Safety and Efficacy of Roux-en-Y Gastric Bypass to Treat Type 2 Diabetes Mellitus in Non-severely Obese Patients Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial. Impact of Bariatric Surgery on Ghrelin and Obestatin Levels in Obesity or Type 2 Diabetes Mellitus Rat Model DiaSurg 2 trial - surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial - DRKS00004550 Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. Predictive Factors of Type 2 Diabetes Remission 1 Year After Bariatric Surgery: Impact of Surgical Techniques Acute effects of gastric bypass versus gastric restrictive surgery on β-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects Differential Changes in Gut Microbiota After Gastric Bypass and Sleeve Gastrectomy Bariatric Surgery Vary According to Diabetes Remission Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastric Bypass Leads to Improvement of Diabetic Neuropathy Independent of Glucose Normalization—Results of a Prospective Cohort Study (DiaSurg 1 Study) Weight loss induced by very low calorie diet is associated with a more beneficial systemic inflammatory profile than by Roux-en-Y gastric bypass. Changes in Gut Microbiome after Bariatric Surgery Versus Medical Weight Loss in a Pilot Randomized Trial Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes Two-year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m(2). Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects. Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m2 Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients.
The efficacy of Roux-en-Y gastric bypass ( RYGB ) to control  type 2 diabetes mellitus ( T2DM )  has been demonstrated in morbidly obese patients . Surgical procedures primarily focused on T2DM control in patients with body mass index ( BMI ) < 35 kg/m2 have shown to effectively induce remission of T2DM . However , only few reports have evaluated the safety and efficacy of RYGB in this group of patients . The aim of this study is to assess the safety and efficacy of RYGB in TD2 M patients with BMI < 35 kg/m2 . All T2DM patients with BMI < 35 kg/m2 and at least 12 months of follow-up who underwent laparoscopic RYGB were included . Safety of the procedure was evaluated according to mortality , need of reoperation/conversion , and complication rates . Metabolic parameters were evaluated at baseline and 6 , 12 , and 24 months after surgery . Thirty patients were included . Seventeen ( 56.6 % ) were women . Age , BMI , and duration of diabetes were 48 ± 9 years , 33.7 ± 1.2 kg/m2 , 4 ± 2.9 years , respectively . No mortality was observed . No conversion/reoperation was needed . Average length of stay was 3.2 ± 0.9 days . Early and late postoperative complications were observed in five ( 16.6 % ) and five ( 16.6 % ) patients , respectively . Twelve months after surgery , remission was observed in 25 of 30 patients ( 83.3 % ) . After 2 years , remission was achieved in 13 of 20 patients ( 65 % ) , and hemoglobin A1c decreased from 8.1 ± 1.8 % to 5.9 ± 1.1 % and homeostasis model assessment of insulin resistance from 5.7 ± 3.2 to 1.9 ± 0.8 after 12 months . RYGB is a safe and effective procedure to induce T2DM remission in otherwise not eligible patients for bariatric surgery . Evidence from prospect i ve studies is needed to vali date this approach IMPORTANCE Questions remain about the role and durability of bariatric surgery for type 2 diabetes mellitus ( T2DM ) . OBJECTIVE To compare the remission of T2DM following surgical and nonsurgical treatments . DESIGN , SETTING , AND PARTICIPANTS In this 3-arm r and omized clinical trial conducted at the University of Pittsburgh Medical Center from October 1 , 2009 , to June 26 , 2014 , in Pittsburgh , Pennsylvania , outcomes were assessed 3 years after treating 61 obese participants aged 25 to 55 years with T2DM . Analysis was conducted with an intent-to-treat population . INTERVENTIONS Participants were r and omized to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments ( Roux-en-Y gastric bypass [ RYGB ] or laparoscopic adjustable gastric b and ing [ LAGB ] ) followed by low-level lifestyle intervention in years 2 and 3 . MAIN OUTCOMES AND MEASURES Primary end points were partial and complete T2DM remission and secondary end points included diabetes medications and weight change . RESULTS Body mass index ( calculated as weight in kilograms divided by height in meters squared ) was less than 35 for 26 participants ( 43 % ) , 50 ( 82 % ) were women , and 13 ( 21 % ) were African American .  Mean ( SD ) values were 100.5 ( 13.7 ) kg for weight , 47.3 ( 6.6 ) years for age , 7.8 % ( 1.9 % ) for hemoglobin A1c level , and 171.3 ( 72.5 ) mg/dL for fasting plasma glucose level . Partial or complete T2DM remission was achieved by 40 % ( n = 8) of RYGB , 29 % ( n = 6 ) of LAGB , and no intensive lifestyle weight loss intervention participants ( P = .004 ) . The use of diabetes medications was reduced more in the surgical groups than the lifestyle intervention-alone group , with 65 % of RYGB , 33 % of LAGB , and none of the intensive lifestyle weight loss intervention participants going from using insulin or oral medication at baseline to no medication at year 3 ( P < .001 ) . Mean ( SE ) reductions in percentage of body weight at 3 years were the greatest after RYGB at 25.0 % ( 2.0 % ) , followed by LAGB at 15.0 % ( 2.0 % ) and lifestyle treatment at 5.7 % ( 2.4 % ) ( P < .01 ) . CONCLUSIONS AND RELEVANCE Among obese participants with T2DM , bariatric surgery with 2 years of an adjunctive low-level lifestyle intervention result ed in more disease remission than did lifestyle intervention alone . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01047735 We aim ed to evaluate the therapeutic efficacy on weight control by different bariatric surgeries and investigate the ghrelin and obestatin changes after these surgeries in obesity and nonobese type 2 diabetes mellitus ( T2DM ) rats . Obese rats were r and omly assigned to receive sleeve gastrectomy ( SG , n = 8) , minigastric bypass ( MGBP , n = 8) , roux-en-Y gastric bypass ( RYGBP , n = 8) , and sham operation ( SO , n = 4 ) . Another 4 rats served as control . Besides , Goto-Kakisaki ( GK ) rats were also r and omly divided into similar groups except for total gastrectomy ( TG , n = 8) group . The results showed that in obese rats , weigh loss in RYGBP group was similar to that in MGBP group but larger than that in SG group . Ghrelin significantly increased in RYGB group , but obestatin increased in MGBP group . Ghrelin/obestatin ratio significantly decreased in SG group . In GK rats , weight loss was most obvious in TG group . Postoperatively , ghrelin was significantly increased in MGBP and RYGB groups but decreased in TG group . Obestatin also showed an increase in MGBP and RYGB groups . Ghrelin/obestatin in TG group decreased significantly . In conclusion , RYGB and MGBP may be more suitable for obese rats , but TG may be the best strategy for T2DM rats to control weight with different mechanisms Background Type 2 diabetes mellitus ( T2DM ) is a disease with high prevalence , associated with severe co-morbidities as well as being a huge burden on public health . It is known that glycemic control decreases long-term morbidity and mortality . The current st and ard therapy for T2DM is medical treatment . Several r and omized controlled trials ( RCTs ) performed in obese patients showed remission of T2DM after bariatric surgery . Recent RCTs have shown bariatric procedures to produce a similar effect in non-morbidly and non-severely obese , insulin-dependent T2DM patients suggesting procedures currently used in bariatric surgery as new therapeutical approach in patients with T2DM . This study aims at investigating whether Roux-en-Y gastric bypass ( RYGB ) is an efficient treatment for non-severely obese T2DM patients in terms of preventing long-term complications and mortality . Methods The DiaSurg 2 trial is a multicenter , open r and omized controlled trial comparing RYGB including st and ardized medical treatment if needed to exclusive st and ardized medical treatment of T2DM ( control group ) . The primary endpoint is a composite time-to-event endpoint ( cardiovascular death , myocardial infa rct ion , coronary bypass , percutaneous coronary intervention , non-fatal stroke , amputation , surgery for peripheral atherosclerotic artery disease ) , with a follow-up period of 8 years . Insulin-dependent T2DM patients aged between 30 and 65 years will be included and r and omly assigned to one of the two groups . The experimental group will receive RYGB and , if needed , st and ardized medical care , whereas the control group will receive exclusive st and ardized medical care , both according to the national treatment guidelines for T2DM . Statistical analysis is based on Cox proportional hazards regression for the intention-to-treat population . Assuming a loss to follow-up rate of 20 % , 200 patients will be r and omly allocated to the comparison groups . A total sample size of n = 400 is sufficient to ensure 80 % power in a two-tailed significance test at alpha = 5 % . Discussion The DiaSurg2 trial will yield long-term data ( 8 years ) on diabetes-associated morbidity and mortality in patients with insulin-dependent T2DM receiving either RYGB or st and ardized medical care . Trial registration The trial protocol has been registered in the German Clinical Trials Register DRKS00004550 AIMS The aim of this study was to evaluate the effect of laparoscopic Roux-en-Y gastric bypass ( RYGB ) surgery compared with usual care with and without Exenatide therapy in obese people with type 2 diabetes mellitus ( T2DM ) and hypertension . METHODS 108 obese T2DM with hypertension were enrolled and r and omly allocated to usual care ( group A ) , usual care plus Exenatide ( group B ) , and RYGB surgery ( group C ) . Demographic characteristics , metabolic parameters and cardiac structure/function along with inflammatory cytokines were measured and compared before and after 12 months . RESULTS At 12 months , diabetes remission had occurred in no patients in groups A and B versus 90 % in group C , and there was a significant decrease in requirement of antihypertensive drugs in group C compared with groups A and B ( P<0.05 ) . Other parameters ( body mass index , hemoglobin A1c , homeostasis model assessment of insulin resistance , lipids ) , inflammation index ( high sensitivity C-reactive protein , tumor necrosis factor-α , high molecular weight adiponectin ) and cardiac structure ( left ventricular mass index ) were significantly improved in groups B and C , but patients in group C had the greatest degree of improvement ( P<0.05 ) . CONCLUSION RYGB surgery improves a number of parameters including cardiovascular function in obese hypertensive people with T2DM . This is likely to be due to , at least in part , an improvement in the abnormal metabolic panel and to reduced inflammation IMPORTANCE Many questions remain unanswered about the role of bariatric surgery for people with type 2 diabetes mellitus ( T2DM ) . OBJECTIVE To determine feasibility of a r and omized clinical trial ( RCT ) and compare initial outcomes of bariatric surgery and a structured weight loss program for treating T2DM in participants with grade s I and II obesity . DESIGN , SETTING , AND PARTICIPANTS A 12-month , 3-arm RCT at a single center including 69 participants aged 25 to 55 years with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 30 to 40 and T2DM . INTERVENTIONS Roux-en-Y gastric bypass ( RYGB ) , laparoscopic adjustable gastric b and ing ( LAGB ) , and an intensive lifestyle weight loss intervention ( LWLI ) . MAIN OUTCOMES AND MEASURES Primary outcomes in the intention-to-treat cohort were feasibility and effectiveness measured by weight loss and improvements in glycemic control . RESULTS Of 667 potential participants who underwent screening , 69 ( 10.3 % ) were r and omized . Among the r and omized participants , 30 ( 43 % ) had grade I obesity , and 56 ( 81 % ) were women . Mean ( SD ) age was 47.3 ( 6.4 ) years and hemoglobin A1c level , 7.9 % ( 2.0 % ) . After r and omization , 7 participants ( 10 % ) refused to undergo their allocated intervention ( 3 RYGB , 1 LAGB , and 3 LWLI ) , and 1 RYGB participant was excluded for current smoking . Twenty participants underwent RYGB ; 21 , LAGB ; and 20 , LWLI , with 12-month retention rates of 90 % , 86 % , and 70 % , respectively . In the intention-to-treat cohort with multiple imputation for missing data , RYGB participants had the greatest mean weight loss from baseline ( 27.0 % ; 95 % CI , 30.8 - 23.3 ) compared with LAGB ( 17.3 % ; 95 % CI , 21.1 - 13.5 ) and LWLI ( 10.2 % ; 95 % CI , 14.8 - 5.61 ) ( P < .001 ) . Partial and complete remission of T2DM were 50 % and 17 % , respectively , in the RYGB group and 27 % and 23 % , respectively , in the LAGB group ( P < .001 and P = .047 between groups for partial and complete remission ) , with no remission in the LWLI group . Significant reductions in use of antidiabetics occurred in both surgical groups . No deaths were noted . The 3 serious adverse events included 1 ulcer treated medically in the RYGB group and 2 rehospitalizations for dehydration in the LAGB group . CONCLUSIONS AND RELEVANCE This study highlights several potential challenges to successful completion of a larger RCT for treatment of T2DM and obesity in patients with a body mass index of 30 to 40 , including the difficulties associated with recruiting and r and omizing patients to surgical vs nonsurgical interventions . Preliminary results show that RYGB was the most effective treatment , followed by LAGB for weight loss and T2DM outcomes at 1 year . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01047735 Type 2 diabetes ( T2D ) remission after bariatric procedures has been highlighted in many retrospective and some recent prospect i ve studies . However , in the most recent prospect i ve study , more than 50 % of patients did not reach T2D remission at 1 year . Our aim was to identify baseline positive predictors for T2D remission at 1 year after bariatric surgery and to build a preoperative predictive score . We analysed the data concerning 161 obese operated on between June 2007 and December 2010 . Among them , 46 were diabetic and were included in the study —11 laparoscopic adjustable gastric b and ing ( LAGB ) , 26 Roux-en-Y gastric bypass ( RYGB ) and 9 sleeve gastrectomy ( SG ) .  We compared anthropometric and metabolic features during 1 year of follow-up . A receiver operating characteristic analysis was performed to predict T2D remission . RYGB and SG were similarly efficient for body weight loss and more efficient than LAGB ; 62.8 % of patients presented with T2DM remission at 1 year , with no significant difference according to the surgical procedure . A 1-year body mass index ( BMI ) < 35 kg m−2 was predictive of T2DM remission whatever the procedure . The preoperative predictive factors of diabetes remission were baseline BMI ≤50 kg m−2 , duration of type 2 diabetes ≤4 years , glycated haemoglobin ≤7.1 % , fasting glucose < 1.14 g/l and absence of insulin therapy . A short duration of diabetes and good preoperative glycaemic control increase the rate of T2DM remission 1 year after surgery . Preoperative metabolic data could be of greater importance than the choice of bariatric procedure Context : Hyperglycemia resolves quickly after bariatric surgery , but the underlying mechanism and the most effective type of surgery remains unclear . Objective : To examine glucose metabolism and β-cell function in patients with type 2 diabetes mellitus ( T2DM ) after two types of bariatric intervention ; Roux-en-Y gastric bypass ( RYGB ) and gastric restrictive ( GR ) surgery .  Design : Prospect i ve , nonr and omized , repeated- measures , 4-week , longitudinal clinical trial . Patients : In all , 16 T2DM patients ( 9 males and 7 females , 52±14 years , 47±9 kg m−2 , HbA1c 7.2±1.1 % ) undergoing either RYGB ( N=9 ) or GR ( N=7 ) surgery . Outcome measures : Glucose , insulin secretion , insulin sensitivity at baseline , and 1 and 4 weeks post-surgery , using hyperglycemic clamps and C-peptide modeling kinetics ; glucose , insulin secretion and gut-peptide responses to mixed meal tolerance test ( MMTT ) at baseline and 4 weeks post-surgery . Results : At 1 week post-surgery , both groups experienced a similar weight loss and reduction in fasting glucose ( P<0.01 ) . However , insulin sensitivity increased only after RYGB , ( P<0.05 ) . At 4 weeks post-surgery , weight loss remained similar for both groups , but fasting glucose was normalized only after RYGB ( 95±3 mg 100 ml−1 ) . Insulin sensitivity improved after RYGB ( P<0.01 ) and did not change with GR , whereas the disposition index remained unchanged after RYGB and increased 30 % after GR ( P=0.10 ) . The MMTT elicited a robust increase in insulin secretion , glucagon-like peptide-1 ( GLP-1 ) levels and β-cell sensitivity to glucose only after RYGB ( P<0.05 ) . Conclusion : RYGB provides a more rapid improvement in glucose regulation compared with GR . This improvement is accompanied by enhanced insulin sensitivity and β-cell responsiveness to glucose , in part because of an incretin effect Background Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGBP ) are associated with similar type 2 diabetes mellitus ( T2DM ) resolution rates for morbidly obese subjects . However , the mechanisms underlying the resolution of T2DM after SG have not been clarified to date . This study aim ed to compare the early changes in gastrointestinal hormones involved in insulin and glucagon secretion in morbidly obese T2DM subjects undergoing SG or RYGBP . Methods This prospect i ve study investigated 12 subjects with T2DM who had undergone SG ( n = 6 ) or RYGBP ( n = 6 ) . Five body mass index ( BMI ) -matched obese non-diabetic subjects and five BMI -matched obese diabetic subjects served as control subjects .  Glucose , insulin , glucagon , glucagon-like peptide 1 ( GLP-1 ) , glucose-dependent insulinotropic polypeptide ( GIP ) , and GLP-2 were determined after a st and ardized mixed liquid meal before surgery and 6 weeks afterward . Results After 6 weeks , five of the six subjects in each surgical group presented with T2DM remission , although the area under the curve (AUC)0–120 of glucose was greater than that of the non-diabetic control subjects ( P < 0.01 ) . Postsurgically , the indices of insulin and glucagon secretion were comparable between the two surgical groups . The AUC0–120 of GLP-1 ( P < 0.05 ) and GLP-2 ( P < 0.05 ) was significantly and comparably enlarged after SG and RYGB . The postsurgical GIP response was significantly associated with the glucagon response throughout the meal test ( ρ = 0.747 ; P < 0.01 ) . Conclusions The data show that in a cohort of morbidly obese T2DM subjects , SG and RYGBP are associated with an early improvement in glucose tolerance , similar changes in insulin and glucagon secretion , and a similar