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comprehensive weight loss maintenance\nprograms that provide at least monthlycontact with trained individuals and focuso no n g o i n gm o n i t o r i n go fb o d yw e i g h t(weekly or more frequently) and/or other\nself-monitoring strategies such as tracking | [
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self-monitoring strategies such as tracking\nintake, steps, etc.; continued focus on nu-trition and behavioral changes; and par-ticipation in high levels of physical activity\n(200–300 min/week) (63,64). Some com-\nmercial and proprietary weight loss pro-\ngrams have shown promising weight lossresults; however, results... | [
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programs, most lack evidence of effec-\ntiveness, many do not satisfy guidelinerecommendations, and some promoteunscienti fic and possibly dangerous prac-\ntices (65,66).\nStructured, very-low-calorie meals, typ-\nically 800 –1,000 kcal/day, utilizing high- | [
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ically 800 –1,000 kcal/day, utilizing high-\nprotein foods and meal replacementproducts, may increase the pace and/ormagnitude of initial weight loss and glyce-\nmic improvements compared with stan-\ndard behavioral interventions (20,21).However, such an intensive nutritional in-tervention should be provided only by | [
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trained practitioners in medical settings\nwith close ongoing monitoring and in-tegration with behavioral support andcounseling, and only for short term (gen-\nerally up to 3 months). Furthermore, due | [
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erally up to 3 months). Furthermore, due\nto the high risk of complications (electro-lyte abnormalities, severe fatigue, cardiacarrhythmias, etc.), such intensive inter-vention should be prescribed only to\ncarefully selected individuals, such as | [
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carefully selected individuals, such as\nthose requiring weight loss and/or gly-cemic management before a neededsurgery, if the bene fits exceed the po-\ntential risks (67 –69). As weight recur-\nrence is common, such interventionsshould include long-term, comprehen-sive weight maintenance strategies and\ncounseling to ... | [
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counseling to maintain weight loss and be-\nhavioral changes (70,71).\nDespite widespread marketing and ex-\norbitant claims, there is no clear evidencethat nutrition supplements (such as herbs\nand botanicals, high-dose vitamins and | [
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and botanicals, high-dose vitamins and\nm i n e r a l s ,a m i n oa c i d s ,e n z y m e s ,a n t i o x i -dants, etc.) are effective for obesity man-agement or weight loss (72 –75). Several\nlarge systematic reviews show that most\ntrials evaluating nutrition supplements | [
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trials evaluating nutrition supplements\nfor weight loss are of low quality and athigh risk for bias. High-quality publishedstudies show little or no weight loss bene-\nfits. In contrast, vitamin/mineral (e.g., iron,\nvitamin B12, vitamin D) supplementationmay be indicated in cases of documented\ndeficiency (76), and pro... | [
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deficiency (76), and protein supplements\nmay be indicated as adjuncts to medicallysupervised weight loss therapies (77,78).\nHealth disparities adversely affect peo- | [
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Health disparities adversely affect peo-\nple who have systematically experiencedgreater obstacles to health based on theirrace or ethnicity, socioeconomic status,gender, disability, or other factors. Over-whelming research shows that these dis-parities may signifi cantly affect health | [
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outcomes, including increasing the riskfor obesity, diabetes, and diabetes-relatedcomplications. Health care professionalsshould evaluate systemic, structural, andsocioeconomic factors that may impactfood choices, access to healthful foods,and nutrition patterns; behavioral pat-terns, such as neighborhood safety andava... | [
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such as neighborhood safety andavailability of safe outdoor spaces forphysical activity; environmental exposures;access to health care; social contexts; and, | [
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ultimately, diabetes risk and outcomes.\nFor a detailed discussion of social determi-nants of health, refer to “Social Determi-\nnants of Health: A Scienti ficR e v i e w ”(79).\nPHARMACOTHERAPY\nRecommendations\n8.14 Whenever possible, minimize\nmedications for comorbid conditions\nthat are associated with weight gain.... | [
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that are associated with weight gain. E\n8.15 When choosing glucose-lowering\nmedications for people with type 2diabetes and overweight or obesity,\nprioritize medications with bene ficial\neffect on weight. B\n8.16 Obesity pharmacotherapy should\nbe considered for people with diabetes\nand overweight or obesity along w... | [
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and overweight or obesity along with\nlifestyle changes. Potential bene fits and\nrisks must be considered. A\n8.17 In people with diabetes and over-\nweight or obesity, the preferred phar-\nmacotherapy should be a glucagon-likepeptide 1 receptor agonist or dual glucose-\ndependent insulinotropic polypeptide | [
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dependent insulinotropic polypeptide\nand glucagon-like peptide 1 receptoragonist with greater weight loss ef fi-\ncacy (i.e., semaglutide or tirzepatide),especially considering their added\nweight-independent bene fits (e.g.,\nglycemic and cardiometabolic). A\n8.18 To prevent therapeutic inertia,\nfor those not reaching... | [
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for those not reaching goals, reevalu-\nate weight management therapiesand intensify treatment with addi-\ntional approaches (e.g., metabolicsurgery, additional pharmacologic\nagents, and structured lifestyle man-agement programs). A\nGlucose-Lowering Therapy\nNumerous effective glucose-lowering medi- | [
