Prediabetes Management
1
AACE Prediabetes Consensus
Statement: Summary
• Untreated individuals with prediabetes are at
increased risk for diabetes as well as for micro- and
macrovascular complications
• Treatment goals are to prevent deterioration in
glucose levels and modify other risk factors such as
obesity, hypertension, and dyslipidemia
– The same blood pressure and lipid goals are suggested for
prediabetes and diabetes
• Intensive lifestyle management is the cornerstone of
all prevention efforts; pharmacotherapy targeted at
glucose may be considered in high-risk patients
Handelsman Y, et al. Endocr Pract. 2015; In press.
Garber AJ, et al. Endocr Pract. 2008;14:933-946.
2
Prediabetes
• Epidemiologic evidence suggests that the
complications of T2D begin early in the progression
from NGT to frank diabetes
• Prediabetes and diabetes are conditions in which
early detection is appropriate, because
– Duration of hyperglycemia is a predictor of adverse
outcomes
– There are effective interventions to prevent disease
progression and to reduce complications
NGT, normal glucose tolerance ; T2D, type 2 diabetes.
Garber AJ, et al. Endocr Pract. 2008;14:933-946.
3
Policy Paradigm Shifts Needed to
Stem Global Tide of T2D
• Integrating primary and secondary prevention along a
clinical continuum
• Early detection of prediabetes and undiagnosed
diabetes
• Implementing cost-effective prevention and control by
integrating community and clinical expertise and
resources within affordable service delivery systems
• Sharing and adopting evidence-based policies at the
global level
T2D, type 2 diabetes.
Narayan KM, et al. Health Aff (Millwood). 2012;31:84-92.
4
5
Feasibility of Preventing
Type 2 Diabetes
• There is a long period of glucose intolerance
that precedes the development of diabetes
• Screening tests can identify persons at high
risk
• There are safe, potentially effective
interventions that can address modifiable risk
factors:
–
–
–
–
Obesity
Body fat distribution
Physical inactivity
High blood glucose
Garber AJ, et al. Endocr Pract. 2008;14:933-946.
6
Interventions to Reduce Risks
Associated With Prediabetes
• Therapeutic lifestyle management is the
cornerstone of all prevention efforts
• No pharmacologic agents are currently
approved for the management of
prediabetes
– Pharmacotherapy targeted at glucose may
be considered in high-risk patients after
individual risk-benefit analysis
Garber AJ, et al. Endocr Pract. 2008;14:933-946.
7
Lifestyle Intervention in
Prediabetes
• Persons with prediabetes should reduce
weight by 5% to 10%, with long-term
maintenance at this level
– A program of regular moderate-intensity
physical activity for 30-60 minutes daily, at
least 5 days a week, is recommended
– A diet that includes caloric restriction,
increased fiber intake, and (in some cases)
carbohydrate intake limitations is advised
Garber AJ, et al. Endocr Pract. 2008;14:933-946.
8
Primary Care-Based Counseling
for T2D Prevention: ADAPT
ADAPT System for Behavior-Change Counseling
Behavior-Change Principles
Persuasive Psychology
•
•
•
•
•
•
•
Patient-selected behavior-change
goals
Behavior-change props
Implementation-intentions
exercise
Behavior-change prescription
Social comparisons
Behavior-change samples
Testimonials
Technology
•
Electronic record–based goalsetting tool with facilitated order
entry and documentation
•
•
Website-based tailored reminders
Frequent feedback about progress
via email
ADAPT, Avoiding Diabetes Thru Action Plan Targeting; T2D, type 2 diabetes.
Mann DM, Lin JJ. Implement Sci. 2012;23:6.
9
Self-Reported Risk Reduction Activities in
Patients With Prediabetes
National Health and Nutrition Examination Survey
100%
90%
80%
70%
68%
60%
Patients
60%
55%
50%
42%
40%
30%
20%
10%
0%
Tried to lose or
control weight
Reduced dietary fat Increased physical
or calories
activity or exercise
CDC. MMWR Morb Mortal Wkly Rep. 2008;57:1203-1205.