GLP-1 , GIP , and GLP-2 response to a st and ardized mixed liquid meal Background It is unclear whether specific gut microbiota is associated with remission of  type 2 diabetes ( T2D ) after distinct types of bariatric surgery . Aims The aim of this study is to examine gut microbiota changes after laparoscopic Roux-en-Y gastric bypass ( RYGB ) or sleeve gastrectomy ( SG ) surgery in obese patients with T2D . Methods Whole-metagenome shotgun sequencing of DNA fragments using Illumina HiSeq2000 was obtained from stool sample s collected from 14 obese T2D patients pre-operatively ( while on very low calorie diet ) and 1 year after r and omisation to laparoscopic SG ( n = 7 ) or RYGB ( n = 7 ) . Result ing shotgun reads were annotated with Kyoto Encyclopedia of Genes and Genomes ( KEGG ) . Results Body weight reduction and dietary change was similar 1 year after both surgery types . Identical proportions ( n = 5/7 ) achieved diabetes remission ( HbA1c < 48 mmol/mol without medications ) 1 year after RYGB and SG . RYGB result ed in increased Firmicutes and Actinobacteria phyla but decreased Bacteroidetes phyla . SG result ed in increased Bacteroidetes phyla . Only an increase in Roseburia species was observed among those achieving diabetes remission , common to both surgery types . KEGG Orthology and pathway analysis predicted contrasting and greater gut microbiota metabolism changes after diabetes remission following RYGB than after SG . Those with persistent diabetes post-operatively had higher Desulfovibrio species pre-operatively . Conclusions Overall , RYGB produces greater and more predicted favourable changes in gut microbiota functional capacity than SG . An increase in Roseburia species was the only compositional change common to both types of surgery among those achieving diabetes remission BACKGROUND & AIMS Visceral adipose tissue ( VAT ) is an important risk factor for the metabolic complications associated with obesity . Therefore , a reduction in VAT is considered an important target of obesity therapy . We evaluated whether reducing VAT mass by surgical removal of the omentum improves insulin sensitivity and metabolic function in obese patients . METHODS We conducted a 12-month r and omized controlled trial to determine whether reducing VAT by omentectomy in 22 obese subjects increased their improvement following Roux-en-Y gastric bypass ( RYGB ) surgery in hepatic and skeletal muscle sensitivity to insulin study 1 . Improvement was assessed by using the hyperinsulinemic-euglycemic clamp technique . We also performed a 3-month , longitudinal , single-arm study to determine whether laparoscopic omentectomy alone , in 7 obese subjects with type 2 diabetes mellitus ( T2DM ) , improved insulin sensitivity study 2 . Improvement was assessed by using the Frequently Sample d Intravenous Glucose Tolerance Test . RESULTS The greater omentum , which weighed 0.82 kg ( 95 % confidence interval : 0.67 - 0.97 ) , was removed from subjects who had omentectomy in both studies . In study 1 , there was an approximate 2-fold increase in muscle insulin sensitivity ( relative increase in glucose disposal during insulin infusion ) and a 4-fold increase in hepatic insulin sensitivity 12 months after RYGB alone and RYGB plus omentectomy , compared with baseline values ( P<.001 ) . There were no significant differences between groups ( P>.87 ) or group x time interactions ( P>.36 ) . In study 2 , surgery had no effect on insulin sensitivity ( P=.844 ) or use of diabetes medications . CONCLUSIONS These results demonstrate that decreasing VAT through omentectomy , alone or in combination with RYGB surgery , does not improve metabolic function in obese patients Objective : Surprisingly , 40 % to 95 % of patients with type 2 diabetes mellitus ( T2DM ) show early remission of hyperglycemia after obesity surgery . It is unknown to what extent other diabetes-associated comorbidities such as distal peripheral neuropathy ( DPN ) might be influenced by obesity surgery . This pilot study aim ed at providing further evidence for the impact of Roux-en-Y gastric bypass ( RYGB ) on both glycemic control and DPN in nonseverely obese patients with insulin-dependent T2DM . Methods : In the present prospect i ve cohort study , 20 patients with long-st and ing , insulin-dependent T2DM and a body mass index ( BMI ) between 25 and 35 kg/m2 underwent laparoscopic RYGB .  Body mass index , glycosylated hemoglobin ( HbA1c ) , and DPN [ quantified by the Neuropathy Symptom Score ( NSS ) and the Neuropathy Deficit Score ( NDS ) ] were investigated . Results : Six months after surgery , the preoperative BMI of 32.8 ± 2.1 kg/m2 ( mean ± st and ard deviation ) dropped to 25.6 ± 2.5 kg/m2 ( P < 0.001 ) . Preoperative HbA1c levels decreased from 8.5 ± 1.2 % to 7.1 ± 1.2 % ( P < 0.001 ) , with 15 % of patients having a normalized HbA1c level lower than 6.2 % . Of 12 patients with documented DPN , the median NSS was 8 ( range , 0–10 ) preoperatively and 0 ( range , 0–9 ) postoperatively ( P = 0.004 ) , with 8 patients scoring an NSS of 0 . The median NDS was 6 ( range , 2–8 ) preoperatively and 4 ( range , 0–8 ) postoperatively ( P = 0.027 ) , with 1 patient scoring an NDS of 0 . All patients had an improvement or normalization in either 1 or both scores . Conclusions : As expected , BMI and HbA1c levels improved significantly after RYGB . More interestingly , neuropathy scores , such as NSS and NDS , improved significantly early after surgery . Symptomatic neuropathy was completely reversible in 67 % of the patients . These findings add further evidence to the fact that RYGB might be a valuable treatment option not only for improving glycemic control but also for reducing diabetes-associated comorbidities , such as DPN . This points to a complex metabolic effect of RYGB that exceeds glucose normalization . However , the results still need to be confirmed in controlled trials INTRODUCTION Weight loss interventions such as Roux-en-Y gastric bypass ( RYGB ) and very low calorie diets ( VLCD ) lead to improvement of glucose metabolism in obese individuals with type-2 diabetes . Weight loss can also positively influence the unfavorable inflammatory profile associated with obesity . However , a direct comparison of the effect of VLCD and RYGB on systemic inflammation is lacking . METHODS Systemic inflammation was investigated in age- and BMI -matched morbidly obese T2DM women by determining the number and activation- or memory status of peripheral blood leukocytes by flow cytometry , in addition to measuring circulating levels of cytokines and CRP . Systemic inflammation was assessed one month before and three months after RYGB ( n=15 ) or VLCD ( n=12 ) . An age matched group of lean women ( n=12 ) was studied as control group . RESULTS Three months after the intervention , CRP and leptin levels were reduced whereas adiponectin levels were increased both by RYGB and VLCD .  TNF-α levels were increased by RYGB , but reduced by VLCD .  IL-2 and IL-6 levels were reduced and IL-4 levels were increased by VLCD but not affected by RYGB . The number of activated peripheral cytotoxic T ( CD8+CD25 + ) and B ( CD19+CD38 + ) cells was significantly higher after RYGB than after VLCD . CONCLUSION In conclusion , RYGB and VLCD have differential effects on the activation status of peripheral leukocytes and levels of cytokines in obese women with T2DM , despite comparable weight loss three months after the intervention . VLCD seems to have more favorable effects on the inflammatory profile as compared to RYGB Gut microbiota likely impact obesity and metabolic diseases . We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity . We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10 % weight loss in adults with diabetes who were r and omized to medical weight loss ( MWL , n = 4 ) , adjustable gastric b and ing ( AGB , n = 4 ) , or Roux-en-Y gastric bypass ( RYGB , n = 4 ) . All participants were female , 75 % reported black race with mean age of 51 years . At similar weight loss amount and glycemic improvement , the RYGB group had the most number of bacterial species ( 10 increased , 1 decreased ) that significantly changed ( p < 0.05 ) in relative abundance . Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB ( observed species for AGB vs. MWL , p = 0.0093 ; AGB vs. RYGB , p = 0.0093 ) . The relative abundance of Faecalibacterium prausnitzii increased in 3 participants after RYGB , 1 after AGB , and 1 after MWL . At similar weight loss and glycemic improvement , the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium , F. prausnitzii . Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL . Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes . NCTDK089557— Clinical Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson Objective To evaluate the impact of Roux-en-Y gastric bypass ( RYGB ) on quality of life in obese diabetic patients compared to st and ard medical therapy for type 2 diabetes mellitus . Methods We prospect ively studied two matched obese population s with type 2 diabetes . Thirty patients underwent laparoscopic RYGB and 31 received st and ard medical therapy combined with a diabetes support and education program ( DSE ) , consisting of educational sessions on diet and exercise . Groups were matched by age , gender , weight , glucostatic parameters , and use of glucose-lowering medications ( oral agents and insulin therapy ) . Health-related quality of life ( HRQOL ) was assessed using the normalized SF-36 question naire , and data were collected at baseline and at 12-month follow-up . Results Diabetic patients who underwent RYGB experienced a statistically significant increase in their overall HRQOL . However , the role-physical and mental health domains increased but did not reach statistical significance . Diabetic patients in the medical therapy and DSE group did not show any significant increase in HRQOL . The between-group differences for the HRQOL changes from baseline were significant , other than for role-physical and mental health domains . Percentage changes in glucostatic parameters , discontinuation of glucose-lowering medications , and T2DM remission were not found to predict the percentage change in SF-36 scores at 12 months after RYGB . Conclusions For the first time , with a prospect i ve matched control study , we demonstrate a significant improvement in HRQOL in obese diabetic patients who underwent RYGB , but not in those who were offered st and ard medical therapy and DSE OBJECTIVE To determine the 2-year outcomes of Roux-en-Y gastric bypass ( RYGB ) and sleeve gastrectomy ( SG ) vs. intensive medical therapy ( IMT ) on lean body mass , total bone mass , and bone mineral density ( BMD ) measures from the STAMPEDE trial . METHODS 54 subjects ( BMI : 36 ± 1 kg/m(2 ) , age : 48 ± 4 years ) with type 2 diabetes ( T2DM ) ( HbA1c : 9.7 ± 2 % ) were r and omized to IMT , RYGB , or SG and underwent DXA at baseline and at 1 and 2 years . RESULTS At 2 years , the reduction in BMI was similar after RYGB and SG and was greater than IMT ( P < 0.001 ) . Lean mass was reduced by ∼10 % , total bone mineral content reduced by ∼8 % , and hip BMD reduced by ∼9 % in both surgical groups and was significantly greater than IMT despite increases in vitamin D intake in all groups . The change in hip BMD correlated with weight loss ( r = 0.84 , P < 0.0001 ) and changes in lean mass ( r = 0.74 , P < 0.0001 ) and leptin ( r = 0.53 , P < 0.0001 ) . Peripheral fractures were self-reported in RYGB ( 4/18 patients ) , SG ( 2/19 patients ) , and IMT ( 4/16 patients ) . CONCLUSIONS Surgically induced weight loss is associated with modest reductions in lean mass , bone mineral content , and BMD , despite calcium and vitamin D supplementation in patients with T2DM . Awareness for bone loss is indicated for patients undergoing bariatric procedures BACKGROUND Roux-en-Y gastric bypass ( RYGB ) benefits patients with type 2 diabetes mellitus ( T2DM ) and a body mass index ( BMI ) > 35 kg/m(2 ) ; however , its effectiveness in patients with T2DM and a BMI < 35 kg/m(2 ) is unclear . Asian Indians have a high risk of T2DM and cardiovascular disease at relatively low BMI levels . We examined the safety and efficacy of RYGB in Asian Indian patients with T2DM and a BMI of 22 - 35 kg/m(2 ) in a tertiary care medical center . METHODS A total of 15 consecutive patients with T2DM and a BMI of 22 - 35 kg/m(2 ) underwent RYGB .  