title: Bariatric surgery versus conventional medical therapy for type 2 diabetes.
abstract: BACKGROUND
  Roux-en-Y gastric bypass and biliopancreatic diversion can markedly ameliorate diabetes in morbidly obese patients, often resulting in disease remission. Prospective, randomized trials comparing these procedures with medical therapy for the treatment of diabetes are needed.
  
  
  METHODS
  In this single-center, nonblinded, randomized, controlled trial, 60 patients between the ages of 30 and 60 years with a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 35 or more, a history of at least 5 years of diabetes, and a glycated hemoglobin level of 7.0% or more were randomly assigned to receive conventional medical therapy or undergo either gastric bypass or biliopancreatic diversion. The primary end point was the rate of diabetes remission at 2 years (defined as a fasting glucose level of <100 mg per deciliter [5.6 mmol per liter] and a glycated hemoglobin level of <6.5% in the absence of pharmacologic therapy).
  
  
  RESULTS
  At 2 years, diabetes remission had occurred in no patients in the medical-therapy group versus 75% in the gastric-bypass group and 95% in the biliopancreatic-diversion group (P<0.001 for both comparisons). Age, sex, baseline BMI, duration of diabetes, and weight changes were not significant predictors of diabetes remission at 2 years or of improvement in glycemia at 1 and 3 months. At 2 years, the average baseline glycated hemoglobin level (8.65±1.45%) had decreased in all groups, but patients in the two surgical groups had the greatest degree of improvement (average glycated hemoglobin levels, 7.69±0.57% in the medical-therapy group, 6.35±1.42% in the gastric-bypass group, and 4.95±0.49% in the biliopancreatic-diversion group).
  
  
  CONCLUSIONS
  In severely obese patients with type 2 diabetes, bariatric surgery resulted in better glucose control than did medical therapy. Preoperative BMI and weight loss did not predict the improvement in hyperglycemia after these procedures. (Funded by Catholic University of Rome; ClinicalTrials.gov number, NCT00888836.).
authors.affiliation: Department of Internal Medicine, Università Cattolica S. Cuore, Largo A. Gemelli 8, 00168 Rome, Italy. gmingrone@rm.unicatt.it
authors.forename: Geltrude
authors.initials: G
authors.lastname: Mingrone
authors.forename: Simona
authors.initials: S
authors.lastname: Panunzi
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Caterina
authors.initials: C
authors.lastname: Guidone
authors.forename: Amerigo
authors.initials: A
authors.lastname: Iaconelli
authors.forename: Laura
authors.initials: L
authors.lastname: Leccesi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nanni
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
authors.forename: Marco
authors.initials: M
authors.lastname: Castagneto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ghirlanda
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015904:Biliopancreatic Diversion; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012074:Remission Induction; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids