May 2, 2012
Volume 7 - Issue 18     

DynaMed Weekly Update

For the week ending April 27, 2012 

Last week 495 articles were evaluated via DynaMed's Systematic Literature Surveillance and 261 were added to DynaMed content.    


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update. 
Feature Article

Bariatric Surgery May Induce Remission of Type 2 Diabetes in Obese Patients


Type 2 Diabetes is a common complication of obesity, and the prevalence of both conditions is rapidly increasing worldwide. Though originally developed as a treatment for weight loss in obese patients, observational data suggest that bariatric surgery may have a beneficial effect on the severity of diabetes in these patients, even to the point of complete resolution, with benefits for weight loss and diabetes lasting for up to 10 years (N Engl J Med 2004 Dec 23;351(26):2683). A recent randomized trial compared 2 forms of bariatric surgery, Roux-en-Y gastric bypass and biliopancreatic diversion, to medical management of diabetes in a small group of 60 patients (mean age 43 years) in Italy. 


All patients had a history of type 2 diabetes for at least 5 years and had a body mass index (BMI) ≥ 35 kg/m2. For the medical therapy group, a multidisciplinary team provided oral hypoglycemic drugs and insulin with HbA1c target < 7%, programs for diet and lifestyle modification, and increased physical activity. The surgical groups also received medical therapy adjusted by glycemic levels, and could discontinue pharmacotherapy upon normalization of glycemic profile, HbA1c or both. The primary outcome was diabetes remission defined as fasting glucose < 100 mg/dL (5.5 mmol/L) and HbA1c < 6.5% for ≥ 1 year without pharmacologic therapy.


At 2 years follow-up, no patients in the medical therapy group had achieved diabetes remission. The remission rates in the surgical groups were 75% for Roux-en-Y bypass surgery (p < 0.001 vs. medical therapy, NNT 2) and 95% for biliopancreatic diversion (p < 0.001 vs. medical therapy, NNT 1) (level 2 [mid-level] evidence). Both surgical groups had significantly greater weight loss than the medical therapy group. The most common complication of surgery was iron deficiency anemia, which occurred in 11% for each group (N Engl J Med 2012 Apr 26;366(17):1577).


Longer follow-up studies will be needed to determine both the duration of these benefits and whether the improvement in diabetes outcomes from surgery leads to fewer cardiovascular events or reduced mortality.



For more information see the Bariatric surgery and Diabetes mellitus type 2

topics in DynaMed.




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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: May 2, 2012
Expiration Date: May 2, 2013
Estimated Completion Time:
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Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

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