المؤلفون: Courcoulas, Anita P., Patti, Mary Elizabeth, Hu, Bo, Arterburn, David E., Simonson, Donald C., Gourash, William F., Jakicic, John M., Vernon, Ashley H., Beck, Gerald J., Schauer, Philip R., Kashyap, Sangeeta R., Aminian, Ali, Cummings, David E., Kirwan, John P.

المصدر: JAMA: Journal of the American Medical Association; 2/27/2024, Vol. 331 Issue 8, p654-664, 11p

مصطلحات موضوعية: GASTRIC bypass, GASTRIC banding, BARIATRIC surgery, TYPE 2 diabetes, SLEEVE gastrectomy, GLYCEMIC control, DISEASE remission

مستخلص: Key Points: Question: What is the long-term durability of glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes? Findings: Bariatric surgery led to superior glycemic control compared with medical/lifestyle intervention (between-group difference in hemoglobin A1c of 1.4% at 7 years and 1.1% at 12 years), with less diabetes medication usage and higher rates of diabetes remission. Meaning: These results combined with existing evidence support the use of bariatric surgery for treatment of type 2 diabetes in people with obesity. Importance: Randomized clinical trials of bariatric surgery have been limited in size, type of surgical procedure, and follow-up duration. Objective: To determine long-term glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes. Design, Setting, and Participants: ARMMS-T2D (Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes) is a pooled analysis from 4 US single-center randomized trials conducted between May 2007 and August 2013, with observational follow-up through July 2022. Intervention: Participants were originally randomized to undergo either medical/lifestyle management or 1 of the following 3 bariatric surgical procedures: Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding. Main Outcome and Measures: The primary outcome was change in hemoglobin A1c (HbA1c) from baseline to 7 years for all participants. Data are reported for up to 12 years. Results: A total of 262 of 305 eligible participants (86%) enrolled in long-term follow-up for this pooled analysis. The mean (SD) age of participants was 49.9 (8.3) years, mean (SD) body mass index was 36.4 (3.5), 68.3% were women, 31% were Black, and 67.2% were White. During follow-up, 25% of participants randomized to undergo medical/lifestyle management underwent bariatric surgery. The median follow-up was 11 years. At 7 years, HbA1c decreased by 0.2% (95% CI, −0.5% to 0.2%), from a baseline of 8.2%, in the medical/lifestyle group and by 1.6% (95% CI, −1.8% to −1.3%), from a baseline of 8.7%, in the bariatric surgery group. The between-group difference was −1.4% (95% CI, −1.8% to −1.0%; P <.001) at 7 years and −1.1% (95% CI, −1.7% to −0.5%; P =.002) at 12 years. Fewer antidiabetes medications were used in the bariatric surgery group. Diabetes remission was greater after bariatric surgery (6.2% in the medical/lifestyle group vs 18.2% in the bariatric surgery group; P =.02) at 7 years and at 12 years (0.0% in the medical/lifestyle group vs 12.7% in the bariatric surgery group; P <.001). There were 4 deaths (2.2%), 2 in each group, and no differences in major cardiovascular adverse events. Anemia, fractures, and gastrointestinal adverse events were more common after bariatric surgery. Conclusion and Relevance: After 7 to 12 years of follow-up, individuals originally randomized to undergo bariatric surgery compared with medical/lifestyle intervention had superior glycemic control with less diabetes medication use and higher rates of diabetes remission. Trial Registration: ClinicalTrials.gov Identifier: NCT02328599 This pooled analysis including 4 trials examines the long-term glycemic control and safety of bariatric surgery compared with medical/lifestyle management of type 2 diabetes. [ABSTRACT FROM AUTHOR]

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المؤلفون: Evans, Lauren L., Lee, William G., Karimzada, Mohammad, Patel, Veeshal H., Aribindi, Vamsi K., Kwiat, Dillon, Graham, James L., Cummings, David E., Havel, Peter J., Harrison, Michael R.