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Glucose-Lowering Therapy\nNumerous effective glucose-lowering medi-\ncations are currently available. However, toachieve both glycemic and weight manage-\nment goals for diabetes treatment, health\ncare professionals should prioritize the useof glucose-lowering medications with a ben-eficial effect on weight. Agents ass... | [
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with clinically meaningful weight loss in-\nclude glucagon-like peptide 1 (GLP-1) re-\nceptor agonists, dual glucose-dependentinsulinotropic polypeptide (GIP) and GLP-1receptor agonist (tirzepatide), sodium –\nglucose cotransporter 2 inhibitors, metfor- | [
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glucose cotransporter 2 inhibitors, metfor-\nmin, and amylin mimetics. Dipeptidyl pepti-dase 4 inhibitors, centrally acting dopamineagonist (bromocriptine), a-glucosidase in-\nhibitors, and bile acid sequestrants (colese-\nvelam) are considered weight neutral. In | [
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velam) are considered weight neutral. In\ncontrast, insulin secretagogues (sulfonylur-eas and meglitinides), thiazolidinediones,and insulin are often associated with weightgain (see Section 9, “Pharmacologic\nApproaches to Glycemic Treatment ”).\nConcomitant Medications\nHealth care professionals should carefully | [
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Concomitant Medications\nHealth care professionals should carefully\nreview the individual ’s concomitant medi-\ncations and, whenever possible, minimize\nor provide alternatives for medications\nthat promote weight gain. Examples of | [
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that promote weight gain. Examples of\nmedications associated with weight gaininclude antipsychotics (e.g., clozapine,olanzapine, risperidone), some antide-pressants (e.g., tricyclic antidepressants,\nsome selective serotonin reuptake inhibi- | [
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some selective serotonin reuptake inhibi-\ntors, and monoamine oxidase inhibitors),glucocorticoids, injectable progestins, someanticonvulsants (e.g., gabapentin and pre-gabalin), b-blockers, and possibly sedating\nantihistamines and anticholinergics (80).\nApproved Obesity Pharmacotherapy | [
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Approved Obesity Pharmacotherapy\nThe U.S. Food and Drug Administration(FDA) has approved several medications forweight management as adjuncts to reducedcalorie diet and increased physical activity\nin individuals with a BMI $30 kg/m\n2or\n$27 kg/m2w i t ho n eo rm o r eo b e s i t y -\nassociated comorbid conditions (... | [
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associated comorbid conditions (e.g., type 2\ndiabetes, hypertension, and/or dyslipide-mia). Nearly all FDA-approved obesity\nmedications have been shown to improve\nglycemia in people with type 2 diabetesS148 Obesity and Weight Management for Type 2 Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©Americ... | [
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and delay progression to type 2 diabetes\nin at-risk individuals (22), and some ofthese agents (e.g., liraglutide and sema-glutide) have an indication for glucoselowering as well as weight management.\nPhentermine and other older adrenergic\nagents are approved for short-term treat-ment (#12 weeks) (81), while all othe... | [
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are approved for long-term treatment\n(>12 weeks) (22) ( Table 8.1 ). (Refer to\nSection 14, “Children and Adolescents, ”\nfor medications approved for adolescents\nwith obesity.) In addition, setmelanotide,\na melanocortin 4 receptor agonist, is ap- | [
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a melanocortin 4 receptor agonist, is ap-\nproved for use in cases of rare geneticmutations resulting in severe hyperphagiaand extreme obesity, such as leptin recep-tor de ficiency and proopiomelanocortin\ndeficiency.\nIn people with type 2 diabetes and | [
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deficiency.\nIn people with type 2 diabetes and\noverweight or obesity, agents with bothglucose-lowering and weight loss ef-fects are preferred (refer to Section 9,\n“Pharmacologic Approaches to Diabetes\nTreatment ”), which include agents from\nthe GLP-1 receptor agonist class and the\ndual GIP and GLP-1 receptor agoni... | [
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dual GIP and GLP-1 receptor agonist\nclass. Should use of these medications\nnot result in achievement of weightmanagement goals, or if they are not tol-erated or contraindicated, other obesity\ntreatment approaches should be consid- | [
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... |
treatment approaches should be consid-\nered. Two phase 3 trials have demon-strated the potential for use of the dualGIP and GLP-1 receptor agonist (tirzepa-tide) for obesity (SURMOUNT-1, individuals\nwith obesity, and SURMOUNT-2, individuals | [
-0.016269873827695847,
0.010399063117802143,
-0.08746811747550964,
0.00989103689789772,
-0.060010917484760284,
0.0344209261238575,
-0.06447161734104156,
0.0542263388633728,
-0.015059662982821465,
-0.02156692184507847,
0.04734155908226967,
0.013308833353221416,
-0.059695132076740265,
0.0162... |
with obesity, and SURMOUNT-2, individuals\nwith obesity and type 2 diabetes) (82,83).In the SURMOUNT-2 trial, tirzepatide re-sulted in body weight loss of 9.6% and\n11.6% more than placebo and A1C lower-\ning of 1.55% and 1.57% more than placeboafter 72 weeks of treatment with the 10mg and 15 mg doses, respectively, wi... | [
0.0421878844499588,
-0.0007002837373875082,
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0.10483193397521973,
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0.017506388947367668,
0.0069465008564293385,
0.1332317739725113,
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-0.03266414999961853,
-0.01507406122982502,
0.045794375240802765,
0.01703043282032013,
0.027... |
adverse effects similar to those seen with\nthe GLP-1 receptor agonist class (83).\nHealth care professionals should be\nknowledgeable about the bene fits, dosing,\nand risks for each treatment option to bal-\nance the potential benefi ts of successful\nweight loss against the potential risks for | [
