Nonsurgical weight loss interventions: A systematic review of systematic reviews and meta-analyses.

Access to bariatric surgery to treat obesity is limited and has long wait times. Many adults are seeking nonsurgical weight loss support. Our study objective was to conduct a systematic review of nonsurgical weight loss interventions. PubMed, EMBASE, CINAHL, PsycInfo, and the CochraneLibrary were searched. Inclusion criteria were adults 18 + with a BMI > 25 enrolled in minimum a 3-month nonsurgical weight loss intervention. Studies were independently extracted and assessed for quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2). Pooled analyses were extracted, graded for evidence quality, and summarized. A total of 1065 studies were assessed for eligibility; 815 screened and 236 full-texts assessed. Sixty-four meta-analyses met eligibility criteria: 1180 RCTs with 184,605 study participants. Studies were categorized as diets (n = 13), combination therapies (n = 10), alternative (n = 16), technology (n = 10), behavioral (n = 5), physical activity (n = 6), and pharmacotherapy (n = 3). In 80% of studies, significant weight losses were reported ranging from 0.34-8.73 k in favor of the intervention. The most effective nonsurgical weight loss interventions were diets, either low-carbohydrate or low-fat diets, followed for 6 months; combination therapy including meal replacements plus enhanced support; and pharmacotherapy followed for 12 months. Although significant weight losses were reported for other types of interventions such as physical activity and technology, the majority of studies reported weight losses less than 2 kgs.

A systematic assessment of the availability and clinical drug information coverage of machine-readable clinical drug data sources for building knowledge translation products.

Objective: To identify and describe clinical drug data sources that have the potential to serve as a repository of information for developing drug knowledge translation products. Methods: Two reviewers independently screened citations from PubMed and Embase, websites from the web search engine Google, and references from selected journals. Publicly licensed or non-proprietary data sources containing clinical drug information accessible in a machine-readable format were eligible. Data sources were assessed for their coverage across 18 pre-specified domains and 74 elements of clinical drug information. Results: Of the 3369 unique citations or webpages screened, 44 drug information data sources were identified. Of these, 22 data sources met the study inclusion criteria. There was a mean of 4.5 (SD = 5.19) domains covered by each source and a mean of 10.9 (SD = 18) elements covered by each source. None of the data sources covered all domains and eight elements were not addressed by any source. All of the data sources identified by the study are government or academic databases. Conclusion: Our study demonstrated the availability of machine-readable clinical drug data that could help facilitate the creation of novel drug knowledge translation products. However, we identified clinical content gaps in the available non-proprietary drug information sources. Further evaluation of the quality of each data source would be necessary prior to incorporating these sources into any knowledge translation products intended for clinical use.

Rapid Reduction in Use of Antidiabetic Medication after Laparoscopic Sleeve Gastrectomy: The Newfoundland and Labrador Bariatric Surgery Cohort (BaSCo) Study.

BACKGROUND: Patients who have undergone bariatric surgery generally need fewer medications as they experience improvement in, or even resolution of, various medical conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia. Published data on changes in medication use after laparoscopic sleeve gastrectomy, a type of bariatric surgery that is growing in popularity, are limited. OBJECTIVE: To determine whether patients took fewer medications for management of type 2 diabetes, hypertension, and dyslipidemia after laparoscopic sleeve gastrectomy, relative to preprocedure medications. METHODS: In this prospective, single-centre cohort study, a nurse practitioner used standard medication reconciliation and study data-extraction forms to interview adult patients who had undergone laparoscopic sleeve gastrectomy and determine their medication use and pertinent demographic data. The data were analyzed using generalized estimating equations and standard statistical software. Outcome measures included changes in the use of antidiabetic, antihypertensive, and antilipemic medications at 1, 3, and 6 months after the surgery. RESULTS: A total of 65 patients who underwent laparoscopic sleeve gastrectomy between May 2011 and January 2014 met the study inclusion criteria. Before surgery, the 30 patients with type 2 diabetes were taking an average of 1.9 antidiabetic medications. One month after the procedure, 15 (50%) had discontinued all antidiabetic medications, with a further decline at 3 and 6 months (p < 0.001 at each time point). Among the patients who were taking antihypertensives (n = 48) and antilipemics (n = 33) before surgery, the decline in use occurred at a more modest rate, with 6 (12%) and 2 (6%), respectively, discontinuing these medication classes within 1 month, and 12 (25%) (p = 0.001) and 8 (24%) (p = 0.015) having discontinued by 6 months. CONCLUSIONS: These findings suggest that patients with a history of type 2 diabetes mellitus, hypertension, and/or dyslipidemia who undergo laparoscopic sleeve gastrectomy are less likely to require disease-specific medications shortly after surgery.

CONTEXTE: Les patients ayant subi une chirurgie bariatrique ont généralement besoin de moins en moins de médicaments au fur et à mesure qu'ils voient leurs différentes affections, notamment le diabète sucré de type 2, l'hypertension et la dyslipidémie, s'estomper ou même se résorber. Or, il existe peu d'études publiées sur les changements apportés à la pharmacothérapie des patients ayant subi une gastrectomie longitudinale laparoscopique, une chirurgie bariatrique de plus en plus utilisée. OBJECTIF: Déterminer si les patients prennent moins de médicaments pour le traitement du diabète de type 2, de l'hypertension et de la dyslipidémie après avoir subi une gastrectomie longitudinale laparoscopique comparativement à leur situation avant l'opération. MÉTHODES: Dans cette étude de cohorte prospective menée dans un seul centre, un membre du personnel infirmier praticien a utilisé des formulaires standards de bilan comparatif des médicaments et d'extraction de données d'étude afin d'interroger des patients adultes ayant subi une gastrectomie longitudinale laparoscopique, et ce, dans le but de connaître leur consommation de médicaments ainsi que de recueillir des données démographiques pertinentes. Les données ont été analysées à l'aide d'équations d'estimation généralisées et d'un logiciel statistique courant. Les critères de jugement incluaient l'adaptation du traitement antidiabétique, antihypertenseur et hypolipémiant, un mois, trois mois et six mois après la chirurgie. RÉSULTATS: Au total, 65 patients ayant subi l'intervention chirurgicale entre mai 2011 et janvier 2014 ont été admis dans l'étude. Avant l'opération, les 30 patients atteints du diabète de type 2 prenaient en moyenne 1,9 antidiabétique. Un mois après la chirurgie, 15 (50 %) d'entre eux ont cessé de prendre des antidiabétiques, un chiffre qui a augmenté après le troisième et le sixième mois (p < 0,001 à chaque point dans le temps). Parmi les patients qui prenaient des antihypertenseurs (n = 48) et des hypolipémiants (n = 33) avant l'intervention chirurgicale, un moins grand nombre a cessé de prendre ces médicaments. Seulement 6 (12 %) patients ont cessé les antihypertenseurs et 2 (6 %) patients ont cessé les hypolipémiants après un mois, puis 12 (25 %) (p = 0,001) et 8 (24 %) (p = 0,015) respectivement après six mois. CONCLUSIONS: Ces résultats laissent croire que les patients atteints du diabète sucré de type 2, d'hypertension ou de dyslipidémie qui subissent une gastrectomie longitudinale laparoscopique courent la chance de ne plus avoir besoin de médicaments pour traiter ces maladies, et ce, peu de temps après la chirurgie.