Sleeve gastrectomy versus Roux-en-Y gastric bypass for type 2 diabetes and morbid obesity: double-blind randomised clinical trial protocol Modified Roux-en-Y gastric bypass for type 2 diabetes mellitus in China. Omentectomy added to Roux-en-Y gastric bypass surgery: a randomized, controlled trial. Safety and Efficacy of Roux-en-Y Gastric Bypass to Treat Type 2 Diabetes Mellitus in Non-severely Obese Patients Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Type II Diabetes Mellitus in Chinese Patients with Body Mass Index of 25–35 Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Superior weight loss and lower HbA1c 3 years after duodenal switch compared with Roux-en-Y gastric bypass--a randomized controlled trial. Can Roux-en-Y gastric bypass provide a lifelong solution for diabetes mellitus? A randomized controlled trial of Roux-en-Y gastrojejunostomy vs. gastroduodenostomy with respect to the improvement of type 2 diabetes mellitus after distal gastrectomy in gastric cancer patients Laparoscopic Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Diabetes and Obesity: a Prospective Randomised Double-Blind Trial Sleeve gastrectomy and Roux-en-Y gastric bypass are equally effective in correcting insulin resistance. Remission of type 2 diabetes after Roux-en-Y gastric bypass or sleeve gastrectomy is associated with a distinct glycemic profile. Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. Body weight, insulin resistance, and serum adipokine levels 2 years after 2 types of bariatric surgery.
Introduction Type 2 diabetes ( T2D ) in association with obesity is an increasing disease burden . Bariatric surgery is the only effective therapy for achieving remission of T2D among those with morbid obesity . It is unclear which of the two most commonly performed types of bariatric surgery , laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) , is most effective for obese patients with T2D . The primary objective of this study is to determine whether LSG or LRYGB is more effective in achieving HbA1c<6 % ( < 42 mmol/mol ) without the use of diabetes medication at 5 years . Methods and analysis Single-centre , double-blind ( assessor and patient ) , parallel , r and omised clinical trial ( RCT ) conducted in New Zeal and , targeting 106 patients . Eligibility criteria include age 20–55 years , T2D of at least 6 months duration and body mass index 35–65 kg/m2 for at least 5 years . R and omisation 1:1 to LSG or LRYGB , used r and om number codes disclosed to the operating surgeon after induction of anaesthesia . A st and ard medication adjustment schedule will be used during postoperative metabolic assessment s. Secondary outcomes include proportions achieving HbA1c<5.7 % ( 39 mmol/mol ) or HbA1c<6.5 % ( 48 mmol/mol ) without the use of diabetes medication , comparative weight loss , obesity-related comorbidity , operative complications , revision rate , mortality , quality of life , anxiety and depression scores . Exploratory outcomes include changes in satiety , gut hormone and gut microbiota to gain underlying mechanistic insights into T2D remission . Ethics and dissemination Ethics approval was obtained from the New Zeal and regional ethics committee ( NZ93405 ) who also provided independent safety monitoring of the trial . Study commenced in September 2011 . Recruitment completed in October 2014 . Data collection is ongoing . Results will be reported in manuscripts su bmi tted to peer- review ed journals and in presentations at national and international meetings . Trial registration numbers ACTRN12611000751976 , NCT01486680 ; Pre- results BACKGROUND / AIMS This study aim ed to evaluate the efficacy of modified Roux-en-Y gastric bypass for type 2 diabetes mellitus . METHODOLOGY Forty-five type 2 diabetes mellitus patients underwent modified Roux-en-Y gastric bypass at WeiFang People 's Hospital . Data on patient demographics , fasting plasma glucose ( FPG ) , body mass index ( BMI ) , medication use , remission and hemoglobin A1c ( HbAlc ) were prospect ively collected and analyzed . RESULTS At 6 months after surgery , all of these 45 patients obtained remission or a marked