Original Article
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
N Engl J Med 2012; 366:1567-1576April 26, 2012DOI: 10.1056/NEJMoa1200225
Comments
open through May 2, 2012
- Abstract
Background
Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery.
Methods
In this randomized, nonblinded, single-center trial, we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes. The mean (±SD) age of the patients was 49±8 years, and 66% were women. The average glycated hemoglobin level was 9.2±1.5%. The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0% or less 12 months after treatment.
Results
Of the 150 patients, 93% completed 12 months of follow-up. The proportion of patients with the primary end point was 12% (5 of 41 patients) in the medical-therapy group versus 42% (21 of 50 patients) in the gastric-bypass group (P=0.002) and 37% (18 of 49 patients) in the sleeve-gastrectomy group (P=0.008). Glycemic control improved in all three groups, with a mean glycated hemoglobin level of 7.5±1.8% in the medical-therapy group, 6.4±0.9% in the gastric-bypass group (P<0.001), and 6.6±1.0% in the sleeve-gastrectomy group (P=0.003). Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group (−29.4±9.0 kg and −25.1±8.5 kg, respectively) than in the medical-therapy group (−5.4±8.0 kg) (P<0.001 for both comparisons). The use of drugs to lower glucose, lipid, and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only. The index for homeostasis model assessment of insulin resistance (HOMA-IR) improved significantly after bariatric surgery. Four patients underwent reoperation. There were no deaths or life-threatening complications.
Conclusions
In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results. (Funded by Ethicon Endo-Surgery and others; ClinicalTrials.gov number, NCT00432809.)
Media in This Article
Figure 1
Changes in Measures of Diabetes Control from Baseline.Table 1
Characteristics of the Patients at Baseline.Article Activity
- Article
The growing incidence of obesity and type 2 diabetes mellitus globally is widely recognized as one of the most challenging contemporary threats to public health.1 Uncontrolled diabetes leads to macrovascular and microvascular complications, including myocardial infarction, stroke, blindness, neuropathy, and renal failure in many patients. The current goal of medical treatment is to halt disease progression by reducing hyperglycemia, hypertension, dyslipidemia, and other cardiovascular risk factors.2,3 Despite improvements in pharmacotherapy, fewer than 50% of patients with moderate-to-severe type 2 diabetes actually achieve and maintain therapeutic thresholds, particularly for glycemic control.4 Observational studies have suggested that bariatric or metabolic surgery can rapidly improve glycemic control and cardiovascular risk factors in severely obese patients with type 2 diabetes.5-9 Few randomized, controlled trials have compared bariatric surgery with intensive medical therapy, particularly in moderately obese patients (defined as those having a body-mass index [BMI, the weight in kilograms divided by the square of the height in meters] of 30 to 35) with type 2 diabetes.10 Accordingly, many unanswered questions remain regarding the relative efficacy of bariatric surgery in patients with uncontrolled diabetes.
This randomized, controlled, single-center study, called the Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial, was designed to compare intensive medical therapy with surgical treatment (gastric bypass or sleeve gastrectomy) as a means of improving glycemic control in obese patients with type 2 diabetes.
Methods
Study Design
The study rationale and nonblinded design have been reported previously.11 From March 2007 through January 2011, we screened 218 patients at the Cleveland Clinic. Using a block-randomization method with a 1:1:1 ratio, we assigned 150 eligible patients to undergo intensive medical therapy alone or intensive medical therapy plus either Roux-en-Y gastric bypass or sleeve gastrectomy, with stratification according to the patients' use of insulin at baseline. The study protocol is available with the full text of this article at NEJM.org.
Eligibility criteria were an age of 20 to 60 years, a diagnosis of type 2 diabetes (glycated hemoglobin level, >7.0%), and a BMI of 27 to 43. Patients were excluded if they had undergone previous bariatric surgery or other complex abdominal surgery or had poorly controlled medical or psychiatric disorders.
Recruitment strategies included the use of electronic medical records and advertisements in local media. Patients providing written informed consent entered a 12-week screening period and underwent repeated physical and laboratory evaluations to confirm eligibility.
Study Treatments
All patients received intensive medical therapy, as defined by American Diabetes Association (ADA) guidelines, including lifestyle counseling, weight management, frequent home glucose monitoring, and the use of newer drug therapies (e.g., incretin analogues) approved by the Food and Drug Administration (FDA).2,12 Every 3 months for the first 12 months, patients returned for study visits with a diabetes specialist at the Cleveland Clinic. Patients were counseled by a diabetes educator and evaluated for bariatric surgery by a psychologist and encouraged to participate in the Weight Watchers program. The goal of medical management was modification of diabetes medications until the patient reached the therapeutic goal of a glycated hemoglobin level of 6.0% or less or became intolerant to the medical treatment (Fig. S1 and S2 in the Supplementary Appendix, available at NEJM.org). All patients were treated with lipid-lowering and antihypertensive medications, according to ADA guidelines, with the following targets: systolic blood pressure, 130 mm Hg or less; diastolic blood pressure, 80 mm Hg or less; and low-density lipoprotein (LDL) cholesterol, 100 mg per deciliter (2.6 mmol per liter) or less.
Bariatric procedures were performed laparoscopically by a single surgeon with the use of instruments provided by Ethicon Endo-Surgery. Gastric bypass consisted of the creation of a 15-to-20-ml gastric pouch, a 150-cm Roux limb, and a 50-cm biliopancreatic limb (Fig. S3 in the Supplementary Appendix).13 Sleeve gastrectomy involved a gastric-volume reduction of 75 to 80% by resecting the stomach alongside a 30-French endoscope beginning 3 cm from the pylorus and ending at the angle of His (Fig. S3 in the Supplementary Appendix). Patients who were assigned to undergo bariatric surgery were evaluated by surgical, nutrition, and psychology services as necessary.14 Vitamin and nutrient supplementation after gastric bypass included a multivitamin, iron, vitamin B12, and calcium citrate with vitamin D; after sleeve gastrectomy, such supplementation included a multivitamin and vitamin B12. Patients were assessed for nutritional deficiencies within 12 months after surgery.
Data Collection and Assessment
At baseline, we collected data on demographic information, coexisting illnesses, rates of diabetes complications, anthropometric values, use of medications, and laboratory values; we also performed physical examinations.
We assessed body weight, waist and hip circumference, blood pressure, and levels of glycated hemoglobin and fasting plasma glucose at baseline and at months 3, 6, 9, and 12. Patients were scheduled for follow-up in a 4-year extension study to assess the durability of glycemic control and diabetes-related complications.
Study End Points
The primary end point was the proportion of patients with a glycated hemoglobin level of 6% or less (with or without diabetes medications) 12 months after randomization. Secondary end points included levels of fasting plasma glucose, fasting insulin, lipids, and high-sensitivity C-reactive protein (CRP); the homeostasis model assessment of insulin resistance (HOMA-IR) index; weight loss; blood pressure; adverse events; coexisting illnesses; and changes in medications.
Study Oversight
This investigator-initiated trial was sponsored by Ethicon Endo-Surgery, with support from LifeScan, the Cleveland Clinic, and the National Institutes of Health. The first author wrote the first draft of the manuscript and made the decision to submit the manuscript for publication. All authors had full and independent access to all the data and vouch for the integrity and the accuracy of the analysis and its fidelity to the protocol. Complete study governance is outlined in the Supplementary Appendix.
Statistical Analysis
The sample-size estimate was based on the primary end point of the proportion of patients with a glycated hemoglobin level of 6% or less at 12 months. On the basis of previous studies, we estimated that 20% of patients would achieve the primary outcome with intensive medical therapy,10 83% with gastric bypass,5,6,9 and 50% with sleeve gastrectomy.15,16 We determined that 150 patients (50 per group) would provide a power of 80% to detect a difference between the two surgical groups (on the basis of a two-sided alpha level of 0.05) and a power of more than 99% to detect any differences among the three groups.