0.011488685384392738,
-0.005526204593479633,
-0.03949223831295967,
0.016777832061052322,
-0.09609688073396683,
-0.0003732909099198878,
0.007831599563360214,
0.17941643297672272,
-0.06427101045846939,
-0.023726722225546837,
0.008682535961270332,
0.04738599434494972,
-0.06295178830623627,
0.... |
weight loss against the potential risks for\neach individual. The high risk and preva-lence of cardiovascular disease in peoplewith diabetes has to be balanced against\nthe lack of long-term cardiovascular out-\ncomes trial data for agents like naltrexone-bupropion and phentermine-topiramate.All these medications are c... | [
0.012697063386440277,
0.06943100690841675,
-0.02676972560584545,
0.04521544277667999,
-0.011941799893975258,
0.059560347348451614,
-0.041495732963085175,
0.13957689702510834,
-0.024419376626610756,
-0.007123381830751896,
-0.08284112811088562,
0.023123281076550484,
-0.008318583481013775,
-0... |
in individuals who are pregnant or actively\ntrying to conceive and are not recommendedfor use in individuals who are nursing. Indi-\nviduals of childbearing potential shouldreceive counseling regarding the use ofreliable methods of contraception. Ofnote, while weight loss medications are\no f t e nu s e di np e o p l ... | [
-0.05530443415045738,
0.010479075834155083,
-0.07231749594211578,
0.015676064416766167,
0.003191200317814946,
0.0752188041806221,
0.04740799590945244,
0.12247702479362488,
0.0009504396002739668,
0.030362624675035477,
0.012847669422626495,
0.07790737599134445,
-0.0662815049290657,
0.0127292... |
o f t e nu s e di np e o p l ew i t ht y p e1d i a b e -\ntes, clinical trial data in this populationare limited.\nAssessing Efficacy and Safety of\nObesity Pharmacotherapy\nUpon initiating medications for obesity,\nassess their ef ficacy and safety at least\nmonthly for the first 3 months and at\nleast quarterly thereaf... | [
0.016218120232224464,
-0.016373194754123688,
-0.060594502836465836,
-0.007249202113598585,
0.020390145480632782,
0.03802330419421196,
-0.05650351569056511,
0.12966810166835785,
-0.004823732655495405,
-0.0049723065458238125,
0.030067062005400658,
0.00857760664075613,
0.01021541003137827,
0.... |
least quarterly thereafter. Modeling from\npublished clinical trials consistently shows\nthat early responders have improvedlong-term outcomes (84,85); however, itis notable that the response rate with thelatest generation of obesity pharmaco-\ntherapies is much higher (48,83). Unless | [
0.038853973150253296,
0.010659638792276382,
-0.011154883541166782,
0.06682717055082321,
-0.009996953420341015,
0.0163191556930542,
-0.13706989586353302,
0.13627491891384125,
0.023265618830919266,
-0.013604946434497833,
0.016184408217668533,
0.03729430213570595,
-0.011203733272850513,
-0.00... |
therapies is much higher (48,83). Unless\nclinical circumstances (such as poor toler-ability) or other considerations (such as fi-\nnancial expense or individual preference)suggest otherwise, those who achieve\nsufficient early weight loss upon starting\na chronic obesity medication (typically de-\nfined as >5% weight los... | [
0.02045232243835926,
-0.01505574956536293,
-0.028338847681879997,
0.03932950273156166,
-0.036623869091272354,
0.0024189534597098827,
-0.04780084267258644,
0.16600298881530762,
-0.03974202275276184,
-0.026803838089108467,
-0.05983411520719528,
0.07746779918670654,
-0.02000129036605358,
0.01... |
fined as >5% weight loss after 3 months\nof use) should continue the medication\nlong term. When early weight loss results\nare modest (typically <5% weight loss af-\nter 3 months of use), the bene fits of on-\ngoing treatment need to be balanced in\nthe context of the glycemic response, the\navailability of other potent... | [
-0.00891935545951128,
-0.020350299775600433,
-0.027345983311533928,
0.018292834982275963,
-0.037492651492357254,
-0.033105868846178055,
-0.014934878796339035,
0.13652832806110382,
-0.033003613352775574,
-0.04503075033426285,
0.0014835462206974626,
0.03494933620095253,
-0.034779343754053116,
... |
availability of other potential treatment\noptions, treatment tolerance, and overalltreatment burden.\nOngoing monitoring of the achievement\nand maintenance of weight managementgoals is recommended. For those not reach-\ning or maintaining weight-related treatment | [
-0.04036113619804382,
0.0701623484492302,
-0.005888395942747593,
0.04335258901119232,
-0.07079549133777618,
0.037873122841119766,
-0.006030655466020107,
0.060182586312294006,
-0.09015683829784393,
-0.04385054484009743,
0.06239856779575348,
-0.00737018883228302,
-0.006509694270789623,
0.027... |
ing or maintaining weight-related treatment\ngoals, reevaluate weight management ther-apies and intensify treatment with addi-tional approaches (e.g., metabolic surgery,\nadditional pharmacologic agents, and struc-\ntured lifestyle management programs).\nMEDICAL DEVICES FOR WEIGHT\nLOSS\nWhile gastric banding devices h... | [
-0.01451845932751894,
0.015785936266183853,
-0.007421205751597881,
0.058466214686632156,
-0.09018892049789429,
-0.0020822964143007994,
0.02103690803050995,
0.09307944029569626,
-0.06652435660362244,
-0.04454934224486351,
0.028162769973278046,
0.016217811033129692,
-0.04881131276488304,
0.0... |
LOSS\nWhile gastric banding devices have fallen\nout of favor due to their limited long-term ef ficacy and high rate of complica-\ntions, several minimally invasive medicaldevices have been approved by the FDAfor short-term weight loss, including im-planted gastric balloons, a vagus nervestimulator, and gastric aspirati... | [
0.002964877290651202,
0.03647886589169502,
-0.00598467793315649,
0.05236300453543663,
-0.02901027537882328,
0.0012429201742634177,
0.04413516819477081,
0.12516731023788452,
-0.021755335852503777,
-0.03209148719906807,
-0.007767159957438707,
0.009311026893556118,
-0.0527978241443634,
-0.008... |
(86). High cost, limited insurance coverage,\nand limited data supporting the effi cacy ofthese devices in the treatment of individu-\nals with diabetes has created uncertaintyfor their current use (87).\nAn oral hydrogel (cellulose and citric\nacid) has been approved for long-termuse in those with BMI >25 kg/m\n2to | [
-0.030327480286359787,
0.02669619768857956,
0.03844612091779709,
