Ethnic Considerations for Metabolic Surgery

Morton, John M.

doi:10.2337/dc16-0413

Cited by 17 publications

(13 citation statements)

References 32 publications

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“…the risks of particular interventions and certainly reducing the effectiveness of knowledge translation [43]. Research may wish to assess the role of race/ethnicity when considering the effectiveness of anesthesia interventions during metabolic and vitreoretinal procedures in particular, given recent findings of racial/ethnic differences in clinical presentation and outcomes [14,15].…”

Section: Discussionmentioning

confidence: 99%

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Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Etherington

Boet

2021

Korean J Anesthesiol

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Sex and gender, among other equity-related characteristics, influence process of care and patients' outcomes. Currently, the extent to which these characteristics are considered in the anesthesia literature remains unknown. This study assesses their incorporation in randomized controlled trials (RCTs) on anaesthesia-related interventions, for both patients and healthcare providers. This is a cross-sectional analysis using an existing dataset derived from the anesthesia literature. The dataset originated from a scoping review searching MEDLINE, EMBASE, CINAHL, CENTRAL, and the Cochrane Database of Systematic reviews. RCTs investigating the effect of anesthesia-related interventions on mortality for adults undergoing surgery were included. Equity outcome measures were recorded for both patients and providers and assessed for inclusion in study design, reporting of results, and analysis of intervention effects. Three-hundred sixty-one RCTs (n patients = 144 674) were included. Most RCTs (91%) reported patient sex/gender, with 58% of patients identified as male. There were 139 studies (39%), where 70% or more of the sample was male, compared to just 14 studies (4%), where 70% or more of the sample was female. Only 10 studies (3%) analyzed results by patient sex/gender, with one reporting a significant effect. There was substantial variation in how age was reported, although nearly all studies (98%) reported some measure of age. For healthcare providers, equity-related information was never available. Better consideration of sex/gender and additional health equity parameters for both patients and providers in RCTs is needed to improve evidence quality, and ultimately, patient care and outcome.

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Section: Discussionmentioning

confidence: 99%

“…Health-related equity characteristics are increasingly being investigated in perioperative care [10][11][12][13][14][15][16]. These characteristics may be particularly relevant in anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Etherington

Boet

2021

Korean J Anesthesiol

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“…Long-term follow-up and further research is required to better understand the mechanisms by which metabolic surgery improves type 2 diabetes and the shortterm and long-term benefits and risks of this procedure in youth. Quality of life and economic (cost-benefit) analyses will also be important components of ongoing follow-up and research (146,147).…”

Section: Metabolic Surgerymentioning

confidence: 99%

Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association

et al. 2018

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Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications. PATHOPHYSIOLOGY Glucose homeostasis is maintained by a balance between insulin secretion from the pancreatic b-cells and sensitivity to insulin in skeletal muscle, adipose tissue, and liver (1). When insulin sensitivity declines, insulin secretion must increase to maintain glucose tolerance, and, in most youth, decreased insulin sensitivity due to puberty and/or obesity is compensated by increased insulin secretion. However, when b-cells cannot secrete sufficient insulin to compensate for insulin resistance, abnormalities in glucose homeostasis ensue, potentially progressing to prediabetes and type 2 diabetes as b-cell function deteriorates further (2-9). The relationship between b-cell function and insulin sensitivity in adults and youth has been demonstrated to be a hyperbolic function and can be described mathematically as the product of insulin sensitivity and b-cell function, called the disposition index (DI) (1). The DI essentially expresses the amount of insulin being secreted relative to the degree of insulin resistance and is a constant for a given degree of glucose tolerance in any one individual. Overweight and obesity are major acquired contributors to the development of insulin resistance, particularly in the face of the physiologic insulin resistance characteristic of puberty. Robust pancreatic b-cell compensatory insulin secretion maintains normal glucose homeostasis. However, in adolescents with obesity who develop type 2 diabetes, there is severe peripheral and hepatic insulin resistance, with ;50% lower peripheral insulin sensitivity than peers with obesity without diabetes, along with increased fasting hepatic glucose production and inadequate firstand second-phase insulin secretion, resulting in ;85% lower DI (2). Additional abnormalities in youth with type 2 diabetes include impaired glucose sensitivity of insulin secretion, lower serum adiponectin concentrations, and reduced incretin effect (3,9-13). While upregulation of a-cell function with hyperglucagonemia has been implicated in the pathophysiology of type 2 diabetes in adults (14,15), there are limited data in youth with type 2 diabetes, with studies showing either hyperglucagonemia or no difference from control subjects without diabetes (3,11,16,17). Cross-sectional and longitudinal studies in youth with obesity along the spectrum of glycemia from normoglycemia to prediabetes to type 2 diabetes show, as in adults, that b-cell failure with declining insulin secretion relative to insulin sensitivity results in prediabetes and type 2 diabetes in high-risk youth (5-9,18-21). Importantly, however, prior to reaching the American Diabetes Association (...

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“…While socioeconomic factors and racial and ethnic differences may intertwine to influence access to bariatric surgery, it appears that the effect of surgery on obesity co-morbidity resolution may not be influenced by race and ethnicity, especially in the remission of type II diabetes where bariatric surgery leads to high remission across all racial and ethnic groups [85•, 86]. It is important, however, to note that in a retrospective study, Istfan N. found that all racial and ethnic groups had a decrease in hemoglobin A1c after Roux-en-Y gastric bypass, but there was a significant increase in the hemoglobin A1c levels of African Americans at 2 year follow-up, while these levels remained stable in Hispanic and white patients [87••].…”

Section: Introductionmentioning

confidence: 99%

“…Race and ethnicity seem to have less of an influence in adolescent surgical patients. In the Bariatric Outcomes Longitudinal Database, which followed 827 adolescents who underwent weight loss surgery, the mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg [86]. Surgery type may have an influence on whether or not race and ethnicity are determinants of weight loss as evidenced by work done by Coleman KJ and colleagues who created a registry system, which was used to track the progress of both Roux-en-y gastric bypass and sleeve gastrectomy patients.…”

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Obesity Treatment

2018

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Purpose of Review Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015–2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity. Recent Findings Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans Summary The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.

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Ethnic Considerations for Metabolic Surgery

Cited by 17 publications

References 32 publications

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Sex/gender and additional equity characteristics of providers and patients in perioperative anesthesia trials: a cross-sectional analysis of the literature

Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association

Racial Disparities in Obesity Treatment

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