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W przypadku wskazań do farmakoterapii, tj. niepowodzenia zmiany trybu życia, jedynym lekiem pozostaje metformina. W celu potwierdzenia insulinooporności w historii choroby wskazane wydaje się zapisanie jej pośrednich markerów: wysoki TG, niski HDL, rozpoznania nadciśnienia, wartość WC czy BMI. Jedynie u młodych osób, u których nie stwierdzono powyższych zaburzeń, należy wyliczyć HOMA-IR, jeśli stężenie glukozy na czczo nie wskazuje na nieprawidłową glikemię na czczo (IFG – impaired fasting glycaemia). Jeżeli potwierdzono jakiekolwiek zaburzenia gospodarki cukrowej, oznaczenie stężenia insuliny dla potwierdzenia IR nie jest według mnie potrzebne.
Nie udowodniono korzyści ze stosowania metforminy czy tiazolidynodionów na zmniejszenie ryzyka sercowo-naczyniowego u osób zdrowych. Uwzględniając mechanizmy powstawania insulinooporności oraz wpływ zbilansowanej diety o niskim IG (najchętniej śródziemnomorskiej) i wysiłku fizycznego na nadciśnienie, profil lipidowy czy wrażliwość mięśni na insulinę, zalecenia te nie powinny budzić wątpliwości. Muszą być podstawą konsultacji medycznej u każdego pacjenta niezależnie od wyników badań w kierunku insulinooporności.
Appropriate diagnostic work-up for insulin resistance – to treat or not to treat, and how?
Abstract
The main targets for insulin are muscles, adipose tissue and liver; therefore, obesity associated with an unhealthy diet, liver steatosis and a sedentary lifestyle is often considered synonymous with insulin resistance. In the presence of excess adipose tissue, cells mute insulin signals and interfere with physiological functioning of the hormone. This disturbed signaling results in a rise in lipid and glucose levels while increased concentration of insulin additionally leads to increases in blood pressure and uric acid concentration. As a result of our lack of ability to directly measure insulin sensitivity in everyday medical practice, as well as the lack of standardized criteria for insulin resistance assessment using insulin concentration values, the use of indirect diagnostic methods appears appropriate. Bearing in mind the pathophysiology of the most common type of hyperinsulinism, the markers of this disorder seem to be as follows: high (at least 130 mg%), triglyceride concentration, increased TG/HDL ( >3) ratio and at least overweight and/or increased waist circumference. Additional value is provided by confirmation of increased blood pressure as well as increased concentration of uric acid. In normostenic patients with waist circumference in the normal range, besides the above biochemical markers, the concentration of fasting glucose and insulin levels can be additionally assessed for the purpose of calculating the HOMA-IR index.
Because of confirmed benefits of behavioral intervention, every patient should be educated about healthy lifestyle, regardless of whether any traits of hyperinsulinism are present. This decreases the future risk of developing diabetes and cardiovascular disease. If behavioral treatment (exercise, diet) is ineffective, metformin therapy can be introduced when there is a high probability of insulin resistance. The treatment of insulin resistance includes the correction of each confirmed disturbance (obesity, hypertension, lipid disorders). In cases of excessive body mass, it is important to consider increasingly popular modern treatment methods, such as metabolic surgery.
Piśmiennictwo
1. Sieradzki J. Zespół metaboliczny – zespół insulinooporności. W: Cukrzyca, t. 1 (red. Sieradzki J). Gdańsk: Via Medica, 2006:269-81.
2. Lillioja S, Mott DM, Zawadzki JK, et al. In vivo insulin action is a familiar characteristic in nondiabetic Pima Indians. Diabetes 1987;36:1329-35.
3. Zoratti R, Godsland IF, Chaturvedi N, et al. Relation of plasma lipids to insulin resistance, nonesterified fatty acids, and body fat in men from three ethnic groups: relevance to variations in risk of diabetes and coronary artery disease. Metabolism 2000;49:245-52.
4. Yeni-Komshian H, Carantoni M, Abbasi F, et al. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 2000;23(2):171-5.
5. Bergman RN, Ader M. Free fatty acids and pathogenesis of type 2 diabetes mellitus. Trends Endocrinol Metab 2000;11(9):351-6.
6. Abbasi F, Brown BW Jr, Lamendola C, et al. Relationship between obesity, insulin resistance, and coronary heart disease risk. J Am Coll Cardiol 2002;40(5):937-43.
