Long-term risk of anaemia after bariatric surgery

The long term risk of anaemia seen in patients who undergo bariatric surgery shows that postoperative clinical reviews and screening for micronutrient deficiencies are needed for life, new research shows.

The first data from a prospective study of patients undergoing bariatric surgery with a follow-up period of up to 20 years showed that anaemia became increasingly prevalent over time.

The study found that among more than 2000 patients who had bariatric surgery, the incidence of anaemia was five time higher than a control group in the gastric bypass group, 2.7 times higher in the vertical-banded gastroplasty group and 2.8 times higher in the gastric banding group.

Despite an increase in iron deficiency anaemia over time, only about 20% of patients were taking iron supplements.

“Our study highlights the importance of patients’ lifelong compliance to nutritional supplements after bariatric surgery, and the need for regular monitoring to prevent and detect serious nutritional deficiencies early,” the study authors concluded.

Lancet Diabetes and Endocrinology

PPIs improve glycaemic control in people with diabetes

Proton pump inhibitors (PPI) can improve glycaemic control among individuals with diabetes but have no effect on reducing the risk of diabetes in the general population, according to a new meta-analysis.

The analysis that included seven studies with 342 participants found that PPIs reduced HbA1c levels by 0.36% in people with diabetes and lower fasting blood sugar by 10 mg/dl. (0.6 mmol/L)

For individuals without diabetes, the results of the five studies involving 244,439 showed no effect of PPIs on risk of incident diabetes.

“Our research demonstrated that prescribing antacids as an add-on to standard care was superior to standard therapy in decreasing HbA1c levels and fasting blood sugar in people with diabetes,” said study author Dr Carol Chiung-Hui Peng of the University of Maryland Medical Center, in Baltimore.

“People with diabetes should be aware that these commonly used antacid medications may improve their blood sugar control, and providers could consider this glucose-lowering effect when prescribing these medications to their patients,” said co-author Associate Professor Kashif Munir, of the division of endocrinology, diabetes and nutrition at the University of Maryland School of Medicine.

The findings are published in the Journal of Clinical Endocrinology and Metabolism.

Call for Medicare review of procedural specialist incomes

Procedural specialists are overpaid compared to other specialists and there needs to be a review of the inequities in the Medicare Benefits Schedule, according to two senior physicians.

The high incomes for procedural specialists are not justified by their long years of training, level of skill or the hours worked compared to other physicians or GPs, according to Dr Kerry Breen and Dr Kerry Goulston.

Writing in Pearls and Irritations, they say the imbalance in incomes between specialties has become wider and more distorted in recent years because of a flaw in the original MBS when Medicare was set up favoured procedural work over consultations.

The distortion is now deterring medical graduates from working in low income specialities, and there is an urgent need for the federal health department to commission a new study to review the 2005 Productivity Commission report on how to address  the income bias.

“Such a study should also be invited to examine whether the earning differentials between various groups of doctors are justifiable and are in the best interests of the health care system and patients,” they suggest.