All 3
10
Prediabetes Management
PREVENTION OF DIABETES:
LIFESTYLE STUDIES
11
Prevention of T2D:
Selected Lifestyle Modification Trials
Study
Country
N
Baseline
BMI
(kg/m2)
Intervention
period
(years)
RRR
(%)
NNT
Diabetes
Prevention
Program
USA
3234
34.0
2.8
58
21
Diabetes
Prevention
Study
Finland
523
31
4
39
22
Da Qing
China
577
25.8
6
51
30
NNT, number needed to treat; RRR, relative risk reduction; T2D, type 2 diabetes.
DPP Research Group. N Engl J Med. 2002;346:393-403. Eriksson J, et al. Diabetologia. 1999;42:793-801.
Li G, et al. Lancet. 2008;371:1783-1789. Lindstrom J, et al. Lancet. 2006;368:1673-1679.
12
Intensive Lifestyle Intervention Effectively
Prevents Progression From IGT to T2D
Diabetes Prevention Program
(N=3234)
Diabetes Incidence
per 100 Person-Years
12
11
31%
10
8
6
7.8
58%
4.8
4
2
0
Intensive lifestyle
intervention*
(n=1079)
Metformin
850mg BID
(n=1073)
Placebo
(n=1082)
*Goal: 7% reduction in baseline body weight through low-calorie, low-fat diet and ≥150 min/week moderate intensity exercise .
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
DPP Research Group. N Engl J Med. 2002;346:393-403.
13
Lifestyle Intervention More Effectively
Prevents Diabetes as Populations Age
Diabetes Prevention Program
(N=3234)
Diabetes Incidence
per 100 Person-Years
14
12
11.6
10.8
10.8
9.6
10
8
48%
6.7
6.2
6
7.6
Placebo
59%
71%
4.7
4
3.1
Metformin
Lifestyle
2
0
25-44
45-59
Age (years)
≥60
*Goal: 7% reduction in baseline body weight through low-calorie, low-fat diet and ≥150 min/week moderate intensity exercise .
DPP Research Group. N Engl J Med. 2002;346:393-403.
14
Effectiveness of Lifestyle Intervention for
Diabetes Prevention Wanes as Weight
Increases
Diabetes Prevention Program
(N=3234)
Diabetes Incidence
per 100 Person-Years
16
14.3
14
12
10
9
51%
8.9
8.8
7.6
8
7.0
6
65%
61%
4
3.3
3.7
7.3
Placebo
Metformin
Lifestyle
2
0
22 to <30
30 to <35
BMI (kg/m2)
≥35
*Goal: 7% reduction in baseline body weight through low-calorie, low-fat diet and ≥150 min/week moderate intensity exercise .
DPP Research Group. N Engl J Med. 2002;346:393-403.
15
Maintenance of Long-Term
Weight Loss
DPP Outcomes Study
(N=2766)
0
1
2
3
4
5
6
7
8
9
10
Years
DPP, Diabetes Prevention Program; T2D, type 2 diabetes.
DPP Research Group. Lancet. 2009;374:1677-1686.
16
10-Year Incidence of T2D
DPP Outcomes Study
(N=2766)
Placebo
Metformin
Lifestyle
0
1
2
3
4
5
6
Years
7
8
9
10
DPP, Diabetes Prevention Program; T2D, type 2 diabetes.
DPP Research Group. Lancet. 2009;374:1677-1686.
17
10-Year Incidence of
Type 2 Diabetes
DPP Outcomes Study
DPP, Diabetes Prevention Program; DPPOS, Diabetes Prevention Program Outcomes Study; T2D, type 2 diabetes.
DPP Research Group. Lancet. 2009;374:1677-1686.
18
T2D Prevention in Women
With a History of GDM
• Findings from the DPP
– Progression to diabetes is more common
in women with a history of GDM vs those
without, despite equivalent degrees of IGT
at baseline
• Both intensive lifestyle and metformin
are highly effective in delaying or
preventing diabetes in women with IGT
and a history of GDM
DPP, Diabetes Prevention Program; GDM, gestational diabetes mellitus; IGT, impaired glucose tolerance;
T2D, type 2 diabetes.
Ratner RE, et al. J Clin Endocrinol Metab. 2008;93:4774-4779.
19
Effect of Lifestyle Modification on
Weight and Blood Pressure
The Finnish Diabetes Prevention Study
Control (n=250)
Weight (kg)
Waist (cm)
Diet intervention (n=256)
SBP (mm Hg)
DBP (mm Hg)
Change from baseline
0
-1
-2
-3
-4
-5
P<0.001
P<0.001
P=0.007
P=0.02
-6
DBP, diastolic blood pressure; SBP, systolic blood pressure.
Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.
20
Effect of Lifestyle Modification on
Glucose in Patients with IGT
The Finnish Diabetes Prevention Study
Control (n=250)
Diet intervention (n=256)
Change from baseline
10
0
-10
P<0.001
P=0.003
-20
-30
P=0.001
-40
FPG
2-h PG
(mg/dL)
(mg/dL)
