Evaluation of Current Eligibility Criteria for Bariatric Surgery Outcomes of bariatric surgery in patients with body mass index <35 kg/m2. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2 Randomized Pilot Trial of Bariatric Surgery Versus Intensive Medical Weight Management on Diabetes Remission in Type 2 Diabetic Patients Who Do NOT Meet NIH Criteria for Surgery and the Role of Soluble RAGE as a Novel Biomarker of Success Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year Effect of Laparoscopic Mini-Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI >35 and <35 kg/m2 Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial. Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. Effects of Bariatric Surgery in Obese Patients With Hypertension The role of bariatric surgery in morbidly obese patients with inflammatory bowel disease. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m(2). Predictive Factors of Type 2 Diabetes Remission 1 Year After Bariatric Surgery: Impact of Surgical Techniques A population-based, shared decision-making approach to recruit for a randomized trial of bariatric surgery versus lifestyle for type 2 diabetes.
OBJECTIVE Patients with a BMI < 35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery .  We used Swedish obese subjects ( SOS ) to explore long-term outcomes in noneligible versus eligible patients . RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery ( 68 % vertical-b and ed gastroplasty , 19 % b and ing , and 13 % gastric bypass ) and 2,037 contemporaneously matched obese controls receiving usual care .  At inclusion , the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women . The effect of surgery was assessed in patients that do ( n = 3,814 ) and do not ( n = 233 ) meet current eligibility criteria . The date of analysis was 1 January 2012 . The follow-up time was up to 20 years , with a median of 10 years . RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up . Surgery reduced the diabetes incidence in both the noneligible ( adjusted hazard ratio 0.33 [ 95 % CI 0.13–0.82 ] , P = 0.017 ) and eligible ( 0.27 [ 0.22–0.33 ] , P < 0.001 ) groups . We could not detect a difference in the effect of surgery between the groups ( adjusted interaction P value = 0.713 ) . CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups . Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors BACKGROUND Patients who are categorized with class I obesity have a body mass index ( BMI ) of 30 - 34.99 kg/m(2 ) . This population of patients has a predisposition to diabetes , hypertension , and dyslipidemia . The aim of the present study was to investigate the improvements of these co-morbidities in a class I obese population that had undergone a bariatric procedure . METHODS After internal review board approval and with adherence to the Health Insurance Portability and Accountability Act guidelines , a retrospective review was performed of a prospect ively maintained data base of 42 class I obese patients who underwent a bariatric procedure at our institution during a 10-year period , from February 2000 to May 2010 . The fasting glucose level , glycosylated hemoglobin level , lipid profile , initial weight , and BMI were measured in the preoperative and postoperative periods . RESULTS Our patient population consisted of 30 women and 12 men , with a preoperative mean BMI of 33.9 kg/m(2 ) .  Laparoscopic sleeve gastrectomy was performed in 24 patients ( 57 % ) , laparoscopic Roux-en-Y gastric bypass in 8 ( 19 % ) , and laparoscopic adjustable gastric b and ing in 10 ( 24 % ) . Of these 42 patients , 25 ( 60 % ) had type 2 diabetes , 1 patient was glucose intolerant , 27 ( 64 % ) had arterial hypertension , 25 ( 60 % ) had dyslipidemia , 17 ( 40 % ) had sleep apnea , and 8 ( 19 % ) had osteoarthritis . The postoperative findings included a mean BMI of 26.5 kg/m(2 ) and a mean weight loss of 41.4 lb . Of the 25 diabetic patients , 5 ( 20 % ) gained remission and 12 ( 48 % ) improvement of their diabetic status . The single patient with glucose intolerance showed improvement . Of the 27 patients with arterial hypertension , 9 ( 33 % ) showed remission and 13 ( 52 % ) improvement . Dyslipidemia resolved in 5 patients ( 20 % ) and improved in 13 ( 52 % ) . Obstructive sleep apnea resolved in 10 ( 59 % ) and improvement was seen in 1 patient ( 6 % ) . Finally , osteoarthritis resolved in 1 patient ( 12 % ) and improved in 5 ( 63 % ) . CONCLUSION Bariatric surgery can significantly improve or resolve co-morbid metabolic conditions in patients with class I obesity BACKGROUND Weight loss protects against type 2 diabetes but is hard to maintain with behavioral modification alone . In an analysis of data from a nonr and omized , prospect i ve , controlled study , we examined the effects of bariatric surgery on the prevention of type 2 diabetes . METHODS In this analysis , we included 1658 patients who underwent bariatric surgery and 1771 obese matched controls ( with matching performed on a group , rather than individual , level ) . None of the participants had diabetes at baseline . Patients in the bariatric-surgery cohort underwent b and ing  ( 19 % ) , vertical b and ed gastroplasty ( 69 % ) , or gastric bypass ( 12 % ) ; nonr and omized , matched , prospect i ve controls received usual care . Participants were 37 to 60 years of age , and the body-mass index ( BMI ; the weight in kilograms divided by the square of the height in meters ) was 34 or more in men and 38 or more in women . This analysis focused on the rate of incident type 2 diabetes , which was a prespecified secondary end point in the main study . At the time of this analysis ( January 1 , 2012 ) , participants had been followed for up to 15 years . Despite matching , some baseline characteristics differed significantly between the groups ; the baseline body weight was higher and risk factors were more pronounced in the bariatric-surgery group than in the control group . At 15 years , 36.2 % of the original participants had dropped out of the study , and 30.9 % had not yet reached the time for their 15-year follow-up examination . RESULTS During the follow-up period , type 2 diabetes developed in 392 participants in the control group and in 110 in the bariatric-surgery group , corresponding to incidence rates of 28.4 cases per 1000 person-years and 6.8 cases per 1000 person-years , respectively ( adjusted hazard ratio with bariatric surgery , 0.17 ; 95 % confidence interval , 0.13 to 0.21 ; P<0.001 ) . The effect of bariatric surgery was influenced by the presence or absence of impaired fasting glucose ( P=0.002 for the interaction ) but not by BMI ( P=0.54 ) . Sensitivity analyses , including end-point imputations , did not change the overall conclusions . The postoperative mortality was 0.2 % , and 2.8 % of patients who underwent bariatric surgery required reoperation within 90 days owing to complications . CONCLUSIONS Bariatric surgery appears to be markedly more efficient than usual care in the prevention of  type 2 diabetes in obese persons . ( Funded by the Swedish Research Council and others ; Clinical Trials.gov number , NCT01479452 . ) Background Many mildly to moderately obese individuals with a body mass index ( BMI ) lower than 35 kg/m2 have serious diseases related to their obesity . Nonsurgical therapy is ineffective in the long term , yet surgery has never been made widely available to this population . Methods Between 2002 and 2007 , 53 patients with a BMI lower than 35 kg/m2 underwent laparoscopic adjustable gastric b and ing at our institution . Data on all these patients were collected prospect ively and entered into an institutional review board – approved electronic registry . The study parameters included preoperative age , gender , BMI , presence of comorbidities , percentage of excess weight loss ( % EWL ) , and resolution of comorbidities . Results The mean preoperative age of the patients was 46.9 years ( range , 16–68 years ) , and the mean preoperative BMI was 33.1 kg/m2 ( range , 28.2–35.0 kg/m2 ) . Of the 53 patients , 49 ( 92 % ) had at least one obesity-related comorbidity . The mean BMI decreased to 28.1 ± 2.4 kg/m2 , 25.8 ± 2.9 kg/m2 , and 25.8 ± 3.1 kg/m2 and mean % EWL was 48.3 ± 17.6 , 69.9 ± 28.0 , and 69.7 ± 31.7 at 0.5 , 1 , and 2 years , respectively . Substantial improvement occurred for the following comorbidities evaluated : hypertension , depression , diabetes , asthma , hypertriglyceridemia , obstructive sleep apnea , hypercholesterolemia , and osteoarthritis . There was one slip , two cases of b and obstruction ( from food ) , two cases of esophagitis , and two port leaks , but no mortality . Conclusion The authors are very encouraged by this series of low- BMI patients who underwent laparoscopic adjustable gastric b and ing .  