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Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study

OBJECTIVE

Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.

RESEARCH DESIGN AND METHODS

The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37–60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.

RESULTS

There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups.

CONCLUSIONS

The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.




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Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach

OBJECTIVE

To construct and internally validate prediction models to estimate the risk of long-term end-organ complications and mortality in patients with type 2 diabetes and obesity that can be used to inform treatment decisions for patients and practitioners who are considering metabolic surgery.

RESEARCH DESIGN AND METHODS

A total of 2,287 patients with type 2 diabetes who underwent metabolic surgery between 1998 and 2017 in the Cleveland Clinic Health System were propensity-matched 1:5 to 11,435 nonsurgical patients with BMI ≥30 kg/m2 and type 2 diabetes who received usual care with follow-up through December 2018. Multivariable time-to-event regression and random forest machine learning models were built and internally validated using fivefold cross-validation to predict the 10-year risk for four outcomes of interest. The prediction models were programmed to construct user-friendly web-based and smartphone applications of Individualized Diabetes Complications (IDC) Risk Scores for clinical use.

RESULTS

The prediction tools demonstrated the following discrimination ability based on the area under the receiver operating characteristic curve (1 = perfect discrimination and 0.5 = chance) at 10 years in the surgical and nonsurgical groups, respectively: all-cause mortality (0.79 and 0.81), coronary artery events (0.66 and 0.67), heart failure (0.73 and 0.75), and nephropathy (0.73 and 0.76). When a patient’s data are entered into the IDC application, it estimates the individualized 10-year morbidity and mortality risks with and without undergoing metabolic surgery.

CONCLUSIONS

The IDC Risk Scores can provide personalized evidence-based risk information for patients with type 2 diabetes and obesity about future cardiovascular outcomes and mortality with and without metabolic surgery based on their current status of obesity, diabetes, and related cardiometabolic conditions.




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A fresh look for your Microblogs, Twitter and Facebook Feeds

If you’ve browsed your Twitter or Facebook page feeds in the last week, you have probably noticed that we changed…




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Inoreader v13 is Here With Improved Looks and New Features!

Since the beginning, Inoreader was meant to be a power-user tool, pushing the boundaries of what RSS readers can do.…




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Send Daily Email Digests to Friends, Colleagues or Even to Yourself

When we announced our v13 update, we mentioned a new feature called Email Digests that we’ll explain further in this…




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Get Free Local COVID-19 Alerts with Inoreader

Everyone is concerned as the novel Coronavirus spreads at rapid rates across all countries of the world. We believe every…




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Get Your Friends Into RSS With Inoreader’s New Invite Feature

Have you ever tried to convince somebody to start using an RSS reader, only to hear back from them something…




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How we made our Free COVID-19 Alerting System and how you can build your own for any topic

Ever since we launched our Free COVID-19 Alerting System, we’ve been continuously asked how we made it. In this blog…




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Convert Almost Any Webpage Into RSS Feed With Inoreader’s Web Feeds

So, you wanted to follow this nice website for new content, but it doesn’t have an RSS feed yet? Don’t…




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Autologous Umbilical Cord Blood Transfusion in Young Children With Type 1 Diabetes Fails to Preserve C-Peptide

OBJECTIVE

We conducted an open-label, phase I study using autologous umbilical cord blood (UCB) infusion to ameliorate type 1 diabetes (T1D). Having previously reported on the first 15 patients reaching 1 year of follow-up, herein we report on the complete cohort after 2 years of follow-up.

RESEARCH DESIGN AND METHODS

A total of 24 T1D patients (median age 5.1 years) received a single intravenous infusion of autologous UCB cells and underwent metabolic and immunologic assessments.

RESULTS

No infusion-related adverse events were observed. β-Cell function declined after UCB infusion. Area under the curve C-peptide was 24.3% of baseline 1 year postinfusion (P < 0.001) and 2% of baseline 2 years after infusion (P < 0.001). Flow cytometry revealed increased regulatory T cells (Tregs) (P = 0.04) and naive Tregs (P = 0.001) 6 and 9 months after infusion, respectively.

CONCLUSIONS

Autologous UCB infusion in children with T1D is safe and induces changes in Treg frequency but fails to preserve C-peptide.




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Effects of MK-0941, a Novel Glucokinase Activator, on Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes

OBJECTIVE

To assess the efficacy and safety of MK-0941, a glucokinase activator (GKA), when added to stable-dose insulin glargine in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

In this double-blind study, 587 patients taking stable-dose insulin glargine (±metformin ≥1,500 mg/day) were randomized (1:1:1:1:1) to MK-0941 10, 20, 30, or 40 mg or matching placebo t.i.d. before meals (a.c.). This study included an initial 14-week, dose-ranging phase followed by a 40-week treatment phase during which patients were to be uptitrated as tolerated to 40 mg (or placebo) t.i.d. a.c. The primary efficacy end point was change from baseline in A1C at Week 14.