Fasting insulin
(mg/mL)
2-h insulin
(g/mL)
IGT, impaired glucose tolerance.
Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.
21
Cumulative Incidence of Diabetes
Over 4 Years
The Finnish Diabetes Prevention Study
Control (n=250)
Incidence of diabetes
(cases/1000 person-years)
80
Diet intervention (n=256)
78
60
58%
40
32
20
0
DBP, diastolic blood pressure; SBP, systolic blood pressure.
Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.
22
Cumulative Incidence of Diabetes in
Asian Patients with IGT
Da Qing Diabetes Prevention Study
(N=577)
Patients with T2D at Year 6 (%)
Total
100
90
80
70
60
50
40
30
20
10
0
Lean
Overweight
72.3
65.9
60
48
47.1
52.5
51.2
44.6
44.2
38.2
34.8
26.3
Control
Diet
Exercise
Diet + Exercise
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Pan XR, et al. Diabetes Care. 1997;20:537-544.
23
20-Year Cumulative T2D Incidence
in Asian Patients with IGT
Da Qing Diabetes Prevention Study
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Li G, et al. Lancet. 2008;371:1783-1789.
24
23-Year All-Cause Mortality in
Asian Patients with IGT
Da Qing Diabetes Prevention Study
IGT, impaired glucose tolerance.
Li G, et al. Lancet Diabetes Endocrinol. 2014;2:474-478.
25
23-Year Cardiovascular Mortality
in Asian Patients with IGT
Da Qing Diabetes Prevention Study
IGT, impaired glucose tolerance.
Li G, et al. Lancet Diabetes Endocrinol. 2014;2:474-478.
26
23-Year Incidence of T2D in
Asian Patients with IGT
Da Qing Diabetes Prevention Study
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Li G, et al. Lancet Diabetes Endocrinol. 2014;2:474-478.
27
Group Lifestyle Balance Program
Intervention
University of Pittsburgh Primary Care Practice and Diabetes
Prevention Support Center
Weight Loss > 3.5%
Weight Loss > 5%
Weight Loss >7%
•
DPP lifestyle intervention
adapted to a 12-session groupbased program
•
Implemented in a community
setting in 2 phases using a
nonrandomized prospective
design
•
Significant decreases in weight,
waist circumference, and BMI
noted in both phases vs
baseline
•
Average combined weight
loss for both groups over the 3month intervention
70
Patients (%)
60
50
40
30
20
10
0
Phase 1 Post Phase 2 Post Completers
(n=51)
(n=42)
Both phases
(n=67)
Phase 2
6 mo
Phase 2
12 mo
•
7.4 pounds (3.5% relative
loss, P<0.001)
DPP, Diabetes Prevention Program.
Kramer MK, et al. Am J Prev Med. 2009;37:505-511.
28
Translating the DPP Into
Community Intervention
The DEPLOY Pilot Study
 Total Weight
(%)
(N=92)
0
-2
-4
-6
-8
-1.8
-2.0
-6.0
P=0.008
P<0.001
Standard
 Total
Cholesterol
(mg/dL)
20
10
-6.0
DPP
11.8
6.0
0
-10
-13.5
-20
-21.6
-30
P=0.002
P<0.001
4-6 months
12-14 months
DEPLOY, Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA; DPP, Diabetes Prevention
Program; YMCA, Young Men’s Christian Association.
Ackermann RT, et al. Am J Prev Med. 2008;35:357-363.
29
Structured Programs Foster
Adherence
Montana Diabetes Control Program
16-session program based on DPP-style intervention
(N=355)
99
Mean weight (kg)
98
350
300
97
250
96
200
95
94
150
93
100
92
50
91
90
1
2
3
4
5
6
7
9
8
Week
10
11
12
13
14
15
16
Exercise per week (min)
Mean weight
Physical activity
7% weight loss goal
100
0
DPP, Diabetes Prevention Program.
Amundson HA, et al. Diabetes Educ. 2009;35:209-223.
30
Prediabetes Management
PREVENTION OF DIABETES:
PHARMACOTHERAPY AND
SURGICAL STUDIES
31
Medical and Surgical
Interventions Shown to Delay or
Prevent T2D
Follow-up Period
Reduction in Risk of T2D
(P value vs placebo)
Metformin1
2.8 years
31% (P<0.001)
Acarbose2
3.3 years
25% (P=0.0015)
Pioglitazone3
2.4 years
72% (P<0.001)
Rosiglitazone4
3.0 years
60% (P<0.0001)
Orlistat5
4 years
37% (P=0.0032)
Phentermine/topiramate6
2 years
79% (P<0.05)
Bariatric surgery7
10 years
75% (P<0.001)
Intervention
Antihyperglycemic agents
Weight loss interventions
T2D, type 2 diabetes.