Their weight loss has been excellent , and their complications have been acceptable . Their comorbidities have partially or wholly resolved . With further study , it is reasonable to expect alteration of the weight guidelines for bariatric surgery to include patients with a BMI lower than 35 kg/m2 Objective : To compare bariatric surgery versus intensive medical weight management ( MWM ) in patients with type 2 diabetes mellitus ( T2DM ) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products ( sRAGE ) is a biomarker to identify patients most likely to benefit from surgery . Background : There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35 . Methods : Fifty-seven patients with T2DM and BMI 30 to 35 , who otherwise met the criteria for bariatric surgery were r and omized to MWM versus surgery ( bypass , sleeve or b and , based on patient preference ) . The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance ( HOMA-IR ) and diabetes remission . Secondary outcomes included changes in HbA1c , weight , and sRAGE . Results : The surgery group had improved HOMA-IR ( −4.6 vs + 1.6 ; P = 0.0004 ) and higher diabetes remission ( 65 % vs 0 % , P < 0.0001 ) than the MWM group at 6 months . Compared to MWM , the surgery group had lower HbA1c ( 6.2 vs 7.8 , P = 0.002 ) , lower fasting glucose ( 99.5 vs 157 ; P = 0.0068 ) , and fewer T2DM medication requirements ( 20 % vs 88 % ; P < 0.0001 ) at 6 months . The surgery group lost more weight ( 7 . vs 1.0 BMI decrease , P < 0.0001 ) . Higher baseline sRAGE was associated with better weight loss outcomes ( r = −0.641 ; P = 0.046 ) . There were no mortalities . Conclusions : Surgery was very effective short-term in patients with T2DM and BMI 30 to 35 . Baseline sRAGE may predict patients most likely to benefit from surgery . These findings need to be confirmed with larger studies . Clinical Trials.gov ID : Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Background Laparoscopic gastric bypass result ed in significant weight loss and resolution of type 2 diabetes mellitus ( T2DM ) .  The current indication for bariatric surgery is mainly applied for patients with body mass index ( BMI ) > 35 kg/m2 with comorbidity status . However , little is known concerning T2DM patients with BMI < 35 kg/m2 . Recent studies have suggested that T2DM patients with BMI < 35 kg/m2 might benefit from gastric bypass surgery . Methods From Jan 2002 to Dec 2006 , 820 patients who underwent laparoscopic mini-gastric bypass were enrolled in a surgically supervised weight loss program .  We identified 201 ( 24.5 % ) patients who had impaired fasting glucose or T2DM . All the clinical data were prospect ively collected and stored . Patients with BMI < 35 kg/m2 were compared with those of BMI > 35 kg/m2 . Successful treatment of T2DM was defined by HbA1C < 7.0 % , LDL < 100 mg/dl , and triglyceride < 150 mg/dl . Results Among the 201 patients , 44 ( 21.9 % ) had BMI < 35 kg/m2 , and 114 ( 56.7 % ) had BMI between 35 and 45 , 43 ( 21.4 % ) had BMI > 45 kg/m2 . Patients with BMI < 35 kg/m2 are significantly older , female predominant , had lower liver enzyme and C-peptide levels than those with BMI > 35 kg/m2 . The mean total weight loss for the population was 32.1 , 33.4 , 31.9 , and 32.8 % ( at 1 , 2 , 3 , 5 years after surgery ) , and percentage to change in BMI was 31.9 , 34.2 , 32.2 , and 29.5 % at 1 , 2 , 3 , and 5 years . One year after surgery , fasting plasma glucose returned to normal in 89.5 % of BMI < 35 kg/m2 T2DM and 98.5 % of BMI > 35 kg/m2 patients ( p = 0.087 ) . The treatment goal of T2DM ( HbA1C < 7.0 % , LDL < 150 mg/dl and triglyceride < 150 mg/dl ) was met in 76.5 % of BMI < 35 kg/m2 and 92.4 % of BMI > 350 kg/m2 ( p = 0.059 ) . Conclusion Laparoscopic gastric bypass result ed in significant and sustained weight loss with successful treatment of T2DM up to 87.1 % . Despite a slightly lower response rate of T2DM treatment , patients with BMI < 35 still had an acceptable DM resolution , and this treatment option can be offered to this group of patients BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND In short-term r and omized trials ( duration , 1 to 2 years ) , bariatric surgery has been associated with improvement in type 2 diabetes mellitus . METHODS We assessed outcomes 3 years after the r and omization of 150 obese patients with uncontrolled type 2 diabetes to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy .  