Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications

Sjöström, Lars; Peltonen, Markku; Jacobson, Peter; Ahlin, Sofie; Andersson‐Assarsson, Johanna C.; Anveden, Åsa; Bouchard, Claude; Carlsson, Björn; Karason, Kristjan; Lönroth, Hans; Näslund, Ingmar; Sjöström, Elisabeth Stoltz; Taube, Magdalena; Wedel, Hans; Svensson, Per‐Arne; Sjöholm, Kajsa; Carlsson, Lena

doi:10.1001/jama.2014.5988

Cited by 896 publications

(705 citation statements)

References 40 publications

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“…Furthermore, we recently showed that diabetes remission is markedly higher in operated patients [9]. We now extend these findings and show that for a given degree of weight loss, from a minor weight reduction (1-9 BMI units) to a major weight reduction (over 15 BMI units), the effect of surgery on diabetes prevention and remission was independent of the initial BMI level.…”

Section: Discussionsupporting

confidence: 72%

“…Type 2 diabetes was defined as fasting blood glucose of 6.1 mmol/l or higher, corresponding to a fasting plasma glucose of 7.0 mmol/l or higher, or diabetes medication use (insulin, oral glucose-lowering drugs, or both). Diabetes remission was defined as blood glucose levels lower than 6.1 mmol/l and no diabetes medication [3,9].…”

Section: Methodsmentioning

confidence: 99%

“…In severely obese individuals, surgically induced weight loss significantly lowers the incidence of type 2 diabetes [2][3][4] and primary prevention trials have shown that moderate weight reduction can reduce the risk for type 2 diabetes in obese individuals with impaired glucose tolerance [5][6][7][8]. Furthermore, in many patients with type 2 diabetes, bariatric surgery results in diabetes remission over 2 years [9,10], although relapses may later occur [9].…”

Section: Introductionmentioning

confidence: 99%

“…Current guidelines for bariatric surgery are based on BMI alone or on BMI in combination with comorbidities [11,12]. In the Swedish Obese Subjects (SOS) study (ClinicalTrials.gov registration NCT01479452), however, we have repeatedly found that baseline BMI is not a predictor of long-term bariatric surgery outcomes such as reduction of cardiovascular events, overall mortality and cancer or type 2 diabetes prevention and remission [3,9,[13][14][15]. In this study, we analyse the SOS study data in more detail to reveal whether incidence and remission rates for type 2 diabetes differ among participants with different baseline BMI but similar weight loss over 2 years.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study

et al. 2015

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Aims/hypothesis The aim of this work was to analyse the rates of incidence and remission of type 2 diabetes in relation to baseline BMI and weight change in the prospective, controlled Swedish Obese Subjects (SOS) study. Methods Three-thousand four-hundred and eighty-five obese individuals receiving bariatric surgery or conventional treatment were grouped into four baseline BMI categories (<35, 35-40, 40-45 or ≥45 kg/m 2 ) and five weight-change categories according to their BMI at 2 years (increase [≥1 BMI unit increase], no change [less than 1 BMI unit change], minor reduction [−1 to −9 BMI units], medium reduction [−10 to −14 BMI units] and major reduction [< −15 BMI units]). The incidence and remission of diabetes at 2 years was assessed. Results Among individuals with no weight change, diabetes incidence rates were 5.5%, 7.4%, 8.3% and 5.2%, in the four baseline BMI categories, respectively. In those with an initial BMI of 35-40, 40-45 and ≥45 kg/m 2 who attained a minor reduction in weight, the corresponding rates were 1.3%, 1.2% and 3.4%, respectively. In both the medium-and majorweight-reduction groups, diabetes incidence was ≤0.5%. Among individuals with diabetes at baseline, the remission rates were 15.3-26.9% in the no-weight-change groups, and 48.1-70% for individuals who attained a minor weight reduction. In the medium-and major-weight-reduction groups, the remission rate was 77-97%. There were no differences in 2 year incidence and remission rates between different baseline BMI groups that achieved the same degree of weight reduction. Conclusions/interpretation In obese individuals, the favourable effect of weight reduction on type 2 diabetes incidence and remission is independent of initial BMI. Trial registration ClinicalTrials.gov number NCT01479452

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Section: Discussionsupporting

confidence: 72%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study

et al. 2015

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“…in 1995 82. Strong evidence has shown that bariatric surgery is an effective treatment for severe obesity (BMI >35 kg/m 2 ) and results in marked improvement of T2DM control 10, 83, 84. Derived from bariatric surgery, metabolic surgery is focused on T2DM treatment in mildly obese or overweight patients (BMI <35 kg/m 2 ) 85.…”

Section: From Bariatric To Metabolic Surgerymentioning

confidence: 99%

Recent advancements in bariatric/metabolic surgery

Lee

Almalki

2017

Annals of Gastroent Surgery

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Obesity and type 2 diabetes mellitus (T2DM) are currently two pan‐endemic health problems worldwide and are associated with considerable increase in morbidity and mortality. Both diseases are closely related and very difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. Bariatric surgery has proven successful in treating not just obesity but also in significantly decreasing overall obesity‐associated morbidities as well as improving quality of life in severely obese patients (body mass index [BMI] >35 kg/m2). A rapid increase in bariatric surgery started in the 2000s when the laparoscopic surgical technique was introduced into this field. Many new procedures had been developed and changed the face of modern bariatric surgery. Recently, bariatric surgery played as gastrointestinal metabolic surgery has been proposed as a new treatment modality for obesity‐related T2DM for patients with BMI >35 kg/m2. Strong evidence has demonstrated that bariatric/metabolic surgery is an effective and durable treatment for obese T2DM patients. Bariatric/metabolic surgery is now becoming an important surgical division. The present article examines and discusses recent advancements in bariatric/metabolic surgery and covers four major fields: (i) the rapid increase in numbers and better safety; (ii) new procedures with better outcomes; (iii) from bariatric to metabolic surgery; and (iv) understanding the mechanisms and personalized treatment.

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Controlling the Metabolic Roller Coaster in Diabetes

Cappola

Livingston²

2014

JAMA

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Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications

Cited by 896 publications

References 40 publications

Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study

Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study

Recent advancements in bariatric/metabolic surgery

Controlling the Metabolic Roller Coaster in Diabetes

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