title: Efficacy of the Roux-en-Y gastric bypass compared to medically managed controls in meeting the American Diabetes Association composite end point goals for management of type 2 diabetes mellitus.
abstract: BACKGROUND
  The treatment goals recommended by the American Diabetes Association (ADA) for patients with type 2 diabetes mellitus include hemoglobin A1c (HbA1C) <7.0%, low-density lipoprotein (LDL) <100 mg/dL, and systolic blood pressure (SBP) <130 mmHg. Only 10% of conventionally treated patients reach these goals as a composite endpoint. The efficacy of the Roux-en-Y gastric bypass (RYGB) in meeting this composite endpoint has not been reported.
  
  
  METHODS
  We compared our database of patients with type 2 diabetes undergoing RYGB to a database of patients with medically managed type 2 diabetes and at least 2 years of follow-up data.
  
  
  RESULTS
  Ultimately, 152 RYGB patients were compared to 115 routine medical management (RMM) patients for whom data on the composite endpoint were available over 2 years. The results show significant decrease in body mass index (kilograms per square meter) in the RYGB group compared to the RMM group (P < 0.001). HbA1C, LDL cholesterol, and SBP all significantly improved in the RYGB group (all P ≤ 0.01) and did not demonstrate any significant change in the RMM group. Over 2 years, when evaluating all three endpoints, the RYGB group (10.5% to 38.2%, P < 0.001) demonstrated increased achievement of the ADA goals compared to the RMM group (13.9% to 17.4%, P = 0.47). There was a significant decrease in medication use in the RYGB cohort; however, discontinuation of medications was sometimes inappropriate.
  
  
  CONCLUSIONS
  RYGB achieves the ADA composite endpoint more frequently than conventional therapy and with less medication.
authors.affiliation: Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 290, Minneapolis, MN 55455, USA. lesli002@umn.edu
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Leslie
authors.forename: Robert B
authors.initials: RB
authors.lastname: Dorman
authors.forename: Federico J
authors.initials: FJ
authors.lastname: Serrot
authors.forename: Therese W
authors.initials: TW
authors.lastname: Swan
authors.forename: Todd A
authors.initials: TA
authors.lastname: Kellogg
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Torres-Villalobos
authors.forename: Henry
authors.initials: H
authors.lastname: Buchwald
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Slusarek
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Sampson
authors.forename: John P
authors.initials: JP
authors.lastname: Bantle
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000706:statistics & numerical data; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery*; D011336:Probability; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin