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: OBJECTIVE To prospect ively examine the effect of weight loss 1 year after  laparoscopic adjustable gastric b and surgery on a broad range of health outcomes in 50 diabetic subjects . RESEARCH DESIGN AND METHODS A total of 50 ( 17 men , 33 women ) of 51 patients with type 2 diabetes , from a total of 500 consecutive patients , were studied preoperatively and again 1 year after surgery . RESULTS Preoperative weight and BMI ( means + /- SD ) were 137 + /- 30 kg and 48.2 + /- 8 kg/m(2 ) , respectively ; at 1 year , weight and BMI were 110 + /- 24 kg and 38.7 + /- 6 kg/m(2 ) , respectively . There was significant improvement in all measures of glucose metabolism . Remission of diabetes occurred in 32 patients ( 64 % ) , and major improvement of glucose control occurred in 13 patients ( 26 % ) ; glucose metabolism was unchanged in 5 patients ( 10 % ) . HbA(1c ) was 7.8 + /- 3.2 % preoperatively and 6.2 + /- 2.7 % at 1 year ( P < 0.001 ) . Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes ( pseudo r(2 ) = 0.44 , P < 0.001 ) . Improvement in diabetes was related to increased insulin sensitivity and beta-cell function . Weight loss was associated with significant improvements in fasting triglyceride level , HDL cholesterol level , hypertension , sleep , depression , appearance evaluation , and health-related quality of life . Early complications occurred in 6 % of patients ( wound infections in 4 % , respiratory support in 2 % ) , and late complications occurred in 30 % of patients ( gastric prolapse in 20 % , b and erosion in 6 % , and tubing leaks in 4 % ) . All late complications were successfully revised surgically . CONCLUSIONS Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes . Surgery should be considered as an early intervention BACKGROUND A very-low-energy diet ( VLED ) can result in substantial , rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity . Despite its growing popularity , a VLED in this setting has received little attention . OBJECTIVE The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED . DESIGN In a prospect i ve observational study , 32 subjects ( n = 19 men and 13 women ) with a mean ( + /-SD ) age of 47.5 + /- 8.3 y and a body mass index ( in kg/m(2 ) ) of 47.3 + /- 5.3 consumed a VLED for 12 wk . Primary outcomes included changes in liver volume ( LV ) and in visceral and subcutaneous adipose tissue ( VAT/SAT ) . Changes in body weight , anthropometric measures , and biochemical variables were also recorded , and compliance with , acceptability of , and side effects of treatment were assessed . Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2 , 4 , 8 , and 12 . RESULTS Mean ( + /-SD ) LV , VAT/SAT , and body weight decreased significantly ( P < 0.001 for all ) . The degree of LV reduction was directly related to the reduction in relative body weight ( r = 0.54 , P = 0.001 ) and initial LV ( r = 0.43 , P = 0.015 ) . Eighty percent of the reduction in LV occurred between weeks 0 and 2 ( P < 0.001 ) . Reductions in body weight and VAT were uniform over the 12-wk period . Attrition was 14 % . Acceptability was adequate but waned over time , and mild transitory side effects occurred . CONCLUSIONS Given the observed early reduction in LV and the progressive reduction in VAT , we suggest that the minimum duration for a preoperative VLED be 2 wk . Ideally , the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability BACKGROUND Gastric bypass ( GBP ) is the most common operation performed in the United States for morbid obesity . However , weight loss is poor in 10 % to 15 % of patients . We sought to determine the independent factors associated with poor weight loss after GBP . DESIGN Prospect i ve cohort study . We examined demographic , operative , and follow-up data by means of multivariate analysis . Variables investigated were age , sex , race , marital and insurance status , initial weight and body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) , comorbidities ( diabetes mellitus , hypertension , joint disease , sleep apnea , hyperlipidemia , and psychiatric disease ) , laparoscopic vs open surgery , gastric pouch area , gastrojejunostomy technique , and alimentary limb length . SETTING University tertiary referral center . PATIENTS All patients at our institution who underwent GBP from January 1 , 2003 , through July 30 , 2006 . MAIN OUTCOME MEASURES Weight loss at 12 months defined as poor ( < or = 40 % excess weight loss ) or good ( > 40 % excess weight loss ) . RESULTS Follow-up data at 12 