Review: Bariatric surgery increases weight loss and diabetes remission more than nonsurgical treatment

2014 ◽  
Vol 160 (2) ◽  
pp. JC7 ◽  
Author(s):  
Lawrence J. Cheskin ◽  
Scott Kahan
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Nonsurgical Treatment

scholarly journals Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial

2020 ◽  
Vol 105 (3) ◽  
pp. 866-876 ◽  
Author(s):  
Anita P Courcoulas ◽  
James W Gallagher ◽  
Rebecca H Neiberg ◽  
Emily B Eagleton ◽  
James P DeLany ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Controlled Trial ◽  
The United States ◽  
Diabetes Remission ◽  
University Of Pittsburgh ◽  
Lifestyle Treatment ◽  
Surgical Treatments ◽  
The University

Abstract Context Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment. Objective Compare the remission of T2DM following surgical or nonsurgical treatments. Design, setting, and participants Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016. Interventions 61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years. Main Outcomes and Measures Diabetes remission assessed at 5 years. Results The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01). Conclusions Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.

scholarly journals Evaluation of the Effects of Bariatric Surgery in Terms of Weight Loss and Diabetes Remission in the Indian Population

2021 ◽  
pp. 1-7
Author(s):  
Manish Khaitan ◽  
Riddhish Gadani ◽  
Koshish Nandan Pokharel
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Complete Remission ◽  
Predictive Factors ◽  
Indian Population ◽  
Diabetes Remission ◽  
Obese Patients ◽  
Sustained Weight Loss

<b><i>Objectives:</i></b> The growing prevalence of obesity rates worldwide is associated with an upsurge in its comorbidities, particularly type 2 diabetes mellitus (T2DM). Bariatric surgery is a proven treatment modality for producing sustained weight loss and resolution of associated T2DM providing marked improvement in quality of life with rapid recovery. This study aims to investigate the effects of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) on obese patients suffering from T2DM in the Indian population and their long-term association with regard to diabetes remission, resolution of comorbidities, and percentage EWL. <b><i>Methods:</i></b> Retrospective data of obese patients with T2DM (preoperative BMI 45.37 ± 8.1) who underwent bariatric surgery (RYGB, LSG, and MGB) were analyzed in this study over a period of 9 years. The mean follow-up period was 2.2 years. Following surgery, the clinical outcome on BMI, resolution of percentage weight loss, and T2DM were studied. The predictive factors of diabetic remission after surgery were determined. Student’s <i>t</i> test and ANOVA and McNemar’s test were applied. <b><i>Results:</i></b> Out of a total of 274 patients, complete remission of T2DM was achieved in 52.9% (<i>n</i> = 145) with mean fasting blood glucose and glycated hemoglobin values being 6.1 ± 0.769 (<i>p</i> = 0.00) at 1 year after surgery. The independent predictive factors of remission were age, gender, BMI, preoperative comorbidities, and % EWL. Gender had no correlation with the chance of achieving disease remission. <b><i>Conclusion:</i></b> Based on our results, bariatric surgery proves to be a successful treatment option resulting in sustained weight loss in obese patients suffering from T2DM. It is found to be beneficial for the long-term resolution of T2DM and improving comorbidities such as hypertension and dyslipidemia. The outcome of the different surgical methods is found to be similar for all patients irrespective of the independent predictors of complete remission.

scholarly journals Minimum Threshold of Bariatric Surgical Weight Loss for Initial Diabetes Remission

2021 ◽  
Author(s):  
Douglas Barthold ◽  
Elizabeth Brouwer ◽  
Lee J. Barton ◽  
David E. Arterburn ◽  
Anirban Basu ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Proportional Hazards ◽  
Reference Group ◽  
Diabetes Remission ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Design And Methods ◽  
Time Varying Covariates

<b>Objective:</b> There are few studies testing the amount of weight loss necessary to achieve initial remission of type 2 diabetes (T2DM) following bariatric surgery and no published studies using weight loss to predict initial T2DM remission in sleeve gastrectomy (SG) patients. <p><b>Research Design and Methods:</b> Cox proportional hazards models examined the relationship between initial T2DM remission and percent total weight loss (%TWL) after bariatric surgery. Categories of %TWL were included in the model as time-varying covariates. </p> <p><b>Results:</b> Patients (N=5,928) were 73% female, 49.8<u>+</u>10.3 years old, had BMI of 43.8<u>+</u>6.92 kg/m<sup>2</sup>, and 57% had Roux-en-Y gastric bypass (RYGB). Over an average follow-up of 5.9 years, 71% of patients experienced initial remission of their T2DM (mean time to remission 1.0 year). Using 0-5% TWL as the reference group in Cox proportional hazards models, patients were more likely to remit with each 5% increase in TWL until 20% TWL (range from HR=1.97 to 2.92). When categories above >25% TWL were examined, all had a likelihood of initial remission similar to 20-25% TWL. Patients who achieved >20% TWL were more likely to achieve initial T2DM remission than patients with 0-5% TWL, even if they were using insulin at the time of surgery.</p> <p><b>Conclusions: </b>Weight loss after bariatric surgery is strongly associated with initial T2DM remission; however, above a threshold of 20% TWL, rates of initial T2DM remission did not increase substantially. Achieving this threshold is also associated with initial remission even in patients who traditionally experience lower rates of remission, such as patients taking insulin.</p>

