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Surgery to Treat Diabetes vs. Lifestyle Interventions

Gastric bypass helping with diabetes remission…. 

In a recent study, the beneficial effects of bariatric surgery for type 2 diabetes were significantly greater than medical and lifestyle interventions. David E. Cummings, MD, of the University of Washington in Seattle, reported that at 1 year, 60% of patients who underwent gastric bypass were in diabetes remission. Only 6% on a medical and/or lifestyle program went into remission. Another beneficial effect of gastric bypass is weight loss. At 1 year, 25.8% experienced weight loss while only 6.4% with a nonsurgical approach experienced weight loss.

Cummings and colleagues conducted a trial known as CROSSROADS (Calorie Reduction Or Surgery: Seeking Remission for Obesity And Diabetes). They selected patients who had type 2 diabetes with a body mass index between 30 and 40 and were willing to be part of a study. Although the surgical and nonsurgical groups were similar, patients in the surgical group had a longer duration of diabetes. It was almost double that of the nonsurgical group.

Results showed that the glycemic control for both groups improved but there was a greater decrease of hemoglobin A1c in the surgical group than the nonsurgical group. In the surgical group, there was also a greater body fat mass reduction. There were no changes observed with total cholesterol and LDL but there was an increase in HDL levels following surgery.

Although there were no major adverse events in the study, the medical group experienced more hypoglycemia events.

Practice Pearls:

  • About 60% of the patients who had gastric bypass were in diabetes remission.
  • At one year, 25.8% experienced weight loss after surgery.
  • HDL increased significantly after surgery.

Obesity Week Nov. 2013