المصدر: Obesity Surgery; Feb2024, Vol. 34 Issue 2, p515-523, 9p

مصطلحات موضوعية: RHESUS monkeys, JEJUNOILEAL bypass, SURGICAL anastomosis, URINARY diversion, GASTRIC bypass, TYPE 2 diabetes, MAGNETIC devices

مستخلص: Purpose: Metabolic surgery remains underutilized for treating type 2 diabetes, as less invasive alternative interventions with improved risk profiles are needed. We conducted a pilot study to evaluate the feasibility of a novel magnetic compression device to create a patent limited caliber side-to-side jejunoileal partial diversion in a nonhuman primate model. Materials and Methods: Using an established nonhuman primate model of diet-induced insulin resistance, a magnetic compression device was used to create a side-to-side jejunoileal anastomosis. Primary outcomes evaluated feasibility (e.g., device mating and anastomosis patency) and safety (e.g., device-related complications). Secondary outcomes evaluated the device's ability to produce metabolic changes associated with jejunoileal partial diversion (e.g., homeostatic model assessment of insulin resistance [HOMA-IR] and body weight). Results: Device mating, spontaneous detachment, and excretion occurred in all animals (n = 5). There were no device-related adverse events. Upon completion of the study, ex vivo anastomoses were widely patent with healthy mucosa and no evidence of stricture. At 6 weeks post-device placement, HOMA-IR improved to below baseline values (p < 0.05). Total weight also decreased in a linear fashion (R² = 0.97) with total weight loss at 6 weeks post-device placement of 14.4% (p < 0.05). Conclusion: The use of this novel magnetic compression device to create a limited caliber side-to-side jejunoileal anastomosis is safe and likely feasible in a nonhuman primate model. The observed glucoregulatory and metabolic effects of a partial jejunoileal bypass with this device warrant further investigation to validate the long-term glucometabolic impact of this approach. [ABSTRACT FROM AUTHOR]

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المؤلفون: Boyd, Eric S., Cummings, David E., Geesey, Gill G.

المصدر: Microbial Ecology, 2007 Jul 01. 54(1), 170-182.

الوصول الحر: https://www.jstor.org/stable/25256184Test

المؤلفون: Fornace, Albert J., Cummings, David E., Comeau, Claudette M., Kant, Jeffery A., Crabtree, Gerald R.

المصدر: Science, 1984 Apr . 224(4645), 161-164.

الوصول الحر: https://www.jstor.org/stable/1692210Test

المؤلفون: Simonson, Donald C., Hu, Bo, Arterburn, David E., Schauer, Philip R., Kashyap, Sangeeta R., Courcoulas, Anita P., Cummings, David E., Patti, Mary‐Elizabeth, Gourash, William F., Vernon, Ashley H., Jakicic, John M., Kirwan, John P.

المصدر: Diabetes, Obesity & Metabolism; Jul2022, Vol. 24 Issue 7, p1206-1215, 10p

مستخلص: Aims: Long‐term data from randomized clinical trials comparing metabolic (bariatric) surgery versus a medical/lifestyle intervention for treatment of patients with obesity/overweight and type 2 diabetes (T2D) are lacking. The Alliance of Randomized Trials of Medicine vs Metabolic Surgery in Type 2 Diabetes (ARMMS‐T2D) is a consortium of four randomized trials designed to compare long‐term efficacy and safety of surgery versus medical/lifestyle therapy on diabetes control and clinical outcomes. Materials and Methods: Patients with T2D and body mass index (BMI) of 27‐45 kg/m2 who were previously randomized to metabolic surgery (Roux‐en‐Y gastric bypass, adjustable gastric band, or sleeve gastrectomy) versus medical/lifestyle intervention in the STAMPEDE, SLIMM‐T2D, TRIABETES, or CROSSROADS trials have been enrolled in ARMMS‐T2D for observational follow‐up. The primary outcome is change in glycated haemoglobin after a minimum 7 years of follow‐up, with additional analyses to determine rates of diabetes remission and relapse, as well as cardiovascular and renal endpoints. Results: In total, 302 patients (192 surgical, 110 medical/lifestyle) previously randomized in the four parent studies were eligible for participation in the ARMMS‐T2D observational study. Participant demographics were 71% white, 27% African‐American and 68% female. At baseline: age, 50 ± 8 years; BMI, 36.5 ± 3.5 kg/m2; duration of diabetes, 8.8 ± 5.6 years; glycated haemoglobin, 8.6% ± 1.6%; and fasting glucose, 168 ± 64 mg/dl. More than 35% of patients had a BMI <35 kg/m2. Conclusions: ARMMS‐T2D will provide the largest body of long‐term, level 1 evidence to inform clinical decision‐making regarding the comparative durability, efficacy and safety of metabolic surgery relative to a medical/lifestyle intervention among patients with T2D, including those with milder class I obesity or mere overweight. [ABSTRACT FROM AUTHOR]

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المؤلفون: Kirwan, John P., Courcoulas, Anita P., Cummings, David E., Goldfine, Allison B., Kashyap, Sangeeta R., Simonson, Donald C., Arterburn, David E., Gourash, William F., Vernon, Ashley H., Jakicic, John M., Patti, Mary Elizabeth, Wolski, Kathy, Schauer, Philip R.

