human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Improvement in  type 2 diabetes after Roux-en-Y gastric bypass ( RYGB )  has been attributed partly to weight loss , but mechanisms beyond weight loss remain unclear . We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins , insulin sensitivity , and secretion 1 year after r and omization to lifestyle modification and intensive medical management ( LS/IMM ) alone  ( n = 34 ) or in conjunction with RYGB  ( n = 34 ) . The RYGB group lost more weight and had greater improvement in HbA1c . Fasting glucose was lower after RYGB than after LS/IMM , although the glucose area under the curve decreased comparably for both groups . Insulin sensitivity increased in both groups . Insulin secretion was unchanged after LS/IMM but decreased after RYGB , except for a rapid increase during the first 30 min after meal ingestion . Glucagon-like peptide 1 ( GLP-1 ) was substantially increased after RYGB , while gastric inhibitory polypeptide and glucagon decreased . Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups . At baseline , a greater C-peptide index and 90-min postpr and ial C-peptide level were predictive of lower HbA1c at 1 year after RYGB . β-Cell glucose sensitivity , which improved only after RYGB , and improved disposition index were associated with lower HbA1c in both groups , independent of weight loss . Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB Objective : To compare bariatric surgery versus intensive medical weight management ( MWM ) in patients with type 2 diabetes mellitus ( T2DM ) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products ( sRAGE ) is a biomarker to identify patients most likely to benefit from surgery . Background : There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35 . Methods : Fifty-seven patients with T2DM and BMI 30 to 35 , who otherwise met the criteria for bariatric surgery were r and omized to MWM versus surgery ( bypass , sleeve or b and , based on patient preference ) . The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance ( HOMA-IR ) and diabetes remission . Secondary outcomes included changes in HbA1c , weight , and sRAGE . Results : The surgery group had improved HOMA-IR ( −4.6 vs + 1.6 ; P = 0.0004 ) and higher diabetes remission ( 65 % vs 0 % , P < 0.0001 ) than the MWM group at 6 months . Compared to MWM , the surgery group had lower HbA1c ( 6.2 vs 7.8 , P = 0.002 ) , lower fasting glucose ( 99.5 vs 157 ; P = 0.0068 ) , and fewer T2DM medication requirements ( 20 % vs 88 % ; P < 0.0001 ) at 6 months . The surgery group lost more weight ( 7 . vs 1.0 BMI decrease , P < 0.0001 ) . Higher baseline sRAGE was associated with better weight loss outcomes ( r = −0.641 ; P = 0.046 ) . There were no mortalities . Conclusions : Surgery was very effective short-term in patients with T2DM and BMI 30 to 35 . Baseline sRAGE may predict patients most likely to benefit from surgery . These findings need to be confirmed with larger studies . Clinical Trials.gov ID : CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 CONTEXT Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes . OBJECTIVE To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control . DESIGN , SETTING , AND PARTICIPANTS Unblinded r and omized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia , with general community recruitment to established treatment programs . Participants were 60 obese patients ( BMI > 30 and < 40 ) with recently diagnosed ( < 2 years ) type 2 diabetes . INTERVENTIONS Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric b and ing with conventional diabetes care . MAIN OUTCOME MEASURES Remission of type 2 diabetes ( fasting glucose level < 126 mg/dL [ 7.0 mmol/L ] and glycated hemoglobin [ HbA1c ] value < 6.2 % while taking no glycemic therapy ) . Secondary measures included weight and components of the metabolic syndrome . Analysis was by intention-to-treat . RESULTS Of the 60 patients enrolled , 55 ( 92 % ) completed the 2-year follow-up . Remission of type 2 diabetes was achieved by 22 ( 73 % ) in the surgical group and 4 ( 13 % ) in the conventional-therapy group . Relative risk of remission for the surgical group was 5.5 ( 95 % confidence interval , 2.2 - 14.0 ) . Surgical and conventional-therapy groups lost a mean ( SD ) of 20.7 % ( 8.6 % ) and 1.7 % ( 5.2 % ) of weight , respectively , at 2 years ( P < .001 ) . Remission of type 2 diabetes was related to weight loss ( R2 = 0.46 , P < .001 ) and lower baseline HbA1c levels ( combined R2 = 0.52 , P < .001 ) . There were no