Metabolic surgery is superior to medical treatment for short-term remission of T2DM and comorbidities .
OBJECTIVE To compare surgical versus medical treatment  of  type 2 diabetes mellitus ( T2DM ) remission and comorbidities in patients with a body mass index ( BMI ) less than 35 kg/m2 .
BACKGROUND Obesity surgery can achieve remission of T2DM and its comorbidities .
Metabolic surgery has been proposed as a treatment option for diabetic patients with BMI less than 35 kg/m2 but the efficacy of metabolic surgery has not been conclusively determined .
Gastric Bypass Leads to Improvement of Diabetic Neuropathy Independent of Glucose Normalization—Results of a Prospective Cohort Study (DiaSurg 1 Study)
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
Metabolic surgery is superior to medical treatment for short-term remission of T2DM and comorbidities .
OBJECTIVE To compare surgical versus medical treatment  of  type 2 diabetes mellitus ( T2DM ) remission and comorbidities in patients with a body mass index ( BMI ) less than 35 kg/m2 .
BACKGROUND Obesity surgery can achieve remission of T2DM and its comorbidities .
Metabolic surgery has been proposed as a treatment option for diabetic patients with BMI less than 35 kg/m2 but the efficacy of metabolic surgery has not been conclusively determined .