-0.0013215031940490007,
-0.08182276785373688,
-0.0047178673557937145,
0.06639157235622406,
0.1483766734600067,
-0.04297726973891258,
-0.02307754009962082,
-0.009458605200052261,
0.029475471004843712,
-0.026450147852301598,
-0... |
2to\nsimulate the space-occupying effect ofimplantable gastric balloons. Taken withwater 30 min before meals, the hydrogelexpands to fill a portion of the stomach\nvolume to help decrease food intake dur-\ning meals. The average weight loss was | [
0.001081752241589129,
0.033514123409986496,
0.04934101551771164,
0.027409907430410385,
-0.054260365664958954,
-0.04144078865647316,
0.05512451380491257,
0.07113471627235413,
-0.026686642318964005,
-0.04923689365386963,
0.018008893355727196,
-0.04051024466753006,
-0.012247774749994278,
0.00... |
ing meals. The average weight loss was\nrelatively small (2.1% greater than pla-cebo), and very few participants had dia-betes at baseline ( /C2410%) (88).\nMETABOLIC SURGERY\nRecommendations\n8.19 Consider metabolic surgery as a\nweight and glycemic management ap-\nproach in people with diabetes with\nBMI$30.0 kg/m2(o... | [
0.0075654820539057255,
0.11364491283893585,
-0.010455366224050522,
-0.014850670471787453,
-0.08887376636266708,
-0.048207804560661316,
0.004065553657710552,
0.0825691819190979,
0.00524902855977416,
0.008005043491721153,
-0.018850786611437798,
-0.009333529509603977,
-0.07441071420907974,
-0... |
proach in people with diabetes with\nBMI$30.0 kg/m2(or$27.5 kg/m2in\nAsian American individuals) who areotherwise good surgical candidates. A\n8.20 Metabolic surgery should be\nperformed in high-volume centerswith interprofessional teams knowl-edgeable about and experienced\nin managing obesity, diabetes, and\ngastroin... | [
-0.023532142862677574,
0.07004514336585999,
-0.013414693996310234,
0.023222964257001877,
-0.07553660869598389,
-0.057752326130867004,
0.05911358818411827,
0.05543805658817291,
-0.013607209548354149,
0.032674696296453476,
-0.025133229792118073,
-0.006344256456941366,
-0.06981242448091507,
0... |
in managing obesity, diabetes, and\ngastrointestinal surgery (www.facs\n.org/quality-programs/accreditation-\nand-veri fication/metabolic-and-bariatric-\nsurgery-accreditation-and-quality-improvement-program/). E\n8.21 People being considered for met-\nabolic surgery should be evaluated forcomorbid psychological conditi... | [
0.016094569116830826,
0.056954652070999146,
-0.044805437326431274,
0.0020324026700109243,
-0.08881824463605881,
-0.01676037162542343,
-0.00918254442512989,
0.025496706366539,
-0.08827150613069534,
-0.048062488436698914,
-0.01210329681634903,
0.03603474795818329,
-0.028554679825901985,
-0.0... |
social and situational circumstances\nthat have the potential to interfere\nwith surgery outcomes. B\n8.22 People who undergo metabolic\nsurgery should receive long-term med-\nical and behavioral support and rou-\ntine micronutrient, nutritional, and\nmetabolic status monitoring. B\n8.23 If post –metabolic surgery hypo... | [
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0.09469354897737503,
-0.02051827870309353,
-0.0062736086547374725,
-0.05085734277963638,
0.0022263743449002504,
-0.01423034816980362,
0.010923934169113636,
-0.08196061104536057,
-0.04249073937535286,
0.02527325041592121,
0.05861876159906387,
-0.02748986706137657,
0.0... |
8.23 If post –metabolic surgery hypogly-\ncemia is suspected, clinical evaluationshould exclude other potential disor-\nders contributing to hypoglycemia, and\nmanagement should include education,\nmedical nutrition therapy with a regis-\ntered dietitian/nutritionist experienced in\npost–metabolic surgery hypoglycemia, | [
-0.022376617416739464,
0.11431385576725006,
0.01436146255582571,
0.016179630532860756,
-0.0091455252841115,
-0.022615376859903336,
-0.012685015797615051,
0.09420624375343323,
-0.10527577996253967,
-0.05971860885620117,
-0.0011943442514166236,
-0.016586916521191597,
-0.09255656599998474,
0.... |
post–metabolic surgery hypoglycemia,\nand medication treatment, as needed.\nAContinuous glucose monitoring\nshould be considered as an importantadjunct to improve safety by alerting\nindividuals to hypoglycemia, especiallydiabetesjournals.org/care Obesity and Weight Management for Type 2 Diabetes S149\n©AmericanDiabete... | [
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0.09683413058519363,
-0.029924454167485237,
0.03216953203082085,
-0.04051671549677849,
-0.016888316720724106,
0.03459085151553154,
0.05086646229028702,
-0.07670286297798157,
-0.020633846521377563,
-0.03922220319509506,
0.05152638629078865,
-0.07840273529291153,
0.029... |
Table 8.1 —Obesity pharmacotherapy\nMedication name and\ntypical adult maintenance\ndoseAverage wholesale price\n(median and range for\n30-day supply) (142)National Average Drug\nAcquisition Cost\n(30-day supply) (143) Treatment armsWeight loss\n(% loss from\nbaseline)Common side effects(144–149)Possible safety concern... | [
-0.005224701017141342,
0.029045602306723595,
0.016738053411245346,
0.032217271625995636,
0.010058239102363586,
0.07829402387142181,
0.03946677967905998,
0.18414552509784698,
-0.11457659304141998,
0.02141416259109974,
-0.008107324130833149,
-0.023779762908816338,
0.03259105235338211,
-0.035... |
Short-term treatment (12 weeks)\nSympathomimetic amine anorectic\nPhentermine (150)\n8–37.5 mg q.d.* $43 ($5 –$90),\n37.5 mg/day$2(37.5 mg dose)15 mg q.d.7.5 mg q.d.Placebo5.04.91.9Dry mouth, insomnia,\ndizziness, irritability,increased blood pressure,\nelevated heart rate/C15Contraindicated for use in\ncombination wit... | [
0.053862065076828,
-0.02795281819999218,
-0.032874248921871185,
0.007930098101496696,
-0.05005770921707153,
0.029687732458114624,
-0.0016023783246055245,
0.12292375415563583,
0.0055608563125133514,
0.04856278374791145,
-0.01208776980638504,
-0.011819225735962391,
-0.004222840070724487,
0.0... |
combination with monoamineoxidase inhibitors\nLong-term treatment (52 or 56 weeks)\nLipase inhibitor\nOrlistat (4)60 mg t.i.d. (OTC)120 mg t.i.d. (Rx)$52 ($41 –$82)\n$843 ($781 –$904)NA$722120 mg t.i.d. †\nPlacebo9.65.6Abdominal pain, flatulence, | [
0.04486294835805893,
-0.009383061900734901,
0.022545455023646355,
0.04082246497273445,
-0.05189213901758194,
0.02425384148955345,
-0.025523679330945015,
0.15096792578697205,
0.042598623782396317,
0.04398181289434433,
-0.03984701260924339,
-0.00235163327306509,
