Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30–35 kg/m2) Indian patients with type 2 diabetes mellitus

Lakdawala, Muffazal; Shaikh, Shehla; Bandukwala, Saifee; Remedios, Carlyne; Shah, Miloni; Bhasker, Aparna Govil

doi:10.1016/j.soard.2012.07.017

Cited by 49 publications

(21 citation statements)

References 30 publications

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“…There is generally agreement among the published studies that gastrointestinal bypass procedures achieve higher rates of remission than procedures involving restriction of the gastric fundus only and that patients who have long-standing T2DM or require insulin at the time of surgery have lower remission rates. 7,19–22 Currently, though, there are relatively few studies reporting long-term T2DM remission rates after bariatric surgery and fewer still that report long-term biochemical evidence of remission (Table 6). …”

Section: Discussionmentioning

confidence: 99%

Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

et al. 2013

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Objective Evaluate the long-term effects of bariatric surgery on type 2 diabetes (T2DM) remission and metabolic risk factors. Background Although the impressive antidiabetic effects of bariatric surgery have been shown in short- and medium-term studies, the durability of these effects is uncertain. Specifically, long-term remission rates following bariatric surgery are largely unknown. Methods Clinical outcomes of 217 patients with T2DM who underwent bariatric surgery between 2004 and 2007 and had at least 5-year follow-up were assessed. Complete remission was defined as glycated hemoglobin (A1C) less than 6% and fasting blood glucose (FBG) less than 100 mg/dL off diabetic medications. Changes in other metabolic comorbidities, including hypertension, dyslipidemia, and diabetic nephropathy, were assessed. Results At a median follow-up of 6 years (range: 5–9) after surgery (Roux-en-Y gastric bypass, n = 162; gastric banding, n = 32; sleeve gastrectomy, n = 23), a mean excess weight loss (EWL) of 55% was associated with mean reductions in A1C from 7.5% ± 1.5% to 6.5% ± 1.2% (P < 0.001) and FBG from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24% and 26%, respectively, whereas 34% improved (>1% decrease in A1C without remission) from baseline and 16% remained unchanged. Shorter duration of T2DM (P < 0.001) and higher long-term EWL (P = 0.006) predicted long-term remission. Recurrence of T2DM after initial remission occurred in 19% and was associated with longer duration of T2DM (P = 0.03), less EWL (P = 0.02), and weight regain (P = 0.015). Long-term control rates of low high-density lipoprotein, high low-density lipoprotein, high triglyceridemia, and hypertension were 73%, 72%, 80%, and 62%, respectively. Diabetic nephropathy regressed (53%) or stabilized (47%). Conclusions Bariatric surgery can induce a significant and sustainable remission and improvement of T2DM and other metabolic risk factors in severely obese patients. Surgical intervention within 5 years of diagnosis is associated with a high rate of long-term remission.

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Section: Discussionmentioning

confidence: 99%

Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

et al. 2013

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“…However, this type of erosion of diabetes remission rates over time is compatible with what is observed among patients with a preoperative BMI ≥35 kg/m 2 , in whom 35–50% of individuals who initially achieve diabetes remission also eventually experience relapse (11,15,16,36). With or without diabetes recurrence, the large majority of patients with a baseline BMI either above or below 35 kg/m 2 who undergo bariatric/metabolic surgery maintain substantial improvement of glycemic control for many years, and Lakdawala et al (42) reported that 96% of their study participants had improved metabolic status at 5 postoperative years.…”

Section: Evidence Regarding the Use Of Bariatric/metabolic Surgery Tomentioning

confidence: 96%

“…6. Lakdawala et al (42) performed a prospective observational analysis of 52 Asian Indian patients with a BMI of 30–35 kg/m 2 and poorly controlled T2DM at baseline who underwent RYGB and were followed for 5 years. Although the rate of complete diabetes remission at 1 year was high at 73% (similar to that typically seen at this time point after RYGB in patients with BMI ≥35 kg/m 2 [2,3,10]), full remission had dropped to 58% by 5 years.…”

Section: Evidence Regarding the Use Of Bariatric/metabolic Surgery Tomentioning

confidence: 99%

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2

2016

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OBJECTIVEGlobal usage of bariatric surgery has been dictated for the past quarter century by National Institutes of Health recommendations restricting these operations to individuals with a BMI ≥35 kg/m2. Strong evidence now demonstrates that bariatric procedures markedly improve or cause remission of type 2 diabetes mellitus (T2DM), in part through weight-independent mechanisms, and that baseline BMI does not predict surgical benefits on glycemic or cardiovascular outcomes. This impels consideration of such operations as “metabolic surgery,” which is used expressly to treat T2DM, including among patients with a BMI <35 kg/m2 who constitute the majority of people with diabetes worldwide. Here, we review available evidence to inform that consideration.RESULTSA meta-analysis of the 11 published randomized clinical trials (RCTs) directly comparing bariatric/metabolic surgery versus a variety of medical/lifestyle interventions for T2DM provides level 1A evidence that surgery is superior for T2DM remission, glycemic control, and HbA1c lowering. Importantly, this is equally true for patients whose baseline BMI is below or above 35 kg/m2. Similar conclusions derive from meta-analyses of high-quality nonrandomized prospective comparisons. Meta-analysis of all pertinent published studies indicates that T2DM remission rates following bariatric/metabolic surgery are comparable above and below the 35 kg/m2 BMI threshold. The safety, antidiabetes durability, and benefits on other cardiovascular risk factors from bariatric/metabolic surgery appear roughly comparable among patients with a BMI below or above 35 kg/m2. Further studies are needed to extend long-term findings and measure “hard” macrovascular/microvascular outcomes and mortality in RCTs.CONCLUSIONSExtant data, including level 1A evidence from numerous RCTs, support new guidelines from the 2nd Diabetes Surgery Summit that advocate for the consideration of bariatric/metabolic surgery as one option, along with lifestyle and medical therapy, to treat T2DM among patients with a BMI <35 kg/m2.

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“…The authors reported a very high T2DM remission rate of more than 80% after SAGB in those with BMI >35, but remission rate decreased to 75% in those with BMI <35. Since then, there have been reports about LGB for T2DM treatment from many areas of Asia [343536,37383940414243]. Table 2 summarized the reported T2DM remission after gastric bypass according to different criteria and follow-up years.…”

Section: Efficacy Of Different Metabolic Proceduresmentioning

confidence: 99%

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Lee

Aung

2016

Diabetes Metab J

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Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m2). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m2. Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.

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Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30–35 kg/m2) Indian patients with type 2 diabetes mellitus

Cited by 49 publications

References 30 publications

Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

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Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30–35 kg/m2) Indian patients with type 2 diabetes mellitus

Cited by 49 publications

References 30 publications

Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

Can Diabetes Be Surgically Cured? Long-Term Metabolic Effects of Bariatric Surgery in Obese Patients with Type 2 Diabetes Mellitus

Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI &lt;35 kg/m2

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

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Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 kg/m2