scholarly journals Nutritional Management in Bariatric Surgery Patients

2021 ◽  
Vol 18 (22) ◽  
pp. 12049
Author(s):  
Andrea Deledda ◽  
Stefano Pintus ◽  
Andrea Loviselli ◽  
Michele Fosci ◽  
Giovanni Fantola ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Life Expectancy ◽  
Diabetes Remission ◽  
Lifestyle Changes ◽  
Nutritional Deficiencies ◽  
Obesity Epidemic ◽  
Sustained Weight Loss ◽  
Before And After ◽  
Reduce Life Expectancy

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

scholarly journals The relationship between specialized pro-resolving lipid mediators, morbid obesity and weight loss after bariatric surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fabian Schulte ◽  
Abdul Aziz Asbeutah ◽  
Peter N. Benotti ◽  
G. Craig Wood ◽  
Christopher Still ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Weight Loss ◽  
White Blood Cells ◽  
Diabetes Remission ◽  
Lipid Mediators ◽  
Morbidly Obese ◽  
Post Surgery ◽  
Obesity And Diabetes ◽  
Obese Subjects

AbstractObesity and diabetes are associated with chronic inflammation. Specialized pro-resolving lipid mediators (SPMs)—resolvins (Rv), protectins (PD) and maresins (MaR)—actively resolve inflammation. Bariatric surgery achieves remission of diabetes, but mechanisms are unclear. We measured SPMs and proinflammatory eicosanoid levels using liquid chromatography-tandem mass spectrometry in 29 morbidly obese subjects (13 with diabetes) and 15 nondiabetic, mildly obese subjects. Compared to the mildly obese, the morbidly obese had higher levels of SPMs—RvD3, RvD4 and PD1—and white blood cells (WBC) and platelets. Post-surgery, SPM and platelet levels decreased in morbidly obese nondiabetic subjects but not in diabetic subjects, suggesting continued inflammation. Despite similar weight reductions 1 year after surgery (44.6% vs. 46.6%), 8 diabetes remitters had significant reductions in WBC and platelet counts whereas five non-remitters did not. Remitters had a 58.2% decrease (p = 0.03) in 14-HDHA, a maresin pathway marker; non-remitters had an 875.7% increase in 14-HDHA but a 36.9% decrease in MaR1 to a median of 0. In conclusion, higher levels of RvD3, PD1 and their pathway marker, 17-HDHA, are markers of leukocyte activation and inflammation in morbid obesity and diabetes and diminish with weight loss in nondiabetic but not diabetic subjects, possibly representing sustained inflammation in the latter. Lack of diabetes remission after surgically-induced weight loss may be associated with reduced ability to produce MaR1 and sustained inflammation.

scholarly journals Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies

2020 ◽  
Author(s):  
Ruveena Kaur ◽  
David Kim ◽  
Richard Cutfield ◽  
Michael Booth ◽  
Lindsay Plank ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Diabetes Remission ◽  
Acid Decarboxylase ◽  
Gad Antibodies ◽  
C Peptide ◽  
Glycemic Outcomes ◽  
Design And Methods

<i>Objective</i>: To evaluate diabetes remission after bariatric surgery by presence of glutamic acid decarboxylase (GAD) antibody among those with obesity and Type 2 diabetes (T2D). <p> </p><i>Research Design and Methods</i>: Screening GAD was performed in 221 patients with T2D and obesity referred for bariatric surgery. 9/16 patients with GAD and 112/205 without GAD proceeded with surgery. Diabetes remission and weight loss was compared by GAD presence. <p> </p><i>Results</i>: GAD titres were 16-91 IU/mL in the first group. Both groups were similar in age, BMI, diabetes duration, insulin treated proportion, HbA1c and C-peptide (1354 ± 548 vs 1358 ± 487pmol/L). At 1 and 5 years post-operatively, both groups achieved similar BMI reduction and diabetes remission (67% vs 73%, p=0.71, and 56% vs 57%, p=1.0). <p><i> </i></p><i>Conclusion</i>: Low-titre GAD in patients with T2D and retained C-peptide, should not be a deterrent for bariatric surgery when the principal aim is diabetes remission.

scholarly journals Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study

2020 ◽  
Author(s):  
Jonathan Q Purnell ◽  
Elizabeth N Dewey ◽  
Blandine Laferrère ◽  
Faith Selzer ◽  
David R Flum ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Beta Cell ◽  
Beta Cell Function ◽  
Cell Function ◽  
Diabetes Remission ◽  
Remission Status

Abstract Context Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. Objective To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). Design An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. Setting Ten US hospitals. Participants A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. Interventions Roux-en-Y gastric bypass or LAGB. Main Outcome Measures Diabetes rates and associations of patient characteristics with remission status. Results Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB. Conclusions Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB. Trial Registration clinicaltrials.gov Identifier: NCT00465829.

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