A study by researchers at the University of Southern California (USC) found that overweight Hispanic children are at significant risk for pre-diabetes, a condition marked by higher than normal blood glucose levels that are not yet high enough for a diagnosis of diabetes. The persistence of pre-diabetes during growth is associated with progression in risk towards future diabetes, according to the study, which will be published in an upcoming issue of the journal Diabetes, and is now available online.
With a population of more than 35 million, Hispanics are the largest and fastest growing minority group in the United States. Despite the fact that Hispanics are at high risk for developing type 2 diabetes, few previous studies have looked at physiological causes of the disease within this population.
Researchers led by Michael I. Goran, Ph.D., professor of preventive medicine, physiology and biophysics and pediatrics, and director of the USC Childhood Obesity Research Center at the Keck School of Medicine of USC, followed a cohort of 128 overweight Hispanic children in East Los Angeles. The children were tested over four consecutive years for glucose tolerance, body mass index, total body fat and lean mass and other risk factors for type 2 diabetes. The study found that an alarming 13% of the children had what the scientists termed "persistent pre-diabetes".
Most prior studies examining pre-diabetes in overweight and obese children looked at a one-time assessment of metabolic risk factors for type 2 diabetes, but fluctuations over time led to poor reliability for these tests. In the new study, Goran and colleagues examined longitudinal data to look at a progression of risk factors over four years. Children were identified as having persistent pre-diabetes if they had three to four positive tests over four annual visits. The children who had persistent pre-diabetes had signs of compromised beta-cell function, meaning that their bodies were unable to fully compensate to maintain blood glucose at an appropriate level, and they had increasing accumulation of visceral fat or deposition of fat around the organs. Both of these outcomes point towards progression in risk towards type 2 diabetes.
"What this study shows is that doctors should be doing regular monitoring of these children over time, because a one-time checkup might not be enough to tell if they are at risk for developing diabetes," Goran says.
Visceral fat, which pads the spaces between abdominal organs, has been linked to metabolic disturbances and increased risk for cardiovascular disease and type 2 diabetes.
Increased obesity has been identified as a major determinant of insulin resistance. Lower beta-cell function is a key component in the development of type 2 diabetes, as the cells are unable to produce enough insulin to adequately compensate for the insulin resistance.
"To better treat at-risk children we need better ways to monitor beta-cell function and visceral fat buildup," Goran says. "Those are tough to measure but are probably the main factors determining who will get type 2 diabetes."
Future studies will examine different interventions, including improving beta-cell function and reducing visceral fat.
"The study provides great insight into the risk factors that lead to the progression towards type 2 diabetes in this population," says Francine Kaufman, professor of pediatrics at the Keck School of Medicine at USC and head of the division of endocrinology and metabolism at Childrens Hospital Los Angeles, who was not directly involved in the study. "Only by understanding how this devastating disease develops will be able to begin taking steps to prevent it".
Posted by: Evelyn
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Bariatric surgery patients treated at highly rated hospitals have, on average, a 65 percent lower chance of experiencing serious complications in comparison to patients who undergo surgery at poorly rated hospitals as per a research studyreleased recently by HealthGrades, the nations leading independent healthcare ratings organization. As part of the study, the quality ratings of hospitals performing bariatric surgery in 17 states became available today at www.healthgrades.com.
HealthGrades' third annual Bariatric Surgery Trends in American Hospitals study, which reviewed bariatric surgical outcomes at every hospital that performed them in 17 states, also observed that the complication rate for these surgeries continues to rise, increasing six percent from 2004 to 2006. One possible reason: lower volume facilities have higher complication rates.
Bariatric surgery is a general term describing several types of weight loss procedures. HealthGrades study analyzed the outcomes of the most common, including traditional open surgical gastric bypass procedures as well as newer, less invasive procedures such as "lap-banding" and laparoscopic gastric bypass.
Complications linked to gastric bypass surgery accounted for the highest rise in complications, increasing 17 percent. Comparatively, complications from less invasive laparoscopic surgery increased by just more than one percent. Complications linked to bariatric surgery include heart attack, kidney failure, stroke and post-surgical infections.
The HealthGrades study found a significant shift toward laparoscopic bariatric procedures. From 2004 through 2006, open gastric bypass procedures declined by 81.82 percent while during the same time period laparoscopic procedures increased 418.86 percent.
Meanwhile, the total volume of bariatric surgical procedures in the U.S. continues to grow rapidly. The American Society for Bariatric Surgery estimates that such surgeries have increased 1,431 percent in the last decade to more than 250,000 annually.
"The tremendous variation we are seeing in quality among bariatric surgery providers underscores the importance of readily available quality data to help consumers make a truly informed decision about where to seek care," said Rick May, MD, a senior doctor advisor with HealthGrades and an author of the study.
Additionally, the third annual HealthGrades Bariatric Surgery Trends in American Hospitals study observed that:
- A typical patient having a bariatric surgical procedure at a five-star rated hospital in one of the 17 states studied has on average, a 65 percent lower chance of experiencing one or more inhospital complications than at a one-star rated hospital and a 41 percent lower chance than at a three-star rated hospital during 2004- 2006.
- Five-star (top rated) hospitals performed almost twice the volume of procedures in comparison to 1-star and 3-star facilitiesan average of 526 procedures from 2004 through 2006 compared with 266 and 283 respectively.
- Higher volume was linked to fewer risk-adjusted complications. Facilities with an annual case volume of 125 procedures had the lowest risk-adjusted complications. Facilities performing less than 25 cases per year had the highest rate of risk-adjusted complications.
- If all patients had received their bariatric surgery procedure at 5-star hospitals (from 2004 through 2006), 5,125 inhospital complications could have been potentially avoided in the 17 states studied.
HealthGrades Bariatric Surgery Ratings HealthGrades' quality ratings for bariatric surgery at individual hospitals in 17 states were posted today to www.healthgrades.com as a free resource for consumers. Each hospital receives a star rating based on their patient outcomes for bariatric surgery. Hospitals with above-average outcomes receive a five-star rating. Hospitals with average outcomes receive a three-star rating, and hospitals with outcomes that are below average receive a one-star rating.
The study included a total of 154,451 bariatric inpatient surgery procedures performed in 680 hospitals in 17 states from 2004 through 2006. The majority of procedures were performed in four states: New York, Texas, Pennsylvania, and California.
- 93 hospitals stand out as "best" performers (5-star rated).
- 263 hospitals were rated as "as expected" performers (3-star rated).
- 99 hospitals were rated as "poor" performers (1-star rated)
Individuals contemplating bariatric surgery will find both quality and cost information at www.healthgrades.com. In addition to the free hospital-quality ratings, Web site visitors can also research surgeons who perform bariatric surgery as well as medical-cost reports that detail all of the costs, including out-of-pocket expenses, for the procedure.
Methodology For this study, HealthGrades analyzed 154,451 bariatric procedures performed in the years 2004, 2005 and 2006. The states included in the study are: Arizona, California, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Pennsylvania, Texas, Utah, Virginia, Washington, Wisconsin.
To make accurate and valid comparisons of clinical outcomes at different hospitals with different patient characteristics, HealthGrades risk adjusted the data using multivariate logistic regression to account for age, gender and underlying medical conditions that could increase the patient's risk of mortality or complication. The full study and individual hospital ratings for bariatric surgery and other procedures can be found at www.healthgrades.com.
Posted by: Evelyn
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