months were available for 310 of the 361 patients ( 85.9 % ) undergoing GBP  during the study period . Mean preoperative BMI was 52 ( range , 36 - 108 ) . Mean BMI and excess weight loss at follow-up were 34 ( range , 17 - 74 ) and 60 % ( range , 8%-117 % ) , respectively . Thirty-eight patients ( 12.3 % ) had poor weight loss . Of the 4 variables associated with poor weight loss in the univariate analysis ( greater initial weight , diabetes , open approach , and larger pouch size ) , only diabetes ( odds ratio , 3.09 ; 95 % confidence interval , 1.35 - 7.09 [ P = .007 ] ) and larger pouch size ( odds ratio , 2.77;95 % confidence interval , 1.81 - 4.22 [ P < .001 ] ) remained after the multivariate analysis . CONCLUSIONS Gastric bypass results in substantial weight loss in most patients . Diabetes and larger pouch size are independently associated with poor weight loss after GBP OBJECTIVE To assess the cost-effectiveness of Roux-en-Y gastric bypass for treating  type 2 diabetes mellitus ( T2DM ) in the United States compared with st and ard medical management , using clinical data from a prospect i ve observational study conducted at an academic medical center . STUDY DESIGN Our study used a predictive health economic model ( the CORE Diabetes Model ) to project the long-term costs and clinical effectiveness of Roux-en-Y gastric bypass as a treatment for T2DM using the prospect i ve observational study as the basis for our clinical effectiveness assumptions . METHODS The CORE Diabetes Model used Monte Carlo simulation with tracker variables to estimate the lifetime costs and clinical outcomes of Roux-en-Y gastric bypass compared with st and ard medical management of obese T2DM patients . Sensitivity analyses were performed on key clinical assumptions , discount rates , and shorter time horizons . RESULTS The base-case scenario yielded an incremental cost-effectiveness ratio ( ICER ) of $ 21,973 per quality -adjusted life-year ( QALY ) gained . In sensitivity analyses , shortening the time horizon to 5 and 10 years and excluding the negative impact of increased body mass index on the patient 's quality of life had the greatest adverse impact on the ICERs ( ie , higher cost per QALY ) . CONCLUSIONS Under base-case assumptions , Roux-en-Y gastric bypass is cost-effective in the treatment of T2DM in the United States with an ICER below $ 50,000 per QALY gained . Sensitivity analyses indicated that bariatric surgery is not cost-effective over shorter time horizons , or if the negative quality -of-life impact of increased body mass index is ignored 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 our most common and serious diseases . Methods Over the last 14 years , 608 morbidly obese patients underwent gastric bypass  , an operation that restricts caloric intake by ( 1 ) reducing the functional stomach to approximately 30 mL , ( 2 ) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet , and ( 3 ) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy . Even though many of the patients were seriously ill , the operation was performed with a perioperative mortality and complication rate of 1.5 % and 8.5 % , respectively . Seventeen of the 608 patients ( <3 % ) were lost to follow-up . Results Gastric bypass provides durable weight control . Weights fell from a preoperative mean of 304.4 lb ( range , 198 to 615 lb ) to 192.2 lb ( range , 104 to 466 ) by 1 year and were maintained at 205.4 lb ( range , 107 to 512 lb ) at 5 years , 206.5 lb ( 130 to 388 lb ) at 10 years , and 204.7 lb ( 158 to 270 lb ) at 14 years . The operation provides long-term control of non-insulin-dependent diabetes mellitus ( NIDDM ) . In those patients with adequate follow-up , 121 of 146 patients ( 82.9 % ) with NIDDM and 150 of 152 patients ( 98.7 % ) with glucose impairment maintained normal levels of plasma glucose , glycosylated hemoglobin , and insulin . These antidiabetic effects appear to be due primarily to a reduction in caloric intake , suggesting that insulin resistance is a secondary protective effect rather than the initial lesion . In addition to the control of weight and NIDDM , gastric bypass also corrected or alleviated a number of other comorbidities of obesity , including hypertension , sleep apnea , cardiopulmonary failure , arthritis , and infertility Aims /hypothesisBoth energy restriction ( ER ) per se and weight loss improve glucose metabolism in obese insulin-treated type 2 diabetic patients . Short-term ER decreases basal endogenous glucose production ( EGP ) but not glucose disposal . In contrast the blood