At 2 years, 10.4% of the surgical patients and 19.9% of the medically treated patients had dropped out. In all, diabetes remission — defined as a fasting plasma glucose less than 5.6 mmol/L without pharmacological treatment — was achieved in 14.4% of the medication group vs 63.7% in the surgical arm (P < .001).

By surgical type, 76% of those with diversionary procedures achieved remission, vs 60% with gastric-only techniques (= .016).

"Probably, as demonstrated by many pathophysiologic studies, it is the bypass of the duodenum and jejunum that improves insulin resistance," Dr Mingrone said.

Tight glycemic control, defined as fasting glycemia less than 7 mmol/L without pharmacological therapy, occurred in 85% of the diversionary-surgery group and 78% of the gastric-only surgery group. By contrast, 40% of medically treated patients achieved tight glycemic control at 2 years.

For the total study population, baseline younger age, shorter diabetes duration, lower fasting glycemia, and nonuse of diabetes drugs all predicted a greater chance of remission at 2 years. When the analysis was divided by medication vs surgery and by surgery type, age was no longer significant.

When the total study population was stratified by baseline BMI, the chance of remission was 2.9-fold greater for those with BMI greater than 40 kg/m2 compared with BMI between 35 and 40 kg/m2, but there was no significant difference between the latter group and those with BMI below 35 kg/m2.

Patients who achieved diabetes remission lost more weight (25% vs 17%) and experienced improved waist circumference (18% vs 13%) and better insulin sensitivity than did those not achieving remission.

Dr Cefalu told Medscape Medical News that this study's strengths are the database of studies and the 2-year observation period for remission.

"Clearly, this study, as others, continues to demonstrate the effectiveness of metabolic surgery for diabetes control."

Dr Mingrone said that while there is now enough literature to prove that bariatric surgery is effective in inducing diabetes remission and in improving glycemic control, "endocrinologists probably want to know better the complications of bariatric surgery both in the short and in the long term and in much larger populations than in the relatively small studies published.

"The major problem in this regard is that for a drug there is a pharmaceutical company paying for the drug study in big population trials, while for bariatric surgery only small grants are available from public funds," he added.

At 2 years, 10.4% of the surgical patients and 19.9% of the medically treated patients had dropped out. In all, diabetes remission — defined as a fasting plasma glucose less than 5.6 mmol/L without pharmacological treatment — was achieved in 14.4% of the medication group vs 63.7% in the surgical arm (P < .001).

By surgical type, 76% of those with diversionary procedures achieved remission, vs 60% with gastric-only techniques (= .016).

"Probably, as demonstrated by many pathophysiologic studies, it is the bypass of the duodenum and jejunum that improves insulin resistance," Dr Mingrone said.

Tight glycemic control, defined as fasting glycemia less than 7 mmol/L without pharmacological therapy, occurred in 85% of the diversionary-surgery group and 78% of the gastric-only surgery group. By contrast, 40% of medically treated patients achieved tight glycemic control at 2 years.

For the total study population, baseline younger age, shorter diabetes duration, lower fasting glycemia, and nonuse of diabetes drugs all predicted a greater chance of remission at 2 years. When the analysis was divided by medication vs surgery and by surgery type, age was no longer significant.

When the total study population was stratified by baseline BMI, the chance of remission was 2.9-fold greater for those with BMI greater than 40 kg/m2 compared with BMI between 35 and 40 kg/m2, but there was no significant difference between the latter group and those with BMI below 35 kg/m2.

Patients who achieved diabetes remission lost more weight (25% vs 17%) and experienced improved waist circumference (18% vs 13%) and better insulin sensitivity than did those not achieving remission.

Dr Cefalu told Medscape Medical News that this study's strengths are the database of studies and the 2-year observation period for remission.

"Clearly, this study, as others, continues to demonstrate the effectiveness of metabolic surgery for diabetes control."

Dr Mingrone said that while there is now enough literature to prove that bariatric surgery is effective in inducing diabetes remission and in improving glycemic control, "endocrinologists probably want to know better the complications of bariatric surgery both in the short and in the long term and in much larger populations than in the relatively small studies published.

"The major problem in this regard is that for a drug there is a pharmaceutical company paying for the drug study in big population trials, while for bariatric surgery only small grants are available from public funds," he added.

From http://www.medscape.com

HELA ARTIKELN UTAN LÖSENORD

http://care.diabetesjournals.org/content/early/2015/11/29/dc15-0575.full.pdf+html

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