PMID- 27783367 OWN - NLM STAT- MEDLINE DCOM- 20171218 LR - 20190927 IS - 1708-0428 (Electronic) IS - 0960-8923 (Print) IS - 0960-8923 (Linking) VI - 27 IP - 5 DP - 2017 May TI - National Differences in Remission of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery-Subgroup Analysis of 2-Year Results of the Diabetes Surgery Study Comparing Taiwanese with Americans with Mild Obesity (BMI 30-35 kg/m(2)). PG - 1189-1195 LID - 10.1007/s11695-016-2433-4 [doi] AB - BACKGROUND: The purpose of this study is to compare effects of different nations on Roux-en-Y gastric bypass (RYGB) vs. intensive medical management (IMM) in achieving remission of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: Between April 2008 and December 2011, this randomized, controlled clinical trial was conducted at four teaching hospitals in the United States and Taiwan involving 71 participants with mild obesity (BMI 30-35 kg/m(2)). Thirty-six of 71 participants were randomly assigned to the RYGB group, and the others were in IMM group. Partial or complete remission of T2DM was defined as blood HbA1c < 6.5 % (48 mmol/mol) or <6 % (42 mmol/mol) without any antihyperglycemic medication for at least 1-year duration, respectively. RESULTS: At baseline, Taiwanese participants had a lower BMI, younger age, and shorter duration of T2DM than American participants. At 24 months, weight loss was greater in the RYGB group in both populations than in the IMM group. No IMM participant of either population had partial or complete remission of T2DM. In the RYGB group, a substantial proportion of the subjects achieved complete or partial remission (57 % in Taiwanese and 27 % in American participants, P = 0.08). Logistic regression revealed stimulated C-peptide (Odds ratio 2.22, P = 0.02) but not nationality as a significant predictor of diabetes remission. CONCLUSION: Adding RYGB to lifestyle and medical management was associated with a greater likelihood of remission of T2DM in both Taiwanese and American subjects with mild obesity with type 2 diabetes. Residual beta-cell function at baseline appears to be the major factor predicting remission of T2DM. Trial registry number: clinicaltrials.gov Identifier: NCT00641251. FAU - Chong, Keong AU - Chong K AD - Department of Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan. FAU - Ikramuddin, Sayeed AU - Ikramuddin S AD - Department of Surgery, University of Minnesota, Minneapolis, MN, USA. FAU - Lee, Wei-Jei AU - Lee WJ AD - Department of Surgery, Min-Sheng General Hospital, Taoyuan City, Taiwan. FAU - Billington, Charles J AU - Billington CJ AD - Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN, USA. FAU - Bantle, John P AU - Bantle JP AD - Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN, USA. FAU - Wang, Qi AU - Wang Q AD - Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA. FAU - Thomas, Avis J AU - Thomas AJ AD - Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA. FAU - Connett, John E AU - Connett JE AD - Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA. FAU - Leslie, Daniel B AU - Leslie DB AD - Department of Surgery, University of Minnesota, Minneapolis, MN, USA. FAU - Inabnet, William B 3rd AU - Inabnet WB 3rd AD - Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA. FAU - Jeffery, Robert W AU - Jeffery RW AD - Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA. FAU - Sarr, Michael G AU - Sarr MG AD - Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA. FAU - Jensen, Michael D AU - Jensen MD AD - Department of Medicine, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, MN, USA. FAU - Vella, Adrian AU - Vella A AD - Department of Medicine, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, MN, USA. FAU - Ahmed, Leaque AU - Ahmed L AD - Department of Surgery, Harlem Hospital Center, New York, NY, USA. FAU - Belani, Kumar AU - Belani K AD - Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA. FAU - Schone, Joyce L AU - Schone JL AD - Nutrition Services, Fairview Health System, Minneapolis, MN, USA. FAU - Olofson, Amy E AU - Olofson AE AD - Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA. FAU - Bainbridge, Heather A AU - Bainbridge HA AD - Department of Bariatric Surgery, Temple University Hospital, Philadelphia, PA, USA. FAU - Laqua, Patricia S AU - Laqua PS AD - Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA. FAU - Korner, Judith AU - Korner J AD - Department of Medicine, Division of Endocrinology, Columbia University Medical Center, New York, NY, USA. FAU - Chuang, Lee-Ming AU - Chuang LM AD - Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan. leeming@ntu.edu.tw. AD - Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. leeming@ntu.edu.tw. LA - eng SI - ClinicalTrials.gov/NCT00641251 GR - UL1 TR002494/TR/NCATS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - Obes Surg JT - Obesity surgery JID - 9106714 RN - 0 (C-Peptide) RN - 0 (Hypoglycemic Agents) SB - IM MH - Adult MH - Body Mass Index MH - C-Peptide MH - Diabetes Mellitus, Type 2/complications/*therapy MH - Female MH - *Gastric Bypass/methods MH - Humans MH - Hypoglycemic Agents/therapeutic use MH - Life Style MH - Male MH - Middle Aged MH - Obesity/complications/*surgery MH - Remission Induction MH - Taiwan MH - Time Factors MH - Treatment Outcome MH - United States PMC - PMC5403871 OTO - NOTNLM OT - Diabetes remission OT - Ethnic differences OT - National differences OT - Roux-en-Y gastric bypass OT - Taiwanese OT - Type 2 diabetes mellitus COIS- CONFLICT OF INTEREST: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Ikramuddin reported that he serves on an advisory board member for Novo Nordisk and receives grant support from Covidien. Dr. Billington reports receiving grant support from Covidien and personal support for consultancy from Novo Nordisk and EnteroMedics Inc. Ms. Thomas reports receiving salary support from Covidien for the Diabetes Surgery Study. Dr. Connett reports receiving institutional and personal grant support from Covidien. Dr. Leslie reports receiving grant support from Covidien and personal fees from EnteroMedics. Ms. Schone reports personal fees from Reshape Medical. Ms. Laqua reports receiving institutional grant support from Covidien. Dr. Korner reports receiving institutional grant support from Covidien and NIH. No other authors reported disclosures. ETHICAL APPROVAL: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. INFORMED CONSENT: Informed consent was obtained from all individual participants included in the study. EDAT- 2016/10/27 06:00 MHDA- 2017/12/19 06:00 PMCR- 2016/10/25 CRDT- 2016/10/27 06:00 PHST- 2016/10/27 06:00 [pubmed] PHST- 2017/12/19 06:00 [medline] PHST- 2016/10/27 06:00 [entrez] PHST- 2016/10/25 00:00 [pmc-release] AID - 10.1007/s11695-016-2433-4 [pii] AID - 2433 [pii] AID - 10.1007/s11695-016-2433-4 [doi] PST - ppublish SO - Obes Surg. 2017 May;27(5):1189-1195. doi: 10.1007/s11695-016-2433-4.