The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation

Cohen, Ricardo; Shikora, Scott A.; Petry, Tarissa Beatrice Zanata; Caravatto, Pedro Paulo de Paris; Roux, Carel W. le

doi:10.1007/s11695-016-2237-6

Cited by 21 publications

(10 citation statements)

References 22 publications

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“…The current favoured treatment for patients with type 2 diabetes (T2DM) who are obese is referral for bariatric surgery. In the 2nd Diabetes Surgery Summit in 2015, several national diabetes societies such as the American Diabetes Association (ADA) and Diabetes UK have recommended the use of bariatric surgery in obese type 2 diabetics reporting diabetes remission rates of between 30–60% following surgery [ 3 ]. However, with a greater demand being placed on bariatric surgery, there is a drive to develop nonsurgical alternatives to combat the ever-rising obesity and diabetes epidemic.…”

Section: Introductionmentioning

confidence: 99%

The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss

Ruban

Ashrafian

Teare

2018

Gastroenterology Research and Practice

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The rapid rise of obesity and type 2 diabetes poses a global threat to healthcare and is a major cause of mortality and morbidity. Bariatric surgery has revolutionised the treatment of both these conditions but is invasive and associated with an increased risk of complications. The EndoBarrier is a device placed endoscopically in the duodenum, which is designed to mimic the effects of gastric bypass surgery with the aim of inducing weight loss and improving glycaemic control. This review outlines the current clinical evidence of the device, its efficacy, potential mechanisms of action, and utility in clinical practice.

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Section: Introductionmentioning

confidence: 99%

The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss

Ruban

Ashrafian

Teare

2018

Gastroenterology Research and Practice

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“…Metabolic surgery is accepted as a potential treatment for both morbid obesity and overweight type 2 diabetic patients without glycemic control. In 2016, the second diabetes surgery summit declared recommendations, which were supported by 45 pioneer medical and scientific societies worldwide, to consider bariatric surgery as a treatment for type 2 DM[ 19 ]. Metabolic surgery is currently approved with the following recommendations: (1) Adults with class III obesity (BMI ≥ 40) regardless of glycemic control or complexity of glucose lowering regimens; (2) Patients with class II obesity (BMI: 35.0-39.9) with inadequately controlled hyperglycemia despite the optimal medical therapy; and (3) Diabetic patients with class I obesity (BMI: 30.0-34.9) and inadequately controlled hyperglycemia despite optimal medical treatment by oral or injectable medications (including insulin).…”

Section: Resultsmentioning

confidence: 99%

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies?

Akkuş

Tetıker

2021

WJD

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BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus (T2DM). Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM. There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM, but remission rates of T2DM after metabolic surgery can display great variability. AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy, adjustable gastric banding, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures. RESULTS In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patient with T2DM, but further studies are needed to clarify better the rate of diabetes remission. CONCLUSION In light of the recent findings, metabolic surgery is a safe and effective treatment option for obese patients with T2DM, but further studies are needed to clarify better the rate of diabetes remission.

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“…33 Following the 2nd Diabetes Surgery Summit in 2015, several national diabetes societies, such as the American Diabetes Association (ADA) and Diabetes UK, have recommended the use of metabolic surgery in obese patients with type 2 diabetes and have reported diabetes remission rates of between 30% and 60% following surgery. 34 The recently published STAMPEDE 31 (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) randomised trial demonstrated that metabolic surgery (gastric bypass or sleeve gastrectomy) plus intensive medical therapy is superior to intensive medical therapy alone for the treatment of obese patients with type 2 diabetes. Of the 134 patients who completed the 5-year study, only 5% of patients in the medical therapy group achieved the primary end point (a HbA 1c level of ≤ 6%), compared with 29% in the gastric bypass group and 23% in the sleeve gastrectomy group.…”

