Surgical vs Lifestyle Treatment for Type 2 Diabetes

Ludwig, David S.; Livingston, Edward H.

doi:10.1001/2012.jama.10156

Cited by 11 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The challenges to achieving and documenting compliance in long-term diet studies are substantial (4)(5)(6). Obstacles to behavioral changes include costs of purchasing food, time involved in food preparation, and willingness to comply with dietary recommendations many times a day for years.…”

Section: Introductionmentioning

confidence: 99%

Metabolomic profiles as reliable biomarkers of dietary composition

Esko¹,

Hirschhorn

Feldman

et al. 2017

The American Journal of Clinical Nutrition

View full text Add to dashboard Cite

Background: Clinical nutrition research often lacks robust markers of compliance, complicating the interpretation of clinical trials and observational studies of free-living subjects. Objective: We aimed to examine metabolomics profiles in response to 3 diets that differed widely in macronutrient composition during a controlled feeding protocol. Design: Twenty-one adults with a high body mass index (in kg/m 2 ; mean 6 SD: 34.4 6 4.9) were given hypocaloric diets to promote weight loss corresponding to 10-15% of initial body weight. They were then studied during weight stability while consuming 3 test diets, each for a 4-wk period according to a crossover design: low fat (60% carbohydrate, 20% fat, 20% protein), low glycemic index (40% carbohydrate, 40% fat, 20% protein), or very-low carbohydrate (10% carbohydrate, 60% fat, 30% protein). Plasma samples were obtained at baseline and at the end of each 4-wk period in the fasting state for metabolomics analysis by using liquid chromatography-tandem mass spectrometry. Statistical analyses included adjustment for multiple comparisons. Results: Of 333 metabolites, we identified 152 whose concentrations differed for $1 diet compared with the others, including diacylglycerols and triacylglycerols, branched-chain amino acids, and markers reflecting metabolic status. Analysis of groups of related metabolites, with the use of either principal components or pathways, revealed coordinated metabolic changes affected by dietary composition, including pathways related to amino acid metabolism. We constructed a classifier using the metabolites that differed between diets and were able to correctly identify the test diet from metabolite profiles in 60 of 63 cases (.95% accuracy). Analyses also suggest differential effects by diet on numerous cardiometabolic disease risk factors. Conclusions: Metabolomic profiling may be used to assess compliance during clinical nutrition trials and the validity of dietary assessment in observational studies. In addition, this methodology may help elucidate mechanistic pathways linking diet to chronic disease risk. This trial was registered at clinicaltrials.gov as NCT00315354.Am J Clin Nutr 2017;105:547-54.

show abstract

Section: Introductionmentioning

confidence: 99%

Metabolomic profiles as reliable biomarkers of dietary composition

Esko¹,

Hirschhorn

Feldman

et al. 2017

The American Journal of Clinical Nutrition

View full text Add to dashboard Cite

show abstract

“…Whereas the lifestyle interventions in prior studies may not have been considered the most rigorous [23], we used a highly intensive nonsurgical intervention, including an aggressive, supervised dieting and aerobic exercise regimen, modelled after the DPP [24] and LookAHEAD trials [25], along with state-of-the-art pharmaceutical care. Our findings indicate that even completion of what we view as the most intensive lifestyle–medical approach that could reasonably be considered in practice cannot improve diabetes and other CVD risk factors as well as RYGB.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the challenges of successfully recruiting and randomly allocating participants into treatment arms as diverse as major surgery vs medical/lifestyle interventions, several RCTs have recently reported various bariatric operations are more effective than nonsurgical approaches in improving glycaemic control and decreasing other CVD risk factors over 1–3 years [16–22]. However, the lifestyle interventions in most of these were not as rigorous as is possible [23], and there is still limited evidence in patients with a BMI <35 kg/m 2 , the standard minimum threshold for bariatric surgery.…”