7. Facchini F, Chen YD, Hollenbeck CB, et al. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 1991;266(21):3008-11.
8. Reaven GM. The kidney: an unwilling accomplice in syndrome X. Am J Kidney Dis 1997;30:928-31.
9. Arnlov J, Pencina MJ, Nam BH, et al. Relations of insulin sensitivity to longitudinal blood pressure tracking: variations with baseline age, body mass index, and blood pressure. Circulation 2005;112(12):1719-27.
10. Facchini FS, Stoohs RA, Reaven GM. Enhanced sympathetic nervous system activity. The linchpin between insulin resistance, hyperinsulinemia, and heart rate. Am J Hypertens 1996;9:1013-7.
11. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities-the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996;334:374-81.
12. Reaven G. Insulin resistance and coronary heart disease in nondiabetic individuals. Arterioscler Thromb Vasc Biol 2012;32:1754-9.
13. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 1979;237(3): E214-23.
14. Muniyappa R, Lee S, Chen H, et al. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab 2008;294(1):E15-26.
15. Matthews DR, Hooker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9.
16. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modelling. Diabetes Care 2004;27(6):1487-95.
17. Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000;85(7):2402-10.
18. Reaven GM. Why Syndrome X? From Harold Himsworth to the insulin resistance syndrome. Cell Metabolism 2005;1:9-14.
19. Robins SJ, Lass A, Zachariah JP, et al. Insulin resistance and the relation of dyslipidemia to coronary hart disease: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2011;31:1208-14.
20. Reaven G. Wanted! A standardized measurement of plasma insulin concentration. Arterioscler Thromb Vasc Biol 2011;31:954-5.
21. Xun P, Liu K, Cao W, et al. Fasting insulin level is positively associated with incidence of hypertension among American young adults: a 20-year follow-up study. Diabetes Care 2012;35(7):1532-7.
22. Arshi B, Tohidi M, Derakhshan A, et al. Sex-specific relations between fasting insulin, insulin resistance and incident hypertension: 8.9 years follow-up in a Middle-Eastern population. J Hum Hypertens 2015;29:260-7.
23. Mykkänen L, Laakso M, Pyörälä K. High plasma insulin level associated with coronary hart disease in the elderly. Am J Epidemiol 1993;137(11):1190-202.
24. Perry IJ, Wannamethee SG, Whincup PH, et al. Serum insulin and incident coronary heart disease in middle-aged British men. Am J Epidemiol 1996;144(3):224-34.
25. Fontbonne AM, Eschwege EM. Insulin and cardiovascular disease: Paris Prospective Study. Diabetes Care 1991;14:461-9.
26. Fontbonne AM, Charles MA, Thibault N, et al. Hyperinsulinemia as a predictor of coronary heart disease mortality in a healthy population: The Paris Prospective Study, 15-year follow up. Diabetologia 1991;34:356-61.
27. Pyörälä K. Relationship of glucose tolerance and plasma insulin to the incidence of coronary hart disease: result from two population studies in Finland. Diabetes Care 1979;2:131-41.
28. Pyörälä K, Savolainen K, Kaukola S, et al. Plasma insulin as coronary heart disease risk factor: relationship to other risk factors and predictive value during 9 ½ year follow-up of the Helsinki Policemen Study population. Acta Med Scand 1985;701(suppl):38-52.
29. Stout RW. Insulin and atheroma. 20-yr perspective. Diabetes Care 1990;13:631-54.
30. Yarnell JW, Sweetnam PM, Marks V, et al. Insulin in ischemic heart disease: are associations explained by triglyceride concentrations? The Caerphilly prospective study. Br Heart J 1994;71:293-6.
31. emedicine.medscape.com/article/2089224-overview. Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Textbook of Endocrinology 12th ed. Philadelphia: Elsevier Saunders, 2011.
32. McLaughlin T, Abbasi F, Cheal K, et al. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med 2003;139(10):802-9.
33. Gast KB, Tjeerdema N, Stijnen T, et al. Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis. PloS ONE 2012;7:e52036.
34. Bogardus C, Lillioja S, Mott DM, et al. Relationship between degree of obesity and in vivo insulin action in man. Am J Physiol 1985;248 (3 Pt 1):E286-91.
35. Olefsky JM., Kolterman OG, Scarlett JA. Insulin action and resistance in obesity and noninsulin-dependent type II diabetes mellitus. Am J Physiol 1982;243:E15-30.
36. Kolterman OG, Insel J, Saekow M, et al. Mechanisms of insulin resistance in human obesity. Evidence for receptor and postreceptor defects. J Clin Invest 1980;65:1272-84.