0.015590154565870762,
0.05625... |
Placebo9.65.6Abdominal pain, flatulence,\nfecal urgency/C15Potential malabsorption of fat-soluble vitamins (A, D, E, K) and ofcertain medications (e.g.,\ncyclosporine, thyroid hormone,\nanticonvulsants)\n/C15Rare cases of severe liver injury\nreported\n/C15Cholelithiasis\n/C15Nephrolithiasis\nSympathomimetic amine anore... | [
-0.021211422979831696,
-0.05618807300925255,
-0.03851184621453285,
0.0019863725174218416,
-0.04216304421424866,
-0.03796444460749626,
-0.01514914445579052,
0.14442460238933563,
0.006920989137142897,
-0.028768910095095634,
-0.020126385614275932,
-0.03868214040994644,
-0.05205395072698593,
0... |
Sympathomimetic amine anorectic/antiepileptic combination\nPhentermine/topiramate ER (47)\n7.5 mg/46 mg q.d. ‡ $223(7.5 mg/46 mg dose)$179(7.5 mg/46 mgdose)15 mg/92 mg q.d. §\n7.5 mg/46 mg q.d. §\nPlacebo9.87.81.2Constipation, paresthesia,\ninsomnia, nasopharyngitis,xerostomia, increased\nblood pressure/C15Contraindica... | [
0.058204054832458496,
-0.051552172750234604,
-0.055183861404657364,
-0.005645452532917261,
-0.03705184534192085,
-0.017184285447001457,
0.09505972266197205,
0.15873682498931885,
0.02786896750330925,
0.09923435002565384,
-0.016018452122807503,
-0.02066463604569435,
-0.010959917679429054,
0.... |
blood pressure/C15Contraindicated for use in\ncombination with monoamineoxidase inhibitors\n/C15Birth defects\n/C15Cognitive impairment\n/C15Acute angle-closure glaucoma\nOpioid antagonist/antidepressant combination\nNaltrexone/bupropion ER (15)16 mg/180 mg b.i.d. $750 $599 16 mg/180 mg b.i.d.Placebo5.01.8Constipation,... | [
0.005602648016065359,
0.005855152849107981,
-0.05156485363841057,
-0.006245572119951248,
0.012792621739208698,
0.009567185305058956,
-0.025453457608819008,
0.17058435082435608,
-0.01109002809971571,
0.019643409177660942,
-0.025985443964600563,
-0.046529509127140045,
-0.06528767198324203,
-... |
headache, xerostomia,\ninsomnia, elevated heart\nrate and blood pressure/C15Contraindicated in people withunmanaged hypertension and/or\nseizure disorders\n/C15Contraindicated for use with\nchronic opioid therapy\n/C15Acute angle-closure glaucoma\nBlack box warning:/C15Risk of suicidal behavior/ideation in | [
-0.026647226884961128,
0.02506771869957447,
-0.037221480160951614,
0.06570085883140564,
0.00939065683633089,
0.0009461486479267478,
0.04500385373830795,
0.09095992892980576,
-0.04164699465036392,
-0.017714859917759895,
0.017846515402197838,
-0.04531421884894371,
-0.0015323467087000608,
0.0... |
Black box warning:/C15Risk of suicidal behavior/ideation in\npeople younger than 24 years oldwho have depression\nContinued on p. S151S150 Obesity and Weight Management for Type 2 Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
-0.02434708923101425,
0.07046161592006683,
-0.09809837490320206,
0.09323439002037048,
0.05141042545437813,
0.06043350324034691,
0.046151310205459595,
0.11576970666646957,
-0.05140512436628342,
-0.03420964255928993,
-0.009487085975706577,
-0.01885165460407734,
-0.04501368850469589,
-0.00302... |
Table 8.1 —Continued\nMedication name and\ntypical adult maintenancedoseAverage wholesale price(median and range for30-day supply) (142)National Average DrugAcquisition Cost(30-day supply) (143) Treatment armsWeight loss(% loss frombaseline)Common side effects(144–149)Possible safety concerns andconsiderations (144–149... | [
0.017782380804419518,
0.03456982597708702,
0.024169689044356346,
-0.0008690130780451,
-0.0001532838068669662,
0.06380578875541687,
0.030876418575644493,
0.21071502566337585,
-0.12457737326622009,
0.019673913717269897,
0.01115445513278246,
-0.016492241993546486,
0.049623169004917145,
-0.009... |
Glucagon-like peptide 1 receptor agonist\nLiraglutide (16,49) jj\n3 mg q.d. $1,619 $1,294 3.0 mg q.d.\n1.8 mg q.d.Placebo6.04.72.0Gastrointestinal side effects\n(nausea, vomiting,diarrhea, esophageal\nreflux), injection site\nreactions, elevated heart | [
0.017121044918894768,
-0.06242522597312927,
-0.061813581734895706,
0.035353366285562515,
-0.06173879653215408,
-0.014941577799618244,
0.04372569918632507,
0.14385342597961426,
0.07295921444892883,
0.019569119438529015,
-0.020296689122915268,
0.01808265782892704,
-0.03409349545836449,
0.020... |
reflux), injection site\nreactions, elevated heart\nrate, hypoglycemia/C15Pancreatitis has been reported inclinical trials, but causality has notbeen established. Discontinue if\npancreatitis is suspected.\n/C15Use caution in people with kidney\ndisease when initiating or increasingdose due to potential risk of acute\nk... | [
0.006300562992691994,
0.004809112753719091,
0.01911100186407566,
-0.009423754177987576,
-0.034932274371385574,
-0.03439321741461754,
0.004043196327984333,
0.09534909576177597,
-0.012339558452367783,
0.02474578097462654,
0.007078649941831827,
0.021333105862140656,
0.01768629439175129,
0.051... |
kidney injury.\n/C15May cause cholelithiasis and gallstone-\nrelated complications.\n/C15Gastrointestinal disorders (severeconstipation and small bowel\nobstruction/ileus progression)\n/C15Monitor for potential consequences of\ndelayed absorption of oral medications.\nBlack box warning:\n/C15Risk of thyroid C-cell tumo... | [
-0.028785299509763718,
-0.01566126011312008,
0.022903140634298325,
0.011655713431537151,
-0.029231896623969078,
0.0081727784126997,
-0.017751792445778847,
0.11571613699197769,
-0.03994216397404671,
-0.03834705799818039,
-0.05902761593461037,
0.004251593258231878,
-0.05137064680457115,
-0.0... |
/C15Risk of thyroid C-cell tumors inrodents; human relevance not\ndetermined\nSemaglutide (48,151) jj\n2.4 mg once weekly $1,619 $1,295 2.4 mg weekly\n1.0 mg weekly\nPlacebo9.6\n7.0\n3.4Gastrointestinal side effects\n(nausea, vomiting,diarrhea, esophagealreflux), injection site\nreactions, elevated heart | [
-0.01140118483453989,
0.06465645879507065,
-0.02022409997880459,
-0.011116144247353077,
0.01600060425698757,
0.0422997921705246,
0.021902291104197502,
0.13304392993450165,
0.015959182754158974,
0.011224955320358276,
-0.0811459869146347,
-0.08097998797893524,
0.02659345045685768,
-0.0911770... |
reactions, elevated heart\nrate, hypoglycemia/C15Pancreatitis has been reported inclinical trials, but causality has not\nbeen established. Discontinue ifpancreatitis is suspected.\n/C15Use caution in people with kidney\ndisease when initiating or increasing\ndose due to potential risk of acutekidney injury. | [