المصدر: Diabetes Care; jul2022, Vol. 45 Issue 7, p1574-1583, 10p

مصطلحات موضوعية: CLINICAL trials, BARIATRIC surgery, TYPE 2 diabetes, TREATMENT effectiveness, RESEARCH funding, BODY mass index, DISEASE remission, DISEASE complications

مستخلص: Objective: The overall aim of the Alliance of Randomized Trials of Medicine versus Metabolic Surgery in Type 2 Diabetes (ARMMS-T2D) consortium is to assess the durability and longer-term effectiveness of metabolic surgery compared with medical/lifestyle management in patients with type 2 diabetes (NCT02328599).Research Design and Methods: A total of 316 patients with type 2 diabetes previously randomly assigned to surgery (N = 195) or medical/lifestyle therapy (N = 121) in the STAMPEDE, TRIABETES, SLIMM-T2D, and CROSSROADS trials were enrolled into this prospective observational cohort. The primary outcome was the rate of diabetes remission (hemoglobin A1c [HbA1c] ≤6.5% for 3 months without usual glucose-lowering therapy) at 3 years. Secondary outcomes included glycemic control, body weight, biomarkers, and comorbidity reduction.Results: Three-year data were available for 256 patients with mean 50 ± 8.3 years of age, BMI 36.5 ± 3.6 kg/m2, and duration of diabetes 8.8 ± 5.7 years. Diabetes remission was achieved in more participants following surgery than medical/lifestyle intervention (60 of 160 [37.5%] vs. 2 of 76 [2.6%], respectively; P < 0.001). Reductions in HbA1c (Δ = -1.9 ± 2.0 vs. -0.1 ± 2.0%; P < 0.001), fasting plasma glucose (Δ = -52 [-105, -5] vs. -12 [-48, 26] mg/dL; P < 0.001), and BMI (Δ = -8.0 ± 3.6 vs. -1.8 ± 2.9 kg/m2; P < 0.001) were also greater after surgery. The percentages of patients using medications to control diabetes, hypertension, and dyslipidemia were all lower after surgery (P < 0.001).Conclusions: Three-year follow-up of the largest cohort of randomized patients followed to date demonstrates that metabolic/bariatric surgery is more effective and durable than medical/lifestyle intervention in remission of type 2 diabetes, including among individuals with class I obesity, for whom surgery is not widely used. [ABSTRACT FROM AUTHOR]

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المؤلفون: Syn, Nicholas L^1,2 (AUTHOR), Cummings, David E^1,3 (AUTHOR), Wang, Louis Z^1,4 (AUTHOR), Lin, Daryl J¹ (AUTHOR), Zhao, Joseph J¹ (AUTHOR), Loh, Marie^5,6 (AUTHOR), Koh, Zong Jie^1,7 (AUTHOR), Chew, Claire Alexandra^1,7 (AUTHOR), Loo, Ying Ern¹ (AUTHOR), Tai, Bee Choo^1,2,8 (AUTHOR), Kim, Guowei^1,7 (AUTHOR), So, Jimmy Bok-Yan^1,7 (AUTHOR), Kaplan, Lee M^9,10 (AUTHOR), Dixon, John B¹¹ (AUTHOR), Shabbir, Asim^1,7 (AUTHOR) cfsasim@nus.edu.sg

المصدر: Lancet. 5/15/2021, Vol. 397 Issue 10287, p1830-1841. 12p.

مصطلحات موضوعية: *RESEARCH, ADULTS, GASTRIC bypass, DIABETES, MORTALITY, SURVIVAL rate, LIFE expectancy, OBESITY complications, BARIATRIC surgery, SURVIVAL, CAUSES of death, CLINICAL trials, META-analysis, RESEARCH methodology, CASE-control method, EVALUATION research, TYPE 2 diabetes, COMPARATIVE studies, PROPORTIONAL hazards models, LONGITUDINAL method, DISEASE complications