improvement . FPG was in the normal range in 39 ( 86.7 % ) patients stopping medicine treatment for their diabetes . Six patients ( 13.3 % ) had an obvious reduced abnormal FPG and they only required lower drug dosage . No statistically significant differences were found between the obese or non-obese groups ( p=0.311 ) . The mean BMI dropped from 28.9±3.0 kg/m2 to 27.4±2.8 kg/m2 ( p=0.000 ) at the third month and 26.3±2.5 kg/m2 ( p=0.000 ) at the sixth month . HbAlc decreased from their preoperative values of 7.4%±2.2 % to 6.3%±1.5 % ( p=0.000 ) at the third month and 5.1%±0.9 % ( p=0.000 ) at the sixth month . CONCLUSIONS Modified Roux-en-Y gastric bypass was effective in treating  type 2 diabetes mellitus , independent of body mass index BACKGROUND Excess visceral adipose tissue predicts for incipient diabetes mellitus and cardiovascular disease . Human data are mixed regarding the benefits of selective visceral adipose tissue reduction . We investigated the effects of omentectomy added to laparoscopic Roux-en-Y gastric bypass on glucose homeostasis and lipids , inflammatory markers , and adipokines 90 days postoperatively in nondiabetic patients at the Legacy Good Samaritan Hospital and Oregon Health and Science University ( Portl and , OR ) . METHODS A single-blind , r and omized study of laparoscopic Roux-en-Y gastric bypass plus omentectomy versus laparoscopic Roux-en-Y gastric bypass alone in 28 subjects ( 7 men and 21 women ) . The groups were matched at baseline for gender , age , and body mass index ( BMI ) . The eligibility criteria included age ≥18 years , BMI ≥40 and < 50 kg/m(2 ) without co-morbid conditions or BMI ≥35 and < 50 kg/m(2 ) with co-morbid conditions . The primary outcome measures were changes in the fasting plasma glucose , insulin , and homostatic model assessment of insulin resistance . The secondary measures were BMI and the high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin , total and high-molecular-weight adiponectin , fibrinogen , and plasminogen activator inhibitor-1 levels . RESULTS After surgery , the BMI decreased significantly in both groups and was not different at the follow-up point . Although many outcome parameters improved with weight loss in both groups postoperatively , only the omentectomy group experienced statistically significant decreases in fasting glucose ( P < .05 ) , total ( P = .004 ) and very-low-density lipoprotein ( P = .001 ) cholesterol , and an increase in the high-molecular-weight/total adiponectin ratio ( P = .013 ) . CONCLUSIONS Omentectomy added to laparoscopic Roux-en-Y gastric bypass results in favorable changes in glucose homeostasis , lipid levels , and adipokine profile at 90 days postoperatively . These data support the hypothesis that selective ablation of visceral adipose tissue conveys metabolic benefits in nondiabetic humans The efficacy of Roux-en-Y gastric bypass ( RYGB ) to control  type 2 diabetes mellitus ( T2DM )  has been demonstrated in morbidly obese patients . Surgical procedures primarily focused on T2DM control in patients with body mass index ( BMI ) < 35 kg/m2 have shown to effectively induce remission of T2DM . However , only few reports have evaluated the safety and efficacy of RYGB in this group of patients . The aim of this study is to assess the safety and efficacy of RYGB in TD2 M patients with BMI < 35 kg/m2 . All T2DM patients with BMI < 35 kg/m2 and at least 12 months of follow-up who underwent laparoscopic RYGB were included . Safety of the procedure was evaluated according to mortality , need of reoperation/conversion , and complication rates . Metabolic parameters were evaluated at baseline and 6 , 12 , and 24 months after surgery . Thirty patients were included . Seventeen ( 56.6 % ) were women . Age , BMI , and duration of diabetes were 48 ± 9 years , 33.7 ± 1.2 kg/m2 , 4 ± 2.9 years , respectively . No mortality was observed . No conversion/reoperation was needed . Average length of stay was 3.2 ± 0.9 days . Early and late postoperative complications were observed in five ( 16.6 % ) and five ( 16.6 % ) patients , respectively . Twelve months after surgery , remission was observed