(Press-News.org) Bottom Line: Roux-en-Y gastric bypass surgery resulted in the greatest average weight and appears to be the best treatment for type 2 diabetes mellitus (T2DM) compared to gastric banding and lifestyle intervention in a clinical trial that also highlights the challenges to completing a larger trial with patients with a body mass index (BMI) of 30 to 40.
Author: Anita P. Courcoulas, M.D., M.P.H., of the University of Pittsburgh Medical Center, and colleagues.
Background: Questions remain unanswered about the role of bariatric surgery in the treatment of T2DM, including the safety, efficacy and economic impact. Answers could come in a large, multicenter randomized clinical trial (RCT), but such a trial would be costly and potentially difficult to execute.
How the Study Was Conducted: The authors report the results of an RCT examining the feasibility of a larger study and comparing the effectiveness of two types of bariatric surgery Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and an intensive lifestyle weight-loss intervention in adults with a BMI of 30 to 40 and T2DM. While 667 adults were assessed for eligibility, the trial included 69 participants (24 assigned to receive RYGB, 22 to LAGB and 23 to the lifestyle intervention).
Results: Patients who had RYGB had the greatest weight change (-27 percent) compared with LAGB and the lifestyle intervention (-17.3 percent and -10.2 percent, respectively). No participants in the lifestyle intervention achieved partial or complete remission of T2DM at 12 months; 50 percent of the patients in the RYGB group had partial remission and 17 percent achieved complete remission, compared with the LAGB group where 27 percent of patients had partial T2DM remission and 23 percent had complete remission.
Discussion: "This study highlights several potential challenges to successfully completing a larger RCT for treatment of T2DM and obesity in patients with a BMI of 30 to 40, including the difficulties associated with recruiting and randomizing patients to surgical vs. nonsurgical interventions."
(JAMA Surgery. Published online June 4, 2014. doi:10.1001/jamasurg.2014.467. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Authors made conflict of interest disclosures. This study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and other sources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Roux-en-Y Gastric Bypass Means Greater Weight Loss, Other Improvements in Obese Patients
Bottom Line: Obese patients type 2 diabetes (T2DM) who underwent Roux-en-Y gastric bypass (RYGB) surgery had greater weight loss and other sustained improvements compared with intensive medical/weight management of the disease in a clinical trial that further confirmed the feasibility of conducting a larger trial to compare bariatric surgery with other interventions.
Author: Florencia Halperin, M.D., of the Brigham and Women's Hospital, Boston, and colleagues
Background: Data support bariatric surgery as a therapeutic strategy to manage T2DM.
How the Study Was Conducted: Authors tested the feasibility of conducting a larger trial to determine the long-term effect of RYGB compared with intensive medical/weight management in obese patients (body mass index 30 to 42) with T2DM. The trial analyzed data from 38 participants (19 in the RYGB group and 19 in the medical/weight management intervention).
Results: At one year, more patients in the RYGB group than the medical/weight management group (58 percent vs. 16 percent, respectively) achieved HbA 1c below 6.5 percent and fasting glucose below 126 mg/dL. Other outcomes, including HbA 1c , weight, waist circumference, fat mass, lean mass, blood pressure and triglyceride levels, decreased more and high-density lipoprotein cholesterol increased more after RYGB than the nonsurgical intervention.
Discussion: "These differences may help inform therapeutic decisions for diabetes and weight loss strategies in obese patients with type 2 diabetes until larger randomized trials are performed."
(JAMA Surgery. Published online June 4, 2014. doi:10.1001/jamasurg.2014.514. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Authors made conflict of interest disclosures. This work was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and other sources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
INFORMATION:
Media Advisory: To contact author Anita P. Courcoulas, M.D., M.P.H., call Cyndy McGrath at 412-260-4586 or email mcgrathc3@upmc.edu. To contact corresponding author Allison B. Goldfine, M.D., email communications@joslin.harvard.edu.
Two JAMA Surgery studies examine bariatric surgery for type 2 diabetes treatment
2014-06-04
ELSE PRESS RELEASES FROM THIS DATE:
Sea star disease epidemic surges in Oregon, local extinctions expected
2014-06-04
CORVALLIS, Ore. – Just in the past two weeks, the incidence of sea star wasting syndrome has exploded along the Oregon Coast and created an epidemic of historic magnitude, one that threatens to decimate Oregon's entire population of purple ochre sea stars.
Prior to this, Oregon had been the only part of the West Coast that had been largely spared this devastating disease.
The ochre sea star, which is the species most heavily affected by the disease in the intertidal zone, may be headed toward localized extinction in Oregon, according to researchers at Oregon State University ...
Are squiggly lines the future of password security?
2014-06-04
VIDEO:
As more people use smart phones or tablets to pay bills, make purchases, store personal information and even control access to their houses, the need for robust password security has...