1. DPP Research Group. N Engl J Med. 2002;346:393-403. 2. STOP-NIDDM Trial Research Group. Lancet. 2002;359:2072-2077.
3. Defronzo RA, et al. N Engl J Med. 2011;364:1104-15. 4. DREAM Trial Investigators. Lancet. 2006;368:1096-1105.
5. Torgerson JS, et al. Diabetes Care. 2004;27:155-161. 6. Garvey WT, et al. Diabetes Care. 2014;37:912-921.
7. Sjostrom L, et al. N Engl J Med. 2004;351:2683-2693.
32
The Effect of Metformin on the
Progression of IGT to Diabetes
Mellitus
The Chinese Prevention Study
(N=321)
Incidence of Diabetes (%/yr)
14
12
11.6
10
8
65%
6
4.1
4
2
0
Control
Metformin
IGT, impaired glucose tolerance; RRR, relative risk reduction.
Yang W, et al. Chin J Endocrinol Metab. 2001;17:131-136.
33
Effect of Lifestyle Modification and Metformin on
Cumulative Diabetes Incidence
The Indian DPP
(N=531)
3-y Cumulative Incidence (%)
60
55.0
50
40
29%
26%
28%
P=0.02
P=0.03
P=0.02
39.3
40.5
39.5
Lifestyle
Modification
(n=133)
Metformin
(n=133)
Lifestyle
Modification
+ Metformin
(n=129)
30
20
10
0
Control
(n=136)
DPP, Diabetes Prevention Program; LSM, lifestyle modification; MET, metformin; RRR, relative risk reduction.
Ramachandran A, et al. Diabetologia. 2006;49:289-297.
34
Effect of Acarbose on
Reversion of IGT to NGT
STOP-NIDDM
P<0.0001
40
35.3
35
30.9
Patients (%)
30
25
20
15
10
5
0
Placebo
(n=715)
Acarbose
(n=714)
IGT, impaired glucose tolerance; NGT, normal glucose tolerance; STOP-NIDDM, Study to Prevent Non-Insulin Dependent Diabetes Mellitus.
Chiasson JL, et al. Lancet. 2002;359:2072-2077.
35
Effect of Rosiglitazone on New-Onset
Diabetes or Death in Patients with
Prediabetes
DREAM
0.6
Placebo
Cumulative
hazard rate
0.5
0.4
60%
0.3
0.2
Rosiglitazone
0.1
0.0
0
1
2
3
4
1148
1310
177
217
Follow-up (years)
No. at risk
Placebo
Rosiglitazone
2634
2635
2470
2538
2150
2414
DREAM, Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication.
DREAM Trial Investigators. Lancet. 2006;368:1096-1105.
36
Effect of Pioglitazone on Development of
T2D in Patients with IGT
ACT NOW
Kaplan-Meier plot of Hazard Ratios for Time
to Development of T2D
ACT NOW, Actos Now for the Prevention of Diabetes; IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Defronzo RA, et al. N Engl J Med. 2011;364:1104-1115.
37
Special Considerations for
Thiazolidinedione Use in Patients
With Prediabetes
• Because of concerns about long-term
safety, use of thiazolidinediones should
be reserved for higher risk populations
and those failing other, lower-risk
strategies
Garber AJ, et al. Endocr Pract. 2008;14:933-946.
38
Effects of Exenatide and Lifestyle Modification on
Body Weight and Glucose Tolerance
in Obese Patients With and Without Prediabetes
• Patients
– N=152, weight 108.6 +/- 23.0 kg, BMI 39.6 +/- 7.0 kg/m2 (IGT
or IFG 25%)
•
Design
– 24-week randomized controlled trial: exenatide or placebo
plus lifestyle intervention
•
Results:
– Exenatide-treated patients lost 5.1 kg from baseline vs 1.6 kg with
placebo (P<0.001)
– Both groups reduced their daily caloric intake
– IGT or IFG normalized at end point in 77% and 56% of exenatide
and placebo subjects, respectively
BMI, body mass index; IFG, impaired fasting glucose; IGT, impaired glucose tolerance.
Rosenstock J, et al. Diabetes Care. 2010;33:1173-1175.
39
Effect of Lorcaserin on Body Weight
in Obese Adults Over 2 Years
BLOOM Study
Smith SR, et al. N Engl J Med. 2010;363:245-256.
40
Effect of Lorcaserin on Progression
to T2D
Proportion of BLOOM and BLOSSOM Patients
With Newly Diagnosed Diabetes After 52 Weeks of Treatment
Patients with A1C ≥6.5% (%)
5
4
P=0.003
3
2
1
0
Placebo
Lorcaserin
T2D, type 2 diabetes.
Lorcaserin hydrochloride briefing document for FDA Advisory Committee. Woodcliff Lake, NJ: Eisai Inc.; 2012. Available at:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryC
ommittee/UCM303200.pdf.
41
Effect of Lorcaserin on
Cardiometabolic Risk Markers
BLOOM Study
Risk Factors
(Mean % Weight Loss)
Lorcaserin 10
mg
(5.8%)
Systolic BP, mmHg