Continuous variables with a normal distribution are reported as means ±SD. Variables with a non-normal distribution are reported as medians and interquartile ranges. Categorical variables are summarized with the use of frequencies. We used the chi-square test to analyze the primary end point and used analysis of variance to analyze continuous laboratory measurements and compare study groups. For glycemic measures and body weight, a mixed model for repeated measures was used to analyze the change from baseline and least-square means with corresponding standard errors plotted graphically. All analyses were performed with the use of SAS software, version 9.2 (SAS Institute).
Results
Patients
During the first year of follow-up, 8 patients withdrew from the study (1 who did not undergo sleeve gastrectomy and 7 in the medical-therapy group who did not have any follow-up visits). Another 2 patients in the medical-therapy group missed follow-up visits at 9 and 12 months, leaving 140 patients (93%) who completed all analyses. There were no significant differences in patients' characteristics in the three study groups at baseline (Table 1Table 1
Characteristics of the Patients at Baseline.). The mean BMI was 36, with 51 of 150 patients (34%) with a BMI of less than 35.Primary End Point
The target glycated hemoglobin level of 6.0% or less at 12 months occurred in 5 of 41 patients (12%) in the medical-therapy group, as compared with 21 of 50 (42%) in the gastric-bypass group (P=0.002) and 18 of 49 (37%) in the sleeve-gastrectomy group (P=0.008). There were no significant differences in the primary end point between the two surgical groups (P=0.59). However, all patients in the gastric-bypass group who achieved the target glycated hemoglobin level did so without medications, whereas 5 of 18 patients (28%) in the sleeve-gastrectomy group required the use of one or more glucose-lowering drugs. There was no significant heterogeneity among the subgroups stratified according to median age, BMI, use of insulin, or duration of diabetes (Table S5 in the Supplementary Appendix).
Glycemic Control
At 12 months, mean levels of glycated hemoglobin and fasting plasma glucose were significantly lower in the two surgical groups than in the medical-therapy group (P<0.01 for both comparisons) (Table 2Table 2
Primary and Secondary End Points at 12 Months.). There was a large and rapid improvement (by 3 months) in levels of glycated hemoglobin and fasting plasma glucose after each of the surgical procedures, an improvement that was sustained over the year of observation with reduced hypoglycemic medication use (Figure 1A and 1BFigure 1Changes in Measures of Diabetes Control from Baseline.). In contrast, patients receiving medical therapy alone had a smaller and more gradual improvement in glycemic control with some attenuation observed over the final 6 months, despite an increase in the use of hypoglycemic medications (Figure 1A).Diabetes Medications
During the trial, the average number of diabetes agents per patient per day tended to increase in the medical-therapy group but decreased significantly in the gastric-bypass group and the sleeve-gastrectomy group (P<0.001 for both comparisons) (Figure 1C). There was a significant reduction in the majority of medication classes used for glycemic control for the two surgical groups at 12 months (Table 3Table 3
Medication Use at Baseline and Month 12.). Insulin use remained high at 12 months (38%) in the medical-therapy group and was reduced to 4% in the gastric-bypass group and to 8% in the sleeve-gastrectomy group (P<0.001 for both comparisons).Weight Loss
At 12 months, changes in body weight, BMI, waist circumference, and waist-to-hip ratio were greater after gastric bypass and sleeve gastrectomy than after medical therapy (Table 2, and Tables S2 and S3 in the Supplementary Appendix). The mean percentage of weight loss among patients undergoing either gastric bypass or sleeve gastrectomy was greater (−27.5±7.3% and −24.7±6.6%, respectively) than among those receiving medical therapy alone (−5.2±7.7%) (P<0.001 for both comparisons). Changes in weight and in BMI were greater after gastric bypass than after sleeve gastrectomy (P=0.02 and 0.03, respectively). The percent of excess weight loss for gastric bypass (88%) and sleeve gastrectomy (81%) was superior to that of medical therapy (13%) (P<0.001 for both comparisons). Both surgical groups had a significantly greater decrease in BMI over time than did the medical-therapy group (P<0.001 for both comparisons) (Figure 1D).
Other Health Outcomes
Table 2 shows changes in clinical and laboratory outcomes at 12 months. The reduction in prevalence of the metabolic syndrome was significantly greater in the two surgical groups than in the medical-therapy group (Table S3 in the Supplementary Appendix). Rates of hyperinsulinemia and the HOMA-IR index improved markedly after each of the two surgical procedures, as compared with medical therapy alone. A significant decrease in triglycerides occurred at 12 months after gastric bypass, but not after sleeve gastrectomy, as compared with medical therapy. There was a marked increase in high-density lipoprotein (HDL) cholesterol and a significant decrease in the high-sensitivity CRP level after the two surgical procedures, as compared with medical therapy alone.
Use of Cardiovascular Medications
Although levels of total and LDL cholesterol did not differ significantly among groups after 12 months, there was a significant reduction in the number of medications needed to treat hyperlipidemia in the two surgical groups (Table 3). For example, lipid-lowering drugs were required at baseline in 86% and 78% of patients assigned to undergo gastric bypass and sleeve gastrectomy, respectively, but use declined to 27% and 39% after 12 months, as compared with 92% for medical therapy (P<0.001 for both comparisons). Likewise, there was no significant difference in values for systolic and diastolic blood pressure among the three groups at 12 months, but there was a significant reduction in the number of hypertension medications after the two bariatric procedures.
Adverse Events
Table 4Table 4
Adverse Events at 12 Months. shows significant adverse events that occurred up to 1 year after surgery or the initiation of medical therapy. Additional surgical interventions were required in four patients, including laparoscopic procedures for blood-clot evacuation, assessment of nausea and vomiting, and cholecystectomy after gastric bypass and jejunostomy for feeding access to treat a gastric leak after sleeve gastrectomy. There were no deaths, episodes of serious hypoglycemia requiring intervention, malnutrition, or excessive weight loss among the three groups.Discussion
In our study, obese patients with poorly controlled diabetes who underwent either gastric bypass or sleeve gastrectomy combined with medical therapy were significantly more likely to achieve a glycated hemoglobin level of 6.0% or less 12 months after randomization than were patients receiving medical therapy alone. Notably, many patients in the surgical groups, particularly those in the gastric-bypass group, achieved glycemic control without the use of diabetes medications (Table 3). The study population had relatively advanced disease, including many patients with major diabetes-related coexisting illnesses or evidence of end-organ damage, including retinopathy in 14 to 22% and nephropathy (microalbuminuria) in 14 to 29% (Table S1 in the Supplementary Appendix). The majority of patients had the metabolic syndrome and increased measures of systemic inflammation (median high-sensitivity CRP level, >4 mg per liter) (Table 2, and Tables S1 and S2 in the Supplementary Appendix). More than 60% of the surgical patients had moderate-to-severe fatty liver disease on the basis of biopsy samples obtained during surgery (Table S1 in the Supplementary Appendix). Accordingly, a significant improvement in type 2 diabetes (a reduction in glycated hemoglobin levels of 2.9 percentage points) can occur after bariatric surgery in obese patients with advanced diabetes, although modest improvement is feasible with the use of intensive medical therapy alone (a reduction of 1.4 percentage points).
Observational studies of bariatric procedures have shown rates of remission of type 2 diabetes of 55 to 95%, although resolution was often determined without biochemical evidence (levels of glycated hemoglobin or fasting plasma glucose) or with the use of more liberal definitions of remission (e.g., fasting plasma glucose, ≤125 mg per deciliter [6.9 mmol per liter]).5 A nonrandomized, prospective trial comparing bariatric surgery with conventional treatment of obesity also showed higher diabetes remission rates for surgery after 2 and 10 years but with gradual recurrence over time.8 A single previous randomized, controlled trial compared medical therapy with gastric banding in patients with moderate-to-severe obesity (BMI, 30 to 40) but involved patients with early diabetes (<2 years) of mild severity (glycated hemoglobin, <7.5%). In that study, gastric banding was superior to medical therapy in achieving glycemic control (glycated hemoglobin, ≤6.2%) and weight loss.10 In contrast, in our trial, patients had more advanced type 2 diabetes, with an average disease duration of more than 8 years and a mean baseline glycated hemoglobin level of 8.9 to 9.5% while undergoing treatment with an average of nearly three diabetes agents, including a relatively high use of insulin (44% of patients) or other injectable therapies (14%). The inclusion of patients with more advanced type 2 diabetes in the STAMPEDE trial probably explains the lower observed rate of diabetes remission; other differences from previous trials included less severe obesity, a greater proportion of men and black patients, and an older age.
