Nanna Lindekilde

The impact of bariatric surgery on quality of life: a systematic review and meta‐analysis

This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between‐study variation by examining the standardized mean magnitude of effect in change in the levels of quality of life. The following databases EMBASE, PubMed, PsycINFO, CINAHL, the Cochrane Library and Web of Science were systematically searched for studies examining change in quality of life in adults receiving bariatric surgery for obesity. Seventy‐two studies were included with a total of 9,433 participants treated for obesity with bariatric surgery. The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 (95% CI: 0.80–0.96), indicating that bariatric surgery has a significant positive influence on quality of life in general. The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life. Bariatric surgery is effective in improving quality of life, especially when looking at physical well‐being. Greater focus on the psychological well‐being of the person undergoing surgery for obesity may lead to a better post‐surgery prognosis for more people.

The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review.

Abstract Objective: To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. Methods: Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). Results: Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. Conclusions: Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individuals ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.

Motivational interventions in the management of HbA1c levels: a systematic review and meta-analysis

AIMS To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin. METHODS Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus. RESULTS The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: -0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant. CONCLUSIONS The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research.

More work is needed to better understand diabetes distress as a predictor of all-cause mortality in type 2 diabetes

To the Editor: With interest, we read a recently published article in Diabetologia, by Hayashino et al, which focused on the association between diabetes distress and all-cause mortality in a prospective cohort study among 3305 Japanese individuals with type 2 diabetes [1]. Diabetes distress and all-cause mortality weremeasured once a year during the median follow-up period of 6.1 years. Interestingly, Hayashino et al found a significant positive association between high baseline diabetes distress and all-cause mortality (HR 1.56 [95% CI 1.17, 208]; p = 0.002) in the individuals with type 2 diabetes (after controlling for possible confounders) compared with those without diabetes distress. We believe that several aspects of this interesting paper need further discussion. The authors conducted several subgroup analyses, investigating whether the association between baseline diabetes distress and all-cause mortality was different for men vs women, participants with different HbA1c levels, different age groups or different diabetes therapy. The association between high baseline diabetes distress (measured using the Problem Areas in Diabetes [PAID] questionnaire) and higher allcause mortality was found in men (HR 1.76 [95% CI 1.26, 2.46]) but not in women (HR 1.09 [95% CI 0.60, 2.00]), with a significant interaction between diabetes distress and sex (p = 0.0336) [1]. This raises the question: why did a high level of diabetes distress predict mortality in the male participants but not in the female participants with diabetes? The final Cox proportional hazards models in the whole sample were adjusted for several potential confounders (age, sex, BMI, HbA1c, types of diabetes therapy, urinary albumin/ creatinine ratio, history of any diabetes retinopathy, symptomatic diabetic neuropathy and past medical history [acute myocardial infarction, chronic stable angina, peripheral artery disease, leg ulceration, ischaemic stroke and haemorrhagic stroke]) [1]. Yet, in order to understand why the association was different for men and women, it would be relevant to provide data on socio-demographic and clinical characteristics for both sexes. In addition, information regarding the mortality rates for men and women (separately) is not reported [1], while this is needed to interpret the results. Furthermore, Hayashino et al measured diabetes distress using the total 20-item scale of PAID. They used a Japanese translation of PAID, reporting that this has shown good consistency and validity [1]. However, earlier research has shown that the sources of diabetes distress can be regarded as a multidimensional construct. In a study in Dutch and American individuals with diabetes, in which the cross-cultural validity of PAID was assessed, the latent structure of the 20–item PAID was best described with a 4factor structure [2]. Four subscales are frequently used for PAID: emotional burden, physician-related distress, regimen-related distress and diabetes-related interpersonal distress [2]. The validation study for the Japanese translation of PAID is written in Japanese [3] and it is unclear whether the factor structure has been investigated. Repeating the original analyses from Hayashino et al using the subscales of PAID instead of the total score might lead to much more detailed insight into the associations * Nanna Lindekilde nlindekilde@health.sdu.dk