مستخلص: Background: Metabolic-bariatric surgery delivers substantial weight loss and can induce remission or improvement of obesity-related risks and complications. However, more robust estimates of its effect on long-term mortality and life expectancy-especially stratified by pre-existing diabetes status-are needed to guide policy and facilitate patient counselling. We compared long-term survival outcomes of severely obese patients who received metabolic-bariatric surgery versus usual care.Methods: We did a prespecified one-stage meta-analysis using patient-level survival data reconstructed from prospective controlled trials and high-quality matched cohort studies. We searched PubMed, Scopus, and MEDLINE (via Ovid) for randomised trials, prospective controlled studies, and matched cohort studies comparing all-cause mortality after metabolic-bariatric surgery versus non-surgical management of obesity published between inception and Feb 3, 2021. We also searched grey literature by reviewing bibliographies of included studies as well as review articles. Shared-frailty (ie, random-effects) and stratified Cox models were fitted to compare all-cause mortality of adults with obesity who underwent metabolic-bariatric surgery compared with matched controls who received usual care, taking into account clustering of participants at the study level. We also computed numbers needed to treat, and extrapolated life expectancy using Gompertz proportional-hazards modelling. The study protocol is prospectively registered on PROSPERO, number CRD42020218472.Findings: Among 1470 articles identified, 16 matched cohort studies and one prospective controlled trial were included in the analysis. 7712 deaths occurred during 1·2 million patient-years. In the overall population consisting 174 772 participants, metabolic-bariatric surgery was associated with a reduction in hazard rate of death of 49·2% (95% CI 46·3-51·9, p<0·0001) and median life expectancy was 6·1 years (95% CI 5·2-6·9) longer than usual care. In subgroup analyses, both individuals with (hazard ratio 0·409, 95% CI 0·370-0·453, p<0·0001) or without (0·704, 0·588-0·843, p<0·0001) baseline diabetes who underwent metabolic-bariatric surgery had lower rates of all-cause mortality, but the treatment effect was considerably greater for those with diabetes (between-subgroup I2 95·7%, p<0·0001). Median life expectancy was 9·3 years (95% CI 7·1-11·8) longer for patients with diabetes in the surgery group than the non-surgical group, whereas the life expectancy gain was 5·1 years (2·0-9·3) for patients without diabetes. The numbers needed to treat to prevent one additional death over a 10-year time frame were 8·4 (95% CI 7·8-9·1) for adults with diabetes and 29·8 (21·2-56·8) for those without diabetes. Treatment effects did not appear to differ between gastric bypass, banding, and sleeve gastrectomy (I2 3·4%, p=0·36). By leveraging the results of this meta-analysis and other published data, we estimated that every 1·0% increase in metabolic-bariatric surgery utilisation rates among the global pool of metabolic-bariatric candidates with and without diabetes could yield 5·1 million and 6·6 million potential life-years, respectively.Interpretation: Among adults with obesity, metabolic-bariatric surgery is associated with substantially lower all-cause mortality rates and longer life expectancy than usual obesity management. Survival benefits are much more pronounced for people with pre-existing diabetes than those without.Funding: None. [ABSTRACT FROM AUTHOR]

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المؤلفون: Kumbhari, Vivek, Cummings, David E., Kalloo, Anthony N., Schauer, Philip R.

المصدر: Clinical Gastroenterology & Hepatology; Aug2021, Vol. 19 Issue 8, p1531-1537, 7p

مستخلص: Endoscopic techniques are paramount in the identification and management of complications after surgery, though collaboration with other specialties is obligatory. Unfortunately, the evaluation and treatment algorithms are not standardized and there is a paucity of high-quality prospective studies to provide clarity regarding the best approach. The purpose of this clinical practice update is to apprise the clinician with respect to the endoscopic evaluation and management of patients with early (<90 days) complications after undergoing bariatric/metabolic surgery. The best practice advice outlined in this expert review are based on available published evidence, including observational studies and systematic reviews, and incorporates expert opinion where applicable. Clinicians performing endoscopic approaches to treat early major postoperative complications should do so in a multidisciplinary manner with interventional radiology and bariatric/metabolic surgery co-managing the patient. Daily communication is advised. Clinicians embarking on incorporating endoscopic management of bariatric/metabolic surgical complications into their clinical practice should have a comprehensive knowledge of the indications, contraindications, risks, benefits, and outcomes of each of the endoscopic treatment techniques. They should also have knowledge of the risks and benefits of alternative methods such as surgical and interventional radiological based approaches. Clinicians incorporating endoscopic management of bariatric/metabolic surgical complications into their clinical practice should have expertise in interventional endoscopy techniques, including but not limited to: using concomitant fluoroscopy, stent deployment and retrieval, managing stenosis, and managing percutaneous drains. Clinicians should screen all patients undergoing endoscopic management of bariatric/metabolic surgical complications and dietary intolerance for comorbid medical (nutrient deficiencies, infection, pulmonary embolism) and psychological (depression, anxiety) conditions. Endoscopic approaches to managing complications of bariatric/metabolic surgery may be considered for patients in the immediate, early and late postoperative periods depending on hemodynamic stability. Clinicians incorporating endoscopic management of bariatric/metabolic surgical complications into their clinical practice should have a detailed understanding of the pathophysiologic mechanisms initiating and perpetuating conditions such as staple-line leaks. This will allow for a prompt diagnosis and appropriate therapy to be targeted not only at the area of interest, but also any concomitant downstream stenosis. Clinicians should recognize that the goal for endoscopic management of staple-line leaks are often not necessarily initial closure of the leak site, but rather techniques to promote drainage of material from the perigastric collection into the gastric lumen such that the leak site closes by secondary intention. [ABSTRACT FROM AUTHOR]

