title: National Differences in Remission of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery-Subgroup Analysis of 2-Year Results of the Diabetes Surgery Study Comparing Taiwanese with Americans with Mild Obesity (BMI 30-35 kg/m2).
abstract: The purpose of this study is to compare effects of different nations on Roux-en-Y gastric bypass (RYGB) vs. intensive medical management (IMM) in achieving remission of type 2 diabetes mellitus (T2DM).
  
  
  
  Between April 2008 and December 2011, this randomized, controlled clinical trial was conducted at four teaching hospitals in the United States and Taiwan involving 71 participants with mild obesity (BMI 30-35 kg/m2). Thirty-six of 71 participants were randomly assigned to the RYGB group, and the others were in IMM group. Partial or complete remission of T2DM was defined as blood HbA1c < 6.5 % (48 mmol/mol) or <6 % (42 mmol/mol) without any antihyperglycemic medication for at least 1-year duration, respectively.
  
  
  
  At baseline, Taiwanese participants had a lower BMI, younger age, and shorter duration of T2DM than American participants. At 24 months, weight loss was greater in the RYGB group in both populations than in the IMM group. No IMM participant of either population had partial or complete remission of T2DM. In the RYGB group, a substantial proportion of the subjects achieved complete or partial remission (57 % in Taiwanese and 27 % in American participants, P = 0.08). Logistic regression revealed stimulated C-peptide (Odds ratio 2.22, P = 0.02) but not nationality as a significant predictor of diabetes remission.
  
  
  
  Adding RYGB to lifestyle and medical management was associated with a greater likelihood of remission of T2DM in both Taiwanese and American subjects with mild obesity with type 2 diabetes. Residual beta-cell function at baseline appears to be the major factor predicting remission of T2DM. Trial registry number: clinicaltrials.gov Identifier: NCT00641251.
authors: Department of Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan.
authors: Keong
authors: K
authors: Chong
authors: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors: Sayeed
authors: S
authors: Ikramuddin
authors: Department of Surgery, Min-Sheng General Hospital, Taoyuan City, Taiwan.
authors: Wei-Jei
authors: WJ
authors: Lee
authors: Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN, USA.
authors: Charles J
authors: CJ
authors: Billington
authors: Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN, USA.
authors: John P
authors: JP
authors: Bantle
authors: Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
authors: Qi
authors: Q
authors: Wang
authors: Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
authors: Avis J
authors: AJ
authors: Thomas
authors: Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA.
authors: John E
authors: JE
authors: Connett
authors: Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
authors: Daniel B
authors: DB
authors: Leslie
authors: Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA.
authors: William B
authors: WB
authors: Inabnet
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors: Robert W
authors: RW
authors: Jeffery
authors: Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Michael G
authors: MG
authors: Sarr
authors: Department of Medicine, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, MN, USA.
authors: Michael D
authors: MD
authors: Jensen
authors: Department of Medicine, Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, MN, USA.
authors: Adrian
authors: A
authors: Vella
authors: Department of Surgery, Harlem Hospital Center, New York, NY, USA.
authors: Leaque
authors: L
authors: Ahmed
authors: Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
authors: Kumar
authors: K
authors: Belani
authors: Nutrition Services, Fairview Health System, Minneapolis, MN, USA.
authors: Joyce L
authors: JL
authors: Schone
authors: Department of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Amy E
authors: AE
authors: Olofson
authors: Department of Bariatric Surgery, Temple University Hospital, Philadelphia, PA, USA.
authors: Heather A
authors: HA
authors: Bainbridge
authors: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors: Patricia S
authors: PS
authors: Laqua
authors: Department of Medicine, Division of Endocrinology, Columbia University Medical Center, New York, NY, USA.
authors: Judith
authors: J
authors: Korner
authors: Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan. leeming@ntu.edu.tw.|Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. leeming@ntu.edu.tw.
authors: Lee-Ming
authors: LM
authors: Chuang
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002096:C-Peptide; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D012074:Remission Induction; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D002096:C-Peptide; D007004:Hypoglycemic Agents
keywords: Diabetes remission; Ethnic differences; National differences; Roux-en-Y gastric bypass; Taiwanese; Type 2 diabetes mellitus