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Bariatric Surgery More Likely Than Lifestyle Intervention to Induce Type 2 Diabetes Remission

Results from a three-year study show surgical intervention is superior to intensive lifestyle intervention in achieving meaningful, lasting glycemic control in type 2 diabetes…

A study conducted at the University of Pittsburgh Medical Center beginning in October 2009 and concluding in June of 2014 randomized 61 obese patients (BMIs ranged from 30-40) with type 2 diabetes into three groups: one group underwent Roux-en-Y gastric bypass surgery, another underwent laparoscopic gastric sleeve surgery, and the third underwent intensive lifestyle weight loss intervention for one year. All three groups received low-level lifestyle intervention treatment in years 2 and 3.

At the conclusion of the study, 40% (n=8) of the Roux-en-Y participants achieved partial or complete diabetes remission, 29% (n=6) of the gastric sleeve participants achieved partial or complete remission, and none of the lifestyle intervention only participants had done so (p=0.004). Partial remission was defined as FBG ≤125 mg/dl and A1c less than 6.5% without diabetes medication, while complete remission was defined as FBG ≤100 mg/dl and A1c less than 5.7% without medication.

The Roux-en-Y group experienced the greatest reductions in A1c (-1.42%; p=0.0013 vs lifestyle modification only), FBG (-66.0 mg/dl; p<0.05 vs lifestyle modification only), as well as weight, lipid and blood pressure measurements. The gastric banding group also experienced superior reduction in A1c and FBG compared to the lifestyle modification-only group (-0.80%; p=0.04 and -35.2 mg/dl; p=0.07 respectively). Mean weight loss was 25% from baseline for the Roux-en-Y group, 15% for the gastric banding group, and 5.7% for the lifestyle intervention group. In addition, 65% of the Roux-en-Y group, 33% of the gastric banding group, and 0% of the lifestyle modification group who were taking diabetes medication at the start of the study were no longer taking any diabetes medication at the conclusion of the study.

Class I obesity, defined as a BMI measurement of 30 to <35, has been largely understudied in terms of weight loss surgery. Forty percent of the participants in this study were defined as having Class I obesity. The results of this study showed similar glycemic and health benefits for this class and those who were more obese.

This study also provided a longer follow-up period than previous studies on gastric banding surgery. The study demonstrated that while the benefits are not as great with gastric banding as with a Roux-en-Y procedure, they still outpace the benefits of lifestyle education only.

Practice Pearls:

  • Roux-en-Y and gastric banding procedures resulted in greater A1c, FBG, and weight reduction, and more instances of total or partial Type 2 diabetes remission than intensive lifestyle modification programs.
  • Roux-en-Y gastric bypass resulted in a greater level of glycemic improvement, diabetes remission and weight reduction than the gastric sleeve procedure.
  • Those with Class I obesity (BMI of 30-<35) saw similar improvements to those who were more severely obese (BMI of 35-40).

Courcoulas AP, Belle SH, Neiberg RH, Pierson SK, Eagleton JK, Kalarchian MA, DeLany JP, Lang W, Jakicic JM. Three-year outcomes of bariatric surgery vs lifestyle intervention for Type 2 diabetes mellitus treatment. JAMA Surgery. 2015 Jun 26; http://archsurg.jamanetwork.com/article.aspx?articleid=2362353.