Skip to main content
Top
Published in: Current Atherosclerosis Reports 10/2013

01-10-2013 | Lipid and Metabolic Effects of Gastrointestinal Surgery (FR Rubino, Section Editor)

Role of Metabolic Surgery in Less Obese or Non-Obese Subjects with Type 2 Diabetes: Influence Over Cardiovascular Events

Authors: Ricardo Cohen, Pedro Paulo Caravatto, Tarissa Petry, David Cummings

Published in: Current Atherosclerosis Reports | Issue 10/2013

Login to get access

Abstract

Bariatric surgery was initially developed as a tool for weight reduction only, but it is gaining increasing popularity because of its remarkable effect on glucose metabolism in morbidly obese and less obese patients. Recent publications have shown the good results of metabolic surgery, creating a new field of clinical research that is currently overflowing in the medical community with outstanding high-quality data. In morbidly obese population, there is compelling data on long term cardiovascular risk reduction and mortality, coming from longitudinal prospective studies and systematic reviews. Numbers range from 33 to 92 % of decrease in fatal and nonfatal cardiovascular events . In low body mass index (BMI) diabetics, there is an increasing number of reported good outcomes after metabolic surgery with the aim to treat type 2 diabetes (T2DM). There is scarce information on cardiovascular outcomes in non–morbidly obese subjects, but the extraordinary glucose, lipid and blood pressure control in the published series are suggesting good long-term effects on cardiovascular risk profile and mortality. The papers review was comprehensive, including the available randomized controlled trials, long-term prospective series and systematic reviews.
Literature
1.
go back to reference American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46.CrossRef American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–46.CrossRef
2.
go back to reference Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.PubMedCrossRef Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.PubMedCrossRef
3.
go back to reference Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–21.PubMedCrossRef Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–21.PubMedCrossRef
4.
go back to reference Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM. 2003;348:383–93.PubMedCrossRef Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM. 2003;348:383–93.PubMedCrossRef
5.
go back to reference Murray P, Chune GW, Raghavan VA. Legacy effects from DCCT and UKPDS: what they mean and implications for future diabetes trials. Curr Atheroscler Rep. 2010;12:432–9.PubMedCrossRef Murray P, Chune GW, Raghavan VA. Legacy effects from DCCT and UKPDS: what they mean and implications for future diabetes trials. Curr Atheroscler Rep. 2010;12:432–9.PubMedCrossRef
6.
go back to reference Gaede P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. New Engl J Med. 2008;358:580–91.PubMedCrossRef Gaede P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. New Engl J Med. 2008;358:580–91.PubMedCrossRef
7.
go back to reference American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34:S11–61.CrossRef American Diabetes Association. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34:S11–61.CrossRef
8.
go back to reference • Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;(in press). doi:10.2337/dc12-2258. Recent report on the “3 endpoints” results achieved in T2DM treatment. • Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010. Diabetes Care. 2013;(in press). doi:10.​2337/​dc12-2258. Recent report on the “3 endpoints” results achieved in T2DM treatment.
9.
go back to reference Grant RW, Buse JB, Meigs JB, University Health System Consortium (UHC) Diabetes Benchmarking Project Team. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005;28:337–442.PubMedCrossRef Grant RW, Buse JB, Meigs JB, University Health System Consortium (UHC) Diabetes Benchmarking Project Team. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005;28:337–442.PubMedCrossRef
11.
go back to reference Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365:1597–604.PubMedCrossRef Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365:1597–604.PubMedCrossRef
12.
go back to reference • Cohen R, Caravatto PP, Petry Z. Metabolic surgery for type 2 diabetes in patients with a BMI of <35 kg/m2: a Surgeon’s perspective. Obes Surg. 2013;23:809–18. A comprehensive review of metabolic surgery in BMIs below 35 kg/m 2 .PubMedCrossRef • Cohen R, Caravatto PP, Petry Z. Metabolic surgery for type 2 diabetes in patients with a BMI of <35 kg/m2: a Surgeon’s perspective. Obes Surg. 2013;23:809–18. A comprehensive review of metabolic surgery in BMIs below 35 kg/m 2 .PubMedCrossRef
