Gastric bypass has better outcomes than gastric b and procedures for long-term weight loss , type 2 diabetes control and remission , hypertension , and hyperlipidemia .
Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections
IMPORTANCE Bariatric surgery is an accepted treatment for obesity .
Despite extensive literature , few studies report long-term follow-up in cohorts with adequate retention rates .
OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss , type 2 diabetes , hypertension , and hyperlipidemia in severely obese adults .
Five-year outcomes of patients with type 2 diabetes who underwent laparoscopic adjustable gastric banding.
BACKGROUND Evidence of the positive effects of gastric b and ing on patients with diabetes has continued to increase . The long-term follow-up of such patients , however , has been limited . The purpose of the present study was to provide the long-term outcomes of patients with diabetes undergoing laparoscopic adjustable gastric b and ing at our institution . METHODS From January 2002 through June 2004 , 102 patients with type 2 diabetes mellitus underwent laparoscopic adjustable gastric b and ing .  The study parameters included preoperative age , gender , race , body mass index , duration of diabetes before surgery , fasting glucose level , hemoglobin A1c ( HbA1c ) , and medications used . Preoperative data from all patients were collected prospect ively and entered into an institutional review board-approved data base . Beginning in 2008 , efforts were made to collect the 5-year follow-up data . RESULTS Of the 102 patients , 7 were excluded because they had not reached the 5-year follow-up point ( 2 patients had had the b and removed early and 5 patients had died ; 2 of cancer and 3 of unknown causes ) , leaving 95 patients for the present study . The mean preoperative age was 49.3 years ( range 21.3 - 68.4 ) . The mean preoperative body mass index was 46.3 kg/m(2 ) ( range 35.1 - 71.9 ) and had decreased to 35.0 kg/m(2 ) ( range 21.1 - 53.7 ) by 5 years of follow-up , yielding a mean percentage of excess weight loss of 48.3 % . The mean duration of the diabetes diagnosis before surgery was 6.5 years . Of 94 patients , 83 ( 88.3 % ) were taking medications preoperatively , with 14.9 % overall taking insulin . At 5 years postoperatively , 33 ( 46.5 % ) of 71 patients were taking medications , with 8.5 % taking insulin . The mean fasting preoperative glucose level was 146.0 mg/dL. The glucose level had decreased to 118.5 mg/dL at 5 years postoperatively ( P = .004 ) . The mean HbA1c level was 7.53 preoperatively in 72 patients and was 6.58 at 5 years postoperatively in 64 patients ( P < .001 ) . Overall , diabetes had resolved ( no medication requirement , with HbA1c < 6 and /or glucose < 100 mg/dL ) in 23 ( 39.7 % ) of 58 patients and had improved ( use of fewer medications and /or fasting glucose levels of 100 - 125 mg/dL ) in 41 ( 71.9 % ) of 57 patients . The combined improvement/remission rate was 80 % ( 64 of 80 patients ) . CONCLUSION Our data have demonstrated that laparoscopic adjustable gastric b and ing results in a substantial sustained positive effect on diabetes in morbidly obese patients , with a significant reduction in HbA1c and an 80 % overall rate of improvement/remission
Gastric bypass has better outcomes than gastric b and procedures for long-term weight loss , type 2 diabetes control and remission , hypertension , and hyperlipidemia .
Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections
IMPORTANCE Bariatric surgery is an accepted treatment for obesity .
Despite extensive literature , few studies report long-term follow-up in cohorts with adequate retention rates .
OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss , type 2 diabetes , hypertension , and hyperlipidemia in severely obese adults .