title: Metabolic effects of bariatric surgery in patients with moderate obesity and type 2 diabetes: analysis of a randomized control trial comparing surgery with intensive medical treatment.
abstract: OBJECTIVE
  To evaluate the effects of two bariatric procedures versus intensive medical therapy (IMT) on β-cell function and body composition.
  
  
  METHODS
  This was a prospective, randomized, controlled trial of 60 subjects with uncontrolled type 2 diabetes (HbA1c 9.7 ± 1%) and moderate obesity (BMI 36 ± 2 kg/m(2)) randomized to IMT alone, IMT plus Roux-en-Y gastric bypass, or IMT plus sleeve gastrectomy. Assessment of β-cell function (mixed-meal tolerance testing) and body composition was performed at baseline and 12 and 24 months.
  
  
  RESULTS
  Glycemic control improved in all three groups at 24 months (N = 54), with a mean HbA1c of 6.7 ± 1.2% for gastric bypass, 7.1 ± 0.8% for sleeve gastrectomy, and 8.4 ± 2.3% for IMT (P < 0.05 for each surgical group versus IMT). Reduction in body fat was similar for both surgery groups, with greater absolute reduction in truncal fat in gastric bypass versus sleeve gastrectomy (-16 vs. -10%; P = 0.04). Insulin sensitivity increased significantly from baseline in gastric bypass (2.7-fold; P = 0.004) and did not change in sleeve gastrectomy or IMT. β-Cell function (oral disposition index) increased 5.8-fold in gastric bypass from baseline, was markedly greater than IMT (P = 0.001), and was not different between sleeve gastrectomy versus IMT (P = 0.30). At 24 months, β-cell function inversely correlated with truncal fat and prandial free fatty acid levels.
  
  
  CONCLUSIONS
  Bariatric surgery provides durable glycemic control compared with intensive medical therapy at 2 years. Despite similar weight loss as sleeve gastrectomy, gastric bypass uniquely restores pancreatic β-cell function and reduces truncal fat, thus reversing the core defects in diabetes.
authors: Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio, USA. kashyas@ccf.org
authors: Sangeeta R
authors: SR
authors: Kashyap
authors: Deepak L
authors: DL
authors: Bhatt
authors: Kathy
authors: K
authors: Wolski
authors: Richard M
authors: RM
authors: Watanabe
authors: Muhammad
authors: M
authors: Abdul-Ghani
authors: Beth
authors: B
authors: Abood
authors: Claire E
authors: CE
authors: Pothier
authors: Stacy
authors: S
authors: Brethauer
authors: Steven
authors: S
authors: Nissen
authors: Manjula
authors: M
authors: Gupta
authors: John P
authors: JP
authors: Kirwan
authors: Philip R
authors: PR
authors: Schauer
mesh_terms: D050110:Bariatric Surgery; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005743:Gastrectomy; D015390:Gastric Bypass; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D050417:Insulin-Secreting Cells / Q000378:metabolism / Q000502:physiology*; D050356:Lipid Metabolism / Q000502:physiology; D009765:Obesity / Q000378:metabolism / Q000601:surgery*; D015431:Weight Loss / Q000502:physiology
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1