Three-year follow-up of the largest cohort of randomized patients followed to date demonstrates that metabolic/bariatric surgery is more effective and durable than medical/lifestyle intervention in remission of type 2 diabetes, including among individuals with class 1 obesity, for whom surgery is not widely used (Diabetes Care)
Diabetes News
Category: Bariatric
Gut microbiota changes after metabolic surgery in adult diabetic patients with mild obesity: a randomised controlled trial
This was the first RCT studying composite clinical, analytic, and microbiome changes in T2DM patients with class 1 obesity after RYGB versus standard medical therapy. The remarkable phenotypic improvement after surgery occurred concomitantly with changes in the gut microbiome, but at a lower level (Diabetology & Metabolic Syndrome)
Long-term incidence of hypoglycaemia-related events after bariatric surgery or usual care in the Swedish Obese Subjects study
Bariatric surgery is associated with an increased incidence of hypoglycaemia-related events in patients without baseline diabetes, especially during the first years after treatment (Diabetes, Obesity and Metabolism)
Gut microbiota changes after metabolic surgery in adult diabetic patients with mild obesity: a randomised controlled trial
This was the first RCT studying composite clinical, analytic, and microbiome changes in T2DM patients with class 1 obesity after RYGB versus standard medical therapy. The remarkable phenotypic improvement after surgery occurred concomitantly with changes in the gut microbiome, but at a lower level (Diabetology & Metabolic Syndrome)
Metabolic surgery for type II diabetes: an update
High quality data from RCTs have clearly established that bariatric procedures are more effective than medical or lifestyle interventions for inducing weight loss and remission of type 2 diabetes, even in mild obese patients with a BMI between 30 and 35 kg/m2 (Acta Diabetologica)
Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial
Metabolic surgery is more effective than conventional medical therapy in the long-term control of type 2 diabetes. Clinicians and policy makers should ensure that metabolic surgery is appropriately considered in the management of patients with obesity and type 2 diabetes (The Lancet)
Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses
In this study, we observed that in patients with obesity and T2DM-Ins, bariatric surgery was associated with high rates of postoperative cessation of insulin therapy, which is, in turn, a major driver of overall reductions in direct healthcare cost. Our findings suggest that a strategy utilising bariatric surgery for patients with obesity and T2DM-Ins is cost saving to the national healthcare provider (National Health Service (NHS)) over a 5-year time horizon (PLOS Medicine)
Potential Benefits and Harms of Gastric Bypass Surgery in Obese Individuals With Type 1 Diabetes
This observational study suggests bariatric surgery may yield similar benefits on risk for cardiovascular outcomes and mortality in patients with T1D and obesity as for patients with type 2 diabetes (Diabetes Care)
Type 2 diabetes and metabolic surgery guidelines and recommendations should urgently be unified
A more harmonious discussion and unified guidelines between clinicians and surgeons are needed in order to provide the same message for those who read different articles (Acta Diabetologica)
Five‐year effectiveness of bariatric surgery on disease remission, weight loss, and changes of metabolic parameters in obese patients with type 2 diabetes
Bariatric surgery was effective in weight loss, remission of diabetes, and dyslipidaemia in 5‐year post‐surgery (Diabetes/Metabolism Research and Reviews)
Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery
This longitudinal retrospective analysis shows that preoperative insulin use and age, one-year weight loss, and regain after that influence T2D remission and relapse following RYGB. Referring patients at a younger age, before insulin is needed, and optimizing both weight loss and weight maintenance after RYGB may improve the rates and durability of T2D remission (Journal of the American College of Surgeons)
Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults
Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults (NEJM)
The Effect of Bariatric Surgery on Asian Patients with Type 2 Diabetes Mellitus and Body Mass Index < 30 kg/m2: a Systematic Review and Meta-analysis
Asian patients with type 2 diabetes and BMI < 30 kg/m2 could achieve significant improvement in weight, glycemic control, lipid profiles, and β-cell function in short and medium terms after bariatric surgery, but long-term follow-up is necessary to evaluate the effectiveness (Obesity Surgery)
Cardiovascular risk reduction over time in patients with diabetes or pre-diabetes undergoing bariatric surgery: data from a single-center retrospective observational study
Bariatric surgery reduces CVD risk in type 2 diabetes and pre-diabetes. Given that patients with type 2 diabetes benefit the most, more studies are necessary to consider pre-diabetes as a criterion for metabolic surgery in patients with BMI ≥ 35 kg/m2 (BMC Endocrine Disorders)
Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes
Among a large cohort of adults who underwent RYGB surgery, weight regain quantified as percentage of maximum weight lost performed better for association with most clinical outcomes than the alternatives examined. These findings may inform standardizing the measurement of weight regain in studies of bariatric surgery(JAMA)
Brain glucose uptake is associated with endogenous glucose production in obese subjects before and after bariatric surgery and predicts metabolic outcome at follow‐up
Our findings confirm suggest the presence of a brain‐liver axis in morbidly obese individuals, which persists postoperatively. This axis might contribute to further deterioration of glucose homeostasis (Diabetes, Obesity and Metabolism)
Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study
In this large, multicenter study of adults with T2DM, bariatric surgery was associated with lower overall incidence of microvascular disease (including lower risk for neuropathy, nephropathy, and retinopathy) than usual care (Annals of Internal Medicine)
Therapeutic luminal coating of the intestine
Oral administration of this gut-coating formulation modulated the nutrient contact with bowel mucosa, which lowered the glucose responses in rodent models indicating a potential therapeutic utility in diabetes (Nature Materials)
Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study
In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement (JAMA)
The role of bariatric surgery to treat diabetes: current challenges and perspectives
The gastrointestinal tract represents a meaningful target to treat T2DM. Surgical operations with intestinal diversion have consistently shown the capacity to improve glucose homeostasis by modulating gut hormones, beyond reducing energy intake and body weight. LAGB, SG, RYGB and BPD are the four best standardized surgical procedures (BMC Endocrine Disorders)
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