RESULTS

At Week 14, A1C and 2-h postmeal glucose (PMG) improved significantly versus placebo with all MK-0941 doses. Maximal placebo-adjusted least squares mean changes from baseline in A1C (baseline A1C 9.0%) and 2-h PMG were –0.8% and –37 mg/dL (–2 mmol/L), respectively. No significant effects on fasting plasma glucose were observed at any dose versus placebo. By 30 weeks, the initial glycemic responses noted at 14 weeks were not sustained. MK-0941 at one or more doses was associated with significant increases in the incidence of hypoglycemia, triglycerides, systolic blood pressure, and proportion of patients meeting criteria for predefined limits of change for increased diastolic blood pressure.

CONCLUSIONS

In patients receiving stable-dose insulin glargine, the GKA MK-0941 led to improvements in glycemic control that were not sustained. MK-0941 was associated with an increased incidence of hypoglycemia and elevations in triglycerides and blood pressure.




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Chronicling Migration in the 21st Century Through One Family’s Journey

Marking the launch of New York Times reporter Jason DeParle's book tracing the arc of migration and its impacts through the life of an extended family of Filipino migrants over a three-decade period, from Manila and through Dubai to the Houston area, this conversation with MPI's Andrew Selee and the World Bank's Dilip Ratha explores migration at both a global and very personal level.




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Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs

Marking a policy brief's release, this webinar explores the promise of home visiting services that support new parents alongside their infants and toddlers, plus strategies for improving how these programs work with immigrant and linguistically diverse families.




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Legal Migration Pathways to Europe for Low- and Middle-Skilled Migrants

This event hosted by MPI Europe and the Research Unit of the Expert Council of German Foundations on Integration and Migration featured a discussion on research into legal migration pathways for work and training for low- and middle-skilled migrants.




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16th Annual Immigration Law and Policy Conference

With immigration a central plank of the Trump administration's policy agenda, the 16th annual Immigration Law and Policy Conference, held in October 2019, featured analysis by top experts in and out of government regarding changing policies implemented at the U.S.-Mexico border, narrowing of asylum, cooperation with migrant-transit countries, and actions that could reduce legal immigration, including revisions to the public-charge rule.




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Turning the Tide: Addressing the Long-Term Challenges of EU Mobility for Sending Countries

Amid ongoing debates about the costs and benefits of free movement, this MPI webinar examines evidence from the EU-funded REMINDER project on different types of East-West mobility. Speakers examine big-picture trends of East-West migration; consider possible policy responses at regional, national, and EU levels to alleviate some of the challenges; and reflect on realistic actions that could be taken under a new European Commission.




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Employment Services for Refugees: Leveraging Mainstream U.S. Systems and Funding

On this webinar, experts and state refugee resettlement program leaders discuss activities that can be key parts of a broader strategy for sustaining and improving employment services for refugees, including partnerships with experts in workforce development strategies, access to federal workforce development funding, and other policies and resources.




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An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA

Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, areas where the law and state efforts to support English Learners can be improved, and findings from the compendium, The Patchy Landscape of State English Learner Policies under ESSA




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Seasonal Worker Programs in Europe: Lessons Learned and Ways Forward

As the European Union prepares to review the implementation of its Seasonal Workers Directive, as well as countries such as the United Kingdom continue to explore new approaches to selecting seasonal workers, this webinar features findings from a policy brief on the topic. 




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Expert Podcast: Meeting Seasonal Labor Needs in the Age of COVID-19

Governments are facing urgent pandemic-related questions. One of the more pressing ones: Who is going to harvest crops in countries that rely heavily on seasonal foreign workers? In this podcast, MPI experts examine ways in which countries could address labor shortages in agriculture, including recruiting native-born workers and letting already present seasonal workers stay longer. Catch an interesting discussion as border closures have halted the movement of seasonal workers even as crops are approaching harvest in some places.




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COVID-19 in Latin America: Tackling Health Care &amp; Other Impacts for Vulnerable Migrant Populations

This MPI webinar brought together public health and migration experts to analyze the impact that COVID-19 preventative measures will have on vulnerable immigrants and refugees in Colombia and Latin America. Speakers also discussed how policymakers and international organizations can include migrant populations in their emergency response plans.




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Humanitarian Protection in an Era of Pandemic

MPI and MPI Europe experts discuss the effects of the coronavirus pandemic on asylum systems in Europe and North America, as well as in developing regions, where 85 percent of refugees live. During this freeform conversation, our analysts also assess the implications for the principle of asylum and the future for a post-World War II humanitarian protection system that is under threat.
 




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Immigration and the U.S.-Mexico Border during the Pandemic: A Conversation with Members of Congress

In this bipartisan discussion, two border-state members of Congress—Rep. Veronica Escobar and Rep. Dan Crenshaw—discuss the response to the coronavirus outbreak, how it is affecting the interconnected border region, and what the future might hold.
 




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Young Refugee Children: Their Schooling Experiences in the United States and in Countries of First Asylum

In this webinar, the authors of three papers on the experiences of refugee children present their findings, with a focus on how such experiences affect their mental health and education.




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Mental Health Risks and Resilience among Somali and Bhutanese Refugee Parents

Somali and Bhutanese refugees are two of the largest groups recently resettled in the United States and Canada. This report examines factors that might promote or undermine the mental health and overall well-being of children of these refugees, with regard to factors such as past exposure to trauma, parental mental health, educational attainment, social support, and discrimination.




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The Nutritional Health of Young Refugee Children Resettling in Washington State

Refugee children are vulnerable to health and nutrition risks that can have long-term consequences for their development and well-being. This report examines the prevalence of malnutrition—from stunting and wasting to overweight and obesity—among refugee children from birth to age 10, using data from an overseas medical screening exam before they were resettled in Washington State between 2012 and 2014.




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A Study of Pregnancy and Birth Outcomes among African-Born Women Living in Utah

Resettled African refugee women may experience particularly acute complications during pregnancy, birth, and the child's early infancy. Yet health care-providers and policymakers may not be aware of the particular challenges that these women and their children face. This report, examining women giving birth in Utah over a seven-year period, compares perinatal complications of the African born and a segment of the U.S. born.




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In the Age of Trump: Populist Backlash and Progressive Resistance Create Divergent State Immigrant Integration Contexts

As long-simmering passions related to federal immigration policies have come to a full boil, less noted but no less important debates are taking place at state and local levels with regards to policies affecting immigrants and their children. As states are increasingly diverging in their responses, this report examines how some of the key policies and programs that support long-term integration success are faring in this volatile era.




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Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use

According to leaked drafts, the Trump administration is considering a rule that could have sweeping effects on both legal immigration to the United States and the use of public benefits by legal immigrants and their families. This report examines the potential scale of the expected rule’s impact, including at national and state levels and among children, as well as Hispanic and Asian American/Pacific Islander immigrants.




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Chilling Effects: The Expected Public-Charge Rule and Its Impact on Immigrant Families

This webinar highlights findings from an MPI report examining the potential impacts of expected changes to the public charge rule by the Trump administration. Leaked draft versions suggest the rule could sharply expand the number of legally present noncitizens facing difficulty getting a green card or extending a visa as a result of their family's use of public benefits. The rule likely would discourage millions from accessing health, nutrition, and social services for which they or their U.S.-citizen dependents are eligible.




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Mitigating the Effects of Trauma among Young Children of Immigrants and Refugees: The Role of Early Childhood Programs

The first years of a child’s life are a time of immense growth, and exposure to trauma—if left unaddressed—can have significant, lifelong effects. This issue brief examines how young children of refugees and other immigrants may be affected by trauma, and what early childhood education and care programs, health-care providers, and others can do to mitigate its adverse effects.




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Addressing Trauma in Young Children in Immigrant and Refugee Families through Early Childhood Programs

During this webinar, speakers provide an overview of an MPI policy brief that seeks to raise awareness of the intersection of trauma and early childhood development, and how U.S. early childhood programs could more effectively address this trauma in young children in refugee and immigrant households. The participants discuss efforts to integrate trauma-informed approaches into early childhood systems and how home visiting services can effectively address trauma and mental health through a two-generation approach.




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Immigrant Families and Child Welfare Systems: Emerging Needs and Promising Policies

With the children of immigrants a growing share of all U.S. children, and federal immigration enforcement and other policies undergoing significant change, some state and local child welfare agencies are developing new ways to improve how they work with immigrant families. This report examines key cultural, linguistic, and legal challenges, and how agencies are adjusting staffing, training, placement, and other policies to tackle them.




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Millions Will Feel Chilling Effects of U.S. Public-Charge Rule That Is Also Likely to Reshape Legal Immigration

The public-charge rule issued by the Trump administration in August 2019 will have profound effects on future immigration and on use of public benefits by millions of legal noncitizens and their U.S.-citizen family members. Complex standards for determining when an immigrant is likely to become a public charge could cause a significant share of the nearly 23 million noncitizens and U.S. citizens in benefits-using immigrant families to disenroll, as this commentary explains.




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Leveraging the Potential of Home Visiting Programs to Serve Immigrant and Dual Language Learner Families

Home visiting programs for young families are growing in popularity across the United States, and have demonstrated their effectiveness in supporting maternal health and child well-being. At the same time, more infants and toddlers are growing up in immigrant families and households where a language other than English is spoken. Why then are these children under-represented in these programs? This brief explores common barriers, ways to address them, and why it is important to do so.