13.
go back to reference Shah SS, Todkar JS, Shah PS, et al. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index. Surg Obes Relat Dis. 2010;6:332–8.PubMedCrossRef Shah SS, Todkar JS, Shah PS, et al. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index. Surg Obes Relat Dis. 2010;6:332–8.PubMedCrossRef
14.
go back to reference Cohen RV, Rubino F, Schiavon C, et al. Diabetes remission without weight loss after duodenal bypass surgery. Surg Obes Relat Dis. 2011;8:66–8.CrossRef Cohen RV, Rubino F, Schiavon C, et al. Diabetes remission without weight loss after duodenal bypass surgery. Surg Obes Relat Dis. 2011;8:66–8.CrossRef
15.
go back to reference Cohen RV, Schiavon CA, Pinheiro Filho JC, et al. Laparoscopic bariatric surgery: new technologies, trends and perspectives. Rev Hosp Clin Fac Med Sao Paulo. 2003;58:I–VIII.PubMedCrossRef Cohen RV, Schiavon CA, Pinheiro Filho JC, et al. Laparoscopic bariatric surgery: new technologies, trends and perspectives. Rev Hosp Clin Fac Med Sao Paulo. 2003;58:I–VIII.PubMedCrossRef
16.
go back to reference Geloneze B, Geloneze SR, Chaim E, et al. Metabolic surgery for non-obese type 2 diabetes: incretins, adipocytokines, and insulin secretion/resistance changes in a 1-year interventional clinical controlled study. Ann Surg. 2012;256:72–8.PubMedCrossRef Geloneze B, Geloneze SR, Chaim E, et al. Metabolic surgery for non-obese type 2 diabetes: incretins, adipocytokines, and insulin secretion/resistance changes in a 1-year interventional clinical controlled study. Ann Surg. 2012;256:72–8.PubMedCrossRef
17.
go back to reference DePaula AL, Macedo ALV, Rassi N, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc. 2007;22:706–16.CrossRef DePaula AL, Macedo ALV, Rassi N, et al. Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35. Surg Endosc. 2007;22:706–16.CrossRef
18.
go back to reference Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008;31:S290–6.PubMedCrossRef Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care. 2008;31:S290–6.PubMedCrossRef
19.
go back to reference Cummings DE, Flum DR. Gastrointestinal surgery as a treatment for diabetes. JAMA. 2008;299:341–3.PubMedCrossRef Cummings DE, Flum DR. Gastrointestinal surgery as a treatment for diabetes. JAMA. 2008;299:341–3.PubMedCrossRef
20.
go back to reference Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2005;28:2780–6.PubMedCrossRef Yamaoka K, Tango T. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2005;28:2780–6.PubMedCrossRef
21.
go back to reference Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index. Diabetes Obes Metab. 2011;14:262–70.PubMedCrossRef Li Q, Chen L, Yang Z, et al. Metabolic effects of bariatric surgery in type 2 diabetic patients with body mass index. Diabetes Obes Metab. 2011;14:262–70.PubMedCrossRef
22.
go back to reference •• Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65. Landmark paper that analyses cardiovascular outcomes after 20 years follow up. Shows that the ony CV predicting factor was fasting insuli and not BMI.PubMedCrossRef •• Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65. Landmark paper that analyses cardiovascular outcomes after 20 years follow up. Shows that the ony CV predicting factor was fasting insuli and not BMI.PubMedCrossRef
23.
go back to reference Bianchi C, Del Prato S. Metabolic memory and individual treatment aims in type 2 diabetes outcome – lessons learned from large clinical trials. Rev Diabet Stud. 2011;8:432–40.PubMedCrossRef Bianchi C, Del Prato S. Metabolic memory and individual treatment aims in type 2 diabetes outcome – lessons learned from large clinical trials. Rev Diabet Stud. 2011;8:432–40.PubMedCrossRef
24.
go back to reference Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk for complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk for complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.
25.
go back to reference Look AHEAD Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD Trial. Arch Intern Med. 2010;170:1566–75.CrossRef Look AHEAD Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD Trial. Arch Intern Med. 2010;170:1566–75.CrossRef
26.
go back to reference Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489–96.PubMedCrossRef Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489–96.PubMedCrossRef
27.
