2011 ADA Posters 1261-2041.indd - Diabetes

Integrated Physiology/
Obesity
POSTERS
1918-P
Prevalence-Adjusted Cost of Comorbidities in Overweight/Obese
Patients with a Body Mass Index 25-34.9 vs ≥35
DIANA I. BRIXNER, MORGAN BRON, BRANDON BELLOWS, XIANGYANG YE,
VENKATESH HARIKRISHNAN, GARY M. ODERDA, Salt Lake City, UT, Deerfi eld, IL
Obesity is associated with an increased prevalence of comorbidities.
This study looked at prevalence and cost of comorbidities in 2 categories of
overweight/obese patients based on BMI.
Prevalence of 25 comorbidities in patients with BMI 25-34.9 and ≥35 was
calculated and ranked based on data from the GE Centricity EMR research
database. Patients whose BMI was within NHLBI guideline categories for
overweight (25-29.9), class I obesity (30-34.9) and class II or III obesity (≥35)
between 3/1/05 and 6/30/09 were included. BMI index date was defi ned as
date of either only BMI on record, or latest BMI for patients with 2 or more
BMI readings. Prevalence of comorbidities was based on presence of ICD-
9 code within 2 y prior to BMI index date. Annual comorbidity-associated
costs were based on an ICD-9 code for overweight or obesity and patient
activity for 1 y post comorbidity index date in Thomson Reuters MedStat
MarketScan database. Prevalence-adjusted cost of comorbidities was
determined by multiplying annual comorbidity-associated cost per patient
from MarketScan by comorbidity prevalence rate ratio from 2 BMI groups
of the EMR database.
The GE EMR database identifi ed 109,885 patients with BMI ≥25 and 2 y EMR
activity before BMI index date. The 3 comorbidities with highest prevalence (BMI
25-34.9, ≥35) were hyperlipidemia (14.6%, 16.3%), hypertension (10.2%, 17.7%),
and back pain (7.5%, 8.3%). Annual comorbidity-associated cost per overweight/
obese patient was $1136 for hyperlipidemia, $1511 for hypertension, and $2081
for back pain. Prevalence-adjusted per patient cost increased from BMI 25-34.9
to BMI ≥35 in hyperlipidemia ($166 to $185), hypertension ($154 to $268), and
back pain ($156 to $173). As an example, a plan with 1,000 members with BMI
25-34.9 would have hyperlipidemia-associated cost of $166,000 vs $185,000 for
a plan with 1,000 members with BMI ≥35.
This study confi rmed the incremental impact of weight on prevalence and
cost of selected comorbidities in overweight or obese patients. Management
or therapies that can lower patients’ BMI have the potential to decrease
comorbidity rates and may lower costs for health plans.
1919-P
Short-Term Evolution of the Insulin Resistance Depending on the
Type of Bariatric Surgery
LOURDES GARRIDO-SANCHEZ, MORA MURRI, JOSE RIVAS-BECERRA, DIEGO
FERNANDEZ-GARCIA, JUAN ALCAIDE, EDUARDO GARCIA-FUENTES, FRANCISCO
TINAHONES, Tarragona, Spain, Malaga, Spain
Obesity is very often accompanied by other diseases, the most common being
type 2 diabetes mellitus and cardiovascular complications. Bariatric surgery
is almost the only effective strategy for treating morbidly obese patients.
The aims of this study was evaluate the metabolic changes that occur in the
early stage after two types of bariatric surgery, biliopancreatic diversión of
Scopinaro (BPD) and Sleeve gastrectomy (SG), in morbidly obese persons. The
study was undertaken in 31 morbidly obese persons (7 men and 24 women) 15
days before and 15, 30, 45 y 90 days after bariatric surgery (times 0, 1, 2, 3, and
4, respectively). There is a signifi cant improvement in anthropometric variables
as result of the two types of bariatric surgery, without signifi cant differences
between both types of interventions. In patients undergoing BPD, serum
glucose, cholesterol, triglycerides, HDL-cholesterol and FFA were signifi cantly
reduced. The changes that occur in these biochemical variables following the
SG were not signifi cant. Insulin resistance decreased signifi cantly over the
90 days after surgery, showing the highest decrease at 15 days. Meanwhile,
in patients undergoing SG, insulin resistance worsened at 15 days and later
diminished. In conclusion, this study shows that the surgical technique that
excludes the duodenum (BPD) has immediate postoperative changes in the
degree of insulin resistance in morbidly obese patients compared to those
techniques that do not exclude (SG).
Supported by: JCI-2009-04086, CP04/00133, PS09/01060, PS09/00997
1920-P
Small Decrements in Glucose Increase Hunger in the Presence of
Visual Food Cues
RENATA BELFORT DE AGUIAR, SARITA NAIK, DONGJU SEO, RAJITA SINHA,
ROBERT SHERWIN, New Haven, CT
Hypoglycemia is associated with increased hunger, triggering increased
food consumption. The mechanism for how circulating glucose infl uence
food-seeking behavior is unclear. In this study, we evaluated the effects of
small changes in glucose within the physiological range on measurements
For author disclosure information, see page 785.
OBESITY—HUMAN
CATEGORY
A518
of food motivation in response to visual food cues. Ten healthy subjects
(mean age 31±8, A1c 5.4±0.4) underwent a 2mU/kg.min hyperinsulinemic
euglycemic clamp (goal=plasma glucose ∼90mg/dl) while viewing high fat,
low fat food and non-food pictures, 2 hours after receiving a standardized
meal. Liking and wanting ratings were collected for each picture. Hunger
ratings were collected at baseline, 60, 85min and at 2 hrs. Initially plasma
glucose rose from 83±9 mg/dL at baseline to 98±11 mg/dL after 10mins.
During the interval between 10 and 60 min plasma glucose showed more
variability, although mean levels decreased slightly to 93±7mg/dL (it
decreased by 14+/-4 mg/dL in 6 subjects and increased by 11+/-5 mg/dL in
4 subjects). Subsequently, plasma glucose stabilized at 95±9mg/dL until the
end of the clamp. Hunger ratings, after subjects viewed food and non-food
images, signifi cantly increased from 1.7±0.7 at baseline to 4.0±0.8 at 60min
(p=0.01) and 5.2±2.9 at 2 hrs. (p=0.004).
Hunger levels at the end of the clamp were associated with glucose at
10min (r=0.816,p=0.004) and 60min (r=-0.702,p=0.02) and the drop in glucose
between 10 and 60mins (r=0.848,p=0.002). The changes in glucose were not
associated with signifi cant increases in plasma glucagon, cortisol, FFA, or
ghrelin from baseline levels. In addition, leptin levels increased (p