The data were prospect ively collected before surgery and at 1 , 3 , 6 , and 9 months postoperatively . RESULTS Of the 15 patients , 8 were men and 7 were women ( age 45.6 + /- 12 years ) . Their preoperative characteristics were BMI 28.9 + /- 4.0 kg/m(2 ) , body weight 78.7 + /- 12.5 kg , waist circumference 100.2 + /- 6.8 cm , and duration of T2DM 8.7 + /- 5.3 years . At baseline , 80 % of subjects required insulin , and 20 % controlled their T2DM with oral hypoglycemic medication . The BMI decreased postoperatively by 20 % , from 28.9 + /- 4.0 kg/m(2 ) to 23.0 + /- 3.6 kg/m(2 ) ( P < .001 ) . All antidiabetic medications were discontinued by 1 month after surgery in 80 % of the subjects . At 3 months and thereafter , 100 % were euglycemic and no longer required diabetes medication . The fasting blood glucose level decreased from 233 + /- 87 mg/dL to 89 + /- 12 mg/dL ( P < .001 ) , and the hemoglobin A1c decreased from 10.1 % + /- 2.0 % to 6.1 % + /- 0.6 % ( P < .001 ) . Their waist circumference , presence of dyslipidemia , and hypertension improved significantly . The predicted 10-year cardiovascular disease risk ( calculated using the United Kingdom Prospect i ve Diabetes Study equations ) decreased substantially for fatal and nonfatal coronary heart disease and stroke . No mortality , major surgical morbidity , or excessive weight loss occurred . CONCLUSION RYGB safely and effectively eliminated T2DM in Asian Indians with a BMI < 35 kg/m(2 ) . Larger , longer term studies are needed to confirm this benefit OBJECTIVE Obesity and weight loss influence thyroid hormone physiology . The effects of weight loss by calorie restriction vs Roux-en-Y gastric bypass ( RYGB ) in obese subjects have not been studied in parallel . We hypothesized that differences in transient systemic inflammation and catabolic state between the intervention types could lead to differential effects on thyroid hormone physiology . DESIGN AND METHODS We recruited 12 lean and 27 obese females with normal fasting glucose ( normal glucose tolerant ( NGT ) ) and 27 obese females with type 2 diabetes mellitus ( T2DM ) for this study . Weight loss was achieved by restrictive treatment ( gastric b and ing or high-protein-low-calorie diet ) or by RYGB .  Fasting serum leptin , TSH , triiodothyronine ( T₃ ) , reverse T₃ ( rT₃ ) , and free thyroxine ( fT₄ ) concentrations were measured at baseline and 3 weeks and 3 months after the start of the interventions . RESULTS Obesity was associated with higher TSH , T₃ , and rT₃ levels and normal fT₄ levels in all the subjects when compared with the controls . After 3 weeks , calorie restriction and RYGB induced a decline in TSH levels and a rise in rT₃ and fT₄ levels . The increase in rT₃ levels correlated with serum interleukin 8 ( IL8 ) and IL6 levels . After 3 months , fT₄ and rT₃ levels returned to baseline levels , whereas TSH and T₃ levels were persistently decreased when compared with baseline levels . No differences in the effects on thyroid hormone parameters between the interventions or between NGT and T2DM subjects were observed at any time point . CONCLUSIONS In summary , weight loss directly influences thyroid hormone regulation , independently of the weight loss strategy used . The effects may be explained by a combination of decreased leptin levels and transient changes in peripheral thyroid hormone metabolism Background To compare long term effects of two bariatric procedures for Chinese type 2 diabetes mellitus ( T2DM ) patients with a body mass index ( BMI ) of 28 - 35 kg/m2 . Methods Sixty four T2DM patients with Glycated hemoglobin A1c ( HbA1c ) ≧ 7.0 % were r and omly assigned to receive laparoscopic sleeve gastrectomy ( SG ) or Roux-en-Y gastric bypass ( RYGB ) procedure . Weight , percentage of excess weight loss ( % EWL ) , BMI , waist circumference , HbA1c , fasting blood glucose ( FBG ) , and C-peptide were measured . Serum lipid levels were also measured during three-year postoperative follow-up visits . Results Fifty five patients completed the 36-month follow-up . Both groups had similar baseline anthropometric and biochemical measures . At the end point , 22 patients ( 78.6 % ) in SG group and 23 patients ( 85.2 % ) in RYGB group achieved complete remission of diabetes mellitus with HbA1c < 6.0 % ( P = 0.525 ) and without taking diabetic medications , and 25 patients in each group ( 89.3 % vs. 92.6 % ) gained successful treatment of diabetes with HbA1c≦6.5 % ( P = 0.100 ) . Change in HbA1c , FBG and C peptide were comparable in the two groups . The RYGB group had significantly greater weight loss than the SG group [ percentage of total weight loss ( % TWL ) of 31.0 % vs. 27.1 % ( P = 0.049 ) , % EWL of 92.3 % vs. 81.9 % ( P = 0.003 ) , and change in BMI of 11.0 vs. 9.1 kg/m2(P = 0.017 ) , respectively ] . Serum lipids in each group were also greatly improved . Conclusion In this three-year study , SG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2DM patients with BMI of 28 - 35 kg/m2 . Longer term follow-ups and larger sample studies are needed to confirm these outcomes , however The profound effects of bariatric surgery on glycemic control are well established in many studies , including several r and omized trials that compared surgery versus intensive medical and lifestyle treatment of type 2 diabetes mellitus ( T2DM ) ( 17 ) . Remission of T2DM is common after bariatric surgery , and Roux-en-Y gastric bypass ( RYGB ) outperforms sleeve gastrectomy ( SG ) in most reports ( 4 , 8 , 9 ) . More important than improvements in glycemic control is whether these glycemic changes reduce the incidence of major complications , such as microvascular events . In the United States , T2DM is the primary cause of nephropathy , end-stage renal disease , adult blindness , and neuropathy , which together lead to significant downstream costs and decreased quality of life ( 1012 ) . Thus , a major goal of diabetes treatment is to mitigate the risk for these long-term sequelae ( 13 ) . We have previously shown that in patients with T2DM who have bariatric surgery  , risk for incident microvascular disease is reduced for every year of remission from T2DMeven if patients eventually relapse back to T2DM ( indicating a legacy effect ) ( 14 ) . However , a detailed 2016 review of long-term microvascular outcomes of diabetes concluded that data were inadequate to support a superior effect of bariatric surgery compared with medical therapy ( 15 ) . Two recently published studies help inform this question ( 4 , 16 ) . The STAMPEDE ( Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently ) trial ( 4 ) r and omly assigned 150 patients with obesity and T2DM to have RYGB , SG , or an intensive medical and lifestyle intervention . After 5 years , urinary albumincreatinine ratios had decreased in the SG group only . Retinopathy did not change in any group , and neuropathy was not examined . STAMPEDE was limited by a relatively small sample size , which made it underpowered for rare outcomes . The prospect i ve SOS ( Swedish Obesity Subjects ) matched cohort study ( 16 ) followed 2010 patients who had bariatric surgery ( 13 % RYGB , 19 % gastric b and ing , and 68 % vertical-b and ed gastroplasty ) and 2037 matched patients who received usual care .  