go back to reference • Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2012;23:93–102. Interesting paper that analyses the long term effects of bariatric surgery & T2DM.CrossRef • Arterburn DE, Bogart A, Sherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2012;23:93–102. Interesting paper that analyses the long term effects of bariatric surgery & T2DM.CrossRef
28.
go back to reference Arterburn DE, O’Connnor PJ. A look ahead at the future of diabetes prevention and treatment. JAMA. 2012;308:2517–9.PubMedCrossRef Arterburn DE, O’Connnor PJ. A look ahead at the future of diabetes prevention and treatment. JAMA. 2012;308:2517–9.PubMedCrossRef
29.
go back to reference Rubino F. Bariatric surgery: effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care. 2006;9:497–507.PubMedCrossRef Rubino F. Bariatric surgery: effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care. 2006;9:497–507.PubMedCrossRef
30.
go back to reference Rubino F, Marescaux J. Effect of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.PubMedCrossRef Rubino F, Marescaux J. Effect of duodenal–jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.PubMedCrossRef
31.
go back to reference Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases. Surg Obes Relat Dis. 2007;3:195–7.PubMedCrossRef Cohen RV, Schiavon CA, Pinheiro JS, et al. Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22–34 kg/m2: a report of 2 cases. Surg Obes Relat Dis. 2007;3:195–7.PubMedCrossRef
32.
go back to reference Cohen R, Caravatto PP, Correa JL, et al. Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index. Surg Obes Relat Dis. 2012;8:375–80.PubMedCrossRef Cohen R, Caravatto PP, Correa JL, et al. Glycemic control after stomach-sparing duodenal-jejunal bypass surgery in diabetic patients with low body mass index. Surg Obes Relat Dis. 2012;8:375–80.PubMedCrossRef
33.
go back to reference Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.PubMedCrossRef Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab. 2008;93:2479–85.PubMedCrossRef
34.
go back to reference • Cohen R, Pinheiro JC, Schiavon CA, et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420–8. Longest follow up of bariatric surgery in BMIs < 35.PubMedCrossRef • Cohen R, Pinheiro JC, Schiavon CA, et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetes Care. 2012;35:1420–8. Longest follow up of bariatric surgery in BMIs < 35.PubMedCrossRef
35.
go back to reference Kim S, Richards WO. Long-term follow-up of the metabolic profiles in obese patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass. Ann Surg. 2010;251:1049–55.PubMedCrossRef Kim S, Richards WO. Long-term follow-up of the metabolic profiles in obese patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass. Ann Surg. 2010;251:1049–55.PubMedCrossRef
36.
go back to reference Asztalos BF, Swarbrick MM, Schaefer EJ, et al. Effects of weight loss, induced by gastric bypass surgery, on HDL remodeling in obese women. J Lipid Res. 2010;51:2405–12.PubMed Asztalos BF, Swarbrick MM, Schaefer EJ, et al. Effects of weight loss, induced by gastric bypass surgery, on HDL remodeling in obese women. J Lipid Res. 2010;51:2405–12.PubMed
37.
go back to reference Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet. 2012;380:572–80.PubMedCrossRef Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet. 2012;380:572–80.PubMedCrossRef
38.
go back to reference Prati P, Vanuzzo D, Casaroli M, et al. Prevalence and determinants of carotid atherosclerosis in a general population. Stroke. 1992;23:1705–11.PubMedCrossRef Prati P, Vanuzzo D, Casaroli M, et al. Prevalence and determinants of carotid atherosclerosis in a general population. Stroke. 1992;23:1705–11.PubMedCrossRef
39.
go back to reference Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRef Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRef
40.
go back to reference Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695–704.PubMedCrossRef Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367:695–704.PubMedCrossRef
41.
go back to reference Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35:2613–7.PubMedCrossRef Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35:2613–7.PubMedCrossRef
42.
go back to reference Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB. Effect of bariatric surgery on cardiovascular risk profile. AJC. 2011;108(10):1499–507.CrossRef Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB. Effect of bariatric surgery on cardiovascular risk profile. AJC. 2011;108(10):1499–507.CrossRef
43.
go back to reference Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–1777. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart. 2012;98(24):1763–1777.
44.
