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Bariatric Surgery And Diabetes Remission

Simpler Test Can Predict Who Will See Diabetes Remission From Weight Loss Surgery

Simpler Test Can Predict Who Will See Diabetes Remission From Weight Loss Surgery

Newsroom Published on: November 27, 2017 Simpler Test Can Predict Who Will See Diabetes Remission From Weight Loss Surgery The research shows that giving patients support to keep weight off after surgery is key to maintaining diabetes remission. Payers may soon have a simpler solution to a question in diabetes care: how to tell which patients will experience remission from the disease after weight loss surgery. Bariatric surgery is now recognized as a potential treatment for type 2 diabetes (T2D), and in June 2016 the American Diabetes Association issued a statement on the topic, referring to the various methods as metabolic surgery. But while many patients who have gastric bypass or other forms of surgery experience diabetes remission following weight loss, not all do. A 2012 study found that up to 68% of patients with T2D initially experience remission, but for 35% of these patients, the disease returned. This week, researchers led by a team at University College of London report in the journal Diabetic Medicine they have developed a simplified test to determine when surgery will be successful. While various studies have attempted to pin down whether certain surgical methods are preferred for reversing diabetes, this study reports that the method surgeons use matters less than keeping weight off afterward. Research pioneered at the Cleveland Clinic speculates that weight loss surgery promotes the reversal of diabetes through 1 of 3 mechanisms: (1) the weight loss promotes insulin sensitivity, (2) reduced insulin resistance leads to less lipotoxicity, which means there is less dysregulated fatty acid reflux and inflammation, and (3) reaction of the hormones in the gut in response to the surgical procedure change the bodys response to carbohydrate and fat absorption. T Continue reading >>

Type 2 Diabetes Remission For Bariatric Surgery

Type 2 Diabetes Remission For Bariatric Surgery

Follow all of ScienceDaily's latest research news and top science headlines ! Type 2 diabetes remission for bariatric surgery Among obese participants with type 2 diabetes mellitus, bariatric surgery with two years of a low-level lifestyle intervention resulted in more disease remission than did lifestyle intervention alone. Among obese participants with type 2 diabetes mellitus, bariatric surgery with 2 years of a low-level lifestyle intervention resulted in more disease remission than did lifestyle intervention alone, according to a study published online by JAMA Surgery. It remains to be established whether bariatric surgery is a durable and effective treatment for type 2 diabetes (T2DM) and how bariatric surgery compares with intensive lifestyle modification and medication management with respect to T2DM-related outcomes. As demonstrated in observational studies and several small randomized clinical trials of short duration, T2DM is greatly improved after bariatric surgery. However, more information is needed about the longer-term effectiveness and risks of all types of bariatric surgical procedures compared with lifestyle and medical management for those with T2DM and obesity, according to background information in the article. Anita P. Courcoulas, M.D., M.P.H., of the University of Pittsburgh Medical Center, Pittsburgh, and colleagues assessed outcomes 3 years after 61 obese participants with T2DM who were randomly assigned to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) followed by low-level lifestyle intervention in years 2 and 3. Fifty participants (82 percent) were women, and Continue reading >>

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

Unveiling The “magic” Of Diabetes Remission After Weight-loss Surgery

An extraordinary thing happens to some patients with type 2 diabetes who undergo weight-loss surgery: Within days of the procedure, they improve their insulin production and need fewer or no diabetes medications. Although it’s well established that losing weight, especially around the waistline, improves pancreas function and insulin sensitivity, it generally takes 6 months to a year after bariatric surgery before a patient sheds a substantial number of pounds. Bruce M. Wolfe, MD, professor of surgery at Oregon Health and Science University School of Medicine, recalled one “remarkable” case in which a patient who required 400 daily units of insulin prior to gastric bypass surgery needed none on the day she was discharged from the hospital. Continue reading >>