37. DeFronzo RA. Insulin secretion, insulin resistance, and obesity. Int J Obes 1982;6(Suppl.1):73-82.
38. Amati F, Pendant M, Azuma K, et al. Lower thigh subcutaneous and higher visceral abdominal tissue content both contribute to insulin resistance. Obesity 2012;20(5):1115-7.
39. McLaughlin T, Lamendola C, Liu A, et al. Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity. J Clin Endocrinol Metabol 2011;96(11):E1756-60.
40. Reaven GM, Lerner RL, Stern MP, et al. Role of insulin in endogenous hypertriglyceridemia. J Clin Invest 1967;46:1756-67.
41. Ferrannini E, Natali A, Bell P, et al. Insulin resistance and hypersecretion in obesity. European Group for the Study of Insulin resistance (EGIR). J Clin Invest 1997;100:1166-73.
42. Farin HM, Abbasi F, Reaven GM. Body mass index and waist circumference both contribute to differences in insulin-mediated glucose disposal in nondiabetic adults. Am J Clin Nutr 2006;83:47-51.
43. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5.
44. Farin HM, Abbasi F, Reaven GM. Comparison of body mass index versus waist circumference with the metabolic changes that increase the risk of cardiovascular disease in insulin-resistant individuals. Am J Cardiol 2006;98:1053-6.
45. Lee J, Ma S, Heng D, et al. Should central obesity be an optional or essential component of the metabolic syndrome? Diabetes Care 2007;30:343-7.
46. Olefsky JM, Farquhar JW, Reaven GM. Reappraisal of the role of insulin in hypertiglyceridemia. Am J Med 1974;57:551-60.
47. Tobey TA, Greenfield M, Kraemer F. Relationship between insulin resistance, insulin secretion, very low density lipoprotein kinetics, and plasma triglyceride levels in normotriglyceridemic man. Metabolism 1981;30(2):165-71.
48. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607.
49. Jeppesen J, Hollenbeck CB, Zhou MY, et al. Relation between insulin resistance, hyperinsulinemia, postheparin plasma lipoprotein lipase activity, and postprandial lipemia. Arterioscler Throm Vasc Biol 1995;15:320-4.
50. Kim HS, Abbasi F, Lamendola C, et al. Effect of insulinresistance on postprandial elevations of remnant lipoprotein concentrations in postmenopausal women. Am J Clin Nutr 2001;74:592-5.
51. Reaven GM, Greenfield MS. Diabetic hypertriglicerydemia: evidence for three clinical syndromes. Diabetes 1981;30(Suppl 2):66-75.
52. Lewis GF. Fatty acid regulation of very low density lipoprotein production. Curr Opin Lipidol 1997;8:146-53.
53. Austin MA, Breslow JL, Hennekens Chet, et al. Low-density lipoprotein subclass patterns and risk of myocardial infarction. JAMA 1988;260:1917-21.
54. Laws A, Reaven GM. Evidence for an independent relationship between insulin resistance and casting plasma HDL-cholesterol, triglyceride and insulin concentrations. J Intern Med 1992;231:25-30.
55. Swenson TL. The role of the cholesteryl ester transfer protein in lipoprotein metabolism. Diabetes Metab Rev 1991;7:139-53.
56. Brinton EA, Eisenberg S, Breslow JL. Human HDL cholesterol levels are determined by apoA-I fractional catabolic rate, which correlates inversely with estimates of HDL particle size. Effects of gender, hepatic and lipoprotein lipases, triglyceride and insulin levels, and body fat distribution Arterioscler Thromb 1994;14:707-20.
57. McLaughlin T, Reaven GM, Abbasi F, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005;96:399-404.
58. Lemieux I, Pascot A, Couillard C, et al. Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men? Circulation 2000;102:179-84.
59. Zavaroni I, Bonora E, Pagliara M, et al. Risk factors for coronary artery disease in healthy persons with hyperinsulinemia and normal glucose tolerance. N Engl J Med 1989;320:702-6.
60. Kim SH, Abbasi F, Reaven GM. Impact of degree of obesity on surrogate estimates of insulin resistance. Diabetes Care 2004;27:1998-2002.
61. Sattar N, McConnachie A, Sharper AG, et al. Can metabolic syndrome predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 2008;371:1927-35.
62. Cameron AJ, Magliano DJ, Zimmet PZ, et al. The metabolic syndrome as a tool for predicting future diabetes. J Intern Med 2008;264:177-86.
63. Wilson PW, D’Agostino RB, Parise H, et al. Metabolic syndrome as a predictor of cardiovascular disease and type 2 diabetes. Circulation 2005;112:3066-72.