in 25 of 30 patients ( 83.3 % ) . After 2 years , remission was achieved in 13 of 20 patients ( 65 % ) , and hemoglobin A1c decreased from 8.1 ± 1.8 % to 5.9 ± 1.1 % and homeostasis model assessment of insulin resistance from 5.7 ± 3.2 to 1.9 ± 0.8 after 12 months . RYGB is a safe and effective procedure to induce T2DM remission in otherwise not eligible patients for bariatric surgery . Evidence from prospect i ve studies is needed to vali date this approach Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson AIMS The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass ( RYGB ) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus ( T2DM ) and hypertension . METHODS 108 obese T2DM with hypertension were enrolled and r and omly allocated to usual care ( group A ) , usual care plus Exenatide ( group B ) , and RYGB surgery ( group C ) . Demographic characteristics , metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months . RESULTS At 12 months , diabetes remission had occurred in no patients in groups A and B versus 90 % in group C , and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B ( P<0.05 ) . Other parameters ( body mass index , hemoglobin A1c , homeostasis model assessment of insulin resistance , lipids ) , inflammation index ( high sensitivity C-reactive protein , tumor necrosis factor-α , high molecular weight adiponectin ) and cardiac structure ( left ventricular mass index ) were significantly improved in groups B and C , but patients in group C had the greatest degree of improvement ( P<0.05 ) . CONCLUSION RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM . This is likely to be due to , at least in part , an improvement in the abnormal metabolic panel and to reduced inflammation Background Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) can dramatically ameliorate  type 2 diabetes mellitus ( T2DM ) in morbidly obese patients . However , there is little evidence supporting the effectiveness of LRYGB in low body mass index ( BMI ) patients . The study was design ed to evaluate the safety and results of LRYGB for achieving T2DM remission in patients with BMI in the range of 25–35 kg/m2 . Methods Twenty-two patients ( two men and 20 women ) with T2DM underwent LRYGB .  Data on patient demographics , BMI , co-morbidities , and details of diabetes mellitus , including disease duration , family history , medication use , and remission , were prospect ively collected and analyzed . Results The mean age was 47 years ( range , 28–63 years ) , mean BMI was 30.81 ( range , 25.00–34.80 kg/m2 ) , and mean duration of T2DM onset was 6.57 years ( range , 1–20 years ) . Sixteen ( 72.27 % ) patients had a family history of T2DM . There was no mortality , but two ( 9 % ) patients experienced complications : an early gastrojejunostomy hemorrhage and frequent loose stools that required revision surgery . At 12 months , 14 ( 63.6 % ) patients showed T2DM remission , six ( 27.3 % ) showed glycemic control , and two ( 9.1 % ) showed improvement . The group achieving remission had a higher BMI ( p = 0.001 ) , younger age ( p = 0.002 ) , and shorter duration of diabetes ( p = 0.001 ) . These three factors may be predictors of diabetes resolution at 12 months . Conclusion Early intervention in low- BMI patients yields better remission rates because age , BMI , and duration of T2DM predict glycemic outcomes BACKGROUND Conventional treatments for patients with type 2 diabetes are often inadequate . We aim ed to assess outcomes of diabetes control and treatment risks 2 years after adding Roux-en-Y gastric bypass to intensive lifestyle and medical management . METHODS We report 2-year outcomes of a 5-year r and omised trial ( the Diabetes Surgery Study ) at four teaching hospitals ( three in the USA and one in Taiwan ) . At baseline , eligible participants had to have HbA1c of at least 8·0 % ( 64 mmol/mol ) , BMI between 30·0 and 39·9 kg/m(2 ) , and type 2 diabetes for at least 6 months , and be aged 30 - 67 years . We r and omly assigned participants to receive either intensive lifestyle and medical management alone ( lifestyle and medical management ) , or lifestyle and