Weight-loss Surgery Leads To Diabetes Remission

Weight-loss Surgery Leads To Diabetes Remission

Home / Conditions / Obesity / Weight-Loss Surgery Leads to Diabetes Remission Weight-Loss Surgery Leads to Diabetes Remission Gastric bypass surgery may treat type 2 diabetes in selected patients. Weight loss surgery has shown more effectiveness in patients with type 2 diabetes (T2D) who underwent gastric bypass surgery resulting in better insulin production in 6 months to a year without the need of further medication. This is rationalized due to dramatic weight loss and calorie cutting along after surgery. Thus, comprehending why gastric bypass is the most effective metabolic surgery to treat diabetes, why obese patients are noticeably less hungry post weight-loss surgery, and why improvement in diabetes after surgery may experience worsening within a matter of years are important considerations to account. Several theories have been proposed to explain the causes of glycemic control post weight loss surgery. Some of the most common bariatric surgeries conducted are sleeve gastrectomy, Roux-en-Y gastric bypass, and gastric banding. The first two reduces the size of the stomach and the latter slows the flow of food into the GI tract. Although all three resolve T2D, gastric bypass has proven to be the most effective one. In the UK, an observational study showed that all participants who underwent gastric bypass, sleeve gastrectomy, and gastric banding were in remission at 43, 17, and 7 times higher respectively than no surgery. In comparison, gastric bypass yields more weight loss and effectiveness with nearly 2-fold higher remission rates than banding. Moreover, the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery (LABS) study found 69% diabetes remission in obese patients in 3 years with Roux-en-Y gastric bypass versus 30% with laparos Continue reading >>

How Does Bariatric Surgery And Diabetes Remission Work?

How Does Bariatric Surgery And Diabetes Remission Work?

How Does Bariatric Surgery and Diabetes Remission Work? As someone who may be both struggling with their weight, and facing the very scary, very real future of living with diabetes, one's future might seem dim. If you are already overweight and also suffering with diabetes, you know just how frustrating the struggles of daily life can be. There may be hope, however, for those who are at the point of considering or deciding on gastric bypass surgery to help control their weight, and regain their lives. Gastric bypass has of course helped hundreds of thousands of people take control back and lose massive amounts of weight. This surgery is no longer a risky, experimental procedure. Rather, gastric bypass is accepted nation-wide as a life-changing, safe way to help turn the tide in the battle against weight gain and potentially deadly obesity. There has been unexpected, ground-breaking side effects to gastric bypass surgery, however, and they come in the form of helping to bring your diabetes under control and in some cases, put it into remission. For someone who has exhausted their other options, has tried traditional avenues of weight loss and medication, and still seen no benefits or change in measurable weight loss, it may be time to consider gastric bypass surgery. This consideration should be elevated when there is a patient who suffers from diabetes and is seeing their A1C levels continuing to go up, up, up. Through recent studies in the international scientific community, doctors and scientists are seeing a correlation between gastric bypass or bariatric surgery and diabetes remission . While gastric bypass of course will help patients lose weight, it isn't the act of weight loss itself that first signals a change in diabetes, but rather the actual changing of the Continue reading >>

Weight Loss Surgery Puts Diabetes Into Remission

Weight Loss Surgery Puts Diabetes Into Remission

Weight Loss Surgery Puts Diabetes Into Remission Bariatric Procedures Beat Out Medication at Controlling Blood Sugar March 26, 2012 (Chicago) -- Weight loss surgery beat out the best available medications at controlling blood sugar in overweight and moderately obese people with type 2 diabetes , researchers report. People who underwent one of two stomach -reducing procedures were three to four times more likely to have their blood sugar drop to normal levels after one year of treatment compared with people who received intensive medical therapy alone. Some people who had surgery got better so quickly that they were able to stop taking their diabetes medication before even leaving the hospital, says study head Philip Schauer, MD, director of the Bariatric and Metabolic Institute at the Cleveland Clinic. They "were eventually weaned off all their diabetes medication -- as close to the definition of remission as you can get," Schauer tells WebMD. "Bariatric [ weight loss ] surgery works and works well -- for both obesity and diabetes," Schauer says. The findings were presented at the annual meeting of the American College of Cardiology and simultaneously published online by The New England Journal of Medicine. Most People With Diabetes Overweight or Obese About 80% of the 23 million American adults living with type 2 diabetes are overweight or obese. High blood sugar is a major risk factor for a host of diabetes complications , including heart attack , amputation , kidney failure , and blindness. In one recent study, 89% of people with type 2 diabetes who underwent gastric bypass surgery went into remission and 57% were still in remission after five years. The new study, called STAMPEDE, involved 150 people -- two-thirds of whom were women -- with a body mass index (BMI) Continue reading >>