Click here for more information.
As more people use smart phones or tablets to pay bills, make purchases, store personal information and even control access to their houses, the need for robust password security has become more critical than ever.
A new Rutgers University study shows that ...
Disinfection caps successful in CLABSI prevention
2014-06-04
Thanks to the simple use of an alcohol-impregnated cap, Loyola University Medical Center achieved a 68 percent decrease in the overall number of central line-associated bloodstream infections (CLABSI) over a 12-month period. A two-year study compared the use of disinfection caps to an intense scrub-the-hub intervention to standard care. Scrub-the-hub refers to cleaning catheter connector hubs and injection ports with alcohol for the recommended 15 seconds before accessing the central line, a catheter placed in a large vein to deliver medicine and liquids during hospitalization. ...
Genetics provide blueprint for new heart disease therapies
2014-06-04
PHILADELPHIA — Advances in the understanding of the genetics of coronary artery disease, or CAD, will revitalize the field and lead to more therapeutic targets for new medicines to combat this common disease, suggests a genetics expert from the Perelman School of Medicine at the University of Pennsylvania in a Perspective article in the new issue of Science Translational Medicine.
Daniel J. Rader, MD, chair of the Department of Genetics and associate director of the Institute for Translational Medicine and Therapeutics, asserts that the lagging search for new heart medicines ...
UCLA researchers identify new gene involved in Parkinson's disease
2014-06-04
A team of UCLA researchers has identified a new gene involved in Parkinson's disease, a finding that may one day provide a target for a new drug to prevent and potentially even cure the debilitating neurological disorder.
Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease, and there is no cure for the progressive and devastating illness. About 60,000 Americans are diagnosed with Parkinson's disease each year. It is estimated that as many as 1 million Americans live with Parkinson's disease, which is more than the number ...
Drones give farmers an eye in the sky to check on crop progress
2014-06-04
CHAMPAIGN, Ill. — This growing season, crop researchers at the University of Illinois are experimenting with the use of drones – unmanned aerial vehicles – on the university's South Farms.
Dennis Bowman, a crop sciences educator with U. of I. Extension, is using two drones to take aerial pictures of crops growing in research plots on the farms. He presented his findings to farmers and other researchers at the 2014 Ford / Iroquois County Agronomy Day meeting.
Bowman intentionally made mistakes on one test plot – "areas where we didn't apply enough nitrogen fertilizer, ...
Increase in number of total knee replacement surgeries, especially in younger adults, linked to obesity
2014-06-04
ROSEMONT, Ill.─The number of total knee replacement (TKR) surgeries more than tripled between 1993 and 2009, while the number of total hip replacements (THR) doubled during the same time period. A study appearing in the June Journal of Bone and Joint Surgery (JBJS) found that an increase in the prevalence of ovrweight and obesity in the U.S. accounted for 95 percent of the higher demand for knee replacements, with younger patients affected to a greater degree.
"We observed that growth of knee replacement volumes was far outpacing that of hip replacements and were ...
Surprisingly strong magnetic fields challenge black holes' pull
2014-06-04
A new study of supermassive black holes at the centers of galaxies has found magnetic fields play an impressive role in the systems' dynamics. In fact, in dozens of black holes surveyed, the magnetic field strength matched the force produced by the black holes' powerful gravitational pull, says a team of scientists from the U.S. Department of Energy's Lawrence Berkeley National Laboratory (Berkeley Lab) and Max Planck Institute for Radio Astronomy (MPIfR) in Bonn, Germany. The findings are published in this week's issue of Nature.
"This paper for the first time systematically ...
No evidence of the double nature of neutrinos
2014-06-04
Neutrinos are tiny, neutral elementary particles that, contrary to the standard model of physics, have been proven to have mass. One possible explanation for this mass could be that neutrinos are their own antiparticles, so-called Majorana particles.
Though experimental evidence for this is still lacking, many theoretical extensions of the standard model of physics predict the Majorana nature of neutrinos. If this hypothesis proves to be true, many previously unanswered questions about the origin of our universe and the origin of matter could be answered.
650 meters ...
NASA sees Depression Boris mOVING over Mexico with heavy rainfall
2014-06-04
Tropical Depression 2E strengthened into Tropical Storm Boris briefly on June 3 before making landfall in southern Mexico and weakening into a depression. While Boris was building to tropical storm strength, NASA's Aqua and TRMM satellites passed overhead identifying heavy rainfall and the extent of the storm.
On June 3 at 19:15 UTC (3:15 p.m. EDT) the Moderate Resolution Imaging Spectroradiometer (MODIS) instrument aboard NASA's Aqua satellite captured a visible image of Tropical Storm Boris over Central America. Boris appeared circular in the imagery and its clouds ...