Placebo + lifestyle Orlistat + lifestyle
Adapted from Torgerson et al. Diabetes Care 2004; 27: 155–61
29
30
31
A clinical composite endpoint: Reach of HbA1c<7.0% combined with weight loss
Rosiglitazone 4 mg
Glimepiride 4 mg
Exenatide 10 μg BID
Liraglutide 1.8 mg
Glargine 24 IU
25%
78%
72%
Liraglutide 1.2 mg
32%
15%
56%
Sitagliptin 100mg
Indirect comparison of intention-to-treat data from 5 phase III trials with liraglutide and active comparators
72%
The modern operating theatre
• bariatric surgery (an aggressive form of weight loss surgery where patients' digestive organs are lobotomized)
http://www.naturalnews.com/010039_surgeons_bariatric_surgery_weight_loss_surgery.html
SOS: Mortality reduction with weight-loss surgery
•Deaths:
•Control: 129 (6.3%)
•Surgery: 101 (5.0%)
•Unadjusted HR 0.76
•(0.59-0.99), P = 0.04
•Adjusted HR 0.71*
•(0.54-0.92), P = 0.01
•*Adjusted for age, sex, risk factors •Sjöström L et al. N Engl J Med. 2007;357:741-52.
•Years
•14
•12
•0
•0 •2
•Cumulative
•mortality
•(%)
•Control
•Surgery
•4 •16
•14
•12
•10
•8•6
•10
•8
•6
•4
•2
40
THANKYOU!THANKYOU!