Clinical Medicine

Hypoglycemia after Roux-en-Y gastric bypass or sleeve gastrectomy bariatric surgery

Supervisor

Assoc. Prof. Rinki Murphy

Faculty of Medical and Health Sciences

Project code: MHS006

Aim: (1) To assess the prevalence of asymptomatic and symptomatic hypoglycemia among patients with type 2 diabetes (T2D) remission following Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) surgery. (2) To assess the prevalence of dumping syndrome after SG or GBP surgery and evaluate whether this is associated with abnormalities in gut hormone response, differences in eating behaviour or weight loss outcomes. 

Bariatric surgery provides the most effective and durable treatment for type 2 diabetes in terms of glycaemia, however, the effects of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on symptomatic or asymptomatic hypoglycemia is poorly characterised. The etiology of symptomatic hypoglycemia triggered by eating sweet foods “dumping syndrome” is unclear, and may involve an amplified gut hormone response to glucose. It is unclear whether the occurrence of dumping syndrome may act as a deterrent that assists with weight control after bariatric surgery by altering the consumption of sweet foods. 

The prevalence and clinical relevence of mildly symptomatic and asymptomatic hypoglycemia episodes detected on continuous glucose monitoring after GBP or SG is unclear, but could include risk of cardiac arrhythmia and accidental injury. One week of continuous glucose monitoring data along with questionnaires about hypoglycemia symptoms and corresponding food diary information has been collected from 20 patients who took part in a prospective, randomized clinical trial comparing sleeve gastrectomy (SG) versus gastric bypass (GBP) surgery among patients with morbid obesity and type 2 diabetes and 20 control patients.

Dumping syndrome symptoms have been recorded systematically in approximately 60 participants who have had either SG or GBP surgery and undergone a 75g oral glucose tolerance test, with measurement of glucose, insulin and gut hormones. These participants have also provided 7 day food diaries.

Nutritional deficiencies and dietary intake after Roux-en-Y gastric bypass or sleeve gastrectomy bariatric surgery

Supervisor

Assoc. Prof. Rinki Murphy

Faculty of Medical and Health Sciences

Project code: MHS007

Aim: To evaluate the impact of Roux-en-Y gastric bypass or sleeve gastrectomy types of bariatric surgery on nutrient deficiencies and food intake. Bariatric surgery provides the most effective and durable treatment for type 2 diabetes in terms of glycaemia, however, the effects of Roux-en-Y gastric bypass and sleeve gastrectomy surgery on nutritional deficiencies and specific food intake are poorly characterized. Reduced energy intake could be due to a combination of changes in appetite, meal patterns, and food preference. 

It remains unclear whether there is any difference in eating behaviour and food selection after different types of bariatric surgery. There are concerns about malabsorptive and or restrictive procedures resulting in calcium, Vitamin D and iron deficiencies despite patients being prescribed daily vitamin supplements. Data are being collected from a prospective, randomized clinical trial comparing sleeve gastrectomy (SG) versus gastric bypass (GBP) surgery among patients with morbid obesity and type 2 diabetes on remission of diabetes and weight loss. Baseline and 1 year follow up has been completed and included 114 patients who received either GBP or SG surgery at North Shore Hospital.  

Diseases of the pancreas in the elderly

Supervisor

Dr Max Petrov

Faculty of Medical and Health Sciences

Project code: MHS008

With improvement in health care, living standards and socioeconomic status, more adults in New Zealand are living to old age. As the population ages, it is increasingly important to identify the factors that might impact on the nutritional status and thus the health status of the elderly. Hence, it is important to understand how ageing affects the digestive system in order to allow appropriate interventions in the case of digestive functional impairment. The pancreas plays a central role in the digestive process due to the production of essential digestive enzymes and bicarbonate.

The aim of this project is to summarise, for the first time, available literature on the peculiarities of exocrine pancreatic diseases, i.e. acute and chronic pancreatitis and pancreatic cancer, in ageing adults. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience.

Abdominal MRI for Quantitative Measurement of Central Obesity

Supervisor

Dr Max Petrov

Faculty of Medical and Health Sciences

Project code: MHS009

The current prevalence of obesity is described as an epidemic by the WHO, and New Zealand has the 3rd highest rate of adult obesity in the world. In addition, visceral obesity, characterised as excessive abdominal fat, is strongly associated with the development of cardiovascular and metabolic diseases. The aim of this project is to analyse parameters of abdominal body composition using magnetic resonance (MR) images. The project is part of a larger research theme of the COSMOS (Clinical and epidemiOlogical inveStigations in Metabolism, nutritiOn, and pancreatitic diseaseS) group. The group offers a vibrant research environment, comprehensive research training, and clinical research experience, including involvement in a case-control study of MRI after diseases of the exocrine pancreas.

Understanding the scope of Liaison Psychiatry referrals over an annual timeframe in a general hospital setting

Supervisor

Dr Frederick Sundram

Faculty of Medical and Health Sciences

Project code: MHS010

There is significant comorbidity between mental and physical illnesses in general hospitals which impacts on recovery, outcomes and healthcare expenditure. However, many cases of mental illness among hospital patients go undetected by acute clinical staff. Estimates of detection rates vary between studies but are commonly around 50%, and may be even lower for some conditions such as delirium. There are various reasons for this. Hospital staff often have little training or expertise in the identification of mental health conditions. They may understandably focus attention on the primary health condition for which a patient has been admitted. They may also feel that a degree of mental distress is a natural reaction to illness and hospitalisation even though this may conceal more serious problems.  

This summer studentship offers a unique opportunity to assess referrals to the Liaison Psychiatry service and pathways of care. There is robust evidence that early identification and treatment of mental health needs of the general hospital group of patients has a direct impact on recovery. The Liaison Psychiatry service at Waitemata DHB covers 2 campuses – North Shore Hospital and Waitakere Hospital. The Liaison Psychiatry service undertakes assessments at the Emergency Department and the wards of North Shore Hospital and also the adult wards at Waitakere Hospital. The service also receives referrals for outpatient assessments, usually these are seen at the North Shore Hospital campus. There are approximately 1800 referrals in an annual timeframe.    

Waitemata DHB is the largest DHB in the country and serves a population of approximately 600,000 in the catchment area. There is provision of secondary hospital and community services from North Shore Hospital, Waitakere Hospital and over 30 community sites throughout the district. There is expected to be an approximate expansion in the population by 20% in the next 15 years. Waitemata DHB has the second largest over-65 population in the country. With the expanding numbers and ageing, there is likely to be increased complexity with future presentations.