Daniel Horwitz1, John K Saunders1, Aku Ude-Welcome1, Ann Marie Schmidt1, Van Dunn2, H Leon Pachter1, Manish Parikh3. 1. Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York. 2. MetroPlus Health Plan, Health and Hospitals Corporation, New York, New York. 3. Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York. Electronic address: manish.parikh@nyumc.org.
Abstract
BACKGROUND:Patients with type 2 diabetes (T2D) and body mass index (BMI)<35 may benefit from metabolic surgery. The soluble form of the receptor for advanced glycation end products (sRAGE) may identify patients at greater chance for T2D remission. OBJECTIVES: To study long-term outcomes of patients with T2D and BMI 30-35 treated with metabolic surgery or medical weight management (MWM) and search for predictors of T2D remission. SETTING: University METHODS: Retrospective review of the original cohort, including patients who crossed over from MWM to surgery. Repeated-measures linear models were used to model weight loss (%WL), change in glycated hemoglobin (HbA1C) and association with baseline sRAGE. RESULTS:Fifty-seven patients with T2D and BMI 30-35 were originally randomly assigned to metabolic surgery versus MWM. Mean BMI and HbA1C was 32.6% and 7.8%, respectively. A total of 30 patients underwent surgery (19 sleeves, 8 bypasses, 3 bands). Three-year follow-up in the surgery group and MWM group was 75% and 86%, respectively. Surgery resulted in higher T2D remission (63% versus 0%; P<.001) and lower HbA1C (6.9% versus 8.4%; P<.001) for up to 3 years. There was no difference in %WL in those with versus those without T2D remission (21.7% versus 20.6%, P = .771), suggesting that additional mechanisms other than %WL play an important role for the studied outcome. Higher baseline sRAGE was associated with greater change in HbA1C and greater %WL after surgery (P< .001). CONCLUSION: Metabolic surgery was effective in promoting remission of T2D in 63% of patients with BMI 30-35; higher baseline sRAGE predicted T2D remission with surgery. Larger-scale randomly assigned trials are needed in this patient population.
RCT Entities:
BACKGROUND:Patients with type 2 diabetes (T2D) and body mass index (BMI)<35 may benefit from metabolic surgery. The soluble form of the receptor for advanced glycation end products (sRAGE) may identify patients at greater chance for T2D remission. OBJECTIVES: To study long-term outcomes of patients with T2D and BMI 30-35 treated with metabolic surgery or medical weight management (MWM) and search for predictors of T2D remission. SETTING: University METHODS: Retrospective review of the original cohort, including patients who crossed over from MWM to surgery. Repeated-measures linear models were used to model weight loss (%WL), change in glycated hemoglobin (HbA1C) and association with baseline sRAGE. RESULTS: Fifty-seven patients with T2D and BMI 30-35 were originally randomly assigned to metabolic surgery versus MWM. Mean BMI and HbA1C was 32.6% and 7.8%, respectively. A total of 30 patients underwent surgery (19 sleeves, 8 bypasses, 3 bands). Three-year follow-up in the surgery group and MWM group was 75% and 86%, respectively. Surgery resulted in higher T2D remission (63% versus 0%; P<.001) and lower HbA1C (6.9% versus 8.4%; P<.001) for up to 3 years. There was no difference in %WL in those with versus those without T2D remission (21.7% versus 20.6%, P = .771), suggesting that additional mechanisms other than %WL play an important role for the studied outcome. Higher baseline sRAGE was associated with greater change in HbA1C and greater %WL after surgery (P< .001). CONCLUSION: Metabolic surgery was effective in promoting remission of T2D in 63% of patients with BMI 30-35; higher baseline sRAGE predicted T2D remission with surgery. Larger-scale randomly assigned trials are needed in this patient population.
Authors: E R Miranda; K N Z Fuller; R K Perkins; C M Kroeger; J F Trepanowski; K A Varady; J M Haus Journal: Nutr Metab Cardiovasc Dis Date: 2018-08-02 Impact factor: 4.222
Authors: Claire K Inman; Abdullah Aljunaibi; Hyunwook Koh; Abdishakur Abdulle; Raghib Ali; Abdullah Alnaeemi; Eiman Al Zaabi; Naima Oumeziane; Marina Al Bastaki; Mohammed Al-Houqani; Fatma Al-Maskari; Ayesha Al Dhaheri; Syed M Shah; Laila Abdel Wareth; Wael Al Mahmeed; Habiba Alsafar; Fatme Al Anouti; Ayesha Al Hosani; Muna Haji; Divya Galani; Matthew J O'Connor; Jiyoung Ahn; Tomas Kirchhoff; Scott Sherman; Richard B Hayes; Huilin Li; Ravichandran Ramasamy; Ann Marie Schmidt Journal: J Clin Transl Endocrinol Date: 2017-08-14