The primary end point was a glycated hemoglobin level of 6.0 % or less . RESULTS The mean ( ±SD ) age of the patients at baseline was 48±8 years , 68 % were women , the mean baseline glycated hemoglobin level was 9.3±1.5 % , and the mean baseline body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 36.0±3.5 . A total of 91 % of the patients completed 36 months of follow-up . At 3 years , the criterion for the primary end point was met by 5 % of the patients in the medical-therapy group , as compared with 38 % of those in the gastric-bypass group ( P<0.001 ) and 24 % of those in the sleeve-gastrectomy group ( P=0.01 ) . The use of glucose-lowering medications , including insulin , was lower in the surgical groups than in the medical-therapy group . Patients in the surgical groups had greater mean percentage reductions in weight from baseline , with reductions of 24.5±9.1 % in the gastric-bypass group and 21.1±8.9 % in the sleeve-gastrectomy group , as compared with a reduction of 4.2±8.3 % in the medical-therapy group ( P<0.001 for both comparisons ) . Quality -of-life measures were significantly better in the two surgical groups than in the medical-therapy group . There were no major late surgical complications . CONCLUSIONS Among obese patients with uncontrolled type 2 diabetes , 3 years of intensive medical therapy plus bariatric surgery result ed in glycemic control in significantly more patients than did medical therapy alone . Analyses of secondary end points , including body weight , use of glucose-lowering medications , and quality of life , also showed favorable results at 3 years in the surgical groups , as compared with the group receiving medical therapy alone . ( Funded by Ethicon and others ; STAMPEDE Clinical Trials.gov number , NCT00432809 . ) BACKGROUND Bariatric surgery improves glycaemia in obese people with type 2 diabetes , but its effects are uncertain in overweight people with this disease . We aim ed to identify whether laparoscopic adjustable gastric b and surgery can improve glucose control in people with type 2 diabetes who were overweight but not obese . METHODS We did an open-label , parallel-group , r and omised controlled trial between Nov 1 , 2009 , and June 30 , 2013 , at one centre in Melbourne , Australia . Patients aged 18 - 65 years with type 2 diabetes and a BMI between 25 and 30 kg/m2 were r and omly assigned ( 1:1 ) , by computer-generated r and om sequence , to receive either multidisciplinary diabetes care plus laparoscopic adjustable gastric b and surgery or multidisciplinary diabetes care alone . The primary outcome was diabetes remission 2 years after r and omisation , defined as glucose concentrations of less than 7.0 mmol/L when fasting and less than 11.1 mmol/L 2 h after 75 g oral glucose , at least two days after stopping glucose-lowering drugs . Analysis was by intention to treat . This trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12609000286246 . FINDINGS 51 patients were r and omised to the multidisciplinary care plus gastric b and group ( n=25 ) or the multidisciplinary care only group ( n=26 ) , of whom 23 participants and 25 participants , respectively , completed follow-up to 2 years . 12 ( 52 % ) participants in the multidisciplinary care plus gastric b and group and two ( 8 % ) participants in the multidisciplinary care only group achieved diabetes remission ( difference in proportions 0.44 , 95 % CI 0.17 - 0.71 ; p=0.0012 ) . One ( 4 % ) participant in the gastric b and group needed revisional surgery and four others ( 17 % ) had a total of five episodes of food intolerance due to excessive adjustment of the b and . INTERPRETATION When added to multidisciplinary care , laparoscopic adjustable gastric b and surgery for overweight people with type 2 diabetes improves glycaemic control with an acceptable adverse event profile . Laparoscopic adjustable gastric b and surgery is a reasonable treatment option for this population . FUNDING Monash University Centre for Obesity Research and Education and Allergan OBJECTIVE To prospect ively examine the effect of weight loss 1 year after  laparoscopic adjustable gastric b and surgery on a broad range of health outcomes in 50 diabetic subjects . RESEARCH DESIGN AND METHODS A total of 50 ( 17 men , 33 women ) of 51 patients with type 2 diabetes , from a total of 500 consecutive patients , were studied preoperatively and again 1 year after surgery . RESULTS Preoperative weight and BMI ( means + /- SD ) were 137 + /- 30 kg and 48.2 + /- 8 kg/m(2 ) , respectively ; at 1 year , weight and BMI were 110 + /- 24 kg and 38.7 + /- 6 kg/m(2 ) , respectively . There was significant improvement in all measures of glucose metabolism . Remission of diabetes occurred in 32 patients ( 64 % ) , and major improvement of glucose control occurred in 13 patients ( 26 % ) ; glucose metabolism was unchanged in 5 patients ( 10 % ) . HbA(1c ) was 7.8 + /- 3.2 % preoperatively and 6.2 + /- 2.7 % at 1 year ( P < 0.001 ) . Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes ( pseudo r(2 ) = 0.44 , P < 0.001 ) . Improvement in diabetes was related to increased insulin sensitivity and beta-cell function . Weight loss was associated with significant improvements in fasting triglyceride level , HDL cholesterol level , hypertension , sleep , depression , appearance evaluation , and health-related quality of life . Early complications occurred in 6 % of patients ( wound infections in 4 % , respiratory support in 2 % ) , and late complications occurred in 30 % of patients ( gastric prolapse in 20 % , b and erosion in 6 % , and tubing leaks in 4 % ) . All late complications were successfully revised surgically . CONCLUSIONS Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes . Surgery should be considered as an early intervention BACKGROUND Observational studies have shown improvement in patients with type 2 diabetes mellitus after bariatric surgery . METHODS In this r and omized , nonblinded , single-center trial , we evaluated the efficacy of intensive medical therapy alone versus medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy in 150 obese patients with uncontrolled type 2 diabetes . The mean ( ±SD ) age of the patients was 49±8 years , and 66 % were women . The average  glycated hemoglobin level was 9.2±1.5 % . The primary end point was the proportion of patients with a glycated hemoglobin level of 6.0 % or less 12 months after treatment . RESULTS Of the 150 patients , 93 % completed 12 months of follow-up . The proportion of patients with the primary end point was 12 % ( 5 of 41 patients ) in the medical-therapy group versus 42 % ( 21 of 50 patients ) in the gastric-bypass group ( P=0.002 ) and 37 % ( 18 of 49 patients ) in the sleeve-gastrectomy group ( P=0.008 ) . Glycemic control improved in all three groups , with a mean glycated hemoglobin level of 7.5±1.8 % in the medical-therapy group , 6.4±0.9 % in the gastric-bypass group ( P<0.001 ) , and 6.6±1.0 % in the sleeve-gastrectomy group ( P=0.003 ) . Weight loss was greater in the gastric-bypass group and sleeve-gastrectomy group ( -29.4±9.0 kg and -25.1±8.5 kg , respectively ) than in the medical-therapy group ( -5.4±8.0 kg ) ( P<0.001 for both comparisons ) . The use of drugs to lower glucose , lipid , and blood-pressure levels decreased significantly after both surgical procedures but increased in patients receiving medical therapy only . The index for homeostasis model assessment of insulin resistance ( HOMA-IR ) improved significantly after bariatric surgery . Four patients underwent reoperation . There were no deaths or life-threatening complications . CONCLUSIONS In obese patients with uncontrolled type 2 diabetes , 12 months of medical therapy plus bariatric surgery  achieved glycemic control in significantly more patients than medical therapy alone . Further study will be necessary to assess the durability of these results . ( Funded by Ethicon Endo-Surgery and others ; Clinical Trials.gov number , NCT00432809 . ) Background : Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution . R and omized trials design ed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed . Methods : In this r and omized , single-center , nonblinded trial , we included patients with hypertension ( using ≥2 medications at maximum doses or > 2 at moderate doses ) and a body mass index between 30.0 and 39.9 kg/m2 . Patients  were r and omized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone . The primary end point was reduction of ≥30 % of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure < 140 mm Hg and 90 mm Hg , respectively , at 12 months . Results : We included 100 patients ( 70 % female , mean age 43.8±9.2 years , mean body mass index 36.9±2.7 kg/m2 ) , and 96 % completed follow-up .  