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Invited Commentary
June 3, 2020

Gastric Bypass vs Medical Treatment in Renoprotection for Patients with Class 1 Obesity, Type 2 Diabetes, and Albuminuria

Author Affiliations
  • 1Turku University, Department of Surgery, Turku, Finland
  • 2Turku University Hospital, Division of Digestive Surgery and Urology, Turku, Finland
  • 3Satasairaala Central Hospital, Department of Surgery, Pori, Finland
  • 4Turku University, Department of Internal Medicine, Turku, Finland
  • 5Turku Pet Center, Turku, Finland
  • 6Turku University, Department of Endocrinology, Turku, Finland
JAMA Surg. Published online June 3, 2020. doi:10.1001/jamasurg.2020.0421

The superiority of bariatric surgery over best medical therapy (BMT) in the treatment of type 2 diabetes has been well demonstrated in high-quality randomized clinical trials. Furthermore, there is sufficient clinical and mechanistic evidence to support consideration of metabolic surgery for the patients with class 1 obesity (body mass index [BMI], 30.0-34.9; calculated as weight in kilograms divided by height in meters squared), type 2 diabetes, and inadequately controlled hyperglycemia.1 At 5-year follow-up, compared with BMT, the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial2 showed the durable and beneficial effects of bariatric surgery among patients with mild obesity (BMI of 27-34) and Diabetes Surgery Study3 found significant and superior improvement after bariatric surgery in a composite outcome of glycosylated hemoglobin level, low-density lipoprotein level, and systolic blood pressure.

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