medical management plus st and ard Roux-en-Y gastric bypass surgery ( gastric bypass ) . Staff from the clinical centres had access to data from individual patients , but were masked to other patients ' data and aggregated data until the 2-year follow-up . Drugs for hyperglycaemia , hypertension , and dyslipidaemia were prescribed by protocol . The primary endpoint was achievement of the composite treatment goal of HbA1c less than 7·0 % ( 53 mmol/mol ) , LDL cholesterol less than 2·59 mmol/L , and systolic blood pressure less than 130 mm Hg at 12 months ; here we report the composite outcome and other pre-planned secondary outcomes at 24 months . Analyses were done on an intention-to-treat basis , with multiple imputations for missing data . This study is registered with Clinical Trials.gov , number NCT00641251 , and is still ongoing . FINDINGS Between April 21 , 2008 , and Nov 21 , 2011 , we r and omly assigned 120 eligible patients to either lifestyle and medical management alone ( n=60 ) or with the addition of gastric bypass ( n=60 ) . One patient in the lifestyle and medical management group died ( from pancreatic cancer ) , thus 119 were included in the primary analysis . Significantly more participants in the gastric bypass group achieved the composite triple endpoint at 24 months than in the lifestyle and medical management group ( 26 [ 43 % ] vs eight [ 14 % ] ; odds ratio 5·1 [ 95 % CI 2·0 - 12·6 ] , p=0·0004 ) , mainly through improved glycaemic control ( HbA1c < 7·0 % [ 53 mmol/mol ] in 45 [ 75 % ] vs 14 [ 24 % ] ; treatment difference -1·9 % ( -2·5 to -1·4 ) ; p=0·0001 ) . 46 clinical ly important adverse events occurred in the gastric bypass group and 25 in the lifestyle and medical management group ( mainly infections in both groups [ four in the lifestyle and medical management group , eight in the gastric bypass group ] ) . With a negative binomial model adjusted for site , the event rate for the gastric bypass group was non-significantly higher than the lifestyle and medical management group by a factor of 1·67 ( 95 % CI 0·98 - 2·87 , p=0·06 ) . Across both years of the study , the gastric bypass group had seven serious falls with five fractures , compared with three serious falls and one fracture in the lifestyle and medical management group . All fractures happened in women . Many more nutritional deficiencies occurred in the gastric bypass group ( mainly deficiencies in iron , albumin , calcium , and vitamin D ) , despite protocol use of nutritional supplements . INTERPRETATION The addition of gastric bypass to lifestyle and medical management in patients with type 2 diabetes improved diabetes control , but adverse events and nutritional deficiencies were more frequent . Larger and longer studies are needed to investigate whether the benefits and risk of gastric bypass for type 2 diabetes can be balanced . FUNDING Covidien , National Institutes of Health , National Institute of Diabetes and Digestive and Kidney Diseases Nutrition Obesity Research Centers , and the National Center for Advancing Translational Sciences BACKGROUND Obesity is a rising threat to public health . The relative increase in the incidence of morbid obesity is most pronounced in the most severely obese .  Roux-en-Y gastric bypass ( RYGB ) results in inferior weight loss in this group . Therefore , we have offered biliopancreatic diversion with duodenal switch ( BPD/DS ) as an alternative for this patient category . Our objective was to compare BPD/DS and RYGB in the surgical treatment of morbid obesity in patients with a body mass index ( BMI ) > 48 kg/m(2 ) . The setting was a university hospital in Sweden . METHODS In a controlled trial ( registration number IS RCT N10940791 ) , 47 patients ( 25 men , BMI 54.5 ± 6.1 kg/m(2 ) ) were r and omized to RYGB ( n = 23 ) or BPD/DS ( n = 24 ) . Biochemical data were collected preoperatively and 1 and 3 years postoperatively . A question naire addressing weight , general satisfaction , and gastrointestinal symptoms was distributed a median of 4 years postoperatively . RESULTS Both procedures were safe . The duration of surgery and postoperative morphine