Clinical Outcomes of Metabolic Surgery: Microvascular and Macrovascular Complications

Adams, Ted D.; Arterburn, David; Nathan, David M.; Eckel, Robert H.

doi:10.2337/dc16-0157

Cited by 57 publications

(43 citation statements)

References 93 publications

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“…A substantial body of evidence has now been accumulated, including data from numerous randomized controlled (nonblinded) clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in patients with type 2 diabetes and obesity compared with various lifestyle/medical interventions (17). Improvements in microvascular complications of diabetes, cardiovascular disease, and cancer have been observed only in nonrandomized observational studies (44)(45)(46)(47)(48)(49)(50)(51)(52)(53). Cohort studies attempting to match surgical and nonsurgical subjects suggest that the procedure may reduce longer-term mortality (45).…”

Section: 16mentioning

confidence: 99%

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

131

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. There is strong and consistent evidence that obesity management can delay the progression from prediabetes to type 2 diabetes (1-5) and is beneficial in the treatment of type 2 diabetes (6-17). In patients with type 2 diabetes who are overweight or obese, modest and sustained weight loss has been shown to improve glycemic control and to reduce the need for glucose-lowering medications (6-8). Small studies have demonstrated that in patients with type 2 diabetes and obesity, more extreme dietary energy restriction with very low-calorie diets can reduce A1C to ,6.5% (48 mmol/mol) and fasting glucose to ,126 mg/dL (7.0 mmol/L) in the absence of pharmacologic therapy or ongoing procedures (10,18,19). Weight lossinduced improvements in glycemia are most likely to occur early in the natural history of type 2 diabetes when obesity-associated insulin resistance has caused reversible b-cell dysfunction but insulin secretory capacity remains relatively preserved (8,11,19,20). The goal of this section is to provide evidence-based recommendations for weight-loss therapy, including diet, behavioral, pharmacologic, and surgical interventions, for obesity management as treatment for hyperglycemia in type 2 diabetes. ASSESSMENT Recommendation 8.1 At each patient encounter, BMI should be calculated and documented in the medical record. B At each routine patient encounter, BMI should be calculated as weight divided by height squared (kg/m 2) (21). BMI should be classified to determine the presence of overweight or obesity, discussed with the patient, and documented in the patient Suggested citation: American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes:

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Section: 16mentioning

confidence: 99%

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

131

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“…A substantial body of evidence has now accumulated, including data from numerous randomized controlled clinical trials, demonstrating that metabolic surgery achieves superior glycemic control and reduction of cardiovascular risk factors in obese patients with type 2 diabetes compared with various lifestyle/medical interventions (35). Improvements in micro-and macrovascular complications of diabetes, cardiovascular disease, and cancer have been observed only in nonrandomized observational studies (37)(38)(39)(40)(41)(42)(43)(44)(45)(46). Cohort studies attempting to match surgical and nonsurgical subjects suggest that the procedure may reduce longer-term mortality (38 (35).…”

mentioning

confidence: 99%

7. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

103

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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“…Imprecise estimates from a few RCTs suggest improvements in cardiovascular risk factors and quality of life, and some observational studies suggest that bariatric surgery may reduce microvascular and macrovascular diabetes complications. 4,5 These benefits have not been confirmed by RCTs. One modeling analysis estimated that the cost per quality-adjusted life-year (QALY) of bariatric surgery in patients with T2D is $3200 to $6300 (with $50000/QALY deemed appropriate for coverage).…”

Section: Benefits and Harmsmentioning

confidence: 97%

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes

Brito

Montori

Davis

2017

JAMA

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Type 2 diabetes affects 12% to 14% of persons in the United States, with prevalence rates exceeding 20% in non-Hispanic black, Asian, and Hispanic populations. 1 Pharmaceutical and behavioral approaches to restore glucose homeostasis and to avoid longterm complications of diabetes may be effective, but sustaining adherence is often difficult. 2 Gastrointestinal operations (Roux-en-Y gastric bypass, vertical sleeve gastrectomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion) provide substantial weight loss and often improve function and reduce obesity-related complications. 3 Some consider bariatric interventions as metabolic surgeries when the goal is to improve metabolic health rather than weight alone, and these procedures can lead to changes in the gut microbiome and hormones, bile acid metabolism, and other factors that affect glucose homeostasis independent of weight loss. 4 Recent studies and an emerging consensus suggest metabolic surgery to treat T2D in some patients. However, a firm link between controlling diabetes through metabolic surgery and preventing diabetes complications has yet to be established. Characteristics of the Guideline SourceThis guideline was published by delegates of the Second Diabetes Surgery Summit (DSS-II), an international consensus conference organized in collaboration with major diabetes organizations (Table ). 4 The DSS-II organizing committee tasked 48 academic experts (75% nonsurgeons) with unclear relevant financial relationships to write a guideline for the surgical treatment of T2D. Prior to meeting, delegates received an evidence summary and the proposed recommendations. They used an interactive feedback process to reach agreement (Ն67%). Consensus recommendations were presented Clinical Review & Education JAMA Clinical Guidelines Synopsis

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Clinical Outcomes of Metabolic Surgery: Microvascular and Macrovascular Complications

Cited by 57 publications

References 93 publications

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2019

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2019

7. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2018

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes

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