64. Eddy DM, Schlessinger L, Heikes K. The metabolic syndrome and cardiovascular risk. Implication for clinical practice. Int J Obes 2008;32(Suppl 2):S5-10.
65. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 2006;444:840-6.
66. Muoio DM, Newgard CB. Mechanisms of disease: molecular and metabolic mechanisms of insulin resistance and beta-cell failure in type 2 diabetes. Nat Rev Mol Cell Biol 2008;9:193-205.
67. Facchini FS, Riccard A, Stoohs A, et al. Enhanced sympathetic nervous system activity. The linchpin between insulin resistance, hyperinsulinemia, and hart rate. Am J Hypertens 1996;9:1013-7.
68. Lima NK, Abbasi F, Lamendola C, et al. Prevalence of insulin resistance and related risk factors for cardiovascular disease in patients with essential hypertension. Am J Hypertens 2009;22:106-11.
69. Skarfors ET, Lithell HO, Selinus I. Risk Factory for The development of hypertension: a 10-year longitudinal study in middle-aged men. J Hypertension 1991;9:217-23.
70. Lissner L, Bengtsson C, Lapidus L, et al. Fasting insulin in relation to subsequent blond pressure changes and hypertension in women. Hypertension 1992;20:797-80.
71. Taittonen L, Uhari M, Nuutinen M, et al. Insulin and blood pressure among healthy children. Cardiovascular risk in young Finns. Am J Hypertens 1996;9:193-9.
72. Liu HY, Hong T, Wen GB, et al. Increased basal level of Akt-dependent insulin signalling May be responsible for the development of insulin resistance. Am J Physiol Endocrinol Metab 2009;297:E898-906.
73. Barnard RJ, Roberts CK, Varon SM, et al. Diet-induced insulin resistance precedes other aspects of the metabolic syndrome. J Appl Physiol 1998;84:1311-5.
74. Brands MW, Hildebrandt DA, Mizelle HL, et al. Sustained hyperinsulinemia increases arterial pressure in conscious rats. Am J Physiol 1991;260:R764-8.
75. Juan CC, Fang VS, Kwok CF, et al. Exogenous hyperinsulinemia causes insulin resistance, hyperendothelinemia, and subsequent hypertension in rats. Metabolism 1999;48:465-71.
76. Wang F, Han L, Hu D. Fasting insulin, insulin resistance and risk of hypertension in the general population: A meta-analysis. Clin Chim Acta 2016;464:57-63.
77. Juhan-Vague I, Thompson SG, Jeppesen J. On behalf of the ECAT Angina Pectoris Study Group. Involvement of the hemostatic system in the insulin resistance syndrome. A study of 1500 patients with angina pectoris. Arterioscler Thromb 1993;13:1864-73.
78. Meigs JB, Middleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglycaemia, and impaired haemostasis: the Framingham Offspring Study JAMA 2000;283:221-8.
79. McLaughlin T, Abbasi F, Lamendola C, et al. Differentiation between obesity and insulin resistance in the association with C-reactive protein. Circulation 2002;106:2908-12.
80. Ingelsson E, Sundstrom J, Arnlov J, et al. Insulin resistance and risk of congestive hart failure. JAMA 2005;294:334-41.
81. Asagami T, Holmes TH, Reaven G. Differential effects of insulin sensitivity in obese women with polycystic ovary syndrome or normal ovulation. Metabolism 2008;57:1355-60.
82. Baillargeon JP, Nestler JE. Polycystic ovary syndrome: A syndrome of ovarian hypersensitivity to insulin. J Clin Endocrinol Metab 2006;91:22-4.
83. Marchesini G, Brizi M, Morselli-Labate AM, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999;107:450-5.
84. Sanyal AJ, Campbell-Sargent C, Mirashi F, et al. Nonalkoholic steatohepatitis: Association of insulin resistance and mitochondrial abnormalities. Gastroenterology 2001;120:1183-92.
85. Ardigo D, Nymeroso F, Valtuena S, et al. Hyperinsulinemia predicts hepatic fat content in healthy individuals with normal transaminase concentrations. Matbolism 2005;54:1566-70.
86. Facchini FS, Hollenbeck CB, Jeppesen J, et al. Insulin resistance and cigarette smoking. Lancet 1992;339:1128-30.
87. Zavaroni I, Bonini L, Gasparini P, et al. Cigarette smokers are relatively glucose intolerant, hyperinsulinemic and dyslipidemic. Am J Cardiol 1994;73:904-5.