consumption were greater after BPD/DS than after RYGB ( 157 versus 117 min and 140 versus 93 mg , respectively ) . BPD/DS result ed in greater weight loss  than RYGB ( -23.2 ± 4.9 versus -16.2 ± 6.9 BMI units or 80 % ± 15 % versus 51 % ± 23 % excess BMI loss , P < .001 ) . BPD/DS  yielded lower glucose and glycated hemoglobin levels at 3 years . More patients listed troublesome diarrhea and malodorous flatus in the question naire after BPD/DS , but no significant difference was seen ( P = .078 and P = .073 , respectively ) . CONCLUSIONS BPD/DS produced superior weight results and lower glycated hemoglobin levels compared with RYGB in patients with a BMI > 48 kg/m(2 ) . Both operations yield high satisfaction rates . However , diarrhea tended to be more common after BPD/DS BACKGROUND The surgical treatment of diabetes had witnessed progressive development and success since the first case of pancreatic transplantation . Although this was a great step , wide clinical application was limited by several factors . Bariatric surgery such as gastric bypass is emerging as a promising option in obese patients with type 2 diabetes . The aim of this article is to explore the current application of gastric bypass in patients with type 2 diabetes and the theoretical bases of gastric bypass as a treatment option for type 1 diabetes . METHODS We performed a MEDLINE search for articles published from August 1955 to December 2008 using the words " surgical treatment of diabetes , " " etiology of diabetes " and " gastric bypass . " RESULTS We identified 3215 studies and selected 72 relevant papers for review . Surgical treatment of diabetes is evolving from complex pancreatic and islets transplantation surgery for type 1 diabetes with critical postoperative outcome and follow-up to a metabolic surgery , including gastric bypass . Gastric bypass ( no immune suppression or graft rejection ) has proven to be highly effective treatment for obese patients and nonobese animals with type 2 diabetes . There are certain shared criteria between types 1 and 2 diabetes , making a selected spectrum of the disease a potential target for metabolic surgery to improve or cure diabetes . CONCLUSION Roux-en-Y gastric bypass is a promising option for lifelong treatment of type 2 diabetes . It has the potential to improve or cure a selected spectrum of type 1 diabetes when performed early in the disease . Further animal model studies or r and omized controlled trials are needed to support our conclusion The purpose of this study is to compare the effect of diabetes control induced by Roux-en-Y gastrojejunostomy(RY ) vs Billroth-I reconstruction(BI ) after distal gastrectomy in patients with early gastric cancer(EGC ) and type 2 diabetes(T2DM ) . Forty EGC patients with T2DM , aged 20–80 years , who were expected to undergo curative distal gastrectomy were r and omized 1:1 to RY(n = 20 ) or BI(n = 20 ) . Diabetes medication status , biochemical and hormonal data including blood glucose , HbA1c , insulin , C-peptide , HOMA-IR , ghrelin , leptin , GLP-1 , PYY , and GIP were evaluated for 12 months after surgery . Although pre- and postoperative 12-month fasting and postpr and ial glucose levels did not show a significant difference , HbA1c , C-peptide , and HOMA-IR levels were significantly improved at 12 months after surgery in both BI and RY groups . Sixty percent of RY patients and 20 % of BI patients decreased their medication satisfying FBS<126 mg/dL and HbA1c<6.5 % and 5 % of BI patients stopped their medication satisfying the criteria of FBS<126 mg/dL and HbA1c<6.0 % . The improvement patterns were more sustainable with less fluctuation in RY than in BI . On hormonal analysis , ghrelin and leptin levels were decreased and PYY and GIP levels were increased at 12 months after surgery in both groups without significant difference according to the reconstruction type and diabetic improvement status except ghrelin . In gastric cancer surgery , RY reconstruction showed better and more durable diabetes control compared to BI during the first year after surgery . Gastric cancer surgery led to decreased ghrelin and leptin and increased