serious complications in either group . CONCLUSIONS Participants r and omized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss . These results need to be confirmed in a larger , more diverse population and have long-term efficacy assessed . TRIAL REGISTRATION actr.org Identifier : ACTRN012605000159651 Objective : Roux-en-Y gastric bypass ( RYGB ) produces more durable glycemic control than sleeve gastrectomy ( SG ) or intensive medical therapy ( IMT ) . However , the contribution of acylated ghrelin ( AG ) , a gluco-regulatory/appetite hormone , to improve glucose metabolism and body composition in patients with type 2 diabetes ( T2D ) following RYGB is unknown . Design : STAMPEDE ( Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently ) was a prospect i ve , r and omized controlled trial . Subjects : Fifty-three ( body mass index : 36±3 kg m−2 , age : 49±9 years ) poorly controlled patients with T2D ( HbA1c ( glycated hemoglobin ) : 9.7±2 % ) were r and omized to IMT , IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline , 12 , and 24 months for evaluation of AG suppression ( postpr and ial minus fasting ) and beta-cell function ( oral disposition index ; glucose-stimulated insulin secretion × Matsuda index ) . Total/ and roid body fat ( dual-energy X-ray absorptiometry ) was also assessed . Results : RYGB and SG reduced body fat comparably ( 15–23 kg ) at 12 and 24 months , whereas IMT had no effect . Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months ( P<0.001 ) . However , there was no difference in insulin secretion between SG vs IMT at 24 months ( P=0.32 ) . Fasting AG was reduced fourfold following SG ( P<0.01 ) and did not change with RYGB or IMT at 24 months . AG suppression improved more following RYGB than SG or IMT at 24 months ( P=0.01 vs SG , P=0.07 vs IMT ) . At 24 months , AG suppression was associated with increased postpr and ial glucagon-like peptide-1 ( r=−0.32 , P<0.02 ) and decreased and roid fat ( r=0.38 ; P<0.006 ) . Conclusions : Enhanced AG suppression persists for up to 2 years after RYGB , and this effect is associated with decreased and roid obesity and improved insulin secretion . Together , these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes .  Summary Background Data Obesity and diabetes , both notoriously resistant to medical therapy , continue to be two of 
    Output:
    
agent
Furthermore , except for certain cardiovascular indicators , bariatric surgery was superior to conventional arms in terms of metabolic secondary parameters ( P < 0.05 ) .
Bariatric surgery is a better therapeutic option for weight loss , irrespective of follow-up duration , surgical techniques and obesity levels
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Improvement in  type 2 diabetes after Roux-en-Y gastric bypass ( RYGB )  has been attributed partly to weight loss , but mechanisms beyond weight loss remain unclear . We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins , insulin sensitivity , and secretion 1 year after r and omization to lifestyle modification and intensive medical management ( LS/IMM ) alone  ( n = 34 ) or in conjunction with RYGB  ( n = 34 ) . The RYGB group lost more weight and had greater improvement in HbA1c . Fasting glucose was lower after RYGB than after LS/IMM , although the glucose area under the curve decreased comparably for both groups . Insulin sensitivity increased in both groups . Insulin secretion was unchanged after LS/IMM but decreased after RYGB , except for a rapid increase during the first 30 min after meal ingestion . Glucagon-like peptide 1 ( GLP-1 ) was substantially increased after RYGB , while gastric inhibitory polypeptide and glucagon decreased . Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups . At baseline , a greater C-peptide index and 90-min postpr and ial C-peptide level were predictive of lower HbA1c at 1 year after RYGB . β-Cell glucose sensitivity , which improved only after RYGB , and improved disposition index were associated with lower HbA1c in both groups , independent of weight loss . Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB Objective : To compare bariatric surgery versus intensive medical weight management ( MWM ) in patients with type 2 diabetes mellitus ( T2DM ) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products ( sRAGE ) is a biomarker to identify patients most likely to benefit from surgery . Background : There are few studies comparing surgery to MWM for patients with T2DM and BMI less than 35 . Methods : Fifty-seven patients with T2DM and BMI 30 to 35 , who otherwise met the criteria for bariatric surgery were r and omized to MWM versus surgery ( bypass , sleeve or b and , based on patient preference ) . The primary outcomes assessed at 6 months were change in homeostatic model of insulin resistance ( HOMA-IR ) and diabetes remission . Secondary outcomes included changes in HbA1c , weight , and sRAGE . Results : The surgery group had improved HOMA-IR ( −4.6 vs + 1.6 ; P = 0.0004 ) and higher diabetes remission ( 65 % vs 0 % , P < 0.0001 ) than the MWM group at 6 months . Compared to MWM , the surgery group had lower HbA1c ( 6.2 vs 7.8 , P = 0.002 ) , lower fasting glucose ( 99.5 vs 157 ; P = 0.0068 ) , and fewer T2DM medication requirements ( 20 % vs 88 % ; P < 0.0001 ) at 6 months . The surgery group lost more weight ( 7 . vs 1.0 BMI decrease , P < 0.0001 ) . Higher baseline sRAGE was associated with better weight loss outcomes ( r = −0.641 ; P = 0.046 ) . There were no mortalities . Conclusions : Surgery was very effective short-term in patients with T2DM and BMI 30 to 35 . Baseline sRAGE may predict patients most likely to benefit from surgery . These findings need to be confirmed with larger studies . Clinical Trials.gov ID : CONTEXT Obstructive sleep apnea ( OSA ) is strongly related to obesity . Weight loss is recommended as part of the overall management plan for obese patients diagnosed with OSA . OBJECTIVE To determine whether surgically induced weight loss is more effective than conventional weight loss therapy in the management of OSA . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 60 obese patients ( body mass index : > 35 and < 55 ) with recently diagnosed ( < 6 months ) OSA and an apnea-hypopnea index ( AHI ) of 20 events/hour or more . These patients had been prescribed continuous positive airway pressure ( CPAP )  therapy to manage OSA and were identified via accredited community sleep clinics . The trial was conducted between September 2006 and March 2009 by university- and teaching hospital-based clinical research ers in Melbourne , Australia . Patients with obesity hypoventilation syndrome , previous bariatric surgery , contraindications to bariatric surgery , or significant cardiopulmonary , neurological , vascular , gastrointestinal , or neoplastic disease were excluded . INTERVENTIONS Patients were r and omized to a conventional weight loss program that included regular consultations with a dietitian and physician , and the use of very low-calorie diets as necessary ( n = 30 ) or to bariatric surgery ( laparoscopic adjustable gastric b and ing ; n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was baseline to 2-year change in AHI on diagnostic polysomnography scored by staff blinded to r and omization . Secondary outcomes were changes in weight , CPAP adherence , and functional status . RESULTS Patients lost a mean of 5.1 kg ( 95 % CI , 0.8 to 9.3 kg ) in the conventional weight loss program compared with 27.8 kg ( 95 % CI , 20.9 to 34.7 kg ) in the bariatric surgery group ( P < .001 ) . The AHI decreased by 14.0 events/hour ( 95 % CI , 3.3 to 24.6 events/hour ) in the conventional weight loss group and by 25.5 events/hour ( 95 % CI , 14.2 to 36.7 events/hour ) in the bariatric surgery group . The between-group difference was -11.5 events/hour ( 95 % CI , -28.3 to 5.3 events/hour ; P = .18 ) . CPAP adherence did not differ between the groups . The bariatric surgery group had greater improvement in the Short Form 36 physical component summary score ( mean , 9.3 [ 95 % CI , 0.5 to 18.0 ] ; P = .04 ) . CONCLUSION Among a group of obese patients with OSA , the use of bariatric surgery compared with conventional weight loss therapy did not result in a statistically greater reduction in AHI despite major differences in weight loss . TRIAL REGISTRATION anzctr.org Identifier : 12605000161628 CONTEXT Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes . OBJECTIVE To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control . DESIGN , SETTING , AND PARTICIPANTS Unblinded r and omized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia , with general community recruitment to established treatment programs . Participants were 60 obese patients ( BMI > 30 and < 40 ) with recently diagnosed ( < 2 years ) type 2 diabetes . INTERVENTIONS Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric b and ing with conventional diabetes care . MAIN OUTCOME MEASURES Remission of type 2 diabetes ( fasting glucose level < 126 mg/dL [ 7.0 mmol/L ] and glycated hemoglobin [ HbA1c ] value < 6.2 % while taking