glucose-lowering mechanism of long-term ER with substantial weight loss has not been fully eluci date d. The aim of this study was to investigate the effect of loss of 50 % of excess weight [ 50 % excess weight reduction ( EWR ) ] on EGP , whole-body insulin sensitivity and the disturbed myocellular insulin-signalling pathway in ten obese insulin-treated type 2 diabetic patients . Methods A euglycaemic – hyperinsulinaemic clamp with stable isotopes ( [6,6 - 2H2]glucose and [2H5]glycerol ) combined with skeletal muscle biopsies was performed during a very low energy diet ( VLED ; 1,883 kJ/day ) on day 2 and again after 50 % EWR . Oral blood glucose-lowering agents and insulin were discontinued 3 weeks prior to the VLED and at the start of the VLED , respectively . Results Loss of 50 % EWR ( 20.3 ± 2.2 kg from day 2 to day of 50 % EWR ) normalised basal EGP and improved insulin sensitivity , especially insulin-stimulated glucose disposal ( 18.8 ± 2.0 to 39.1 ± 2.8 μmol kg fat-free mass−1 min−1 , p = 0.001 ) . The latter was accompanied by improved insulin signalling at the level of the recently discovered protein kinase B/Akt substrates AS160 and PRAS40 along with a decrease in intramyocellular lipid ( IMCL ) content . Conclusions /interpretationConsiderable weight loss in obese , insulin-treated type 2 diabetic patients normalises basal EGP and improves insulin sensitivity result ing from an improvement in insulin signal transduction in skeletal muscle . The decrease in IMCL might contribute to this effect Background : Biliopancreatic diversion with duodenal switch ( BPD-DS ) is an operation which provides one of the greatest maintained weight losses of any bariatric procedure . We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity . Methods : A 150 - 200 ml sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum . The median length of the common channel was 100 cm . All patients were prospect ively followed up to 12 months . Results : 40 consecutive patients underwent laparoscop 
    Output:
    
agent
Bariatric surgery leads to marked and long-lasting weight reduction .
A large proportion of patients undergoing bariatric surgery have DM2 .
Glycemic control improves in the months after laparoscopic adjustable gastric b and ing , but it improves more rapidly and completely after laparoscopic Roux-en-Y gastric bypass surgery .
Thus , both types of surgery are capable of improving or even curing DM2 , but the mechanisms may differ
***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: OBJECTIVE To prospect ively examine the effect of weight loss 1 year after  laparoscopic adjustable gastric b and surgery on a broad range of health outcomes in 50 diabetic subjects . RESEARCH DESIGN AND METHODS A total of 50 ( 17 men , 33 women ) of 51 patients with type 2 diabetes , from a total of 500 consecutive patients , were studied preoperatively and again 1 year after surgery . RESULTS Preoperative weight and BMI ( means + /- SD ) were 137 + /- 30 kg and 48.2 + /- 8 kg/m(2 ) , respectively ; at 1 year , weight and BMI were 110 + /- 24 kg and 38.7 + /- 6 kg/m(2 ) , respectively . There was significant improvement in all measures of glucose metabolism . Remission of diabetes occurred in 32 patients ( 64 % ) , and major improvement of glucose control occurred in 13 patients ( 26 % ) ; glucose metabolism was unchanged in 5 patients ( 10 % ) . HbA(1c ) was 7.8 + /- 3.2 % preoperatively and 6.2 + /- 2.7 % at 1 year ( P < 0.001 ) . Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes ( pseudo r(2 ) = 0.44 , P < 0.001 ) . Improvement in diabetes was related to increased insulin sensitivity and beta-cell function . Weight loss was associated with significant improvements in fasting triglyceride level , HDL cholesterol level , hypertension , sleep , depression , appearance evaluation , and health-related quality of life . Early complications occurred in 6 % of patients ( wound infections in 4 % , respiratory support in 2 % ) , and late complications occurred in 30 % of patients ( gastric prolapse in 20 % , b and erosion in 6 % , and tubing leaks in 4 % ) . All late complications were successfully revised surgically . CONCLUSIONS Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes . Surgery should be considered as an early intervention BACKGROUND A very-low-energy diet ( VLED ) can result in substantial , rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity . Despite its growing popularity , a VLED in this setting has received little attention . OBJECTIVE The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED . DESIGN In a prospect i ve observational study , 32 subjects ( n = 19 men and 13 women ) with a mean ( + /-SD ) age of 47.5 + /- 8.3 y and a body mass index ( in kg/m(2 ) ) of 47.3 + /- 5.3 consumed a VLED for 12 wk . Primary outcomes included changes in liver volume ( LV ) and in visceral and subcutaneous adipose tissue ( VAT/SAT ) . Changes in body weight , anthropometric measures , and biochemical variables were also recorded , and compliance with , acceptability of , and side effects of treatment were assessed . Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2 , 4 , 8 , and 12 . RESULTS Mean ( + /-SD ) LV , VAT/SAT , and body weight decreased significantly ( P < 0.001 for all ) . The degree of LV reduction was directly related to the reduction in relative body weight ( r = 0.54 , P = 0.001 ) and initial LV ( r = 0.43 , P = 0.015 ) . Eighty percent of the reduction in LV occurred between weeks 0 and 2 ( P < 0.001 ) . Reductions in body weight and VAT were uniform over the 12-wk period . Attrition was 14 % . Acceptability was adequate but waned over time , and mild transitory side effects occurred . CONCLUSIONS Given the observed early reduction in LV and the progressive reduction in VAT , we suggest that the minimum duration for a preoperative VLED be 2 wk . Ideally , the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability BACKGROUND Gastric bypass ( GBP ) is the most common operation performed in the United States for morbid obesity . However , weight loss is poor in 10 % to 15 % of patients . We sought to determine the independent factors associated with poor weight loss after GBP . DESIGN Prospect i ve cohort study . We examined demographic , operative , and follow-up data by means of multivariate analysis . Variables investigated were age , sex , race , marital and insurance status , initial weight and body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) , comorbidities ( diabetes mellitus , hypertension , joint disease , sleep apnea , hyperlipidemia , and psychiatric disease ) , laparoscopic vs open surgery , gastric pouch area , gastrojejunostomy technique , and alimentary limb length . SETTING University tertiary referral center . PATIENTS All patients at our institution who underwent GBP from January 1 , 2003 , through July 30 , 2006 . MAIN OUTCOME MEASURES Weight loss at 12 months defined as poor ( < or = 40 % excess weight loss ) or good ( > 40 % excess weight loss ) . RESULTS Follow-up data at 12 months were available for 310 of the 361 patients ( 85.9 % ) undergoing GBP  during the study period . Mean preoperative BMI was 52 ( range , 36 - 108 ) . Mean BMI and excess weight loss at follow-up were 34 ( range , 17 - 74 ) and 60 % ( range , 8%-117 % ) , respectively . Thirty-eight patients ( 12.3 % ) had poor weight loss . Of the 4 variables associated with poor weight loss in the univariate analysis ( greater initial weight , diabetes , open approach , and larger pouch size ) , only diabetes ( odds ratio , 3.09 ; 95 % confidence interval , 1.35 - 7.09 [ P = .007 ] ) and larger pouch size ( odds ratio , 2.77;95 % confidence interval , 1.81 - 4.22 [ P < .001 ] ) remained after the multivariate analysis . CONCLUSIONS Gastric bypass results in substantial weight loss in most patients . Diabetes and larger pouch size are independently associated with poor weight loss after GBP OBJECTIVE To assess the cost-effectiveness of Roux-en-Y gastric bypass for treating  type 2 diabetes mellitus ( T2DM ) in the United States compared with st and ard medical management , using clinical data from a prospect i ve observational study conducted at an academic medical center . STUDY DESIGN Our study used a predictive health economic model ( the CORE Diabetes Model ) to project the long-term costs and clinical effectiveness of Roux-en-Y gastric bypass as a treatment for T2DM using the prospect i ve observational study as the basis for our clinical effectiveness assumptions . METHODS The CORE Diabetes Model used Monte Carlo simulation with tracker variables to estimate the lifetime costs and clinical outcomes of Roux-en-Y gastric bypass compared with st and ard medical management of obese T2DM patients . Sensitivity analyses were performed on key clinical assumptions , discount rates , and shorter time horizons . RESULTS The base-case scenario yielded an incremental cost-effectiveness ratio ( ICER ) of $ 21,973 per quality -adjusted life-year ( QALY ) gained . In sensitivity analyses , shortening the time horizon to 5 and 10 years and excluding the negative impact of increased body mass