PMID- 27222550
OWN - NLM
STAT- MEDLINE
DCOM- 20170928
LR  - 20210727
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 39
IP  - 6
DP  - 2016 Jun
TI  - Bariatric/Metabolic Surgery to Treat Type 2 Diabetes in Patients With a BMI <35 
      kg/m2.
PG  - 924-33
LID - 10.2337/dc16-0350 [doi]
AB  - OBJECTIVE: Global usage of bariatric surgery has been dictated for the past 
      quarter century by National Institutes of Health recommendations restricting 
      these operations to individuals with a BMI >/=35 kg/m(2). Strong evidence now 
      demonstrates that bariatric procedures markedly improve or cause remission of 
      type 2 diabetes mellitus (T2DM), in part through weight-independent mechanisms, 
      and that baseline BMI does not predict surgical benefits on glycemic or 
      cardiovascular outcomes. This impels consideration of such operations as 
      "metabolic surgery," which is used expressly to treat T2DM, including among 
      patients with a BMI <35 kg/m(2) who constitute the majority of people with 
      diabetes worldwide. Here, we review available evidence to inform that 
      consideration. RESULTS: A meta-analysis of the 11 published randomized clinical 
      trials (RCTs) directly comparing bariatric/metabolic surgery versus a variety of 
      medical/lifestyle interventions for T2DM provides level 1A evidence that surgery 
      is superior for T2DM remission, glycemic control, and HbA1c lowering. 
      Importantly, this is equally true for patients whose baseline BMI is below or 
      above 35 kg/m(2). Similar conclusions derive from meta-analyses of high-quality 
      nonrandomized prospective comparisons. Meta-analysis of all pertinent published 
      studies indicates that T2DM remission rates following bariatric/metabolic surgery 
      are comparable above and below the 35 kg/m(2) BMI threshold. The safety, 
      antidiabetes durability, and benefits on other cardiovascular risk factors from 
      bariatric/metabolic surgery appear roughly comparable among patients with a BMI 
      below or above 35 kg/m(2). Further studies are needed to extend long-term 
      findings and measure "hard" macrovascular/microvascular outcomes and mortality in 
      RCTs. CONCLUSIONS: Extant data, including level 1A evidence from numerous RCTs, 
      support new guidelines from the 2nd Diabetes Surgery Summit that advocate for the 
      consideration of bariatric/metabolic surgery as one option, along with lifestyle 
      and medical therapy, to treat T2DM among patients with a BMI <35 kg/m(2).
CI  - (c) 2016 by the American Diabetes Association. Readers may use this article as long 
      as the work is properly cited, the use is educational and not for profit, and the 
      work is not altered.
FAU - Cummings, David E
AU  - Cummings DE
AD  - VA Puget Sound Health Care System and Diabetes and Obesity Center of Excellence, 
      University of Washington, Seattle, WA davidec@u.washington.edu.
FAU - Cohen, Ricardo V
AU  - Cohen RV
AD  - Center for Diabetes and Obesity, Oswaldo Cruz Hospital, Sao Paulo, Brazil.
LA  - eng
GR  - R01 DK084324/DK/NIDDK NIH HHS/United States
GR  - R01 DK089528/DK/NIDDK NIH HHS/United States
GR  - R01 DK103842/DK/NIDDK NIH HHS/United States
GR  - U34 DK107917/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (Blood Glucose)
SB  - IM
CIN - Diabetes Care. 2017 Jun;40(6):e71-e72. PMID: 28533258
CIN - Diabetes Care. 2017 Jun;40(6):e73-e74. PMID: 28533259
MH  - Bariatric Surgery/adverse effects/*methods
MH  - Blood Glucose/metabolism
MH  - *Body Mass Index
MH  - Cardiovascular Diseases/prevention & control
MH  - Diabetes Mellitus, Type 2/complications/*surgery
MH  - Evidence-Based Practice
MH  - Humans
MH  - Life Style
MH  - Obesity, Morbid/complications/*surgery
MH  - Remission Induction
MH  - Weight Loss
PMC - PMC4878219
EDAT- 2016/05/26 06:00
MHDA- 2017/09/29 06:00
PMCR- 2017/06/01
CRDT- 2016/05/26 06:00
PHST- 2016/02/17 00:00 [received]
PHST- 2016/03/22 00:00 [accepted]
PHST- 2016/05/26 06:00 [entrez]
PHST- 2016/05/26 06:00 [pubmed]
PHST- 2017/09/29 06:00 [medline]
PHST- 2017/06/01 00:00 [pmc-release]
AID - 39/6/924 [pii]
AID - 0350 [pii]
AID - 10.2337/dc16-0350 [doi]
PST - ppublish
SO  - Diabetes Care. 2016 Jun;39(6):924-33. doi: 10.2337/dc16-0350.