In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .
Acute effects of gastric bypass versus gastric restrictive surgery on β-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes
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
In contrast , some RCT data of nonsurgical therapies show benefits at 10 years of follow-up or more .
AND RELEVANCE Current evidence suggests that , when compared with nonsurgical treatments , bariatric surgical procedures in patients with a BMI of 30 to 35 and diabetes are associated with greater short-term weight loss and better intermediate glucose outcomes .
IMPORTANCE Bariatric surgery is beneficial in persons with a body mass index ( BMI ) of 35 or greater with obesity-related comorbidities .
There is interest in using these procedures in persons with lower BMI and diabetes .
OBJECTIVE To assess the association between bariatric surgery vs nonsurgical treatments and weight loss and glycemic control among patients with diabetes or impaired glucose tolerance and BMI of 30 to 35 .