The incidence of microvascular disease after 15 years of follow-up was significantly lower in the surgery group than the control group ( hazard ratio [ HR ] , 0.56 [ 95 % CI , 0.48 to 0.66 ] ) , including among subgroups with prediabetes ( HR , 0.18 [ CI , 0.11 to 0.30 ] ) , established diabetes ( HR , 0.54 [ CI , 0.40 to 0.72 ] ) , and normoglycemia ( HR , 0.63 [ CI , 0.48 to 0.81 ] ) at baseline . The SOS study was limited by the small number of RYGB procedures and lack of SG procedures , which are now the 2 most common bariatric procedures worldwide ( 17 ) . To address these gaps in the literature , we did a matched cohort study to determine whether bariatric surgery was associated with lower incidence of microvascular disease than usual care for severe obesity and T2DM . We hypothesized that patients having  bariatric surgery would have lower risk for any incident microvascular disease ( composite of the first occurrence of retinopathy , neuropathy , or nephropathy ) . We further hypothesized that patients having bariatric surgery would have lower risk for incident retinopathy , nephropathy , and neuropathy than nonsurgical patients . Methods Setting s We did a retrospective observational cohort study of adults with T2DM who had bariatric surgery between 2005 and 2011 while enrolled in 1 of 4 integrated health care systems from the Health Care Systems Research Network : Kaiser Permanente ( KP ) Washington in Washington state , HealthPartners in Minnesota , KP Northern California , and KP Southern California . All study procedures were review ed and approved by the institutional review board at each site , and we were permitted to do the research without explicit consent from participants . Data Sources At each study site , staff used st and ardized electronic medical records , insurance cl aims , and other data systems ( 18 ) to extract enrollee data , including enrollment and insurance coverage ; demographics ; blood pressure ; height ; weight ; laboratory values ; medications dispensed ; deaths ; outpatient , inpatient , and emergency department use ; and inpatient and outpatient diagnosis and procedure codes . Surgical Participants The bariatric population included adults ( aged 19 to 79 years ) with severe obesity ( body mass index [ BMI ] 35 kg/m2 ) and T2DM who had a primary ( first observed ) bariatric surgical procedure between 1 January 2005 and 31 December 2011 . Following an approach adopted in prior studies ( 14 , 19 , 20 ) , we used a combination of bariatric registries ; review of medical records ; codes from the International Classification of Diseases , Ninth Revision ( ICD-9 ) ( 43.89 , 44.31 , 44.38 , 44.39 , 44.68 , 44.69 , and 44.95 ) ; and Current Procedural Terminology codes ( 43633 , 43644 , 43645 , 43659 , 43770 , 43775 , 43842 , 43843 , 43844 , 43845 , 43846 , and 43847 ) to identify bariatric procedures .  Patients were classified as having T2DM if they had a hemoglobin A1c ( HbA1c ) level of at least 6.5 % or fasting plasma glucose level of at least 6.99 mmol/L ( 126 mg/dL ) at the most recent measurement within 2 years before surgery , or a current prescription for any diabetes medication . After selecting the population , we applied the following exclusion criteria based on information in the 2 years before surgery : less than 1 full year of continuous enrollment ; history of gastrointestinal surgery for cancer ; pregnancy in the year before surgery ; gestational diabetes as the sole diabetes diagnosis ; metformin as the sole indicator of possible T2DM ( that is , no other T2DM medications , laboratory values , or diagnoses ) ; preexisting neuropathy , retinopathy , or nephropathy ( defined in Outcome and Censoring Definitions ) ; and maximum preoperative BMI less than 35 kg/m2 . This left 4972 patients . We further excluded 850 patients who were missing values for BMI , HbA1c level , or serum creatinine concentration in the 2 years before surgery . Surgical patients who were missing these values differed from those who had complete data ( Appendix Table 1 ) . Specifically , they were more likely to be non-Hispanic white , to be from the HealthPartners site , to have had their procedure in the first year of our study ( 2005 ) , and to have had a shorter observed duration of T2DM at the time of surgery . Of the remaining 4122 patients , 4024 could be matched to at least 1 nonsurgical patient ( Figure 1 ) . Figure 1 . Flow diagram for identification of eligible patients with T2DM and no history of microvascular disease who had bariatric surgery .  BMI = body mass index ; EHR= electronic health record ; HbA1c= hemoglobin A1c ; T2DM= type 2 diabetes mellitus . * Adults aged 2079 y who had a primary ( first observed ) bariatric surgical procedure between 1 January 2005 and 31 December 2011 .  Bariatric procedures were identified using a combination of bariatric registries ; review of medical records ; International Classification of Diseases , Ninth Revision , codes ( 43.89 , 44.31 , 44.38 , 44.39 , 44.68 , 44.69 , and 44.95 ) ; and Current Procedural Terminology codes ( 43633 , 43644 , 43645 , 43659 , 43770 , 43775 , 43842 , 43843 , 43844 , 43845 , 43846 , and 43847 ) . We excluded patients with any of the following : < 1 y of continuous enrollment ; history of gastrointestinal surgery for cancer ; pregnancy in the year before surgery ; gestational diabetes as the sole diabetes diagnosis ; preexisting neuropathy , nephropathy , or retinopathy ; metformin as the sole indicator of possible T2DM ( no other T2DM medications , laboratory values , or diagnoses ) ; or maximum BMI < 35 kg/m2 . Patients may have > 1 type of missing data ( BMI , creatinine concentration , or HbA1c level ) or have no follow-up time after surgery . 