go back to reference •• Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery vs. intensive medical therapy in obese patients with diabetes. New Engl J Med. 2012;366:1567–76.PubMedCrossRef •• Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery vs. intensive medical therapy in obese patients with diabetes. New Engl J Med. 2012;366:1567–76.PubMedCrossRef
45.
go back to reference •• Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. New Engl J Med. 2012;366:1577–85. First 2 RCTs that compared surgery versus medical treatment focusing T2DM.PubMedCrossRef •• Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. New Engl J Med. 2012;366:1577–85. First 2 RCTs that compared surgery versus medical treatment focusing T2DM.PubMedCrossRef
46.
go back to reference Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher AR, Hu J, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA. 2013;309(21):2250–61.PubMedCrossRef Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher AR, Hu J, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA. 2013;309(21):2250–61.PubMedCrossRef
47.
go back to reference Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. A randomized controlled trial. JAMA. 2008;299:316–23.PubMedCrossRef Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. A randomized controlled trial. JAMA. 2008;299:316–23.PubMedCrossRef
48.
go back to reference Sultan S, Parikh M, Youn H, Kurian M, Fielding G, Ren C. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg Endosc. 2009;23:1569–73.PubMedCrossRef Sultan S, Parikh M, Youn H, Kurian M, Fielding G, Ren C. Early U.S. outcomes after laparoscopic adjustable gastric banding in patients with a body mass index less than 35 kg/m2. Surg Endosc. 2009;23:1569–73.PubMedCrossRef
49.
go back to reference Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–9.PubMedCrossRef Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147:664–9.PubMedCrossRef
50.
go back to reference Lee WJ, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg. 2012;16:45–52.PubMedCrossRef Lee WJ, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg. 2012;16:45–52.PubMedCrossRef
51.
go back to reference Abbatini F, Capoccia D, Casella G, et al. Type 2 diabetes in obese patients with body mass index of 30–35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis. 2012;8:20–4.PubMedCrossRef Abbatini F, Capoccia D, Casella G, et al. Type 2 diabetes in obese patients with body mass index of 30–35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis. 2012;8:20–4.PubMedCrossRef
52.
go back to reference Lee WJ, Chong K, Chen CY, et al. Diabetes remission and insulin secretion after gastric bypass in patients with body mass index < 35kg/m2. Obes Surg. 2011;21:889–95.PubMedCrossRef Lee WJ, Chong K, Chen CY, et al. Diabetes remission and insulin secretion after gastric bypass in patients with body mass index < 35kg/m2. Obes Surg. 2011;21:889–95.PubMedCrossRef
53.
go back to reference Scopinaro N, Adami GF, Papadis FS, et al. Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35. Ann Surg. 2011;253:699–703.PubMedCrossRef Scopinaro N, Adami GF, Papadis FS, et al. Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35. Ann Surg. 2011;253:699–703.PubMedCrossRef
54.
go back to reference Chellini C, Rubino F, Castagneto M, et al. The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI < 35 kg/m2. Diabetologia. 2009;52:1027–30.CrossRef Chellini C, Rubino F, Castagneto M, et al. The effect of bilio-pancreatic diversion on type 2 diabetes in patients with BMI < 35 kg/m2. Diabetologia. 2009;52:1027–30.CrossRef
Metadata
Title
Role of Metabolic Surgery in Less Obese or Non-Obese Subjects with Type 2 Diabetes: Influence Over Cardiovascular Events
Authors
Ricardo Cohen
Pedro Paulo Caravatto
Tarissa Petry
David Cummings
Publication date
01-10-2013
Publisher
Springer US
Published in
Current Atherosclerosis Reports / Issue 10/2013
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-013-0355-3

Other articles of this Issue 10/2013

Current Atherosclerosis Reports 10/2013 Go to the issue

Clinical Trials and Their Interpretations (J Plutzky, Section Editor)

Multiple Adipose Depots Increase Cardiovascular Risk via Local and Systemic Effects

Lipid and Metabolic Effects of Gastrointestinal Surgery (F Rubino, Section Editor)

Diabetes Remission Following Metabolic Surgery: Is GLP-1 the Culprit?

Clinical Trials and Their Interpretations (J Plutzky, Section Editor)

Update on Lipoprotein(a) as a Cardiovascular Risk Factor and Mediator

Clinical Trials and Their Interpretations (J Plutzky, Section Editor)

Imaging Atherosclerosis and Risk of Plaque Rupture

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.