Reduction of ≥30 % of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group ( 83.7 % ) compared with 6 of 47 patients ( 12.8 % ) from the control group with a rate ratio of 6.6 ( 95 % confidence interval , 3.1–14.0 ; P<0.001 ) . Remission of hypertension was present in 25 of 49 ( 51 % ) and 22 of 48 ( 45.8 % ) patients r and omized to gastric bypass , considering office and 24-hour ambulatory blood pressure monitoring , respectively , whereas no patient su bmi tted to medical therapy was free of antihypertensive drugs at 12 months . A post hoc analysis for the primary end point considering the SPRINT ( Systolic Blood Pressure Intervention Trial ) target reached consistent results , with a rate ratio of 3.8 ( 95 % confidence interval , 1.4–10.6 ; P=0.005 ) . Eleven patients ( 22.4 % ) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives . Waist circumference , body mass index , fasting plasma glucose , glycohemoglobin , low-density lipoprotein cholesterol , triglycerides , high-sensitivity C-reactive protein , and 10-year Framingham risk score were lower in the gastric bypass than in the control group . Conclusions : Bariatric surgery represents an effective strategy for blood pressure control in a broad population of patients with obesity and hypertension . Clinical Trial Registration : URL : https:// clinical trials.gov . Unique identifier : NCT01784848 BACKGROUND Bariatric surgery is considered as being contraindicated for morbidly obese patients who also have inflammatory bowel disease ( IBD ) . The aim of our study was to report the outcomes of bariatric surgery in morbidly obese IBD patients . METHODS The prospect ively collected data of all the patients diagnosed as having IBD who underwent bariatric operations in 2 medical centers between October 2006 and January 2014 were retrieved and analyzed . RESULTS One male and 9 female morbidly obese IBD patients ( 8 with Crohn 's disease and 2 with ulcerative colitis ) underwent bariatric surgery .  Their mean age was 40 years , and their mean body mass index was 42.6 kg/m2 . Nine of them underwent a laparoscopic sleeve gastrectomy and 1 underwent a laparoscopic adjustable gastric b and .  Eight patients had obesity-related co-morbidities , including type 2 diabetes , hypertension , sleep apnea , osteoarthropathy , etc  . After a median follow-up of 46 months ( range 9 - 67 ) , all of the patients lost weight , with an excess weight loss of 71 % , and 10 out of 16 obesity-related co-morbidities were resolved . There was 1 complication not related to IBD , and no IBD exacerbation . CONCLUSION Bariatric surgery was safe and effective in our morbidly obese IBD patients . The surgical outcome in this selected patient group was similar to that of comparable non-IBD patients BACKGROUND Roux-en-Y gastric bypass ( RYGB ) benefits patients with type 2 diabetes mellitus ( T2DM ) and a body mass index ( BMI ) > 35 kg/m(2 ) ; however , its effectiveness in patients with T2DM and a BMI < 35 kg/m(2 ) is unclear . Asian Indians have a high risk of T2DM and cardiovascular disease at relatively low BMI levels . We examined the safety and efficacy of RYGB in Asian Indian patients with T2DM and a BMI of 22 - 35 kg/m(2 ) in a tertiary care medical center . METHODS A total of 15 consecutive patients with T2DM and a BMI of 22 - 35 kg/m(2 ) underwent RYGB .  The data were prospect ively collected before surgery and at 1 , 3 , 6 , and 9 months postoperatively . RESULTS Of the 15 patients , 8 were men and 7 were women ( age 45.6 + /- 12 years ) . Their preoperative characteristics were BMI 28.9 + /- 4.0 kg/m(2 ) , body weight 78.7 + /- 12.5 kg , waist circumference 100.2 + /- 6.8 cm , and duration of T2DM 8.7 + /- 5.3 years . At baseline , 80 % of subjects required insulin , and 20 % controlled their T2DM with oral hypoglycemic medication . The BMI decreased postoperatively by 20 % , from 28.9 + /- 4.0 kg/m(2 ) to 23.0 + /- 3.6 kg/m(2 ) ( P < .001 ) . All antidiabetic medications were discontinued by 1 month after surgery in 80 % of the subjects . At 3 months and thereafter , 100 % were euglycemic and no longer required diabetes medication . The fasting blood glucose level