Section: Introductionmentioning

confidence: 99%

Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial

et al. 2016

View full text Add to dashboard Cite

Aims/hypothesis Mounting evidence indicates that Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes, but randomised trials comparing surgical vs nonsurgical care are needed. With a parallel-group randomised controlled trial (RCT), we compared RYGB vs an intensive lifestyle and medical intervention (ILMI) for type 2 diabetes, including among patients with a BMI <35 kg/m2. Methods By use of a shared decision-making recruitment strategy targeting the entire at-risk population within an integrated community healthcare system, we screened 1,808 adults meeting inclusion criteria (age 25–64, with type 2 diabetes and a BMI 30–45 kg/m2). Of these, 43 were allocated via concealed, computer-generated random assignment in a 1:1 ratio to RYGB or ILMI. The latter involved ≥45 min of aerobic exercise 5 days per week, a dietitian-directed weight- and glucose-lowering diet, and optimal diabetes medical treatment for 1 year. Although treatment allocation could not be blinded, outcomes were determined by a blinded adjudicator. The primary outcome was diabetes remission at 1 year (HbA1c <6.0% [<42.1 mmol/mol], off all diabetes medicines). Results Twenty-three volunteers were assigned to RYGB and 20 to ILMI. Of these, 11 withdrew before receiving any intervention. Hence 15 in the RYGB group and 17 in the IMLI group were analysed throughout 1 year. The groups were equivalent regarding all baseline characteristics, except that the RYGB cohort had a longer diabetes duration (11.4±4.8 vs 6.8±5.2 years, p=0.009). Weight loss at 1 year was 25.8±14.5% vs 6.4±5.8% after RYGB vs ILMI, respectively (p<0.001). The ILMI exercise programme yielded a 22±11% increase in V̇O2max (p <0.0001), whereas V̇O2max after RYGB was unchanged. Diabetes remission at 1 year was 60.0% with RYGB vs 5.9% with ILMI (p=0.002). The HbA1c decline over 1 year was only modestly more after RYGB than ILMI: from 7.7±1.0% (60.7 mmol/mol) to 6.4 ±1.6% (46.4 mmol/mol) vs 7.3±0.9% (56.3 mmol/mol) to 6.9±1.3% (51.9 mmol/mol), respectively (p=0.04); however, this drop occurred with significantly fewer or no diabetes medications after RYGB. No life-threatening complications occurred. Conclusions/interpretation Compared with the most rigorous ILMI yet tested against surgery in a randomised trial, RYGB yielded greater type 2 diabetes remission in mild-to-moderately obese patients recruited from a well-informed, population-based sample. Trial registration ClinicalTrials.gov NCT01295229

show abstract

“…Strengths include two large prospectively designed nationwide registries of bariatric surgery and intensive lifestyle treatment with a program that is a relevant comparator to gastric bypass surgery, 33 and a validated outcome ascertained using nationwide health registries with complete coverage and negligible loss to follow-up.…”

Section: Discussionmentioning

confidence: 99%

Weight Loss and Heart Failure

et al. 2017

View full text Add to dashboard Cite

Background Associations of obesity with incidence of heart failure have been observed, but the causality is uncertain. We hypothesized that gastric bypass surgery leads to lower incidence of heart failure compared to intensive lifestyle modification in obese people. Methods We included obese people without previous heart failure from a Swedish nationwide registry of people treated with a structured intensive lifestyle program, and the Scandinavian Obesity Surgery Registry. All analyses used inverse probability weights, based on baseline body-mass index and a propensity score estimated using baseline variables. Treatment groups were well balanced regarding weight, body mass index and most potential confounders. Associations of treatment with heart failure incidence, as defined in the National Patient Register, were analyzed using Cox regression. Results The 25,804 gastric bypass surgery patients had on average lost 18.8 kg more weight after 1 year, and 22.6 kg more after 2 years, than the 13,701 lifestyle modification patients. During a median of 4.1 years, surgery patients had lower heart failure incidence than lifestyle modification patients (hazard ratio 0.54, 95% CI 0.36–0.82). A 10 kg achieved weight loss after 1 year was related to a hazard ratio for heart failure of 0.77, 95% confidence interval 0.60 to 0.97, in both treatment groups combined. Results were robust in sensitivity analyses. Conclusions Gastric bypass surgery was associated with approximately one half the incidence of heart failure compared with intensive lifestyle modification in this study of two large nationwide registries. We also observed a graded association between increasing weight loss and decreasing risk of heart failure.

show abstract

Surgical vs Lifestyle Treatment for Type 2 Diabetes

Cited by 11 publications

References 8 publications

Metabolomic profiles as reliable biomarkers of dietary composition

Metabolomic profiles as reliable biomarkers of dietary composition

Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial

Weight Loss and Heart Failure

Contact Info

Product

Resources

About