PYY and GIP , which might have a role in improving insulin resistance and glucose homeostasis Background There are very few r and omised , blinded trials comparing laparoscopic sleeve gastrectomy ( LSG ) versus laparoscopic Roux-en-Y gastric bypass ( LRYGB ) in achieving remission of type 2 diabetes ( T2D ) , particularly silastic ring (SR)-LRYGB . We compared the effectiveness of ( LSG ) versus SR-LRYGB among patients with T2D and morbid obesity . Methods Prospect i ve , r and omised , parallel , 2-arm , blinded clinical trial conducted in a single Auckl and ( New Zeal and ) centre . Eligible patients aged 20–55 years , T2D of at least 6 months duration and BMI 35–65 kg/m2 were r and omised 1:1 to LSG ( n = 58 ) or SR-LRYGB ( n = 56 ) using r and om number codes disclosed after anaesthesia induction . Primary outcome was T2D remission defined by different HbA1c thresholds at 1 year . Secondary outcomes included weight loss , quality of life , anxiety and depressive symptoms , post-operative complications and mortality . Results Mean ± st and ard deviation ( SD ) pre-operative BMI was 42.5 ± 6.2 kg/m2 , HbA1c 63 ± 16 mmol/mol ( 30 % insulin-treated , 28 % had diabetes duration over 10 years ) . Proportions achieving HbA1c ≤ 38 mmol/mol , < 42 mmol/mol , < 48 mmol/mol and < 53 mmol/mol without diabetes medication at 1 year in SR-LRYGB vs LSG were 38 vs 43 % ( p = 0.56 ) , 52 vs 49 % ( p = 0.85 ) , 75 vs 72 % ( p = 0.83 ) and 80 vs 77 % ( p = 0.82 ) , respectively . Mean ± SD % total weight loss at 1 year was greater after SR-LRYGB than LSG : 32.2 ± 7.7 vs 27.1 ± 7.5 % , respectively ( p < 0.001 ) . Gastrointestinal complications were more frequent after SR-LRYGB ( including 3 ulcers , 1 anastomotic leak , 1 abdominal bleeding ) . Quality of life and depression symptoms improved significantly in both groups . Conclusion Despite significantly greater weight loss after SR-LRYGB , there was similar T2D remission and psychosocial improvement after LSG and SR-LRYGB at 1 year . Trial Registration Prospect ively registered at Australia and New Zeal and Clinical Trials Register ( ACTRN 12611000751976 ) and retrospectively registered at Clinical Trials ( NCT1486680 ) BACKGROUND Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and laparoscopic sleeve gastrectomy ( LSG ) are associated with glucose metabolism improvement although data on insulin resistance remission rates after these procedures are lacking . AIMS Primary aim was to compare insulin resistance remission rates achieved after LRYGB and LSG , using population -specific HOMA-IR cut-off points . Secondary objectives were to analyze factors associated with type 2 diabetes mellitus ( T2DM ) complete remission according to the new American Diabetes Association criteria and to examine changes in HOMA-B during follow-up . METHODS Non-r and omized , prospect i ve cohort study of patients undergoing LRYGB or LSG with a minimal follow-up of 24 months . Patients on insulin therapy were excluded . RESULTS At baseline , 56 ( 48.7 % ) of the 115 LRYGB group and 48 ( 61.5 % ) of the 78 LSG group had insulin resistance , and 29 ( 25.2 % ) and 20 ( 25.6 % ) T2DM , respectively . No differences were detected in insulin resistance remission rate ( 92.9 % LRYGB and 87.5 % LSG , p = 0.355 ) nor in T2DM complete remission at 2 years ( 62.1 vs 60 % respectively , p = 0.992 ) . Factors independently associated with T2DM complete remission were diabetes treatment and a greater decrease in 3-month HOMA-IR index . The HOMA-B index showed a progressive decline during follow-up . CONCLUSION Both surgical techniques are equally effective in achieving insulin resistance normalization in the majority of severely obese patients . Three-month HOMA-IR reduction after surgery was the main predictor of T2DM complete remission BACKGROUND Roux-en-Y gastric bypass ( RYGBP ) and sleeve gastrectomy ( SG ) have been associated with a high remission rate of type 2 diabetes mellitus ( T2DM ) . However , whether such remission is associated with full restoration of postpr and ial glucose profile and /or the potentially nonrestored glycemic profile is associated with altered beta