-0.0034295159857720137,
0.01764814741909504,
0.023396672680974007,
-0.0047636451199650764,
0.013164365664124489,
-0.022703487426042557,
0.012997613288462162,
0.10331559181213379,
-0.023528164252638817,
0.050922270864248276,
0.004152047913521528,
0.000042898427636828274,
-0.019004812464118004... |
dose due to potential risk of acutekidney injury.\n/C15May cause cholelithiasis and gallstone-related complications.\n/C15Gastrointestinal disorders (severeconstipation and small bowel\nobstruction/ileus progression)\n/C15Monitor for potential consequences of\ndelayed absorption of oral medications. | [
0.027205519378185272,
-0.06135199964046478,
-0.005165286362171173,
-0.004912863951176405,
-0.03233896195888519,
-0.05218496173620224,
0.008812607266008854,
0.1435946226119995,
0.013207059353590012,
-0.048468217253685,
0.007495791185647249,
0.012434737756848335,
-0.03686647489666939,
0.0539... |
delayed absorption of oral medications.\nBlack box warning:/C15Risk of thyroid C-cell tumors in\nrodents; human relevance notdetermined\nContinued on p. S152diabetesjournals.org/care Obesity and Weight Management for Type 2 Diabetes S151\n©AmericanDiabetesAssociation | [
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0.039671335369348526,
-0.07235673815011978,
0.020890790969133377,
0.008828007616102695,
0.01653362810611725,
0.013886037282645702,
0.07048340886831284,
-0.030528409406542778,
-0.027780843898653984,
-0.0514841191470623,
0.03876723349094391,
-0.014231076464056969,
-0.0... |
Table 8.1 —Continued\nMedication name and\ntypical adult maintenance\ndoseAverage wholesale price\n(median and range for\n30-day supply) (142)National Average Drug\nAcquisition Cost\n(30-day supply) (143) Treatment armsWeight loss\n(% loss from\nbaseline)Common side effects(144–149)Possible safety concerns andconsidera... | [
0.0013349219225347042,
0.015993738546967506,
0.01879427395761013,
0.00318282563239336,
0.01218020636588335,
0.07809602469205856,
0.04039304703474045,
0.21143870055675507,
-0.12618747353553772,
0.01843281462788582,
0.031014064326882362,
-0.012831241823732853,
0.03010403737425804,
-0.0097291... |
Dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptor agonist\nTirzepatide (83)\n5 mg, 10 mg, or\n15 mg once weeklyNA NA 10 mg weekly15 mg weeklyPlacebo12.814.73.2Gastrointestinal side effects\n(nausea, vomiting,diarrhea, esophagealreflux), injection site | [
0.03800778463482857,
-0.03522013500332832,
-0.08195765316486359,
0.039763566106557846,
-0.03569626808166504,
-0.0361117348074913,
0.08448928594589233,
0.08577663451433182,
-0.030933838337659836,
0.004841991234570742,
-0.060669489204883575,
0.02654057927429676,
-0.041484534740448,
-0.020022... |
(nausea, vomiting,diarrhea, esophagealreflux), injection site\nreactions, elevated heartrate, hypoglycemia/C15Pancreatitis has been reported inclinical trials, but causality has notbeen established. Discontinue ifpancreatitis is suspected. | [
0.08022774755954742,
-0.02167118899524212,
-0.006136876530945301,
0.0389421321451664,
0.033724796026945114,
-0.040764495730400085,
0.04311328008770943,
0.10408513993024826,
-0.021754510700702667,
0.044325102120637894,
-0.008767051622271538,
-0.02183314599096775,
0.025220444425940514,
0.044... |
/C15Use caution in people with kidneydisease when initiating or increasingdose due to potential risk of acutekidney injury.\n/C15May cause cholelithiasis andgallstone-related complications.\n/C15Gastrointestinal disorders (severe\nconstipation and small bowel\nobstruction/ileus progression)\n/C15Monitor effects of oral... | [
-0.02628760039806366,
-0.04568753018975258,
0.040799640119075775,
-0.003989395685493946,
-0.0385887548327446,
-0.04224167391657829,
-0.02571350894868374,
0.1356412023305893,
-0.016760827973484993,
-0.051606763154268265,
0.003411324694752693,
0.013775529339909554,
-0.043648406863212585,
0.0... |
/C15Monitor effects of oral medications\nwith narrow therapeutic index\n(warfarin) or whose ef ficacy is\ndependent on threshold\nconcentration.\n/C15Advise those using oral hormonal\ncontraception to use or add a non-\noral contraception method for4 weeks after initiation and doseescalations. | [
-0.03820187970995903,
0.00653779087588191,
-0.09123615175485611,
0.010608255863189697,
0.021742943674325943,
0.0548921599984169,
-0.0021853914950042963,
0.1665593683719635,
0.008156892843544483,
0.0016739109996706247,
-0.002533484948799014,
-0.020264148712158203,
-0.0775316059589386,
0.055... |
Black box warning:/C15Risk of thyroid C-cell tumors inrodents; human relevance not\ndetermined.\nSelect safety and side effect information is provided; for a comprehensive discussion of safety considerations, please refer to the prescribing information for each agent. b.i.d., twice daily; ER, extended release; | [
-0.03058250993490219,
0.044731609523296356,
-0.08124403655529022,
-0.027675310149788857,
0.04272959381341934,
0.05371423065662384,
0.013987617567181587,
0.14040686190128326,
-0.03000243939459324,
-0.04731394350528717,
-0.0296405591070652,
-0.03146151453256607,
0.032893285155296326,
-0.0713... |
OTC, over the counter; NA, data not available; Rx, prescription; t.i.d., three times daily, p.o., by mouth; SC, subcutaneous injection; AWP, average wholesale price; NADAC, National Average Drug AcquisitionCost. *Use lowest effective dose; maximum appropriate dose is 37.5 mg. Weight loss data were extracted from the 12... | [
0.02667572908103466,
0.01369253545999527,
-0.010168329812586308,
-0.006132901180535555,
-0.07905618846416473,
-0.030871644616127014,
0.02924809418618679,
0.17142747342586517,
0.012784725986421108,
0.06467337906360626,
-0.008658179081976414,
-0.005234996322542429,
0.03178746625781059,
0.045... |
mg. Weight loss data were extracted from the 12-week time point, as phentermine is approved for use for up to 12 weeks. †Enrolled partic- | [
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0.06364555656909943,
0.07044154405593872,
0.046570517122745514,
0.01816951297223568,
-0.014973514713346958,
-0.030069706961512566,
0.036142367869615555,
-0.09539198875427246,
-0.00590865220874548,
-0.015114073641598225,
0.013142990879714489,
0.011273863725364208,
-0.01... |
