title: Case-matched outcomes in bariatric surgery for treatment of type 2 diabetes in the morbidly obese patient.
abstract: OBJECTIVE
  To compare the relative efficacy of medical management, the duodenal switch (DS), and the laparoscopic adjustable gastric band (LAGB) to the Roux-en-Y gastric bypass (RYGB) for treatment of type 2 diabetes mellitus (T2DM).
  
  
  BACKGROUND
  The RYGB resolves T2DM in a high proportion of patients and is considered the standard operation for T2DM resolution in morbidly obese patients. However, no data exist comparing the efficacy of medical management and other bariatric operations to the RYGB for treatment of T2DM in comparable patient populations.
  
  
  METHODS
  We performed a retrospective case-matched study of morbidly obese patients with T2DM who had undergone medical management (nonsurgical controls [NSC]; N = 29), LAGB (N = 30), or DS (N = 27) and were compared with matched T2DM patients who had undergone RYGB. Matching was performed with respect to age, sex, body mass index, and hemoglobin A1C (HbA1C). Outcomes assessed were changes in body mass index, HbA1C, and diabetes medication scores at 1 year.
  
  
  RESULTS
  The Roux-en-Y gastric bypass produced greater weight loss, HbA1C normalization, and medication score reduction compared to both NSC and LAGB-matched cohorts. Duodenal switch produced greater reductions in HbA1C and medication score than RYGB, despite no greater weight loss at 1 year. Surgical complications were rarely life threatening.
  
  
  CONCLUSIONS
  This study provides an important perspective about the comparative efficacy of LAGB, DS, and NSC to the RYGB for treatment of T2DM among obese patients. After 1 year of follow-up, RYGB is superior to NSC and LAGB with respect to weight loss and improvement in diabetes whereas DS is superior to RYGB in reducing HbA1C and medication score.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Dorman
authors.forename: Federico J
authors.initials: FJ
authors.lastname: Serrot
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Slusarek
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Sampson
authors.forename: Henry
authors.initials: H
authors.lastname: Buchwald
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Leslie
authors.forename: John P
authors.initials: JP
authors.lastname: Bantle
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human