cell function , and relapse of T2DM over time is unknown . METHODS Cross-sectional studies comparing ( 1 ) glucose and proinsulin/insulin response to a st and ardized liquid mixed meal ( SLMM ) challenge  ( n = 31 ) , ( 2 ) glucose response in normal living conditions assessed using continuous glucose monitoring ( CGM ) ( n = 16 ) , and prospect i ve observational study comparing ( 3 ) rates of relapse of T2DM after surgery ( n = 232 ) in subjects with remission of T2DM ensuing RYGBP or SG . RESULTS In  RYGB individuals , SLMM elicited faster and sharper rise in plasma glucose compared with SG , with 88.2 % and 42.9 % of the study subjects presenting respectively a peak glucose more than 180 mg/dL ( all , P < 0.05 ) . During CGM , average percent time in hyperglycemic and hypoglycemic range was larger in RYGBP ( respectively , 4.6 % and 12.7 % ) compared with SG subjects ( respectively , 0.4 % and 3.2 % ; both P < 0.05 ) . However , ( 1 ) no differences were found in fasting or stimulated proinsulin/insulin ratio , and ( 2 ) higher rates of T2DM relapse were observed after SG ( hazard ratio : 2.339 ; P = 0.034 ) . CONCLUSIONS Remission of T2DM after RYGBP and SG is associated with distinct glycemic profiles . However , longer time spent in hyperglycemia and in hypoglycemia after RYGBP compared with SG is not associated with persistence of altered beta cell function or higher rates of relapse of T2DM over time Background Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGBP ) are associated with similar type 2 diabetes mellitus ( T2DM ) resolution rates for morbidly obese subjects . However , the mechanisms underlying the resolution of T2DM after SG have not been clarified to date . This study aim ed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP . Methods This prospect i ve study investigated 12 subjects with T2DM who had undergone SG ( n = 6 ) or RYGBP ( n = 6 ) . Five body mass index ( BMI ) -matched obese non-diabetic subjects and five BMI -matched obese diabetic subjects served as control subjects .  Glucose , insulin , glucagon , glucagon-like peptide 1 ( GLP-1 ) , glucose-dependent insulinotropic polypeptide ( GIP ) , and GLP-2 were determined after a st and ardized mixed liquid meal before surgery and 6 weeks afterward . Results After 6 weeks , five of the six subjects in each surgical group presented with T2DM remission , although the area under the curve (AUC)0–120 of glucose was greater than that of the non-diabetic control subjects ( P < 0.01 ) . Postsurgically , the indices of insulin and glucagon secretion were comparable between the two surgical groups . The AUC0–120 of GLP-1 ( P < 0.05 ) and GLP-2 ( P < 0.05 ) was significantly and comparably enlarged after SG and RYGB . The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test ( ρ = 0.747 ; P < 0.01 ) . Conclusions The data show that in a cohort of morbidly obese T2DM subjects , SG and RYGBP are associated with an early improvement in glucose tolerance , similar changes in insulin and glucagon secretion , and a similar GLP-1 , GIP , and GLP-2 response to a st and ardized mixed liquid meal IMPORTANCE Controlling glycemia , blood pressure , and cholesterol is important for patients with diabetes . How best to achieve this goal is unknown . OBJECTIVE To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors . DESIGN , SETTING , AND PARTICIPANTS A 12-month , 2-group unblinded r and omized trial at 4 teaching hospitals in the United States and Taiwan involving 120 participants who had a hemoglobin A1c ( HbA1c ) level of 8.0 % or higher , body mass index ( BMI ) between 30.0 and 39.9 , C peptide level of more than 1.0 ng/mL , and type 2 diabetes for at least 6 months . The study began in April 2008 . INTERVENTIONS Lifestyle-intensive medical management intervention and Roux-en-Y gastric bypass surgery . Medications for hyperglycemia , hypertension , and dyslipidemia were prescribed according to protocol and surgical techniques that were st and ardized . MAIN OUTCOMES AND MEASURES Composite goal of HbA1c less than 7.0 % , low-density lipoprotein cholesterol less than 100 mg/dL , and systolic blood pressure less than 