In our study, results were generally similar in the two surgical groups although somewhat more favorable in the gastric-bypass group. Most differences between the gastric-bypass group and the sleeve-gastrectomy group were not significant, although it should be noted that the study was not adequately powered to detect modest differences between these two surgical procedures. Secondary end points, including BMI, body weight, waist circumference, and the HOMA-IR index, also showed more favorable results in the surgical groups than in the medical-therapy group (Table 2, and Tables S2 and S3 in the Supplementary Appendix). Maximal improvements after bariatric surgery occurred quickly, often within 3 months, and were maintained throughout the 12-month follow-up period. Reductions in the use of diabetes medications occurred before achievement of maximal weight loss, which supports the concept that the mechanisms of improvement in diabetes involve physiologic effects in addition to weight loss, probably related to alterations in gut hormones.17-20 As noted in observational studies, some adverse effects of surgical treatment were observed in this study but were modest in severity.6,7,9,21 Self-reported symptoms of hypoglycemia occurred with a similar frequency in the surgical and medical groups.
The mechanism of improved glycemic control appears to involve improvement in insulin sensitivity, with a marked reduction in insulin levels and improvement in the HOMA-IR index, which may be linked to the attenuation of chronic inflammation, as suggested by the greater reduction in high-sensitivity CRP in the surgery groups (−84% for gastric bypass and −80% for sleeve gastrectomy) than in the medical-therapy group (−33%). All patients received intensive medical therapy, including lifestyle counseling, home glucose monitoring, and the most effective pharmacotherapy currently available. Using these strategies, the patients receiving medical therapy alone did well, achieving a substantial reduction in glycated hemoglobin levels (−1.4±1.5 percentage points, P<0.001) and body weight (−5.4±8.0 kg, P<0.001) over 12 months. Although the study was not powered to assess the effects of improved glycemic control on clinical outcomes, improvements in cardiovascular risk factors were observed (Table 2, and Tables S2 and S3 in the Supplementary Appendix). Although lipoprotein and blood-pressure levels were similar in all three study groups at 12 months, improvements in the surgical groups allowed reduction or elimination of concomitant medications in many patients.
Important limitations of our study include the relatively short duration of follow-up (12 months) and the single-center, open-label nature of the study. Some adverse events occurred in the bariatric-surgery group, including in four patients who required reoperation. The durability and long-term safety profile of these results remain uncertain, but the protocol specifies further 4-year follow-up of all patients, which should allow additional assessment of long-term efficacy and safety results to guide patient counseling regarding specific bariatric procedures for the treatment of type 2 diabetes.
Despite these limitations, we conclude that bariatric surgery represents a potentially useful strategy for management of uncontrolled diabetes, since it has been shown to eliminate the need for diabetes medications in some patients and to markedly reduce the need for drug treatment in others. In addition, among patients undergoing surgery, cardiovascular risk factors improved, allowing reductions in lipid-lowering and antihypertensive therapies. Theoretically, such improvements have the potential to reduce cardiovascular morbidity and mortality, as shown in nonrandomized studies, although such benefits will need to be balanced with surgical risk and safety as shown in larger, multicenter clinical-outcome trials.8,22
Supported by a grant (EES IIS 19900) from Ethicon Endo-Surgery, a grant (R01-DK089547) from the National Institutes of Health, and LifeScan.
Dr. Schauer reports receiving payment for board membership from Ethicon Endo-Surgery, Surgiquest, Barosense, RemedyMD, and Stryker, consulting fees from Ethicon Endo-Surgery, Stryker, Gore, and Carefusion, payment for expert testimony from Physicians Review of Surgery, and lecture fees from Ethicon Endo-Surgery, Allergan, Cinemed, and Quadrant Healthcare, holding a patent for a medical device to enhance weight loss in codevelopment with the Cleveland Clinic, royalties from Springer, having an equity interest in Intuitive Surgical, Barosense, Surgiquest, and RemedyMD, and receiving institutional grant support (to the Cleveland Clinic) from Ethicon Endo-Surgery and Bard Davol; Dr. Kashyap, receiving consulting fees from Ethicon; Dr. Brethauer, receiving consulting fees, lecture fees, and payment for board membership from Ethicon Endo-Surgery and lecture fees from Covidien; Dr. Kirwan, receiving grant support from Nestle and ScottCare; Dr. Nissen, receiving institutional grant support (to the Cleveland Clinic) from Orexigen and Vivus; and Dr. Bhatt, receiving institutional grant support (to Brigham and Women's Hospital) from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, and Sanofi Aventis and from Medtronic and the Medicines Company (to Boston VA Research Institute) and serving as the international principal investigator for the CRESCENDO cardiovascular outcome trial of the weight-loss drug rimonabant versus placebo. The Cleveland Clinic had received a grant from Sanofi Aventis for the CRESCENDO trial. No other potential conflict of interest relevant to this article was reported.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article (10.1056/NEJMoa1200225) was published on March 26, 2012, and updated on April 26, 2012, at NEJM.org.
We thank Chytaine Hall for recruitment support; Craig Balog, Debbie Gladish, Betty Moore, Karen Myers, Tammy Scebbi, Diane Smith, Maura Schnauffer, Randy Scott, and Janice Bell for statistics and data-management support; Matthew Kroh, M.D., Tomasz Rogula, M.D., Bipan Chand, M.D., Derrick Cetin, M.D., Betul Hatipoglu, M.D., Mario Skugor, M.D., Adi Mehta, M.D., Leslie Heinberg, Ellen Calogeras, Wendy Kirby, and Lauren Sullivan for medical-site support; Rishi Singh, M.D., and Lisa Yerian, M.D., for technical support; and Suzanne Turner and Mary Ann Citraro for graphical support.
Source Information
From the Bariatric and Metabolic Institute (P.R.S., S.A.B., S.T., B.A.), the Endocrinology Institute (S.R.K.), the Cleveland Clinic Coordinating Center for Clinical Research (K.W., C.E.P.), the Heart and Vascular Institute (S.E.N.), and the Lerner Research Institute (J.P.K.), Cleveland Clinic, Cleveland; and the Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School — all in Boston (D.L.B.).
Address reprint requests to Dr. Schauer at the Bariatric and Metabolic Institute, Cleveland Clinic M61, 9500 Euclid Ave., Cleveland, OH 44195, or at schauep@ccf.org.
- References
References
1
Danaei G ,Finucane MM ,Lu Y , et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011;378:31-40
CrossRef | Web of Science | Medline2
Nathan DM ,Buse JB ,Davidson MB , et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009;32:193-203
CrossRef | Web of Science | Medline3
The Look AHEAD Research Group
CrossRef | Web of Science | Medline4
Saydah SH ,Fradkin J ,Cowie CC . Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004;291:335-342
CrossRef | Web of Science | Medline5
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122(3):248.e5-256.e5.
6
Schauer PR ,Burguera B ,Ikramuddin S , et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003;238:467-484
CrossRef | Web of Science | Medline7
Scopinaro N ,Marinari GM ,Camerini GB ,Papadia FS ,Adami GF . Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care 2005;28:2406-2411
CrossRef | Web of Science | Medline8
Sjostrom L ,Lindroos AK ,Peltonen M , et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683-2693
Free Full Text | Web of Science | Medline9
Pories WJ ,Swanson MS ,MacDonald KG , et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:339-350
CrossRef | Web of Science | Medline10
Dixon JB ,O'Brien PE ,Playfair J , et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008;299:316-323
CrossRef | Web of Science | Medline11
Kashyap SR ,Bhatt DL ,Schauer PR . Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently trial (STAMPEDE). Diabetes Obes Metab 2010;12:452-454[Erratum, Diabetes Obes Metab 2010;12:833.]
CrossRef | Web of Science | Medline12
American Diabetes Association
CrossRef | Web of Science | Medline13
Schauer PR ,Ikramuddin S ,Hamad G , et al. Laparoscopic gastric bypass surgery: current technique. J Laparoendosc Adv Surg Tech A 2003;13:229-239
CrossRef | Web of Science | Medline14
Eldar S ,Heneghan HM ,Brethauer S ,Schauer PR . A focus on surgical preoperative evaluation of the bariatric patient -- the Cleveland Clinic protocol and review of the literature. Surgeon 2011;9:273-277
CrossRef | Web of Science | Medline15
Gill RS ,Birch DW ,Shi X ,Sharma AM ,Karmali S . Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 2010;6:707-713
CrossRef | Medline16
Lee WJ ,Chong K ,Ser KH , et al. Gastric bypass vs. sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg 2011;146:143-148
CrossRef | Web of Science | Medline17
Cummings DE ,Overduin J ,Shannon MH ,Foster-Schubert KE . Hormonal mechanisms of weight loss and diabetes resolution after bariatric surgery. Surg Obes Relat Dis 2005;1:358-368
CrossRef | Medline18
Kashyap SR ,Daud S ,Kelly KR , et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes. Int J Obes (Lond) 2010;34:462-471
CrossRef | Web of Science | Medline19
Korner J ,Bessler M ,Inabnet W ,Taveras C ,Holst JJ . Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding. Surg Obes Relat Dis 2007;3:597-601
CrossRef | Medline20
Laferrere B ,Heshka S ,Wang K , et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care 2007;30:1709-1716
CrossRef | Web of Science | Medline21
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
Free Full Text | Web of Science | Medline22
Adams TD ,Gress RE ,Smith SC , et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753-761
Free Full Text | Web of Science | Medline
- Citing Articles (135)
Citing Articles
1
Xuechao Yang, Guang Yang, Wensheng Wang, Guoqing Chen, Hua Yang. (2013) A Meta-analysis: To Compare the Clinical Results Between Gastric Bypass and Sleeve Gastrectomy for the Obese Patients. Obesity Surgery 23:7, 1001-1010
2
Andrei Keidar, Karen J. Hershkop, Limor Marko, Chaya Schweiger, Lior Hecht, Noam Bartov, Assaf Kedar, Ram Weiss. (2013) Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia
3
Sanjeev Sockalingam, Stephanie Cassin, Raed Hawa, Attia Khan, Susan Wnuk, Timothy Jackson, Allan Okrainec. (2013) Predictors of Post-bariatric Surgery Appointment Attendance: the Role of Relationship Style. Obesity Surgery
4
(2013) Weight Management in Diabetes. Canadian Journal of Diabetes 37, S317
5
Donna H. Ryan, George A. Bray. (2013) Pharmacologic Treatment Options for Obesity: What Is Old Is New Again. Current Hypertension Reports 15:3, 182-189
6
Jan Peter Yska, Susanne Linde, Véronique V. Tapper, Jan A. Apers, Marloes Emous, Erik R. Totté, Bob Wilffert, Eric N. Roon. (2013) Influence of Bariatric Surgery on the Use and Pharmacokinetics of Some Major Drug Classes. Obesity Surgery 23:6, 819-825
7
K. J. Neff, C. W. Roux. (2013) Metabolic Effects of Bariatric Surgery: A Focus on Inflammation and Diabetic Kidney Disease. Current Obesity Reports 2:2, 120-127
8
Antonio Amor, Amanda Jiménez, Violeta Moizé, Ainitze Ibarzabal, Lílliam Flores, Antonio M. Lacy, Josep Vidal. (2013) Weight loss independently predicts urinary albumin excretion normalization in morbidly obese type 2 diabetic patients undergoing bariatric surgery. Surgical Endoscopy 27:6, 2046-2051
9
R. Schouten, J. C. M. Dijke, G. Hof, P. B. G. M. Feskens. (2013) Prevalence and Risk Factors of Urinary Incontinence and Bladder Retention in Gastric Bypass Surgery: a Cross-Sectional Study. Obesity Surgery 23:6, 760-763
10
M. Robert, C. Ferrand-Gaillard, E. Disse, P. Espalieu, C. Simon, M. Laville, C. Gouillat, C. Thivolet. (2013) Predictive Factors of Type 2 Diabetes Remission 1 Year After Bariatric Surgery: Impact of Surgical Techniques. Obesity Surgery 23:6, 770-775
11
Guillaume Lassailly, Robert Caïazzo, François Pattou, Philippe Mathurin. (2013) Bariatric surgery for curing NASH in the morbidly obese?. Journal of Hepatology 58:6, 1249-1251
12
Jorge Daes. (2013) Self-Locking First Stitch in Suture Reinforcement of the Laparoscopic Gastric Sleeve. Obesity Surgery 23:6, 794-795
13
Ricardo Cohen, Pedro Paulo Caravatto, Tarissa Petry. (2013) Metabolic Surgery for Type 2 Diabetes in Patients with a BMI of <35 kg/m2: A Surgeon’s Perspective. Obesity Surgery 23:6, 809-818
14
Harold E. Lebovitz. (2013) Metabolic Surgery for Type 2 Diabetes with BMI <35 kg/m2. Obesity Surgery 23:6, 800-808
15
Michael N. Sack. (2013) Obesity and cardiac function – the role of caloric excess and its reversal. Drug Discovery Today: Disease Mechanisms
16
Ana Ramos-Levi, Andres Sanchez-Pernaute, Pilar Matia, Lucio Cabrerizo, Ana Barabash, Carmen Hernandez, Alfonso Calle-Pascual, Antonio Torres, Miguel Rubio. (2013) Diagnosis of Diabetes Remission After Bariatic Surgery May be Jeopardized by Remission Criteria and Previous Hypoglycemic Treatment. Obesity Surgery
17
Dong Sun, Kexin Wang, Zhibo Yan, Guangyong Zhang, Shaozhuang Liu, Fengjun Liu, Chunxiao Hu, Sanyuan Hu. (2013) Duodenal–Jejunal Bypass Surgery Up-Regulates the Expression of the Hepatic Insulin Signaling Proteins and the Key Regulatory Enzymes of Intestinal Gluconeogenesis in Diabetic Goto–Kakizaki Rats. Obesity Surgery
18
Ricardo Cohen, Pedro Paulo Caravatto, Tarissa Petry. (2013) Surgery for Diabetes. Current Surgery Reports
19
Lionel Rebibo, Pierre Verhaeghe, Cyril Cosse, Abdennaceur Dhahri, Virginie Maréchal, Jean-Marc Regimbeau. (2013) Does longitudinal sleeve gastrectomy have a family “halo effect”? A case-matched study. Surgical Endoscopy 27:5, 1748-1753
20
David M. Krpata, Cory N. Criss, Yue Gao, Emmanuel E. Sadava, James M. Anderson, Yuri W. Novitsky, Michael J. Rosen. (2013) Effects of weight reduction surgery on the abdominal wall fascial wound healing process. Journal of Surgical Research
21
Michel Vix, Michele Diana, Keng-Hao Liu, Antonio D’Urso, Didier Mutter, Hurng-Sheng Wu, Jacques Marescaux. (2013) Evolution of Glycolipid Profile After Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass: Results of a Prospective Randomized Clinical Trial. Obesity Surgery 23:5, 613-621
22
John F. Mission, Nicole E. Marshall, Aaron B. Caughey. (2013) Obesity in Pregnancy. Obstetrical & Gynecological Survey 68:5, 389-399
23
David E. Arterburn, Guilherme M. Campos, Sebastien Haneuse, Nancy E. Sherwood, Andy Bogart, Stephen Sidney, Karen J. Coleman, Mary Kay Theis, Patrick O’Connor, David Fisher. (2013) The Authors Respond: A Multisite Study of Long-Term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass. Obesity Surgery
24
