title: Comparative effectiveness of bariatric surgery and nonsurgical therapy in adults with type 2 diabetes mellitus and body mass index <35 kg/m2.
abstract: BACKGROUND
  Outcomes of bariatric surgery in patients with a body mass index (BMI) <35 kg/m(2) have been an active area of investigation. We examined the comparative effectiveness of Roux-en-Y gastric bypass (RYGB) to routine medical management (nonsurgical controls; NSCs) in achieving appropriate targets defined by the American Diabetes Association for type 2 diabetes mellitus (T2DM) in patients with class I obesity (BMI 30.0-34.9 kg/m(2)) T2DM at 1 year.
  
  
  METHODS
  We identified patients undergoing RYGB (N = 17) with both class I obesity and T2DM and compared them to similar NSC (N = 17) treated in the Primary Care Center. Data were collected at baseline and 1 year for systolic blood pressure (SBP), as well as blood levels for low-density lipoprotein (LDL) cholesterol and hemoglobin A1c (HbA1c).
  
  
  RESULTS
  After RYGB, BMI decreased from 34.6 ± 0.8 kg/m(2) to 25.8 ± 2.5 kg/m(2) (P < .001) and HbA1c decreased from 8.2 ± 2.0% to 6.1 ± 2.7% (P < .001). The NSC cohort had no significant change in either BMI or HbA1c. SBP and LDL did not significantly change in either group. The RYGB group had a decrease in medication use compared to the NSC group (P < .001). The RYGB group ceased the use of antihypertensive and antihyperlipidemia medications by 1 year despite abnormal values.
  
  
  CONCLUSIONS
  RYGB can be performed in patients with both a BMI <35 kg/m(2) and T2DM with better weight loss, glycemic control, and fewer antihyperglycemic medications than NSC. Inappropriate cessation of medications may partially explain the persistent increase in both SBP and LDL after RYGB.
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors: Federico J
authors: FJ
authors: Serrot
authors: Robert B
authors: RB
authors: Dorman
authors: Christopher J
authors: CJ
authors: Miller
authors: Bridget
authors: B
authors: Slusarek
authors: Barbara
authors: B
authors: Sampson
authors: Brian T
authors: BT
authors: Sick
authors: Daniel B
authors: DB
authors: Leslie
authors: Henry
authors: H
authors: Buchwald
authors: Sayeed
authors: S
authors: Ikramuddin
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; C517652:hemoglobin A1c protein, human