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المؤلفون: Vangoitsenhoven, Roman, Wilson, Rickesha L., Cherla, Deepa V., Tu, Chao, Kashyap, Sangeeta R., Cummings, David E., Schauer, Philip R., Aminian, Ali

المصدر: Diabetes Care; Feb2021, Vol. 44 Issue 2, p321-325, 5p

مصطلحات موضوعية: GASTRIC bypass, FATTY liver, FATTY degeneration, GLYCOSYLATED hemoglobin, DIABETES, LIVER, RESEARCH, BARIATRIC surgery, RESEARCH methodology, MORBID obesity, MEDICAL cooperation, EVALUATION research, TYPE 2 diabetes, TREATMENT effectiveness, COMPARATIVE studies, DISEASE remission, DISEASE complications

مستخلص: Objective: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and β-cell dysfunction. Ectopic fat accumulation in liver and muscle causes IR. Since bariatric and metabolic surgery significantly improves fatty liver disease, we hypothesized that coexistence of liver steatosis (i.e., when hepatic IR contributes in T2DM) would be associated with greater diabetes improvement after surgery.Research Design and Methods: A total of 519 patients with T2DM who underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a minimum 5-year follow-up were analyzed to assess the independent association between biopsy-proven liver steatosis and postoperative long-term diabetes remission (glycated hemoglobin <6.5% [48 mmol/mol] off medications).Results: Of the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission was achieved in 211 (52%) patients compared with remission in 44 out of 112 (39%) patients without steatosis (P = 0.027). In multivariable analysis, presence of liver steatosis was an independent predictor of long-term diabetes remission (odds ratio 1.96 [95% CI 1.04-3.72]; P = 0.038). Hepatocyte ballooning, lobular inflammation, or fibrosis at baseline did not predict diabetes remission.Conclusions: This study, for the first time, suggests that in patients with T2DM who are considering bariatric and metabolic surgery, coexistence of liver steatosis is associated with better long-term glycemic outcomes. Furthermore, our data suggest that there are distinct variants of T2DM in which metabolic responses to surgical weight loss are different. A subgroup of patients whose T2DM is characterized by the presence of hepatic steatosis (presumably associated with worse IR) experience better postoperative metabolic outcomes. [ABSTRACT FROM AUTHOR]

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المؤلفون: Rosenbaum, Jennifer L., Frayo, R. Scott, Melhorn, Susan J., Cummings, David E., Schur, Ellen A.

المصدر: American Journal of Physiology: Endocrinology & Metabolism; Nov2019, Vol. 317 Issue 5, pE863-E870, 8p

مصطلحات موضوعية: WEIGHT loss, BODY weight, GLUCOSE tolerance tests, LOW-calorie diet, BODY composition, RATS

مستخلص: We studied the effects of multiple cycles of weight loss and regain on the defended body weight in rats. Thirty-six male Wistar rats were divided into three weight-matched groups: weight cyclers (n = 18), ad libitum-fed controls (n = 9), and maturity controls (n = 9). Cyclers underwent four rounds of 20% weight loss from 50% caloric restriction, each cycle followed by recovery to stable plateau weight on ad libitum feeding. Controls ate ad libitum. Maturity controls ate ad libitum and then weight cycled the final two rounds to evaluate the effect of age in later cycles. Cyclers' postdiet plateau weight became progressively lower than that of controls. With each weight loss, ghrelin increased, while insulin and leptin decreased; the magnitude of these changes did not differ across cycles. After four rounds, cyclers' weight (504 ± 7 vs. 540 ± 22 g; P < 0.05) and percent body fat (11.7 vs. 15.2%; P < 0.05) were lower than in controls. After a 4-mo follow-up period of ad libitum feeding, cyclers maintained a lower total fat-pad mass versus controls (8.6 ± 0.5 vs. 15.9 ± 3.6 g; P < 0.01) and a lower glucose area-under-the-curve on oral glucose tolerance tests (P < 0.05). Repeated weight-loss cycles exerted positive effects, durably lowering defended levels of body adiposity and improving glucose tolerance. [ABSTRACT FROM AUTHOR]

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