Paul O’Brien. (2013) Ask the Expert: Metabolic surgery and diabetes. Diabetes Management 3:3, 199-201
25
Wei-Jei Lee, Kyung Yul Hur, Muffazal Lakadawala, Kazunori Kasama, Simon K.H. Wong, Shu-Chun Chen, Yi-Chih Lee, Kong-Han Ser. (2013) Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surgery for Obesity and Related Diseases 9:3, 379-384
26
Héctor Romero-Talamás, Stacy A Brethauer. (2013) A novel approach for diabetes: recent evidence on endoluminal liners. Diabetes Management 3:3, 235-244
27
Timothy Raymond, Russell Raymond, A Michael Lincoff. (2013) Management of the patient with diabetes and coronary artery disease: a contemporary review. Future Cardiology 9:3, 387-403
28
A. Samat, S. K. Malin, H. Huang, P. R. Schauer, J. P. Kirwan, S. R. Kashyap. (2013) Ghrelin suppression is associated with weight loss and insulin action following gastric bypass surgery at 12 months in obese adults with type 2 diabetes. Diabetes, Obesity and Metabolismn/a-n/a
29
Manasi Sinha, Takara L. Stanley, Jessica Webb, Christina Scirica, Kathleen Corey, Janey Pratt, Paul A. Boepple, Alison Hoppin, Madhusmita Misra. (2013) Metabolic Effects of Roux-en-Y Gastric Bypass in Obese Adolescents and Young Adults. Journal of Pediatric Gastroenterology and Nutrition 56:5, 528-531
30
Barham K. Abu Dayyeh, Elizabeth Rajan, Christopher J. Gostout. (2013) Endoscopic sleeve gastroplasty: a potential endoscopic alternative to surgical sleeve gastrectomy for treatment of obesity. Gastrointestinal Endoscopy
31
Arthur M. Carlin, Telal M. Zeni, Wayne J. English, Abdelkader A. Hawasli, Jeffrey A. Genaw, Kevin R. Krause, Jon L. Schram, Kerry L. Kole, Jonathan F. Finks, John D. Birkmeyer, David Share, Nancy J. O. Birkmeyer. (2013) The Comparative Effectiveness of Sleeve Gastrectomy, Gastric Bypass, and Adjustable Gastric Banding Procedures for the Treatment of Morbid Obesity. Annals of Surgery 257:5, 791-797
32
Vo Nguyen Trung, Hiroshi Yamamoto, Tsuyoshi Yamaguchi, Satoshi Murata, Hiroya Akabori, Satoshi Ugi, Hiroshi Maegawa, Tohru Tani. (2013) Effect of sleeve gastrectomy on body weight, food intake, glucose tolerance, and metabolic hormone level in two different rat models: Goto-Kakizaki and diet-induced obese rat. Journal of Surgical Research
33
Philippe Mathurin. NAFLD, Obesity, and Bariatric Surgery. In: Non-Alcoholic Fatty Liver Disease. Wiley-Blackwell, 2013:149-156.
34
J. C. Espinós, R. Turró, A. Mata, M. Cruz, M. Costa, V. Villa, J. N. Buchwald, J. Turró. (2013) Early Experience with the Incisionless Operating Platform™ (IOP) for the Treatment of Obesity. Obesity Surgery
35
Sheng Yan, Fei Sun, Zhiwei Li, Jie Xiang, Yuan Ding, Zhongjie Lu, Yang Tian, Hui Chen, Jinhua Zhang, Yan Wang, Penghong Song, Lin Zhou, Shusen Zheng. (2013) Reduction of Intestinal Electrogenic Glucose Absorption After Duodenojejunal Bypass in a Mouse Model. Obesity Surgery
36
Ciaran S. O’Brien, Gary Wang, James McGinty, Keesandra K. Agénor, Roxanne Dutia, Antonia Colarusso, Koji Park, Ninan Koshy, Blandine Laferrère. (2013) Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels. Obesity Surgery
37
Kathleen A. Page, Tamar Reisman. (2013) Interventions to Preserve Beta-Cell Function in the Management and Prevention of Type 2 Diabetes. Current Diabetes Reports 13:2, 252-260
38
Stephan R. Myers, John McGuirl, Jillian Wang. (2013) Robot-Assisted Versus Laparoscopic Gastric Bypass: Comparison of Short-Term Outcomes. Obesity Surgery 23:4, 467-473
39
Ilona S. Lorincz, Brittany C. T. Lawson, Judith A. Long. (2013) Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes. Current Diabetes Reports 13:2, 188-195
40
Michael Connolly, Ian B. A. Menown. (2013) Key Advances in Clinical Cardiology. Advances in Therapy 30:4, 369-386
41
Lan Vu, Noah J. Switzer, Christopher De Gara, Shahzeer Karmali. (2013) Surgical interventions for obesity and metabolic disease. Best Practice & Research Clinical Endocrinology & Metabolism 27:2, 239-246
42
K.O. Schwab. (2013) Evidenzbasierung von Maßnahmen zur Behandlung der Folgeerkrankungen kindlicher Adipositas. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 56:4, 551-554
43
David C.W. Lau, Hwee Teoh. (2013) Benefits of Modest Weight Loss on the Management of Type 2 Diabetes Mellitus. Canadian Journal of Diabetes 37:2, 128-134
44
Sean Wharton, Arya M. Sharma, David C.W. Lau. (2013) Weight Management in Diabetes. Canadian Journal of Diabetes 37, S82-S86
45
Kathrin Abegg, Marc Schiesser, Thomas A. Lutz, Marco Bueter. (2013) Acute peripheral GLP-1 receptor agonism or antagonism does not alter energy expenditure in rats after Roux-en-Y gastric bypass. Physiology & Behavior
46
Juan Jesús Tur, Antonio Jorge Escudero, María Micaela Alos, Ramón Salinas, Emma Terés, Joan B. Soriano, Gabriela Nicola, Juan Ramón Urgelés, Alberto Pagán, Baltasar Cortes, Xavier González, Bartolomé Burguera. (2013) One year weight loss in the TRAMOMTANA study. A randomized controlled trial. Clinical Endocrinologyn/a-n/a
47
R. Caiazzo, F. Pattou. (2013) Adjustable gastric banding, sleeve gastrectomy or gastric bypass. Can evidence-based medicine help us to choose?. Journal of Visceral Surgery 150:2, 85-95
48
Jacopo Desiderio, Stefano Trastulli, Vittorio Scalercio, Roberto Cirocchi, Giancarlo Carloni, Eleonora Moriconi, Carlo Boselli, Giuseppe Noya, Amilcare Parisi. (2013) Laparoscopic Sleeve Gastrectomy and Medical Management for the Treatment of Type 2 Diabetes Mellitus in Non-Morbidly Obese Patients: A Single-Center Experience. Diabetes Technology & Therapeutics 15:4, 281-288
49
J. B. Dixon, K.-Y. Hur, W.-J. Lee, M.-J. Kim, K. Chong, S.-C. Chen, N. E. Straznicky, P. Zimmet. (2013) Gastric bypass in Type 2 diabetes with BMI < 30: weight and weight loss have a major influence on outcomes. Diabetic Medicine 30:4, e127-e134
50
Brent L. Johnson, Dawn W. Blackhurst, Bruce B. Latham, David L. Cull, Eric S. Bour, Thomas L. Oliver, Bradley Williams, Spence M. Taylor, John D. Scott. (2013) Bariatric Surgery Is Associated with a Reduction in Major Macrovascular and Microvascular Complications in Moderately to Severely Obese Patients with Type 2 Diabetes Mellitus. Journal of the American College of Surgeons 216:4, 545-556
51
Amos Pines. (2013) Climacteric Commentaries. Climacteric 16:2, 293-302
52
Noah J., Andrew Smith, Daniel Birch, Shahzeer Karmali. (2013) The Metabolic Effects of Laparoscopic Sleeve Gastrectomy: A Review. Journal of Minimally Invasive Surgical Sciences 2:1,
53
Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer. (2013) Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society fo. Obesity 21:S1, S1-S27
54
Julia Kenkre, Tricia Tan, Stephen Bloom. (2013) Treating the obese diabetic. Expert Review of Clinical Pharmacology 6:2, 171-183
