Class 3 obesity in a multidisciplinary metabolic weight management program : the effect of preexisting Type 2 diabetes on 6-month weight loss

Introduction. Class 3 obesity (BMI ≥ 40 kg/m2) is a growing health problem worldwide associated with considerable comorbidity including Type 2 diabetes mellitus (T2DM). The multidisciplinary medical management of obesity can be difficult in T2DM due to potential weight gain from medications including sulphonylureas and insulin. However, newer weight-neutral/losing diabetes medications can aid additional weight loss. The aim of this study was to compare weight loss outcomes of patients with and without T2DM, and in patients with T2DM, to compare diabetes outcomes and change in medications at 6 months. Methods. All patients entering a multidisciplinary weight management metabolic program in a publicly funded hospital clinic in Sydney between March 2018 and March 2019, with BMI ≥ 40 kg/m2 and aged ≥18 years were included. Data was collected from patient clinical and electronic notes at baseline and 6 months. Results. Of the 180 patients who entered the program, 53.3% had T2DM at baseline. There was no difference in percentage weight loss in those with or without T2DM (4:2±4:9% vs. 3:6±4:7%, p = 0:35). Additionally, T2DM patients benefited from a 0.47% reduction in HbA1c (p < 0:01) and a reduction in the number of medications from baseline to 6 months (1:8±1:0/patient vs. 1:0±1:2/patient, p < 0:001). T2DM patients who started on weigh-neutral/losing medications in the program lost more weight than those started on weight-gaining medications (7:7±5:3% vs. 2:4±3:8%, p = 0:015). Conclusions. Patients with class 3 obesity had significant weight loss at 6 months in this program. Patients with T2DM at baseline had comparable weight loss at 6 months, a significant improvement in glycaemic control, and a reduction in diabetes medication load. Additionally, patients with T2DM who were started on weight-neutral/losing medications lost significantly more weight than those started on weight-gaining medications, and these medications should be preferentially used in class 3 obesity and comorbid T2DM

Meta-analysis of everolimus-eluting bioabsorbable vascular scaffolds versus everolimus-eluting metallic stents at three years

Background: This study aimed to assess the efficacy and safety of bioabsorbable vascular scaffolds (BVS) vs everolimus-eluting metallic stents (EES) after 3 years. Methods: MEDLINE, EMBASE, CENTRAL, and relevant websites were searched for articles published between 30 November 2006 and 18 December 2017. The primary efficacy outcome was target lesion revascularisation and the primary safety outcome was definite or probable stent (scaffold) thrombosis. Secondary outcomes included target lesion failure, myocardial infarction, death, all revascularisation, and patient-oriented composite endpoint. Odds ratios (ORs) and weighted mean differences with 95% CIs were derived, and the risk estimates for the outcomes according to a fixed-effects model were calculated. This study was registered with PROSPERO (CRD42017084290). Results: The study included five trials comprising data for 3,575 patients randomised to receive BVS (n = 2256) or EES (n = 1319). Patients treated with BVS had a non-statistically significant increased risk of target lesion revascularisation (OR 1.30, 95% CI 0.95–1.78, p = 0.10). Patients treated with a BVS had a higher risk of definite or probable stent thrombosis (OR 2.68, 95% CI 1.57–4.58, p < 0.001), target lesion failure (1.41, 1.12–1.78, p = 0.004), myocardial infarction (1.49, 1.13–1.98, p = 0.005), and a patient-oriented composite endpoint (1.21, 1.01–1.44, p = 0.038) than those treated with a metallic stent. Patients treated with BVS had no statistically significant differences in death (0.80, 0.51–1.25, p = 0.325) and all revascularisation (1.12, 0.91–1.40, p = 0.052) compared to those treated with EES. Conclusion: Bioabsorbable vascular scaffolds were inferior to EES at 3 years

Everolimus-eluting bioabsorbable vascular scaffolds (BVS) versus everolimus-eluting metallic stents (EES) at 3 years : systematic review and meta-analysis

BACKGROUND: This systematic review and meta‐analysis aimed to assess the efficacy and safety of the Absorb bioabsorbable vascular scaffold (BVS) versus everolimus‐ eluting metallic stents (EES) at 3 years. METHODS: We searched MEDLINE, EMBASE, CENTRAL and relevant websites for articles published between 30 November 2006 and 18 December 2017. The primary efficacy outcome was target lesion revascularization (TLR), and the primary safety outcome was definite or probable stent (scaffold) thrombosis. Secondary outcomes included target lesion failure, myocardial infarction (MI), death, all revascularization and a patient‐oriented composite end‐point. We derived odds ratios (ORs) for the outcomes according to a fixed‐effects model. This study was registered with PROSPERO (CRD42017084290). Results: We included five trials comprising data for 3,575 patients randomized to re‐ ceive BVS (n = 2,256) or EES (n = 1,319). Patients treated with the BVS had a non‐statistically significant increased risk of TLR (OR 1.30 [95% CI 0.95–1.78]; p = 0.10). Patients treated with the BVS had a higher risk of definite or probable stent thrombosis (OR 2.68 [95% CI 1.57–4.58]; p < 0.001), target lesion failure (1.41 [1.12–1.78]; p = 0.004), MI (1.49 [1.13–1.98]; p = 0.005) and a patient‐oriented composite end‐point (1.21 [1.01– 1.44]; p = 0.038) than those treated with an EES. Patients treated with the BVS had no statistically significant difference in death (0.80 [0.51–1.25]; p = 0.325) and all revascu‐ larization (1.12 [0.91–1.40]; p = 0.052) compared to those treated with an EES. CONCLUSION: Everolimus‐eluting bioabsorbable vascular scaffolds are inferior to everolimus‐eluting metallic stents at 3 years

[In Press] Factors affecting blood alcohol concentration (BAC) estimation and drinking intention during voluntary breath testing (VBT) : a cross-sectional study

This study aimed to assess the accuracy and factors influencing blood alcohol concentration self-estimation during voluntary breath testing. It also aimed to assess whether intended drinking behaviour changed after reviewing blood alcohol concentration and factors influencing this. A total of 462 Australian music festival patrons aged 18–40 years completed a survey exploring factors likely to affect estimation accuracy and provided an estimation of their blood alcohol concentration. A breathalyser reading was taken and participants were asked whether reviewing this reading changed their drinking intentions. Most respondents (58.4%) were accurate within 0.02% range, while 11.4% underestimated and 29.1% overestimated. Machine-read blood alcohol concentration was the most significant estimation accuracy predictor. Reviewing their readings changed the intention to drink in one-third of participants, indicating that voluntary breath testing may influence future drinking behaviour. Underestimation was associated with intention to drink less, whilst completing the survey earlier and <1 h since last drink was associated with intention to drink more