Metabolic And Bariatric Surgery And Type 2 Diabetes

Metabolic And Bariatric Surgery And Type 2 Diabetes

Did You Know? Someone in the world dies from complications associated with diabetes every 10 seconds. Diabetes is one of the top ten leading causes of U.S. deaths. One out of ten health care dollars is attributed to diabetes. Diabetics have health expenditures that are 2.3 times higher than non-diabetics. Approximately 90 percent of type 2 diabetes mellitus (T2DM), the most common form of diabetes, is attributable to excessive body fat. If current trends continue, T2DM or pre diabetic conditions will strike as many as half of adult Americans by the end of the decade. (according to the United HealthGroup Inc., the largest U.S. health insurer by sales). The prevalence of diabetes is 8.9 percent for the U.S. population but more than 25 percent among individuals with morbid obesity. Metabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases. Type 2 Diabetes Mellitus (T2DM) Type 2 diabetes(T2DM) is the most common form of diabetes, accounting for approximately 95 percent of all cases. Obesity is the primary cause for T2DM and the alarming rise in diabetes prevalence throughout the world has been in direct association increase rates of obesity worldwide. T2DM leads to many health problems including cardiovascular disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer. Premature death from T2DM is increased by as much as 80 percent and life expectancy is reduced by 12 to 14 years. Current therapy for type 2 diabetes includes lifestyle intervention (weight-loss, appropriate diet, exercise) and anti-diabetes medication(s). Medical supervision and strict adh Continue reading >>

Predictors For Type 2 Diabetes Mellitus Remission After Metabolic/bariatric Surgery

Predictors For Type 2 Diabetes Mellitus Remission After Metabolic/bariatric Surgery

Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery 1Division of General Surgery, Department of Surgery, 2Department of Surgery, Min-Sheng General Hospital, Contributions: (I) Conception and design: WJ Lee; (II) Administrative support: WJ Lee; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Dr. Wei-Jei Lee, MD, PhD. Min-Sheng General Hospital, No 168, Chin Kuo Road, Taoyuan, Taiwan. Email: Abstract: Type 2 diabetes mellitus (T2DM), fueled by an obesity epidemic, have emerged as a major health problem worldwide. Metabolic surgery, derived from bariatric surgery, is now proposed for the treatment of obese T2DM patients. Several randomized trials aimed at T2DM treatment have been performed and universally showed that metabolic surgery is more effective than medical treatment in glycemic control. However, not every T2DM patient benefit from metabolic surgery. An article review disclosed that pre-operative -cell function, and its surrogates, including duration of diabetes and C-peptide, was the most important predictor of T2DM remission. Other factors were insulin use, HbA1c level, BMI, age, type of operation and miscellaneous ones. Some scoring systems, such as ABCD in the Diabetes surgery score (age, BMI, C-peptide and duration of T2DM), may help evaluate effectiveness of T2DM remission after surgery. In conclusion, metabolic surgery is a novel treatment opti Continue reading >>

Bariatric Surgery And Diabetes Remission: Who Would Have Thought It?

Bariatric Surgery And Diabetes Remission: Who Would Have Thought It?

Bariatric surgery and diabetes remission: Who would have thought it? We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Bariatric surgery and diabetes remission: Who would have thought it? Awadhesh Kumar Singh, Ritu Singh, and Sunil Kumar Kota Type 2 diabetes mellitus (T2DM) and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes) study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1st year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been see Continue reading >>

Ranking Factors Involved In Diabetes Remission After Bariatric Surgery Using Machine-learning Integrating Clinical And Genomic Biomarkers

Ranking Factors Involved In Diabetes Remission After Bariatric Surgery Using Machine-learning Integrating Clinical And Genomic Biomarkers