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Health Insurance Test for Green-Card Applicants Could Sharply Cut Future U.S. Legal Immigration

A new Trump administration action requiring intending immigrants to prove they can purchase eligible health insurance within 30 days of arrival has the potential to block fully 65 percent of those who apply for a green card from abroad, MPI estimates.




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Health Insurance Coverage of Immigrants and Latinos in the Kansas City Metro Area

Latinos and immigrants are at least twice as likely to lack health insurance coverage as the overall population in the Kansas City metropolitan area. This gap that has significant implications for the region, as Latinos and immigrants will form an ever-growing share of the area’s labor force and tax base amid anticipated declines in the native-born, non-Latino population.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar MPI experts discuss their estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They also discuss the broader consequences of the public-charge rule implemented in February 2020, through its "chilling effects" and imposition of a wealth test aimed at assessing whether green-card applicants ever would be likely to use a public benefit in the future. 




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The Public-Charge Rule: Broad Impacts, But Few Will Be Denied Green Cards Based on Actual Benefits Use

While the Trump administration public-charge rule is likely to vastly reshape legal immigration based on its test to assess if a person might ever use public benefits in the future, the universe of noncitizens who could be denied a green card based on current benefits use is quite small. That's because very few benefit programs are open to noncitizens who do not hold a green card. This commentary offers estimates of who might be affected.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar, MPI experts discussed the public-charge rule and released estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They examined the far larger consequences of the rule, through its "chilling effects" and imposition of a test aimed at assessing whether green-card applicants are likely to ever use a public benefit in the future. And they discussed how the latter holds the potential to reshape legal immigration to the United States. 




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As U.S. Health-Care System Buckles under Pandemic, Immigrant &amp; Refugee Professionals Could Represent a Critical Resource

In a time of critical shortages of U.S. health-care workers during the COVID-19 pandemic, retired doctors are being called back to work and medical students are graduating on a fast track. There is another important pool that could be tapped: Immigrants and refugees who have college degrees in health fields but are working in low-skilled jobs or out of work. MPI estimates 263,000 immigrants are experiencing skill underutilization and could be a valuable resource.




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The Digital Transformation Playbook: Rethink Your Business for the Digital Age

Every business begun before the Internet now faces the same challenge: How to transform to compete in a digital economy? This is the leadership challenge examined by BRITE founder and Columbia Business School faculty member David Rogers in his newest book, The Digital Transformation Playbook (April 5, 2016; Columbia Business School Publishing). In the book, […]




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Can a Company be pro-regulation and pro-commerce? Gregg Renfrew from Beautycounter thinks so

It’s the middle of an election year and, according to the Pew Research Center, the country hasn’t been this polarized since the Civil War. In such a climate, it would seem to be an oxymoron for a company to push for both financial growth and tighter regulations. Gregg Renfrew, CEO & Founder of Beautycounter, wouldn’t […]




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Reflections on Business, Leadership, and Branding: Shelly Lazarus ’70

Much has changed in the world of advertising from the picture painted by Mad Men. Shelly Lazarus ’70, Chairman Emeritus, Ogilvy & Mather, was one of the women helping pioneer these changes. Making the journey from ‘the only woman in the room’ to CEO and Chairman of Ogilvy gives Lazarus a lot to reflect on […]




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Thinking with AND: Insights from KIND’s story

“I’m a confused Mexican Jew.” So says Daniel Lubetzky, Founder and CEO of KIND Snack, in his very personal interview with Columbia faculty member David Rogers at BRITE ’16. Their discussion touched on the many ideas behind KIND Snacks, from the beginnings of the company, to the strategic thinking that forces Lubetzky to stay away […]




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Algorhythms for Marketing Transformation

We all understand that digital media, data, and analytics are driving transformations in society and business. Most marketers are now armed with case studies of what can be done differently, but many are still challenged with how to truly develop new ideas and execute new strategies to grow their business. Mitch Joel, President of Mirum […]




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Musculoskeletal Complications of Diabetes Mellitus

Rachel Peterson Kim
Jul 1, 2001; 19:
Practical Pointers




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Evaluating the Effect of U-500 Insulin Therapy on Glycemic Control in Veterans With Type 2 Diabetes

Joseph A. Granata
Jan 1, 2015; 33:14-19
Feature Articles




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Cutaneous Manifestations of Diabetes Mellitus

Michelle Duff
Jan 1, 2015; 33:40-48
Practical Pointers




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Case Study: Potential Pitfalls of Using Hemoglobin A1c as the Sole Measure of Glycemic Control

Huy A. Tran
Jul 1, 2004; 22:141-143
Case Studies