-1.4
0.04
Diastolic BP, mmHg

-1.1
0.01
Triglycerides, %

-6.15
<0.001
Total cholesterol, %

-0.90
0.001
LDL-C, %

2.87
0.049
HDL-C, %

0.05
NS
hsCRP, mg/L

-1.19
<0.001
Fibrinogen, mg/dL

-21.5
0.001
P value*
*P values represent comparisons to placebo.
Intent to treat, last observation carried forward analysis for total study population.
Smith SR, et al. N Engl J Med. 2010;363:245-256.
42
Effect of Phentermine/Topiramate ER on
Weight Loss in Obese Adults Over 2
Years
SEQUEL Study
(Completer Analysis)
Placebo
Phen/TPM ER 7.5/46
Phen/TPM ER 15/92
LS mean weight loss (%)
0
-2
-4
-6
-8
-10
-12
-14
CONQUER Trial
SEQUEL Extension
-16
0
12
Placebo n:
227
Phen/TPM 7.5/46 n: 153
Phen/TPM 15/92 n: 295
20
28
36
227
152
295
44
52
227
153
295
60 68
Weeks
76
84
208
137
268
92
100 108 LOCF
197
129
248
227
153
295
Data are shown with mean (95% CI).
Phen/TPM ER, phentermine/topiramate extended release.
Garvey WT, et al. Am J Clin Nutr. 2012;95:297-308.
43
Effects of Phentermine/Topiramate ER on
Glucose, Insulin, and Progression to T2D
SEQUEL Study
(N=675)
Glucose and Insulin
Fasting
2-h OGTT
0
-5
4
-3.6 -5.4
-15
-7.2
*
*
Insulin
(pmol/L)
-25
0
-100
-200
-300
-400
-10.8
-18
*
-18
-39
-37
-157
Placebo
3.7
3.5
54%
3
P=NS
76%
2.5
2
1.7
P=0.008
1.5
0.9
1
0.5
0
-264
*
Progressors per year (%)
Glucose
(mg/dL)
5
Annualized Incidence of T2D
-327
Placebo
*
Phen/TPM ER 7.5/46 mg
Phen/TPM CR Phen/TPM CR
7.5/46 mg
15/92 mg
Phen/TPM ER 15/92 mg
*P≤0.005 vs placebo.
NS, not significant; Phen/TPM ER, phentermine/topiramate extended release; T2D, type 2 diabetes.
Garvey WT, et al. Am J Clin Nutr. 2012;95:297-308.
44
Effects of Phentermine/Topiramate ER in
Patients at High Risk of Developing T2D
SEQUEL Prediabetes/Metabolic Syndrome Cohort
(N=475)
Placebo*
Phen/TPM ER 7.5/46 mg*
Annualized incidence
rate of T2D
7
Phen/TPM ER 15/92 mg*
6.4
6
5
4
3
3.5
49%
P=NS
89%
1.8
P=0.013
2
1
0
77%
80%
P=0.009
P<0.001
1.5
1.3
0.4
Prediabetes
(n=316)
Metabolic syndrome
(n=451)
*All groups had lifestyle intervention.
NS, not significant; Phen/TPM ER, phentermine/topiramate extended release; T2D, type 2 diabetes.
Garvey WT, et al. Diabetes Care. 2014;37:912-921.
45
Relationship Between Weight Loss and
Prevention of Type 2 Diabetes
SEQUEL Prediabetes/Metabolic Syndrome Cohort
(N=475)
ITT-LOCF Analysis
Annualized incidence
rate of T2D
8
7
6
5
4
3
2
1
0
<5
≥5 to <10
≥10 to <15
≥15
Magnitude of Weight Loss (%)
ITT, intent to treat; LOCF, last observation carried forward.
Garvey WT, et al. Diabetes Care. 2014;37:912-921.
46
Effect of Phentermine/Topiramate
ER on Cardiometabolic Risk Markers
CONQUER Study
Risk Factors
(Mean % Weight
Loss)
Phentermine/
Topiramate ER
7.5/46 mg
(8.4%)
P value*
Phentermine/
Topiramate ER
15/92 mg
(10.4%)
P value*
Systolic BP, mmHg