ipants had normal (79%) or impaired (21%) glucose tolerance. ‡Maximum dose, depending on response, is 15 mg/92 mg q.d. §Approximately 68% of enrolled participants had type 2 diabetes or impaired glu- | [
0.07275637984275818,
0.003351717023178935,
-0.06701219081878662,
-0.002441050484776497,
-0.13379955291748047,
-0.05554909631609917,
0.0689949318766594,
0.13094523549079895,
-0.003129267366603017,
-0.050216469913721085,
0.00018891484069172293,
0.035440485924482346,
-0.11038438230752945,
0.0... |
cose tolerance. jjAgent has indication for reduction of cardiovascular events (49,151). AWP and NADAC prices for 30-day supply of maximum or maintenance dose as of 6 Sep tember 2023.S152 Obesity and Weight Management for Type 2 Diabetes Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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0.030783487483859062,
-0.050002627074718475,
-0.012199456803500652,
0.010741702280938625,
0.04886979982256889,
0.004141052253544331,
0.12767796218395233,
-0.015507923439145088,
-0.05871933698654175,
-0.005403892602771521,
-0.008939114399254322,
-0.039140909910202026,
... |
for those with severe hypoglycemia\nor hypoglycemia unawareness. E\n8.24 In people who undergo metabolic\nsurgery, routinely screen for psychoso-cial and behavioral health changes and\nrefer to a quali fied behavioral health\nprofessional as needed. C\n8.25 Monitor individuals who have\nundergone metabolic surgery for i... | [
-0.019364913925528526,
0.08209454268217087,
-0.07254409790039062,
0.046568579971790314,
-0.018782388418912888,
-0.0029117944650352,
0.04165398329496384,
0.10339191555976868,
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-0.026041319593787193,
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0.0... |
8.25 Monitor individuals who have\nundergone metabolic surgery for in-\nsufficient weight loss or weight recur-\nrence at least every 6 –12 months. E\nIn those who have insuf ficient weight | [
-0.010444795712828636,
0.06760311871767044,
-0.020358141511678696,
0.05196067690849304,
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0.0011780012864619493,
0.03272764012217522,
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... |
In those who have insuf ficient weight\nloss or experience weight recurrence,assess for potential predisposing fac-tors and, if appropriate, consider addi-tional weight loss interventions (e.g.,obesity pharmacotherapy). C\nSurgical procedures for obesity treat-\nment —often referred to interchangeably\nas bariatric surg... | [
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0.02635897696018219,
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0.09476587921380997,
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0.025827161967754364,
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... |
as bariatric surgery, weight loss surgery,\nmetabolic surgery, or metabolic/bariatric\nsurgery —can promote signi ficant and du-\nrable weight loss and improve type 2 dia-betes. Given the magnitude and rapidity\nof improvement of hyperglycemia and\nglucose homeostasis, these procedures\nhave been suggested as treatments... | [
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0.07503555715084076,
-0.0038076872006058693,
-0.010330580174922943,
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0.011499153450131416,
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0.008594856597483158,
0.0615282766520977,
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... |
have been suggested as treatments for\ntype 2 diabetes even in the absence ofsevere obesity, hence the current pre-\nferred terminology of “metabolic sur-\ngery”(89).\nA substantial body of evidence, includ-\ning data from numerous large cohort\nstudies and randomized controlled (non-\nblinded) clinical trials, demonst... | [
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0.0854654535651207,
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0.003661354072391987,
-0.03344675898551941,
0.09101992845535278,
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0.05267709866166115,
-0.052847541868686676,
0.00... |
blinded) clinical trials, demonstrates that\nmetabolic surgery achieves superior gly-\ncemic management and reduction of car-\ndiovascular risk in people with type 2diabetes and obesity compared with non-\nsurgical intervention (45). In addition to\nimproving glycemia, metabolic surgery re-\nduces the incidence of micr... | [
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0.0650080144405365,
-0.010666889138519764,
0.006275915075093508,
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0.09554547071456909,
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0.021205823868513107,
0.0005604001344181597,
0.06927122175693512,
-0.05525161325931549,
-0.03... |
duces the incidence of microvascular dis-\nease (90), improves quality of life (45,91,92),\ndecreases cancer risk, and improves car-\ndiovascular disease risk factors and long-\nterm cardiovascular events (93 –104).\nCohort studies that match surgical andnonsurgical subjects strongly suggest that | [
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0.035745278000831604,
0.022516576573252678,
-0.036484479904174805,
-0.04147454723715782,
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-0.02900848723948002,
0.18118251860141754,
0.008097059093415737,
0.031467266380786896,
0.0018797616939991713,
0.05207861214876175,
-0.001984886359423399,
0.0... |
metabolic surgery reduces all-cause mor-tality (105,106).\nThe overwhelming majority of proce-\ndures in the U.S. are vertical sleeve gastrec-tomy (VSG) and Roux-en-Y gastric bypass\n(RYGB). Both procedures result in an ana-\ntomically smaller stomach pouch and often\nrobust changes in enteroendocrine hor- | [
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0.06853318959474564,
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0.02594941481947899,
0.01120047364383936,
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0.09284666180610657,
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0.006522759795188904,
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0.06882565468549728,
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robust changes in enteroendocrine hor-\nmones. In VSG, /C2480% of the stomach isremoved, leaving behind a long, thin\nsleeve-shaped pouch. RYGB creates amuch smaller stomach pouch (roughlythe size of a walnut), which is thenattached to the distal small intestine,\nthereby bypassing the duodenum and\njejunum.\nMetabolic... | [