no glycemic therapy ) . Secondary measures included weight and components of the metabolic syndrome . Analysis was by intention-to-treat . RESULTS Of the 60 patients enrolled , 55 ( 92 % ) completed the 2-year follow-up . Remission of type 2 diabetes was achieved by 22 ( 73 % ) in the surgical group and 4 ( 13 % ) in the conventional-therapy group . Relative risk of remission for the surgical group was 5.5 ( 95 % confidence interval , 2.2 - 14.0 ) . Surgical and conventional-therapy groups lost a mean ( SD ) of 20.7 % ( 8.6 % ) and 1.7 % ( 5.2 % ) of weight , respectively , at 2 years ( P < .001 ) . Remission of type 2 diabetes was related to weight loss ( R2 = 0.46 , P < .001 ) and lower baseline HbA1c levels ( combined R2 = 0.52 , P < .001 ) . There were no serious complications in either group . CONCLUSIONS Participants r and omized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss . These results need to be confirmed in a larger , more diverse population and have long-term efficacy assessed . TRIAL REGISTRATION actr.org Identifier : ACTRN012605000159651 Objective : Roux-en-Y gastric bypass ( RYGB ) produces more durable glycemic control than sleeve gastrectomy ( SG ) or intensive medical therapy ( IMT ) . However , the contribution of acylated ghrelin ( AG ) , a gluco-regulatory/appetite hormone , to improve glucose metabolism and body composition in patients with type 2 diabetes ( T2D ) following RYGB is unknown . Design : STAMPEDE ( Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently ) was a prospect i ve , r and omized controlled trial . Subjects : Fifty-three ( body mass index : 36±3 kg m−2 , age : 49±9 years ) poorly controlled patients with T2D ( HbA1c ( glycated hemoglobin ) : 9.7±2 % ) were r and omized to IMT , IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline , 12 , and 24 months for evaluation of AG suppression ( postpr and ial minus fasting ) and beta-cell function ( oral disposition index ; glucose-stimulated insulin secretion × Matsuda index ) . Total/ and roid body fat ( dual-energy X-ray absorptiometry ) was also assessed . Results : RYGB and SG reduced body fat comparably ( 15–23 kg ) at 12 and 24 months , whereas IMT had no effect . Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months ( P<0.001 ) . However , there was no difference in insulin secretion between SG vs IMT at 24 months ( P=0.32 ) . Fasting AG was reduced fourfold following SG ( P<0.01 ) and did not change with RYGB or IMT at 24 months . AG suppression improved more following RYGB than SG or IMT at 24 months ( P=0.01 vs SG , P=0.07 vs IMT ) . At 24 months , AG suppression was associated with increased postpr and ial glucagon-like peptide-1 ( r=−0.32 , P<0.02 ) and decreased and roid fat ( r=0.38 ; P<0.006 ) . Conclusions : Enhanced AG suppression persists for up to 2 years after RYGB , and this effect is associated with decreased and roid obesity and improved insulin secretion . Together , these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients . Objective . This controlled , clinical trial with a two-year intervention was aim ed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery , on body weight changes and metabolic parameters in morbidly obese patients . Methods . Patients were r and omized to an Intensive Lifestyle Intervention ( ILI ) ( n = 60 ) or Conventional Obesity Therapy ( COT ) ( n = 46 ) . The ILI group received behavioral therapy and nutritional counseling . The COT group received st and ard medical treatment . They were compared with a third group , Surgical Obesity Group ( SOG ) ( n = 37 ) . Results . Patients who received ILI had a greater percentage of weight loss than patients receiving COT ( −11.3 % versus −1.6 % ; p < 0.0044 ) . Interestingly 31.4 % of patients included in the ILI group were no longer morbidly obese after just six months of intervention , increasing to 44.4 % after 24 months of intervention . The percentage weight loss in SOG was −29.6 % after that same period of time . Conclusions . ILI was associated with significant weight loss when compared to COT , in a group of patients with obesity .  An ILI approach could be an alternative therapy to patients with obesity , who are not c and i date s to undergo bariatric surgery . This trial is registered with EudraCT 2009 - 013737 - 24 Objective This report documents that the gastric bypass operation provides long-term control for obesity and diabetes .  Summary Background Data Obesity and diabetes , both notoriously resistant to medical therapy , continue to be two of 
    Output:
    