55
Jeroen Maljaars. (2013) Overeating makes the gut grow fonder; new insights in gastrointestinal satiety signaling in obesity. Current Opinion in Gastroenterology 29:2, 177-183
56
Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer. (2013) Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocrine Practice 19:2, 337-372
57
Jeffrey I. Mechanick, Adrienne Youdim, Daniel B. Jones, W. Timothy Garvey, Daniel L. Hurley, M. Molly McMahon, Leslie J. Heinberg, Robert Kushner, Ted D. Adams, Scott Shikora, John B. Dixon, Stacy Brethauer. (2013) Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surgery for Obesity and Related Diseases 9:2, 159-191
58
L. Sjöström. (2013) Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. Journal of Internal Medicine 273:3, 219-234
59
Matthew L Maciejewski, Lesley H Curtis, Bryan Dowd. (2013) Study design elements for rigorous quasi-experimental comparative effectiveness research. Journal of Comparative Effectiveness Research 2:2, 159-173
60
Dimitris Papamargaritis, Carel W. le Roux, Eleni Sioka, George Koukoulis, George Tzovaras, Dimitris Zacharoulis. (2013) Changes in gut hormone profile and glucose homeostasis after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases 9:2, 192-201
61
Ana Lopez-de-Andres, Rodrigo Jiménez-García, Valentin Hernández-Barrera, Ángel Gil-de-Miguel, Mª Isabel Jiménez-Trujillo, Pilar Carrasco-Garrido. (2013) Trends in utilization and outcomes of bariatric surgery in obese people with and without type 2 diabetes in Spain (2001–2010). Diabetes Research and Clinical Practice 99:3, 300-306
62
Luca Busetto, Fabio De Stefano, Sabrina Pigozzo, Gianni Segato, Maurizio De Luca, Franco Favretti. (2013) Long-term cardiovascular risk and coronary events in morbidly obese patients treated with laparoscopic gastric banding. Surgery for Obesity and Related Diseases
63
Dijian Shen, Huan Ye, Yuedong Wang, Yun Ji, Xiaoli Zhan, Jinhui Zhu, Wei Li. (2013) Comparison of short-term outcomes between laparoscopic greater curvature plication and laparoscopic sleeve gastrectomy. Surgical Endoscopy
64
Thomas Gautier, Thomas Sarcher, Nicolas Contival, Yannick Roux, Arnaud Alves. (2013) Indications and Mid-Term Results of Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Obesity Surgery 23:2, 212-215
65
Andrew C. Shin, Hans-Rudolf Berthoud. (2013) Obesity surgery: happy with less or eternally hungry?. Trends in Endocrinology & Metabolism 24:2, 101-108
66
Anoopa A. Koshy, Alexandria M. Bobe, Matthew J. Brady. (2013) Potential mechanisms by which bariatric surgery improves systemic metabolism. Translational Research 161:2, 63-72
67
Hideharu Shimizu, Shai Eldar, Helen M. Heneghan, Philip R. Schauer, John P. Kirwan, Stacy A. Brethauer. (2013) The effect of selective gut stimulation on glucose metabolism after gastric bypass in the Zucker diabetic fatty rat model. Surgery for Obesity and Related Diseases
68
Enrique Lanzarini, Attila Csendes, Luis Gutierrez, Pedro Cuevas, Hanns Lembach, Juan C. Molina, Maher Musleh, Italo Braghetto, Karin Papapietro, Verónica Araya, Rodolfo Lahsen, Pablo Olguin, Andrea Riffo, Emma Diaz, Denisse Montt, Luciana Marín. (2013) Type 2 Diabetes Mellitus in Patients with Mild Obesity: Preliminary Results of Surgical Treatment. Obesity Surgery 23:2, 234-240
69
Renato Pasquali. Management of the metabolic syndrome and glucose intolerance in women with PCOS. In: Novel Insights into the Pathophysiology & Treatment of PCOS. Future Medicine Ltd, 2013:110-121.
70
Karl J Neff, Carel W le Roux. (2013) Incretins: new targets for the prevention of diabetes and obesity. Clinical Lipidology 8:1, 109-121
71
Helene Johannessen, Yosuke Kodama, Chun-Mei Zhao, Mirta M L Sousa, Geir Slupphaug, Bård Kulseng, Duan Chen. (2013) Eating Behavior and Glucagon-Like Peptide-1-Producing Cells in Interposed Ileum and Pancreatic Islets in Rats Subjected to Ileal Interposition Associated with Sleeve Gastrectomy. Obesity Surgery 23:1, 39-49
72
C. Cardillo. (2013) Drug treatments to restore vascular function and diabesity. Annales Pharmaceutiques Françaises 71:1, 27-33
73
David E. Arterburn, Andy Bogart, Nancy E. Sherwood, Stephen Sidney, Karen J. Coleman, Sebastien Haneuse, Patrick J. O’Connor, Mary Kay Theis, Guilherme M. Campos, David McCulloch, Joe Selby. (2013) A Multisite Study of Long-term Remission and Relapse of Type 2 Diabetes Mellitus Following Gastric Bypass. Obesity Surgery 23:1, 93-102
74
ASMBS Clinical Issues Committee. (2013) Bariatric surgery in class I obesity (body mass index 30–35 kg/m2). Surgery for Obesity and Related Diseases 9:1, e1-e10
75
James R. Taylor, Eric Dietrich, Jason G. Powell. (2013) New and Emerging Pharmacologic Therapies for Type 2 Diabetes, Dyslipidemia, and Obesity. Clinical Therapeutics 35:1, A3-A17
76
Ana M Ramos-Levi, Lucio Cabrerizo, Pilar Matía, Andrés Sánchez-Pernaute, Antonio J Torres, Miguel A Rubio. (2013) Which criteria should be used to define type 2 diabetes remission after bariatric surgery?. BMC Surgery 13:1, 8
77
KJ Neff, T Olbers, CW le Roux. (2013) Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes. BMC Medicine 11:1, 8
78
Gábor Winkler. (2013) A súlyleadás sebészetének (bariátriai sebészet) anyagcsere-vonatkozásai. Orvosi Hetilap 154:1, 3-9
79
Suleyman Bozkurt, Halil Coskun, Huseyin Kadioglu, Naim Memmi, Gokhan Cipe, Yeliz Emine Ersoy, Banu Lebe, Mahmut Muslumanoglu. (2013) Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery. Case Reports in Dermatological Medicine 2013, 1-4
80
David Benaiges, Juana A. Flores Le-Roux, Juan Pedro-Botet, Juan J. Chillarón, Marine Renard, Alejandra Parri, José M. Ramón, Manuel Pera, Alberto Goday. (2013) Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance. International Journal of Surgery 11:4, 309-313
81
Shelby Sullivan. (2013) Endoscopy in the Management of Obesity. Gastrointestinal Endoscopy Clinics of North America 23:1, 165-175
82
Mark E. Williams, Greta Magerowski, George L. Blackburn. Nutritional and Metabolic Management of Obesity and the Metabolic Syndrome in the Patient with Chronic Kidney Disease. In: Nutritional Management of Renal Disease. Elsevier, 2013:457-471.
83
Young Min Cho. (2013) Mechanism of Weight Loss and Diabetes Remission after Bariatric/Metabolic Surgery. Korean Journal of Medicine 84:5, 629
84
Joel D. Kopple. Nutrition and Blood Pressure. In: Nutritional Management of Renal Disease. Elsevier, 2013:415-443.
85
Joo-Ho Lee. (2013) Bariatric Surgery. Korean Journal of Medicine 84:5, 640
86
Ya-Xiong Tao, Zong-Hui Yuan, Jun Xie. G Protein-Coupled Receptors as Regulators of Energy Homeostasis. Elsevier, 2013:1-43.