130 mm Hg . RESULTS All 120 patients received the intensive lifestyle-medical management protocol and 60 were r and omly assigned to undergo Roux-en-Y gastric bypass . After 12-months , 28 participants ( 49 % ; 95 % CI , 36%-63 % ) in the gastric bypass group and 11 ( 19 % ; 95 % CI , 10%-32 % ) in the lifestyle-medical management group achieved the primary end points ( odds ratio [ OR ] , 4.8 ; 95 % CI , 1.9 - 11.7 ) . Participants in the gastric bypass group required 3.0 fewer medications ( mean , 1.7 vs 4.8 ; 95 % CI for the difference , 2.3 - 3.6 ) and lost 26.1 % vs 7.9 % of their initial body weigh compared with the lifestyle-medical management group ( difference , 17.5 % ; 95 % CI , 14.2%-20.7 % ) . Regression analyses indicated that achieving the composite end point was primarily attributable to weight loss . There were 22 serious adverse events in the gastric bypass group , including 1 cardiovascular event , and 15 in the lifestyle-medical management group . There were 4 perioperative complications and 6 late postoperative complications . The gastric bypass group experienced more nutritional deficiency than the lifestyle-medical management group . CONCLUSIONS AND RELEVANCE In mild to moderately obese patients with type 2 diabetes , adding gastric bypass surgery to lifestyle and medical management was associated with a greater likelihood of achieving the composite goal . Potential benefits of adding gastric bypass surgery to the best lifestyle and medical management strategies of diabetes must be weighed against the risk of serious adverse events . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00641251 OBJECTIVE Bariatric surgery reverses obesity-related comorbidities , including type 2 diabetes mellitus . Several studies have already described differences in anthropometrics and body composition in patients undergoing Roux-en-Y gastric bypass compared with laparoscopic adjustable gastric b and ing  , but the role of adipokines in the outcomes after the different types of surgery is not known . Differences in weight loss and reversal of insulin resistance exist between the 2 groups and correlate with changes in adipokines . METHODS Fifteen severely obese women ( mean body mass index [ BMI ] : 46.7 kg/m(2 ) ) underwent 2 types of laparoscopic weight loss surgery ( Roux-en-Y gastric bypass=10 , adjustable gastric b and ing=5 ) .  Weight , waist and hip circumference , body composition , plasma metabolic markers , and lipids were measured at set intervals during a 24-month period after surgery . RESULTS At 24 months , patients who underwent Roux-en-Y were overweight ( BMI 29.7 kg/m(2 ) ) , whereas patients who underwent gastric b and ing remained obese ( BMI 36.3 kg/m(2 ) ) . Patients who underwent Roux-en-Y lost significantly more fat mass than patients who underwent gastric b and ing ( mean difference 16.8 kg , P<.05 ) . Likewise , leptin levels were lower in the patients who underwent Roux-en-Y ( P=.003 ) , and levels correlated with weight loss , loss of fat mass , insulin levels , and Homeostasis Model of Assessment 2 . Adiponectin correlated with insulin levels and Homeostasis Model of Assessment 2 ( r=-0.653 , P=.04 and r=-0.674 , P=.032 , respectively ) in the patients who underwent Roux-en-Y at 24 months . CONCLUSION After 2 years , weight loss and normalization of metabolic parameters were less pronounced in patients who underwent gastric b and ing  compared with patients who underwent Roux-en-Y gastric bypass . Our findings require confirmation in a prospect i ve r and omized trial
Bariatric surgery leads to marked and long-lasting weight reduction .
A large proportion of patients undergoing bariatric surgery have DM2 .
Glycemic control improves in the months after laparoscopic adjustable gastric b and ing , but it improves more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery .
Thus , both types of surgery are capable of improving or even curing DM2 , but the mechanisms may differ
OBJECTIVE To systematic ally review the literature pertaining to the reversal of  type 2 diabetes mellitus ( DM2 ) after Roux-en-Y gastric bypass and adjustable gastric b and ing .