PMID- 25203878
OWN - NLM
STAT- MEDLINE
DCOM- 20141103
LR  - 20240324
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Print)
IS  - 0003-4932 (Linking)
VI  - 260
IP  - 4
DP  - 2014 Oct
TI  - 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.
PG  - 617-22; discussion 622-4
LID - 10.1097/SLA.0000000000000919 [doi]
AB  - 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 randomized to MWM 
      versus surgery (bypass, sleeve or band, 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.ClinicalTrials.gov ID: NCT01423877.
FAU - Parikh, Manish
AU  - Parikh M
AD  - Departments of *Surgery daggerMedicine double daggerPopulation Health, NYU School of 
      Medicine/Bellevue Hospital  section signDepartment of Medicine, Lincoln Hospital; and 
       paragraph signMetroPlus Health Plan, Health and Hospitals Corporation, New York City, NY.
FAU - Chung, Mimi
AU  - Chung M
FAU - Sheth, Sheetal
AU  - Sheth S
FAU - McMacken, Michelle
AU  - McMacken M
FAU - Zahra, Tasneem
AU  - Zahra T
FAU - Saunders, John K
AU  - Saunders JK
FAU - Ude-Welcome, Aku
AU  - Ude-Welcome A
FAU - Dunn, Van
AU  - Dunn V
FAU - Ogedegbe, Gbenga
AU  - Ogedegbe G
FAU - Schmidt, Ann Marie
AU  - Schmidt AM
FAU - Pachter, H Leon
AU  - Pachter HL
LA  - eng
SI  - ClinicalTrials.gov/NCT01423877
GR  - K12 HS019473/HS/AHRQ HHS/United States
GR  - UL1 RR029893/RR/NCRR NIH HHS/United States
GR  - 1UL1RR029893/RR/NCRR NIH HHS/United States
GR  - K12HS019473/HS/AHRQ HHS/United States
GR  - KL2 RR029891/RR/NCRR NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
RN  - 0 (Biomarkers)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Glycation End Products, Advanced)
RN  - 0 (Receptor for Advanced Glycation End Products)
RN  - 0 (Receptors, Immunologic)
SB  - IM
MH  - Adult
MH  - Bariatric Surgery
MH  - Biomarkers/analysis
MH  - Body Mass Index
MH  - Counseling
MH  - Diabetes Mellitus, Type 2/*complications/*therapy
MH  - Exercise Therapy
MH  - Female
MH  - Glycated Hemoglobin/analysis
MH  - Glycation End Products, Advanced/*analysis
MH  - Humans
MH  - Insulin Resistance
MH  - Male
MH  - Middle Aged
MH  - Obesity/*complications/surgery/*therapy
MH  - Pilot Projects
MH  - Receptor for Advanced Glycation End Products
MH  - Receptors, Immunologic/*analysis
MH  - Remission Induction
MH  - Weight Loss
PMC - PMC4691842
MID - NIHMS744501
COIS- The authors declare there are no conflicts of interest.
EDAT- 2014/09/10 06:00
MHDA- 2014/11/05 06:00
PMCR- 2015/12/28
CRDT- 2014/09/10 06:00
PHST- 2014/09/10 06:00 [entrez]
PHST- 2014/09/10 06:00 [pubmed]
PHST- 2014/11/05 06:00 [medline]
PHST- 2015/12/28 00:00 [pmc-release]
AID - 00000658-201410000-00007 [pii]
AID - 10.1097/SLA.0000000000000919 [doi]
PST - ppublish
SO  - Ann Surg. 2014 Oct;260(4):617-22; discussion 622-4. doi: 
      10.1097/SLA.0000000000000919.