Treating Diabetes With Surgery

Wolfe, Bruce M.; Purnell, Jonathan Q.; Belle, Steven H.

doi:10.1001/jama.2013.4772

Cited by 16 publications

(12 citation statements)

References 17 publications

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“…Our study shows that mixed and restrictive types of surgical procedures are effective in reducing the EBL%, without significant differences between them; similar results can be found in several recent studies [17,18]. We only found differences between types of surgical procedures in the evolution of the lipid parameters, except for the triglycerides, which were similar in both groups.…”

Section: Discussionsupporting

confidence: 90%

Remisja cukrzycy typu 2 po leczeniu bariatrycznym — porównanie różnych procedur

Fernández-Soto¹,

Martín-Leyva²,

González-Jiménez³

et al. 2017

Endokrynologia Polska

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Introduction: We aimed to assess the mid-term type 2 diabetes mellitus recovery patterns in morbidly obese patients by comparing some relevant physiological parameters of patients of bariatric surgery between two types of surgical procedures: mixed (roux-en-Y gastric bypass and biliopancreatic diversion) and restrictive (sleeve gastrectomy). Material and methods: This is a prospective and observational study of co-morbid, type 2 diabetes mellitus evolution in 49 morbidly obese patients: 37 underwent mixed surgery procedures and 12 a restrictive surgery procedure. We recorded weight, height, body mass index, and glycaemic, lipid, and nutritional blood parameters, prior to procedure, as well as six and twelve months post-operatively. In addition, we tested for differences in patient recovery and investigated predictive factors in diabetes remission. Results: Both glycaemic and lipid profiles diminished significantly to healthy levels by 6 and 12 months post intervention. Type 2 diabetes mellitus showed remission in more than 80% of patients of both types of surgical procedures, with no difference between them. Baseline body mass index, glycated haemoglobin, and insulin intake, among others, were shown to be valuable predictors of diabetes remission one year after the intervention. Conclusions:The choice of the type of surgical procedure did not significantly affect the remission rate of type 2 diabetes mellitus in morbidly obese patients. (Endokrynol Pol 2017; 68 (1): 18-25)

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Section: Discussionsupporting

confidence: 90%

Remisja cukrzycy typu 2 po leczeniu bariatrycznym — porównanie różnych procedur

Fernández-Soto¹,

Martín-Leyva²,

González-Jiménez³

et al. 2017

Endokrynologia Polska

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“…1–4 Bariatric surgery is very effective at inducing weight reduction and controlling obesity-related type 2 diabetes (T2DM) in the setting of grade 2 or 3 obesity. 2,3,5–9 However, there is insufficient evidence regarding its longer term outcomes resulting in less than uniform acceptance of these procedures as a primary diabetes treatment.…”

Section: Introductionmentioning

confidence: 99%

Surgical vs Medical Treatments for Type 2 Diabetes Mellitus

et al. 2014

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IMPORTANCE Address unanswered questions about the role of bariatric surgery for people with diabetes. OBJECTIVE Determine feasibility of a randomized controlled trial (RCT) and compare initial outcomes of bariatric surgery and a structured weight loss program for treating type 2 diabetes mellitus in grade 1 and 2 obese participants. DESIGN, SETTING, PARTICIPANTS A 12-month, 3-arm RCT at a single center including 69 participants age 25–55 years, BMI 30–40 with type 2 diabetes. INTERVENTIONS Two surgical procedures; Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB) and an intensive lifestyle weight loss intervention (LWLI). MAIN OUTCOMES AND MEASURES Primary outcomes in the intention to treat (ITT) cohort were feasibility and effectiveness measured by weight loss and improvements in glycemic control. RESULTS 667 potential participants were screened of whom 69 (10.3%) were randomized, 30 (43.5%) with grade 1 obesity. Mean age was 47.3±6.4 years, 81% were women, and mean glycated hemoglobin was 7.9±2.0. After randomization, 7 (10%) participants refused to undergo their allocated intervention (3 RYGB, 1 LAGB, 3 LWLI) and 1 RYGB was excluded for current smoking. Twenty subjects underwent RYGB, 21 LAGB, and 20 LWLI with retention at 12 months of 90%, 86%, and 70%, respectively. In the ITT cohort with multiple imputation for missing data, RYGB participants had the greatest weight loss compared to LAGB and LWLI with average weight loss of 27%, 17%, 10% from baseline, respectively (p<.0001). Partial/complete remission of diabetes was 50%/17% in RYGB, 27%/23% in LAGB and 0%/0% in LWLI (p=.0005/.047, partial/complete) and there were significant reductions in medication usage in both surgical groups. There were no deaths and 3 serious adverse events; 1 RYGB ulcer was treated medically and 2 LAGB were re-hospitalized for dehydration. CONCLUSIONS This study highlights several potential challenges to successfully completing a larger RCT for diabetes and obesity treatment in those with BMI 30–40 kg/m2, including the difficulties associated with recruiting and randomizing patients to surgical versus non-surgical interventions. Preliminary results show that RYGB was the most effective treatment followed by LAGB for both weight loss and diabetes outcomes at one year.

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“…The incidence of nephropathy and foot ulcers was elevated in the surgical groups (especially in the RYGB group) in the 3-year follow-up of the STAMPEDE study [4]. Other studies have reported surgical complications, including anastomotic stricture, bleeding, bowel obstruction, kidney stones and fractures [8].…”

Section: Ilmi Intensive Lifestyle and Medical Intervention Rygb Roux-mentioning

confidence: 87%