Ranking factors involved in diabetes remission after bariatric surgery using machine-learning integrating clinical and genomic biomarkers npj Genomic Medicine volume 1, Articlenumber:16035 (2016) As weight-loss surgery is an effective treatment for the glycaemic control of type 2 diabetes in obese patients, yet not all patients benefit, it is valuable to find predictive factors for this diabetic remission. This will help elucidating possible mechanistic insights and form the basis for prioritising obese patients with dysregulated diabetes for surgery where diabetes remission is of interest. In this study, we combine both clinical and genomic factors using heuristic methods, informed by prior biological knowledge in order to rank factors that would have a role in predicting diabetes remission, and indeed in identifying patients who may have low likelihood in responding to bariatric surgery for improved glycaemic control. Genetic variants from the Illumina CardioMetaboChip were prioritised through single-association tests and then seeded a larger selection from proteinprotein interaction networks. Artificial neural networks allowing nonlinear correlations were trained to discriminate patients with and without surgery-induced diabetes remission, and the importance of each clinical and genetic parameter was evaluated. The approach highlighted insulin treatment, baseline HbA1c levels, use of insulin-sensitising agents and baseline serum insulin levels, as the most informative variables with a decent internal validation performance (74% accuracy, area under the curve (AUC) 0.81). Adding information for the eight top-ranked single nucleotide polymorphisms (SNPs) significantly boosted classification performance to 84% accuracy (AUC 0.92). The eight SNPs mapped to eight genes A Continue reading >>

Score Predicts Diabetes Remission With Sleeve Vs Bypass Surgery

Score Predicts Diabetes Remission With Sleeve Vs Bypass Surgery

Score Predicts Diabetes Remission With Sleeve vs Bypass Surgery Using data from the longest, largest study of obese patients with type 2 diabetes who underwent Roux-en-Y gastric bypass or sleeve gastrectomy, researchers at the Cleveland Clinic have developed a validated nomogram known as the Individualized Metabolic Surgery Score that classifies patients into three categories of diabetes severity and suggests which surgery type will provide the best balance between diabetes remission and procedure risk. The model, based on a 5-year or longer follow-up, was developed in a cohort of more than 600 patients from their single center in Cleveland and then was validated in a cohort of more than 200 patients at another single center in Barcelona, Spain. Ali Aminian, MD, associate professor of surgery at the Cleveland Clinic, Ohio, presented the findings recently at the American Surgical Association 2017 Annual Meeting in Philadelphia. In the mild-diabetes subgroup, both bariatric procedures were highly effective, but gastric bypass was slightly better than sleeve gastrectomy for long-term diabetes remission and reduction in diabetes medications, so bypass is suggested as a better option for such patients, he told Medscape Medical News. In the moderate-diabetes subgroup, on the other hand, gastric bypass was significantly more effective than sleeve gastrectomy, so this procedure is highly recommended. In contrast, in patients with severe diabetes, both bariatric procedures were less effective for long-term diabetes remission, so sleeve gastrectomy a less risky, less complicated procedure is suggested for these patients, who have had diabetes for a long time and are typically on insulin. Nomogram Will Help Guide Patients, Doctors on Procedure Selection The nomogram, which is ava Continue reading >>

Choosing The Best Bariatric Procedure For Long-term Type 2 Diabetes Remission

Choosing The Best Bariatric Procedure For Long-term Type 2 Diabetes Remission

A team of researchers from Cleveland Clinic and several universities around the world have created the first online tool to help physicians make evidence-based recommendations for the appropriate bariatric surgery for long-term remission of type 2 diabetes mellitus. They recently presented the tool and the study behind it at the 2017 American Surgical Associations Annual Meeting in Philadelphia. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy The online calculator, which can be found here , asks doctors to input four independent criteria: how long the patient has had diabetes, the number of diabetes medications they are taking, whether they are taking insulin, and whether their HbA1C is less than or greater than 7 percent. From there, it creates an Individual Metabolic Surgery (IMS) score for the patient that grades their diabetes as either mild, moderate or severe and recommends either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) . Several high-quality studies, including randomized clinical trials , have shown that bariatric surgery is more effective than medical therapy in achieving glucose control in patients with type 2 diabetes, says Cleveland Clinic general surgeon Ali Aminian, MD , of Cleveland Clinic Bariatric and Metabolic Institute and lead author on the study. So the next question that needed to be answered was, What procedure would be more appropriate in each individual patient? Long-term remission depends on diabetes severity Dr. Aminian and his colleagues first analyzed data from 659 Cleveland Clinic patients who had type 2 diabetes, underwent either RYGB or SG between 2004 and 2011 and had at least five years of po Continue reading >>