0.003368489444255829,
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0.0711238905787468,
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0.020028535276651382,
0.02046566642820835,
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jejunum.\nMetabolic surgery has been demon-\ns t r a t e dt oh a v eb e n e ficial effects on type 2\ndiabetes irrespective of the presurgicalBMI (107). The American Society for Met-abolic and Bariatric Surgery is now recom-mending metabolic surgery for people\nwith type 2 diabetes and a BMI $30 kg/m\n2\n(or$27.5 kg/m2f... | [
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0.0718875452876091,
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0.038113243877887726,
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0.033659227192401886,
0.054597243666648865,
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0.01066085509955883,
0.02775627188384533,
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2\n(or$27.5 kg/m2for Asian American indi-\nviduals) in surgically eligible individuals.\nStudies have documented diabetes remis-sion after 1 –5y e a r si n3 0 –63% of individ-\nuals with RYGB (17,108).\nMost notably, the Surgical Treatment\nand Medications Potentially Eradicate Di-abetes Ef ficiently (STAMPEDE) trial, w... | [
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0.01855391077697277,
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0.07878296822309494,
0.1094060018658638,
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0.015456483699381351,
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... |
randomized 150 participants with poorlymanaged diabetes to receive either meta-bolic surgery or medical treatment, foundthat 29% of those treated with RYGB and23% treated with VSG achieved A1C of\n6.0% or lower after 5 years (45). Available\ndata suggest an erosion of diabetes re-mission over time (46); at least 35 –50... | [
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0.013897941447794437,
0.03867734596133232,
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0.022518886253237724,
0.11634650081396103,
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0.058834370225667953,
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-0... |
of individuals who initially achieve remis-\nsion of diabetes eventually experience re-\ncurrence. Still, the median disease-freeperiod among such individuals followingRYGB is 8.3 years (109,110), and the major-\nity of those who undergo surgery maintain\nsubstantial improvement of glycemiafrom baseline for at least 5 ... | [
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(45,91,94,95,110– 113).\nExceedingly few presurgical predictors\nof success have been identi fied, but youn-\nger age, shorter duration of diabetes (e.g.,<8 years) (84), and lesser severity of dia-\nbetes (better glycemic control, not using\ninsulin) are associated with higher rates | [
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0.05326950550079346,
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0.02793978340923786,
0.11608083546161652,
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0.0003771819465328008,
0.07794395834207535,
-0.007609452586621046,
-0.021... |
insulin) are associated with higher rates\nof diabetes remission (45,94,112,114).Greater baseline visceral fat area mayalso predict improved postoperative out-\ncomes, especially among Asian American\npeople with type 2 diabetes (115).\nAlthough surgery has been shown to\nimprove the metabolic pro files and car- | [
0.03249654918909073,
0.05745663493871689,
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0.08200236409902573,
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0.017093166708946228,
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0.07059895247220993,
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-0... |
improve the metabolic pro files and car-\ndiovascular risk of people with type 1 dia-\nbetes, larger and longer-term studies are\nneeded to determine the role of meta-bolic surgery in such individuals (116).\nWhereas metabolic surgery has greater\ninitial costs than nonsurgical obesity treat-\nments, retrospective analy... | [
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0.07176526635885239,
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... |
ments, retrospective analyses and model-\ning studies suggest that surgery may becost-effective or even cost-saving for indi-viduals with type 2 diabetes. However,these results largely depend on assump-tions about the long-term effectivenessand safety of the procedures (117,118).\nThe safety of metabolic surgery has im... | [
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0.07350698858499527,
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The safety of metabolic surgery has im-\nproved signi ficantly with continued re fine-\nment of minimally invasive (laparoscopic)approaches, enhanced training andcredentialing, and involvement of inter-\nprofessional teams. Perioperative mortal-\nity rates are typically 0.1 –0.5%, similar to | [
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0.0462... |
ity rates are typically 0.1 –0.5%, similar to\nthose of common abdominal proceduressuch as cholecystectomy or hysterectomy\n(119–123). Major complications occur in\n2–6% of those undergoing metabolic sur-\ngery, which compares favorably with the\nrates for other commonly performed elec-\ntive operations (123). Postsurg... | [
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tive operations (123). Postsurgical recovery\ntimes and morbidity have also dramaticallydeclined. Minor complications and needfor operative reintervention occur in upto 15% (119– 128). Empirical data suggest\nthat the pro ficiency of the operating sur- | [
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that the pro ficiency of the operating sur-\ngeon and surgical team is an important fac-tor in determining mortality, complications,reoperations, and readmissions (129). Ac-\ncordingly, metabolic surgery should be\nperformed in high-volume centers withinterprofessional teams experienced inmanaging diabetes, obesity, and... | [
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