Bariatric Surgery Versus Intensive Medical Therapy in Obese Patients With Diabetes

Schauer, Philip; Kashyap, Sangeeta R.; Wolski, Kathy; Brethauer, Stacy A.; Kirwan, John P.; Pothier, Claire E.; Thomas, Shirley; Abood, Beth; Nissen, Steven E.; Bhatt, Deepak L.

doi:10.1097/sa.0b013e31827f316e

Cited by 169 publications

(202 citation statements)

References 17 publications

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“…Schauer et al, then used an A1c value of 6.0% as their target for T2DM and glycemic control outcomes. The surgical groups had significantly more patients reach the A1c target of 6.0% (42% for RYGB, 37% for LSG) in comparison to the medical therapy group (12%) [15]. However, there was no difference between the RYGB and LSG groups with respect to the A1c target.…”

Section: Bariatric Surgery and Medical Therapy For T2dmmentioning

confidence: 65%

“…Fasting glucose was also significantly lower in the surgical groups (5.5 mmol/L for RYGB and 5.4 mmol/L for LSG) when compared to the medical therapy group (6.7 mmol/L). The limitations of this study was the short follow-up time and the fact that 9 (18%) of the medical therapy patients did not follow-up [15]. However, the use of well-defined lab measurements for monitoring T2DM outcomes is commendable.…”

Section: Bariatric Surgery and Medical Therapy For T2dmmentioning

confidence: 99%

“…A recent randomized trial by Schauer et al, compared bariatric surgery to conventional medical therapy with the major outcome being improvement in T2DM [15]. A total of 150 patients were divided evenly into a medical therapy, RYGB, and LSG groups.…”

Section: Bariatric Surgery and Medical Therapy For T2dmmentioning

confidence: 99%

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Treatment of obesity and diabetes with bariatric surgery

Whitlock¹,

Gill²,

Switzers³

et al. 2013

Glob Epidemi Obes

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Obesity rates are on the rise worldwide. Nearly 1 in every 4 Canadians is classified as being overweight. With an increase in obesity, there is also a correlated rise in its comorbidities, most notably Type-2 Diabetes Mellitus (T2DM). Bariatric surgery is superior to diet and lifestyle management in managing the severe obese. These bariatric procedures are traditionally classified as either being restrictive(reducing caloric intake), or malabsorptive (re-routing the gastrointestinal tract). The roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric surgery. Studies have shown that post-RYGB, there is a significant improvement or even complete resolution in patients' type-2 diabetes mellitus (T2DM), with significantly more patients achieving euglycemia compared to the control population. RYGB has also been shown to prevent the development of T2DM. When RYGB was compared to more restrictive procedures, it achieved superior results in both weight-loss and T2DM resolution and the maintenance of these results long-term. The superiority of procedures, such as RYGB, is potentially explained through alterations in gut hormones, ghrelin and GLP-1. In this review, we explore the role of bariatric surgery in the prevention and treatment of T2DM, with a specific focus on the recent evidence surrounding surgical treatment via RYGB.

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Section: Bariatric Surgery and Medical Therapy For T2dmmentioning

confidence: 65%

Section: Bariatric Surgery and Medical Therapy For T2dmmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of obesity and diabetes with bariatric surgery

Whitlock¹,

Gill²,

Switzers³

et al. 2013

Glob Epidemi Obes

View full text Add to dashboard Cite

show abstract

“…one study (25) included patients with mild T2DM; in other studies (26)(27)(28), patients had on average 6-to 9-year duration of T2DM with inadequate glycemic control (HbA1c from 8.5% to 9.6%). Surgery in all studies resulted in significantly better glycemic control, and more patients achieved primary end points.…”

Section: Surgery Versus Conventional Treatmentmentioning

confidence: 99%

“…Schauer et al (28,29) in a single-center RCT included 150 patients with T2DM and BMI 27-43 kg/ m 2 into intensive medical therapy alone or intensive medical therapy plus either RyGB or sleeve gastrectomy (SG) group. The number of patients was equally distributed between the treatment arms.…”

Section: Surgery Versus Conventional Treatmentmentioning

confidence: 99%

Surgery in the treatment of type 2 diabetes mellitus

et al. 2015

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Background and Aims: the prevalence of diabetes is increasing worldwide, and most of the cases are type 2 diabetes mellitus. the relationship between type 2 diabetes mellitus and obesity is well established, and surgical treatment is widely used for obese patients with type 2 diabetes mellitus. the aim was to present current knowledge about the possible mechanisms responsible for glucose control after surgical procedures and to review the surgical treatment results.Material and Methods: medical literature was searched for the articles presenting the impact of surgical treatment on glycemic control, long-term results, and possible mechanisms of action among obese individuals with type 2 diabetes mellitus.Results: remission of type 2 diabetes mellitus after bariatric surgery depends on the definition of the remission used. complete remission rate after surgery with the new criteria is lower than was considered before. randomized controlled studies demonstrate that surgery is superior to best medical treatment for the patients with type 2 diabetes mellitus. the recurrence of type 2 diabetes mellitus after bariatric surgery is observed in up to 40% of cases with ≥5 years of follow-up. despite the recurrence of type 2 diabetes mellitus in this group, better glycemic control and lower risk of macrovascular complications are present. incretin effects on glycemic control after bariatric surgery are well described, but the role of other possible mechanisms (bile acids, microbiota, intestinal gluconeogenesis) in humans is unclear.Conclusion: Surgery is an effective treatment of type 2 diabetes mellitus in obese patients. the most optimal surgical procedure for the treatment of obese patients with type 2 diabetes mellitus is still to be established. more research is needed to explore the mechanisms of glycemic control after bariatric surgery.

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