-4.7
0.0008

-5.6
<0.0001
Diastolic BP, mmHg

-3.4
NS

-3.8
0.0031
Triglycerides, %

-8.6
<0.0001

-10.6
<0.0001
Total cholesterol, %

-4.9
0.0345

-6.3
<0.0001
LDL-C, %

-3.7
NS

-6.9
0.0069
HDL-C, %

5.2
<0.0001

6.8
<0.0001
hsCRP, mg/L

-2.49
<0.0001

-2.49
<0.0001
Adiponectin, g/mL

1.40
<0.0001

2.08
<0.0001
*P values represent comparisons to placebo.
Intent to treat, last observation carried forward analysis for total study population.
Gadde KM, et al. Lancet. 2011;377:1341-1352.
47
 Weight (kg)
Effects of Liraglutide and Orlistat on
Body Weight Over 2 Years
Astrup A, et al. Int J Obes (Lond). 2012;36:843-854
48
Effects of Liraglutide in Obese Patients
with Prediabetes
SCALE Obesity and Prediabetes
(N=3731)
Weight Change After 56 Weeks
Patients with Prediabetes After
56 Weeks
Liraglutide 3 mg
Placebo
-2
-2.8
-4
-6
-8
-10
-8.4
*
Patients (%)
 Weight (kg)
0
80
70
60
50
40
30
20
10
0
67.3
*
30.8
*
20.7
7.2
Normoglycemia
at screening
Prediabetes at
screening
*P<0.001 vs placebo.
Pi-Sunyer X, et al. N Engl J Med. 2015;373:11-22.
49
Effect of Bariatric Surgery on
Incidence of Type 2 Diabetes
Swedish Obesity Study
Carlsson LM, et al. N Engl J Med. 2012;367:695-704.
50
Effect of Different Bariatric Surgeries on
Weight-Related Comorbidities at 1 Year
ACS Bariatric Surgery Center Network
Prospective Observational Study
(N=28,616)
Patients with resolution or
improvement of condition (%)
LAGB
90
83
†
68
80
‡
55
70
60
50
44
LSG*
LRYGB
79
†
62
66
66
64
40
33
35
‡
50
‡
44
70
38
30
20
10
0
Diabetes
Hypertension
Hyperlipidemia
Sleep apnea
GERD
*Small numbers of patients with 1 year of follow-up for all comorbidities (n≤38).
†P<0.05
vs LAGB; ‡P<0.05 vs LRYGB.
ACS, American College of Surgeons; BMI, body mass index; GERD, gastroesophageal reflux disease; LAGB, laparoscopic adjustable
gastric band; LSG, laparoscopic sleeve gastrectomy; LRYGB, laparoscopic Roux-en-Y gastric bypass.
Hutter MM, et al. Ann Surg. 2011;254:410-420.
51