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Bariatric Procedure vs. Intensive Medical Therapy (IMT)

The study evaluated the effects of a combination of bariatric procedure with intensive medical therapy (IMT) versus intensive medical therapy alone based on beta cell function and body composition…. 

Sixty participants with uncontrolled type 2 diabetes (HbA1c 9.7+/- 1%, BMI 36+/-2 kg/m2) were randomized to either roux-en-y gastric bypass and IMT, sleeve gastrectomy and IMT, or IMT alone. Body composition and B-cell function were assessed at baseline, 12, and 24 months.

The results showed improvements in HbA1c level in all three groups with a mean HbA1c of 6.7+/-1.2%, 7.1+/-0.8%, and 8.4+/-2.3% for roux-en-y gastric bypass plus IMT, sleeve gastrectomy plus IMT, and IMT alone respectively. Insulin sensitivity increased roughly three times more in gastric bypass compared to sleeve gastrectomy and IMT. Beta cell function also significantly increased approximately six times in gastric bypass from baseline. However, there was no significant difference between sleeve gastrectomy plus IMT and IMT alone in beta cell function. Body composition improved in both bariatric surgeries with greater reduction in truncal fat in gastric bypass compared with sleeve gastrectomy.

In conclusion, bariatric surgery plus IMT are more likely to achieved HbA1c levels of 6% compared to IMT alone. Furthermore, patients with roux-en-y gastric bypass surgery have proved to have more constant and lasting glycemic control compared with patients with sleeve gastrectomy despite the durable weight loss in both bariatric surgeries.

Kashyap SR, Bhatt DL, Wolski K, et al. Metabolic Effects of Bariatric Surgery in Patients With Moderate Obesity and Type 2 Diabetes: Analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes Care. 2013 Aug;36(8):2175-82