88. Ducimetière P, Eschwege E, Papoz L, et al. Relationship of plasma insulin levels to the incidence of myocardial infarction and coronary heart disease in middle-aged population. Diabetologia 1980;19:205-10.
89. Punjabi NM, Beamer BA. Alterations in glucose disposal in sleep-disordered breathing. Am J Resp Crit Care 2009;179:235-40.
90. Van Cauter E. Sleep disturbances and insulin resistance. Diabetic Medicine 2011;28:1455-62.
91. https://www.ncbi.nlm.nih.gov/books/NBK278936/]
92. Despres JP, Lamarche B, Mauriege P, et al. Hyperinsulinemia as an independent risk factor for ischemic hart disease. N Engl J Med 1996;334:952-7.
93. Lempiainen P, Mykkanen, Pyorala K, et al. Insulin resistance syndrome predicts coronary hart disease events in elderly nondiabetic men. Circulation 1999;100:123-8.
94. Pyorala M, Miettinen H, Laakso M, et al. Plasma insulin and all-cause, cardiovascular, and noncardiovascular mortality: The 22-year follow-up results of the Helsinki Policemen Study. Diabetes Care 2000;23:1097-02.
95. Bonora E, Kiechl S, Willeit J, et al. Insulin resistance as estimated by homeostasis model assessment predicts incident symptomatic cardiovascular disease in Caucasian subjects from The general population: the Bruneck Study . Diabetes Care 2007;30:318-24.
96. Robins SJ, Rubins HB, Faas FH, et al. Insulin resistance and cardiovascular events with low HDL cholesterol: the Veterans Affairs HDL Intervention Trial (VA-HIT). Diabetes Care 2003;26:1513-7.
97. Laws A, King AC, Haskell WL, et al. Relation of fasting plasma insulin concentration to high density lipoprotein cholesterol and triglyceride concentrations in men. Arterioscler Thromb 1991;11:1636-42.
98. Xun P, Wu Y, He Q, et al. Fasting insulin concentrations and incidence of hypertension, stroke, and coronary heart disease: a meta-analysis of prospective cohort studies. Am J Clin Nutr 2013;98(6):1543-54.
99. Warram JH, Martin BC, Krolewski AS, et al. Slow glucose removal rate amd hyperinsulinemia precede the development of type 2 diabetes in the offspring of diabetic parents. Ann Intern Med 1990;113:909-15.
100. Boden G, Sargrad K, Homko C, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Inter Med 2005;142(6):403-11.
101. Folsom AR, Jackobs DR Jr, Wagenknecht LE, et al. Increase in casting insulin and glucose over seven years with increasing Wright and inactivity of young adults. The CARDIA Study. Coronary Artery Risk Development in Young Adults. Am J Epidemiol 1996;144:235-46.
102. Johnson ML, Distelmaier K, Lanza IR, et al. Mechanism by which caloric restriction improves insulin sensitivity in sedentary obese adults. Diabetes 2016;65(1):74-84.
103. Dubé JJ, Amati F, Toledo FG, et al. Effects of weight loss and exercise on insulin resistance, and intramyocellular triacylglycerol, diacylglycerol and ceramide. Diabetologia 2011;54:1147-56.
104. Orchard TJ, Temprosa M, Goldberg R, et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005;142:611-9.
105. Smith DO, LeRoith D. Insulin resistance syndrome, pre-diabetes, and the prevention of type 2 diabetes mellitus. Clin Cornerstone 2004;6:7-6.
106. Onat A. Metabolic syndrome: nature, therapeutic solutions and options. Expert Opin Pharmacother 2011;12:1887-1900.
107. Gallagher EJ, Leroith D, Karnieli E. The metabolic syndrome-from insulin resistance to obesity and diabetes. Med Clin North Am 2011; 95:855-73.
108. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52.
109. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. Diabetes Prevention Program Research Group 2002;346(6):393-403.
110. Pi-Sunyer X, Astrup A, Fujioka K, et al. SCALE Obesity and Prediabetes NN8022-1839 Study Group. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med 2015;373:11-22.
111. Astrup A, Carraro R, Finer N, et al. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. Int J Obes (Lond) 2012;36:843-54.
112. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724-37.
113. Sjöholm K, Anveden A, Peltonen M, et al. Evaluation of current eligibility criteria for bariatric surgery: diabetes prevention and risk factor changes in the Swedish obese subjects (SOS) study. Diabetes Care 2013;36(5):1335-40.
114. O’Brien PE, Dixon JB, Laurie C. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 2006;144:625-33.