decreased from 233 + /- 87 mg/dL to 89 + /- 12 mg/dL ( P < .001 ) , and the hemoglobin A1c decreased from 10.1 % + /- 2.0 % to 6.1 % + /- 0.6 % ( P < .001 ) . Their waist circumference , presence of dyslipidemia , and hypertension improved significantly . The predicted 10-year cardiovascular disease risk ( calculated using the United Kingdom Prospect i ve Diabetes Study equations ) decreased substantially for fatal and nonfatal coronary heart disease and stroke . No mortality , major surgical morbidity , or excessive weight loss occurred . CONCLUSION RYGB safely and effectively eliminated T2DM in Asian Indians with a BMI < 35 kg/m(2 ) . Larger , longer term studies are needed to confirm this benefit Type 2 diabetes ( T2D ) remission after bariatric procedures has been highlighted in many retrospective and some recent prospect i ve studies . However , in the most recent prospect i ve study , more than 50 % of patients did not reach T2D remission at 1 year . Our aim was to identify baseline positive predictors for T2D remission at 1 year after bariatric surgery and to build a preoperative predictive score . We analysed the data concerning 161 obese operated on between June 2007 and December 2010 . Among them , 46 were diabetic and were included in the study —11 laparoscopic adjustable gastric b and ing ( LAGB ) , 26 Roux-en-Y gastric bypass ( RYGB ) and 9 sleeve gastrectomy ( SG ) .  We compared anthropometric and metabolic features during 1 year of follow-up . A receiver operating characteristic analysis was performed to predict T2D remission . RYGB and SG were similarly efficient for body weight loss and more efficient than LAGB ; 62.8 % of patients presented with T2DM remission at 1 year , with no significant difference according to the surgical procedure . A 1-year body mass index ( BMI ) < 35 kg m−2 was predictive of T2DM remission whatever the procedure . The preoperative predictive factors of diabetes remission were baseline BMI ≤50 kg m−2 , duration of type 2 diabetes ≤4 years , glycated haemoglobin ≤7.1 % , fasting glucose < 1.14 g/l and absence of insulin therapy . A short duration of diabetes and good preoperative glycaemic control increase the rate of T2DM remission 1 year after surgery . Preoperative metabolic data could be of greater importance than the choice of bariatric procedure BACKGROUND R and omized trials of bariatric surgery versus lifestyle treatment likely enroll highly motivated patients , which may limit the interpretation and generalizability of study findings . The objective of this study was to assess the feasibility of a population -based shared decision-making ( SDM ) approach to recruitment for a trial comparing laparoscopic Roux-en-Y gastric bypass surgery with intensive lifestyle intervention among adults with mild to moderate obesity and type 2 diabetes . METHODS Adult members with a body mass index ( BMI ) between 30 and 45 kg/m(2 ) taking diabetes medications were identified in electronic data bases and underwent a multiphase screening process . C and i date s were given a telephone survey , education about treatment options for obesity and diabetes using decision aids , and an SDM phone call with a nurse practitioner , in addition to st and ard office-based consent . RESULTS We identified 1808 members , and 828 ( 45.7 % ) had a BMI of 30 - 34.9 kg/m(2 ) . Among these , 1063 ( 59 % ) agreed to the telephone survey , 416 ( 23 % ) expressed interest in education about treatment options , and 277 ( 15 % ) completed the SDM process . The preferred treatment options were surgery ( 21 [ 8 % ] ) ,  diet and exercise  ( 149 [ 53.8 % ] ) , pharmacotherapy ( 5 [ 2 % ] ) , none of the above ( 8 [ 3 % ] ) , and unsure ( 94 [ 34 % ] ) . Ultimately , 43 participants were r and omly assigned to the trial . Significant differences , mainly related to sex , disease severity , and hypoglycemic medication use , were observed among people who did and did not agree to participate in our trial . CONCLUSION This population -based , SDM-based recruitment strategy successfully identified , enrolled , and r and omly assigned patients who had balanced views of surgery and lifestyle management . Even with this approach , selection biases may remain , highlighting the need for careful characterization of non participants in all future studies
In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .