title: Three-year follow-up comparing metabolic surgery versus medical weight management in patients with type 2 diabetes and BMI 30-35. The role of sRAGE biomarker as predictor of satisfactory outcomes.
abstract: BACKGROUND
  Patients with type 2 diabetes (T2D) and body mass index (BMI)<35 may benefit from metabolic surgery. The soluble form of the receptor for advanced glycation end products (sRAGE) may identify patients at greater chance for T2D remission.
  
  
  OBJECTIVE
  To study long-term outcomes of patients with T2D and BMI 30-35 treated with metabolic surgery or medical weight management (MWM) and search for predictors of T2D remission.
  
  
  METHODS
  University METHODS: Retrospective review of the original cohort, including patients who crossed over from MWM to surgery. Repeated-measures linear models were used to model weight loss (%WL), change in glycated hemoglobin (HbA1C) and association with baseline sRAGE.
  
  
  RESULTS
  Fifty-seven patients with T2D and BMI 30-35 were originally randomly assigned to metabolic surgery versus MWM. Mean BMI and HbA1C was 32.6% and 7.8%, respectively. A total of 30 patients underwent surgery (19 sleeves, 8 bypasses, 3 bands). Three-year follow-up in the surgery group and MWM group was 75% and 86%, respectively. Surgery resulted in higher T2D remission (63% versus 0%; P<.001) and lower HbA1C (6.9% versus 8.4%; P<.001) for up to 3 years. There was no difference in %WL in those with versus those without T2D remission (21.7% versus 20.6%, P = .771), suggesting that additional mechanisms other than %WL play an important role for the studied outcome. Higher baseline sRAGE was associated with greater change in HbA1C and greater %WL after surgery (P< .001).
  
  
  CONCLUSIONS
  Metabolic surgery was effective in promoting remission of T2D in 63% of patients with BMI 30-35; higher baseline sRAGE predicted T2D remission with surgery. Larger-scale randomly assigned trials are needed in this patient population.
authors.affiliation: Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Horwitz
authors.affiliation: Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York.
authors.forename: John K
authors.initials: JK
authors.lastname: Saunders
authors.affiliation: Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York.
authors.forename: Aku
authors.initials: A
authors.lastname: Ude-Welcome
authors.affiliation: Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York.
authors.forename: Ann
authors.initials: A
authors.lastname: Marie Schmidt
authors.affiliation: MetroPlus Health Plan, Health and Hospitals Corporation, New York, New York.
authors.forename: Van
authors.initials: V
authors.lastname: Dunn
authors.affiliation: Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York.
authors.forename: H
authors.initials: H
authors.lastname: Leon Pachter
authors.affiliation: Department of Surgery, New York University School of Medicine/Bellevue Hospital, New York, New York. Electronic address: manish.parikh@nyumc.org.
authors.forename: Manish
authors.initials: M
authors.lastname: Parikh
mesh_terms: D000704:Analysis of Variance; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D050110:Bariatric Surgery; D015415:Biomarkers / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000628:therapy*; D000067759:Receptor for Advanced Glycation End Products / Q000378:metabolism*; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019440:Anti-Obesity Agents; D015415:Biomarkers; D006442:Glycated Hemoglobin; D000067759:Receptor for Advanced Glycation End Products; C000593871:AGER protein, human
keywords: BMI under 35; Band; Bariatric surgery; Biomarker; Diabetes; Gastric bypass; Metabolic surgery; Obesity; SRAGE; Sleeve