Section: Metabolic Surgerymentioning

confidence: 99%

A duodenal sleeve bypass device added to intensive medical therapy for obesity with type 2 diabetes: a RCT

et al. 2020

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Background The EndoBarrier® (GI Dynamics Inc., Boston, MA, USA) is an endoluminal duodenal–jejunal bypass liner developed for the treatment of patients with obesity and type 2 diabetes mellitus. Meta-analyses of its effects on glycaemia and weight have called for larger randomised controlled trials with longer follow-up. Objectives The primary objective was to compare intensive medical therapy with a duodenal–jejunal bypass liner with intensive medical therapy without a duodenal–jejunal bypass liner, comparing effectiveness on the metabolic state as defined by the International Diabetes Federation as a glycated haemoglobin level reduction of ≥ 20%. The secondary objectives were to compare intensive medical therapy with a duodenal–jejunal bypass liner with intensive medical therapy without a duodenal–jejunal bypass liner, comparing effectiveness on the metabolic state as defined by the International Diabetes Federation as a glycated haemoglobin level of < 42 mmol/mol, blood pressure of < 135/85 mmHg, and the effectiveness on total body weight loss. Additional secondary outcomes were to investigate the cost-effectiveness and mechanism of action of the effect of a duodenal–jejunal bypass liner on brain reward system responses, insulin sensitivity, eating behaviour and metabonomics. Design A multicentre, open-label, randomised controlled trial. Setting Imperial College Healthcare NHS Trust and University Hospital Southampton NHS Foundation Trust. Participants Patients aged 18–65 years with a body mass index of 30–50 kg/m2 and with inadequately controlled type 2 diabetes mellitus who were on oral glucose-lowering medications. Interventions Participants were randomised equally to receive intensive medical therapy alongside a duodenal–jejunal bypass liner device (n = 85) or intensive medical therapy alone for 12 months (n = 85), and were followed up for a further 12 months. Results There was no significant difference between groups in the percentage of patients achieving the glycaemic primary or secondary outcomes [primary outcome at 12 months: duodenal–jejunal bypass liner group 54.5% vs. control group 55.2% (odds ratio 0.93, 95% confidence interval 0.44 to 1.98; p = 0.85); primary outcome at 24 months: duodenal–jejunal bypass liner group 39.7% vs. control group 36.5% (odds ratio 1.13, 95% confidence interval 0.52 to 2.47; p = 0.75)]. Significantly more patients in the duodenal–jejunal bypass liner group than in the control group lost > 15% of their total body weight (duodenal–jejunal bypass liner group 24.2% vs. control group 3.7%; odds ratio 8.33, 95% confidence interval 1.78 to 39.0; p = 0.007) and achieved blood pressure targets (duodenal–jejunal bypass liner group 68.2% vs. control group 44.4%; odds ratio 2.57, 95% confidence interval 1.21 to 5.48; p = 0.014). These differences were observed at 12 months but not at 24 months. There were more adverse events in the duodenal–jejunal bypass liner group, including one liver abscess. The increase in peripheral insulin sensitivity was superior in the duodenal–jejunal bypass liner group. Spectroscopic analyses of plasma, urine and faeces revealed several distinct metabolic perturbations in the duodenal–jejunal bypass liner group but not in the control group. Brain reward responses to food cues were not different between groups. The number of mean quality-adjusted life-years gained was similar in both groups and the additional costs of the duodenal–jejunal bypass liner may outweigh the value of the health benefits by £2560 per patient treated. Conclusions The results show that the endoluminal duodenal–jejunal bypass liner was not superior to intensive medical therapy for glycaemic control and was associated with more adverse events. The duodenal–jejunal bypass liner was associated with significant weight loss and improvement in cardiometabolic parameters at 12 months but not at 24 months. Economic evaluation showed that the bypass liner was not cost-effective for glycaemic control or for weight loss. Trial registration Current Controlled Trials ISRCTN30845205. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 7, No. 6. See the NIHR Journals Library website for further project information. This study was executed with the support of GI Dynamics Inc. and with the kind support of Nutricia Advanced Medical Nutrition for providing oral nutritional supplements.

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The Diabetes Surgery Summit II Guidelines: a Disease-Based Clinical Recommendation

Cited by 21 publications

References 22 publications

The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss

The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery: A general perspective of current studies?

A duodenal sleeve bypass device added to intensive medical therapy for obesity with type 2 diabetes: a RCT

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