98 surgical patients could not be matched to a nonsurgical patient on site , age , BMI , insulin use , HbA1c level , and sex . Appendix Table 1 . Comparison of Characteristics of Surgical Patients Who Were Missing Values for BMI , HbA1c , or Serum Creatinine at Baseline Versus Those Who Had Complete Information on These Values at Baseline Matched Nonsurgical Participants For each surgical patient , we identified up to 3 matched nonsurgical control participants via a 2-step process . First , among all patients with diabetes and at least 1 BMI measurement of 35 kg/m2 or greater who did not have bariatric surgery during the study ( n= 320345 ) , we identified a pool of potential control participants who were enrolled at the time of the surgery ; satisfied the study inclusion criteria ; and matched the surgical patient on the basis of study site , sex , age ( 10 years ) , BMI ( 5 kg/m2 ) , HbA1c level ( 1.5 percentage points ) , and insulin use . Second , for each control participant in the pool , we calculated Mahalanobis distance from the surgical patient on the basis of age , BMI , HbA1c level , diabetes duration , and total days of health care use in the 7 to 24 months before the date of surgery ( 21 ) . Finally , up to 3 control participants were selected on the basis of the shortest Mahalanobis distance . Throughout , nonsurgical patients could be used as a control for only 1 surgical patient ( matching without replacement ) . The Appendix gives additional details on the process we used to establish the matched cohort . Outcome and Censoring Definitions The primary outcome measure was time to incident microvascular disease ( composite of the first occurrence of retinopathy , neuropathy , or nephropathy ) . Retinopathy was defined by the first appearance of either ICD-9 code 362.0x ( diabetic retinopathy ) or both a retinal surgical procedure code or other retinopathic code ( Appendix Table 2 ) and ICD-9 code 250.5x ( diabetes with ophthalmic manifestations ) . Neuropathy was identified on the basis of the first occurrence of ICD-9 code 250.6 ( diabetes with neurologic manifestations ) or 357.2 ( polyneuropathy in diabetes ) . Finally , nephropathy was defined by at least 2 measures of estimated glomerular filtration rate less than 60 mL/min/1.73 m2 separated by at least 90 days without any intervening values of 60 mL/min/1.73 m2 or greater . We approximated IMPORTANCE Emerging data support bariatric surgery as a therapeutic strategy for management of type 2 diabetes mellitus . OBJECTIVE To test the feasibility of methods to conduct a larger multisite trial to determine the long-term effect of Roux-en-Y gastric bypass ( RYGB ) surgery compared with an intensive diabetes medical and weight management ( Weight Achievement and Intensive Treatment [ Why WAIT ] ) program for type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A 1-year pragmatic r and omized clinical trial was conducted in an academic medical institution . Participants included persons aged 21 to 65 years with type 2 diabetes diagnosed more than 1 year before the study ; their body mass index was 30 to 42 ( calculated as weight in kilograms divided by height in meters squared ) and hemoglobin A1c ( HbA1c ) was greater than or equal to 6.5 % . All participants were receiving antihyperglycemic medications . INTERVENTIONS RYGB ( n = 19 ) or Why WAIT ( n = 19 ) including 12 weekly multidisciplinary group lifestyle , medical , and educational sessions with monthly follow-up thereafter . MAIN OUTCOMES AND MEASURES Proportion of patients with fasting plasma glucose levels less than 126  mg/dL  and HbA1c less than 6.5 % , measures of cardiometabolic health , and patient-reported outcomes . RESULTS At 1 year , the proportion of patients achieving HbA1c below 6.5 % and fasting glucose below 126 mg/dL was higher following RYGB than Why WAIT ( 58 % vs 16 % , respectively ; P = .03 ) . Other outcomes , including HbA1c , weight , waist circumference , fat mass , lean mass , blood pressure , and triglyceride levels , decreased and high-density lipoprotein cholesterol increased more after RYGB compared with Why WAIT . Improvement in cardiovascular risk scores was greater in the surgical group . At baseline the participants exhibited moderately low self-reported quality -of-life scores reflected by Short Form-36 total , physical health , and mental health , as well as high Impact of Weight on Quality of Life-Lite and Problem Areas in Diabetes health status scores . At 1 year , improvements in Short Form-36 physical and mental health scores and Problem Areas in Diabetes scores did not differ significantly between groups . The Impact of Weight on Quality of Life-Lite score improved more with RYGB and correlated with greater weight loss compared with Why WAIT . CONCLUSIONS AND RELEVANCE In obese patients with type 2 diabetes , RYGB produces greater weight loss and sustained improvements in HbA1c and cardiometabolic risk factors compared with medical management , with emergent differences over 1 year . Both treatments improve general quality -of-life measures , but RYGB provides greater improvement in the effect of weight on quality of life . These differences may help inform therapeutic decisions for diabetes and weight loss strategies in obese patients with type 2 diabetes until larger r and omized trials are performed . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01073020 BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure
The medicine use and quality of life were solely improved in the surgical group .
Nutritional deficiencies and anemia were noted more frequently in the RYGB group .
RYGB surgery is superior to medical treatment for short- to medium-term remission of T2DM , improvement of metabolic condition , and cardiovascular risk factors .
Abstract The aim of the study is to compare Roux-en-Y gastric bypass ( RYGB ) surgery versus medical treatment for  type 2 diabetes mellitus ( T2DM ) in obese patients .Bariatric  surgery can achieve remission of T2DM in obese patients .
RYGB surgery has been performed as one of the most common surgical treatment options for obese patients with T2DM , but the efficacy of RYGB surgery comparing with medical treatment alone has not been conclusively determined .