87
Hermann J. Kissler, Utz Settmacher. (2013) Bariatric Surgery to Treat Obesity. Seminars in Nephrology 33:1, 75-89
88
Helen M. Heneghan, Derrick Cetin, Sankar D. Navaneethan, Neil Orzech, Stacy A. Brethauer, Philip R. Schauer. (2013) Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surgery for Obesity and Related Diseases 9:1, 7-14
89
Ankur Jindal, Adam Whaley-Connell, Stephen Brietzke, James R Sowers. (2013) Therapy of obese patients with cardiovascular disease. Current Opinion in Pharmacology
90
A. Vella. (2013) Enteroendocrine secretion after roux-en-Y gastric bypass: is it important?. Neurogastroenterology & Motility 25:1, 1-3
91
Lovely Chhabra, Besiana Liti, Gayatri Kuraganti, Sudesh Kaul, Nitin Trivedi. (2013) Challenges in the Management of Type 2 Diabetes Mellitus and Cardiovascular Risk Factors in Obese Subjects: What Is the Evidence and What Are the Myths?. International Journal of Endocrinology 2013, 1-10
92
E. Ritz. (2012) Bariatric surgery and the kidney--much benefit, but also potential harm. Clinical Kidney Journal
93
Hilary Hoey, Anita Mlinac, Cam-Tuan Tran, Christof Schlaeger. (2012) 5 th Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, May 3–5, 2012, Dublin, Ireland. Diabetes Technology & Therapeutics 14:12, 1155-1173
94
Marco Castagneto, Geltrude Mingrone. (2012) The Effect of Gastrointestinal Surgery on Insulin Resistance and Insulin Secretion. Current Atherosclerosis Reports 14:6, 624-630
95
Ted D. Adams, Lance E. Davidson, Sheldon E. Litwin, Steven C. Hunt. (2012) Gastrointestinal Surgery: Cardiovascular Risk Reduction and Improved Long-Term Survival in Patients with Obesity and Diabetes. Current Atherosclerosis Reports 14:6, 606-615
96
Fady Moustarah, Audrée Gilbert, Jean-Pierre Després, André Tchernof. (2012) Impact of Gastrointestinal Surgery on Cardiometabolic Risk. Current Atherosclerosis Reports 14:6, 588-596
97
Bjørn Hofmann. (2012) Parachutes for diabetes: Bariatric surgery beyond evidence?. Diabetes Research and Clinical Practice 98:3, 406-407
98
Dimitrios Papamargaritis, Eleftheria Panteliou, Alexander D. Miras, Carel W. Roux. (2012) Mechanisms of Weight Loss, Diabetes Control and Changes in Food Choices After Gastrointestinal Surgery. Current Atherosclerosis Reports 14:6, 616-623
99
Melanie E. Mabrey, Allison Vorderstrasse, Mary Champagne, Lisa Clark Pickett. (2012) Continuous Intravenous Insulin: An Evaluation in Bariatric Patients Outside of the Intensive Care Unit. Bariatric Nursing and Surgical Patient Care 7:4, 172-182
100
H. M. Heneghan, S. Nissen, P. R. Schauer. (2012) Gastrointestinal Surgery for Obesity and Diabetes: Weight Loss and Control of Hyperglycemia. Current Atherosclerosis Reports 14:6, 579-587
101
Francesco Rubino, David E. Cummings. (2012) Surgery: The coming of age of metabolic surgery. Nature Reviews Endocrinology 8:12, 702-704
102
Matthew L. Maciejewski, Deborah A. Winegar, Joel F. Farley, Bruce M. Wolfe, Eric J. DeMaria. (2012) Risk stratification of serious adverse events after gastric bypass in the Bariatric Outcomes Longitudinal Database. Surgery for Obesity and Related Diseases 8:6, 671-677
103
F. L. Santos, S. S. Esteves, A. da Costa Pereira, W. S. Yancy Jr, J. P. L. Nunes. (2012) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews 13:11, 1048-1066
104
(2012) Scientific surgery. British Journal of Surgery 99:11, 1604-1604
105
Polonsky , Kenneth S. , . (2012) The Past 200 Years in Diabetes. New England Journal of Medicine 367:14, 1332-1340
Free Full Text106
J Graessler, Y Qin, H Zhong, J Zhang, J Licinio, M-L Wong, A Xu, T Chavakis, A B Bornstein, M Ehrhart-Bornstein, V Lamounier-Zepter, T Lohmann, T Wolf, S R Bornstein. (2012) Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters. The Pharmacogenomics Journal
107
Charlotte X. Dong, Patricia L. Brubaker. (2012) Ghrelin, the proglucagon-derived peptides and peptide YY in nutrient homeostasis. Nature Reviews Gastroenterology & Hepatology 9:12, 705-715
108
Sheila A Doggrell, Vincent Chan. (2012) Bariatric surgery or medicine for type 2 diabetes?. Expert Opinion on Pharmacotherapy 13:15, 2249-2253
109
H. S. Füessl. (2012) Kausale Diabetestherapie durch den Chirurgen. MMW - Fortschritte der Medizin 154:17, 42-42
110
Bipan Chand. (2012) Endoluminal bariatric therapy: beyond weight loss. Gastrointestinal Endoscopy 76:4, 761-762
111
Rachel H. Mackey, Steven H. Belle, Anita P. Courcoulas, Greg F. Dakin, Clifford W. Deveney, David R. Flum, Luis Garcia, Wendy C. King, Lewis H. Kuller, James E. Mitchell, Alfons Pomp, Walter J. Pories, Bruce M. Wolfe. (2012) Distribution of 10-Year and Lifetime Predicted Risk for Cardiovascular Disease Prior to Surgery in the Longitudinal Assessment of Bariatric Surgery-2 Study. The American Journal of Cardiology 110:8, 1130-1137
112
P. E. Marik. (2012) The malignant obesity hypoventilation syndrome (MOHS). Obesity Reviews 13:10, 902-909
113
David Bradley, Faidon Magkos, Samuel Klein. (2012) Effects of Bariatric Surgery on Glucose Homeostasis and Type 2 Diabetes. Gastroenterology 143:4, 897-912
114
P. E. Harris, R. L. Leibel. (2012) Neurofunctional imaging of β-cell dynamics. Diabetes, Obesity and Metabolism 14, 91-100
115
Bruce M. Wolfe. (2012) Presidential address—obesity discrimination: what can we do?. Surgery for Obesity and Related Diseases 8:5, 495-500
116
Jeffrey I. Mechanick, Alan J. Garber, Yehuda Handelsman, W. Timothy Garvey. (2012) American Association of Clinical Endocrinologists' Position Statement on Obesity and Obesity Medicine. Endocrine Practice 18:5, 642-648
117
Young Min Cho, Catherine E. Merchant, Timothy J. Kieffer. (2012) Targeting the glucagon receptor family for diabetes and obesity therapy. Pharmacology & Therapeutics 135:3, 247-278
118
A.E. Pontiroli. (2012) Bariatric surgery for obese type 2 diabetes: Do we have enough information?. Nutrition, Metabolism and Cardiovascular Diseases 22:9, e24-e25
119
Francesca Abbatini, Danila Capoccia, Giovanni Casella, Emanuele Soricelli, Frida Leonetti, Nicola Basso. (2012) Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy. Surgery for Obesity and Related Diseases
120
Jacobs , Danny O. , . (2012) Bariatric Surgery — From Treatment of Disease to Prevention?. New England Journal of Medicine 367:8, 764-765
Full Text121
(2012) Bariatric Surgery or Medical Therapy for Obesity. New England Journal of Medicine 367:5, 473-476
Free Full Text122
Mitchell S. Roslin, Yuriy Dudiy, Joanne Weiskopf, Tanuja Damani, Paresh Shah. (2012) Comparison Between RYGB, DS, and VSG Effect on Glucose Homeostasis. Obesity Surgery 22:8, 1281-1286
123
(2012) Glycemic Management of Type 2 Diabetes Mellitus. New England Journal of Medicine 367:2, 181-183
Free Full Text124
Katrina Brakoniecki, Christine Ren-Fielding, Blandine Laferrère. (2012) A closer look at diabetes remission after gastric bypass surgery: a case study. Surgery for Obesity and Related Diseases
125
C. Ciangura, J. Aron-Wisnewsky, C. Poitou-Bernert, J. -L. Bouillot, A. Basdevant. (2012) Urgences chez le patient opéré d’une chirurgie de l’obésité. Annales françaises de médecine d'urgence 2:4, 243-252
126
Allen , David B. , . (2012) TODAY — A Stark Glimpse of Tomorrow. New England Journal of Medicine 366:24, 2315-2316
Full Text127
David A Sarruf, Susan Bonner-Weir, Michael W Schwartz. (2012) New clues to bariatric surgery's benefits. Nature Medicine 18:6, 860-861
128
C. Jurowich, C.T. Germer, F. Seyfried, A. Thalheimer. (2012) Metabolische Chirurgie. Der Chirurg 83:6, 583-600
129
Scott P. Edwards. (2012) Prevention: Nipped in the bud. Nature 485:7398, S18-S19
130
Albert Lecube, Bartolomé Burguera, Miguel Ángel Rubio. (2012) Breaking therapeutic inertia: Should metabolic surgery be considered one more option for the treatment of type 2 diabetes mellitus?. Endocrinología y Nutrición (English Edition) 59:5, 281-283
131