index on the patient 's quality of life had the greatest adverse impact on the ICERs ( ie , higher cost per QALY ) . CONCLUSIONS Under base-case assumptions , Roux-en-Y gastric bypass is cost-effective in the treatment of T2DM in the United States with an ICER below $ 50,000 per QALY gained . Sensitivity analyses indicated that bariatric surgery is not cost-effective over shorter time horizons , or if the negative quality -of-life impact of increased body mass index is ignored 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 our most common and serious diseases . Methods Over the last 14 years , 608 morbidly obese patients underwent gastric bypass  , an operation that restricts caloric intake by ( 1 ) reducing the functional stomach to approximately 30 mL , ( 2 ) delaying gastric emptying with a c. 0.8 to 1.0 cm gastric outlet , and ( 3 ) excluding foregut with a 40 to 60 cm Roux-en-Y gastrojejunostomy . Even though many of the patients were seriously ill , the operation was performed with a perioperative mortality and complication rate of 1.5 % and 8.5 % , respectively . Seventeen of the 608 patients ( <3 % ) were lost to follow-up . Results Gastric bypass provides durable weight control . Weights fell from a preoperative mean of 304.4 lb ( range , 198 to 615 lb ) to 192.2 lb ( range , 104 to 466 ) by 1 year and were maintained at 205.4 lb ( range , 107 to 512 lb ) at 5 years , 206.5 lb ( 130 to 388 lb ) at 10 years , and 204.7 lb ( 158 to 270 lb ) at 14 years . The operation provides long-term control of non-insulin-dependent diabetes mellitus ( NIDDM ) . In those patients with adequate follow-up , 121 of 146 patients ( 82.9 % ) with NIDDM and 150 of 152 patients ( 98.7 % ) with glucose impairment maintained normal levels of plasma glucose , glycosylated hemoglobin , and insulin . These antidiabetic effects appear to be due primarily to a reduction in caloric intake , suggesting that insulin resistance is a secondary protective effect rather than the initial lesion . In addition to the control of weight and NIDDM , gastric bypass also corrected or alleviated a number of other comorbidities of obesity , including hypertension , sleep apnea , cardiopulmonary failure , arthritis , and infertility Aims /hypothesisBoth energy restriction ( ER ) per se and weight loss improve glucose metabolism in obese insulin-treated type 2 diabetic patients . Short-term ER decreases basal endogenous glucose production ( EGP ) but not glucose disposal . In contrast the blood glucose-lowering mechanism of long-term ER with substantial weight loss has not been fully eluci date d. The aim of this study was to investigate the effect of loss of 50 % of excess weight [ 50 % excess weight reduction ( EWR ) ] on EGP , whole-body insulin sensitivity and the disturbed myocellular insulin-signalling pathway in ten obese insulin-treated type 2 diabetic patients . Methods A euglycaemic – hyperinsulinaemic clamp with stable isotopes ( [6,6 - 2H2]glucose and [2H5]glycerol ) combined with skeletal muscle biopsies was performed during a very low energy diet ( VLED ; 1,883 kJ/day ) on day 2 and again after 50 % EWR . Oral blood glucose-lowering agents and insulin were discontinued 3 weeks prior to the VLED and at the start of the VLED , respectively . Results Loss of 50 % EWR ( 20.3 ± 2.2 kg from day 2 to day of 50 % EWR ) normalised basal EGP and improved insulin sensitivity , especially insulin-stimulated glucose disposal ( 18.8 ± 2.0 to 39.1 ± 2.8 μmol kg fat-free mass−1 min−1 , p = 0.001 ) . The latter was accompanied by improved insulin signalling at the level of the recently discovered protein kinase B/Akt substrates AS160 and PRAS40 along with a decrease in intramyocellular lipid ( IMCL ) content . Conclusions /interpretationConsiderable weight loss in obese , insulin-treated type 2 diabetic patients normalises basal EGP and improves insulin sensitivity result ing from an improvement in insulin signal transduction in skeletal muscle . The decrease in IMCL might contribute to this effect Background : Biliopancreatic diversion with duodenal switch ( BPD-DS ) is an operation which provides one of the greatest maintained weight losses of any bariatric procedure . We looked at the safety and efficacy of laparoscopic BPD-DS for morbid obesity . Methods : A 150 - 200 ml sleeve gastrectomy was created and anastomosed to the distal 250 cm of divided ileum . The median length of the common channel was 100 cm . All patients were prospect ively followed up to 12 months . Results : 40 consecutive patients underwent laparoscop 
    Output:
    