Curing Diabetes: The Only Confirmed (pseudo) Cure

Curing Diabetes: The Only Confirmed (pseudo) Cure

Curing diabetes has been a goal of physicians and diabetic patients since it was first discovered by the Ancient Greeks in the 1st century (1). Almost 2,000 years later, it seems that we have finally learned how to cure diabetes, or at least provide a “pseudo-cure” that puts diabetes into potentially permanent remission: bariatric surgery. Review and click the sections below to learn more about the only known cure for diabetes. Continue reading >>

Diabetes Remission After Bariatric Surgery In T2d

Diabetes Remission After Bariatric Surgery In T2d

Objective The impact of bariatric surgeries on insulin-treated type 2 diabetes (I-T2D) in the general population is largely undocumented. We assessed changes in insulin treatment after bariatric surgery in a large cohort of I-T2D patients, comparing Roux-en-Y gastric bypass surgery (RYGB) with laparoscopic adjustable gastric banding (LAGB), controlling for differences in weight loss between procedures. Research Design and Methods Of 113,638 adult surgical patients in the Bariatric Outcomes Longitudinal Database (BOLD), 10% had I-T2D. Analysis was restricted to 5,225 patients with I-T2D and at least 1 year of postoperative follow-up. Regression models were used to identify factors that predict cessation of insulin therapy. To control for differences in weight loss patterns between RYGB and LAGB, a case-matched analysis was also performed. Results Of I-T2D patients who underwent RYGB (n = 3,318), 62% were off insulin at 12 months compared with 34% (n = 1,907) after LAGB (P < 0.001). Regression analysis indicated that RYGB strongly predicted insulin cessation at both 1 and 12 months postoperatively. In the case-matched analysis at 3 months, the proportion of insulin cessation was significantly higher in the RYGB group than in the LAGB group (P = 0.03), and the diabetes remission rate was higher at all time points after this surgery. RYGB was a weight-independent predictor of insulin therapy cessation early after surgery, whereas insulin cessation after LAGB was linked to weight loss. Conclusions I-T2D patients have a greater probability of stopping insulin after RYGB than after LAGB (62% vs. 34%, respectively, at 1 year), with weight-independent effects in the early months after surgery. These findings support RYGB as the procedure of choice for reversing I-T2D. Obesity a Continue reading >>

Variations In Diabetes Remission Rates After Bariatric Surgery In Spanish Adults According To The Use Of Different Diagnostic Criteria For Diabetes

Variations In Diabetes Remission Rates After Bariatric Surgery In Spanish Adults According To The Use Of Different Diagnostic Criteria For Diabetes

Abstract There are multiple criteria to define remission of type 2 diabetes (DM2) after bariatric surgery but there is not a specific one widely accepted. Our objectives were to compare diagnostic criteria for DM2 remission after bariatric surgery: Criteria from Spanish scientific associations (SEEN/SEEDO/SED) and from the American Diabetes Association (ADA). We also aim to analyse the degree of correlation between these sets of criteria. Retrospective observational study in 127 patients undergoing bariatric surgery in a single centre (Hospital Universitario Reina Sofía, Córdoba, Spain) between January 2001 and December 2009. We analysed DM2 remission following bariatric surgery comparing DM2 diagnostic criteria approved by Spanish scientific associations and ADA criteria. In total, 62.2% of patients were women; mean age was 47.1 years. Following surgery, 52% achieved complete remission according to ADA criteria, and 63.8% following the criteria approved by Spanish associations (p = 0.001);18.9 and 8.7%, respectively, showed partial remission (p = 0.007), and 29.1 and 27.6% no remission, according to the criteria approved by each association (p = 0.003). There was good correlation between both sets of criteria (Rho 0.781; p < 0.001). In our series, using more stringent criteria for defining DM2 remission (ADA criteria) results in a lower rate of remission, although we found a a high degree of correlation between both sets of criteria. Background Worldwide prevalence of type 2 diabetes (DM2) continues to increase simultaneously with obesity rates [1, 2]. Over 60% of DM2 patients are obese [1], and this tandem is now a public health problem. Recent studies have shown that medical therapy for DM2 and comorbid obesity is not as successful as bariatric surgery, suggesting Continue reading >>

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