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SCOPE School Dublin - David Haslam

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Page 1: SCOPE School Dublin - David Haslam
Page 2: SCOPE School Dublin - David Haslam
Page 3: SCOPE School Dublin - David Haslam

Results: primary careResults: primary care

Figure. Mean total GP and nurse visits over six weeks by BMI (post-discharge)

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Nanchahal K et al Int J Obes 2005 29; 317-323

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-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

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MA

TER

NA

L OB

ES

ITY

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Shai et al for the DIRECT study group

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Case 1Case 1

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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

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*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

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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%

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The modern operating theatre

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• 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

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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

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THANKYOU!THANKYOU!


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