PMID- 31579501
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2042-0188 (Print)
IS  - 2042-0196 (Electronic)
IS  - 2042-0188 (Linking)
VI  - 10
DP  - 2019
TI  - Review of multimodal treatment for type 2 diabetes: combining metabolic surgery 
      and pharmacotherapy.
PG  - 2042018819875407
LID - 10.1177/2042018819875407 [doi]
LID - 2042018819875407
AB  - Treating type 2 diabetes mellitus (T2DM) in patients with obesity remains a 
      challenge for physicians, endocrinologists and surgeons, a fact supported by 
      uncontroverted evidence from studies looking at mortality and associated 
      morbidity. Metabolic surgery remains the most effective treatment for obesity and 
      T2DM with evidence demonstrating an improvement or resolution of symptoms of T2DM 
      and a reduction in a mortality and rates of cardiovascular events compared with 
      pharmacotherapy alone. While these results are promising, two important 
      limitations must be recognized and addressed. With regards to long-term remission 
      of T2DM, the metabolic benefits of bariatric surgery appear to fatigue with time 
      and a proportion of patients will not maintain normoglycaemia without 
      pharmacotherapy. Second, there has been noteworthy progress in the development of 
      several classes of medications for the treatment of T2DM which were unavailable 
      when the original studies comparing the effects of bariatric surgery with 
      pharmacotherapy were conducted. Recognizing the need for further treatment 
      following metabolic surgery for long-term disease control in conjunction with the 
      availability of newer medications offering more effective, nonsurgical treatment 
      presents a critical turning point in treatment treating obesity. While the 
      traditional approach would be to determine the superiority (or non-inferiority) 
      of these agents compared with surgery, clinicians and surgeons must acknowledge 
      the limitations of this attitude towards treatment given evidence from fields 
      such as cancer, where a combinational approach is the gold standard. Recent 
      advances in pharmacotherapy, present not only a novel approach to medical therapy 
      but a renewed impetus to investigate what can be achieved through multimodal 
      care.
CI  - (c) The Author(s), 2019.
FAU - Sudlow, Alexis
AU  - Sudlow A
AD  - Southmead Hospital, Department of Upper Gastrointestinal Surgery, Bristol, UK.
FAU - le Roux, Carel W
AU  - le Roux CW
AD  - University College Dublin, Department of Experimental Pathology, Dublin, Ireland.
FAU - Pournaras, Dimitri J
AU  - Pournaras DJ
AUID- ORCID: 0000-0001-8798-920X
AD  - Southmead Hospital, Department of Upper Gastrointestinal Surgery, Southmead Rd, 
      Westbury-on-Trym, Bristol BS10 5NB, UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20190923
PL  - United States
TA  - Ther Adv Endocrinol Metab
JT  - Therapeutic advances in endocrinology and metabolism
JID - 101532143
PMC - PMC6759694
OTO - NOTNLM
OT  - antiobesity drugs
OT  - bariatric surgery
OT  - obesity
OT  - type 2 diabetes
OT  - weight regain
OT  - weight-loss drugs
COIS- Conflict of interest statement: AS: no conflict of interest to declare. ClR: 
      reports grants from the Science Foundation Ireland; grants from the Health 
      Research Board; grants from AnaBio during the conduct of the study; another from 
      NovoNordisk; another from GI Dynamics; personal fees from Eli Lilly; grants and 
      personal fees from Johnson and Johnson; personal fees from Sanofi Aventis; 
      personal fees from Astra Zeneca; personal fees from Janssen; personal fees from 
      Bristol-Myers Squibb; personal fees from Boehringer-Ingelheim; outside the 
      submitted work and shares in Keyron. DJP: reports receiving honoraria from 
      NovoNordisk and Johnson and Johnson for lectures.
EDAT- 2019/10/04 06:00
MHDA- 2019/10/04 06:01
PMCR- 2019/09/23
CRDT- 2019/10/04 06:00
PHST- 2019/05/21 00:00 [received]
PHST- 2019/08/20 00:00 [accepted]
PHST- 2019/10/04 06:00 [entrez]
PHST- 2019/10/04 06:00 [pubmed]
PHST- 2019/10/04 06:01 [medline]
PHST- 2019/09/23 00:00 [pmc-release]
AID - 10.1177_2042018819875407 [pii]
AID - 10.1177/2042018819875407 [doi]
PST - epublish
SO  - Ther Adv Endocrinol Metab. 2019 Sep 23;10:2042018819875407. doi: 
      10.1177/2042018819875407. eCollection 2019.