Albert Lecube, Bartolomé Burguera, Miguel Ángel Rubio. (2012) Rompiendo la inercia terapéutica: ¿debe considerarse la cirugía metabólica una opción más en el tratamiento de la diabetes mellitus tipo 2?. Endocrinología y Nutrición 59:5, 281-283
132
Zimmet , Paul , Alberti , K. George M.M. , . (2012) Surgery or Medical Therapy for Obese Patients with Type 2 Diabetes?. New England Journal of Medicine 366:17, 1635-1636
Full Text133
R.N. Abramof. (2012) Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. Yearbook of Endocrinology 2012, 122-124
134
R.N. Abramof. (2012) Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. Yearbook of Medicine 2012, 438-440
135
Yoon-Seok Heo, Joong-Min Park, Yong-Jin Kim, Seong-Min Kim, Do-Joong Park, Sang-Kuon Lee, Sang-Moon Han, Kyung-Won Shim, Yeon-Ji Lee, Ja-Youn Lee, Jin-Won Kwon. (2012) Bariatric surgery versus conventional therapy in obese Korea patients: a multicenter retrospective cohort study. Journal of the Korean Surgical Society 83:6, 335
- Comments (9)
-
9 Reader's Comments
FERNANDO MENESES, MD | Physician - CARDIOVASCULAR DISEASE | Disclosure: NoneQUITO EcuadorApril 27, 2012A great step in tretment of obese diabetics
The recommendations on the management of obese diabetics will change in this sense if the patients of this study are continued long term and improvements are demonstrated in clinical results such as improvements in cardiovascular morbidity and mortality. When we design and execute multicentric prospective studies that compare bariatric surgery and Intensive Medical Therapy, (IMT); when “the procedures of bariatric surgery must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures.” Also, it is necessary to study the cost-effectiveness thoroughly in developing countries as mine.
Dr. Shauer and collaborators have opened the way in the search from an universal recommendation of bariatric surgery,as first line therapy,associated with IMT, in obese diabetic patients.Nick Cross | Physician - Nephrology | Disclosure: NoneNew ZealandApril 27, 2012Effect on proteinuria?
A very well conducted and reported study, thank you.
I'm interested in whether there was any effect of the intervention in the admittedly small proportion of patients with microalbuminuria and established diabetic nephropathy (macroalbuminuria)?DR JONATHAN EHRMAN, PHD | Other | Disclosure: NoneDETROIT MIApril 26, 2012Agree with Dr. Primack-Not the BEST comparison
This study is interesting..thank you. But as stated by Dr. Primack the wt loss is not a fair comparison. Although stated as intensive medical therapy, the wt loss portion was not intensive and achieved what would be expected from a standard hypo-caloric meal plan. Look AHEAD achieved an 8.5% wt reduction at 12 months in the ILI group which included meal replacements.
It is time to do a head-to-head prospective comparison of surgery vs. highly aggressive non-surgical weight loss to determine if improvement is due to wt loss alone or the method of wt loss (surgery vs. diet). In my opinion complete meal replacement (aka, VLCD) would be the best comparison. And it MUST be delivered in a behavior-based program with experience and clinical experts (registered dietitians on board with this method of weight loss, clinical exercise physiologists trained in this difficult population, and behavioralists with an interest and expertise in this population). Wt loss will not be equal..but it will be far closer than the current study. And as with surgery, experts would deliver the intervention.PHIL SCHAUER, MD | Physician - GENERAL SURGERY | Disclosure: Financial tie to a maker of a relevant drug or deviceCLEVELAND OHApril 25, 2012The Author Replies
Comment #1 in response to Diana Cox:
DS or duodenal switch (approximately 2% of bariatric operations) is similar to the BPD procedure performed in the Mingrone study of this issue. It was not mentioned in our study because it was not performed. While it does result in improvement in glycemic control like other BPD procedures it does carry a greater risk of nutritional deficiencies than sleeve gastrectomy and Roux-enY gastric bypass.
Comment #2, in response to Craig Primack, MD:
This study did include medical weight loss strategies along with intense medical treatment (see methods and supplement). The average weight loss was 5.4 Kg for the medical group which was similar to weight loss achieved in the LookAhead study that did employ such weight loss strategies. The medical patients did achieve a drop in HbA1c by 1.4%, comparable to other studies.
Comment #3, in response to Priyadarshi Mir
There is no evidence in humans to support "periodic feed withdrawal or fasting" as a practical therapeutic strategy for treating type 2 diabetes.
Comment #4, in response to Joseph Chemplavil, MD
Control of hyperglycemia is well supported by multiple large RCTS. Major long-term complications of gastric bypass are generally rare and manageable while uncontrolled diabetes has a high morbidity and mortality.DIANA COX | Other | Disclosure: NoneSAN JOSE CAMarch 27, 2012Wither the DS?
Not one WORD about the duodenal switch, which you KNOW works better and has more durable results, in your report, nor in your interviews with the media. I call that intellectual disingenuousness, if not outright dishonesty.
CRAIG PRIMACK, MD | Physician - INTERNAL MEDICINE/PEDIATRICS | Disclosure: NoneSCOTTSDALE AZMarch 26, 2012Disappointing Comparison: apple vs. not apples
It's disappointing to see that this study compares surgery with "standard" medical therapy. I feel that we all would have been better served comparing bariatric surgery with medical weight loss therapy (diet, exercise, behavior change and other appropriate medical interventions) and not standard medical care with routine medications.
If these patients had been successful with standard medical treatments, they would possibly not need to undergo surgery at all. Surgery does have its place in diabetes care yet it was not a fair comparison in this study.Priyadarshini Mir | Other | Disclosure: NoneCanadaMarch 26, 2012Barriatric surgery and metabolic syndrome
Our research studies with pigs indicated that 48h feed withdrawal every 4 weeks led to increase in glucose uptake into fat in adipocytes from the omental adipose. The highest glucose uptake activity was noted in omental adipocytes in the diameter range of 90-110micro metres. This regimen also led to decrease in area under the curve for glucose during a GTT, when considered against that in non-feed withdrawan pigs. It would be less intrusive to try periodic feed withdrawal or fasting to control metabolic syndrome symptoms than surgery.
JOSEPH CHEMPLAVIL, MD | Physician - ENDOCRINOLOGY DIABETES METAB | Disclosure: NoneHAMPTON VAMarch 26, 2012Is this the Eureka moment or Flavor of the decade for type 2 DM treatment?
Hyperglycemia is not diabetes even though that is what we measure and treat in diabetes. The development of diabetes and its microvascular and macrovascular complications are genetically determined and aggravated by obesity and other risk factors. Bariatric surgery can bring about remission of hyperglycemia but not remission or cure of diabetes, as seen in these studies.
Will this glucose control induce remission of diabetic complications as well in this population in the long run? Are we trading glucose control by bariatric surgery with another life long post-surgery syndrome/disease with all other associated problems that comes with it? We should use judicious restraint and caution not to replace our present epidemic of type 2 diabetes with obesity with another epidemic of post-gastric by-pass syndrome. - Letters
Simplify self control
Although it was not reported, it seems likely that the surgical paitients did better because they ate less. The rest might find this easier if food were labelled by the time needed to get rid of it rather than by percentage of a daily calory requirement. And urinary testing would call attention to occasional overload more directly than fasting glucose or glycation.