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Bariatric surgery with lifestyle intervention increased diabetes remission
Bariatric surgery with 2 years of a low-level lifestyle intervention increased disease remission in patients with type 2 diabetes and obesity more than lifestyle intervention alone, according to recent study findings published in JAMA Surgery.
“This report addresses the primary question of comparative efficacy of surgical and nonsurgical treatments for [type 2 diabetes] remission and reports other glycemic control outcomes, weight change, lipids, blood pressure and body composition,” the researchers wrote. “These results contribute to addressing questions about the relative efficacy of different surgical vs. nonsurgical treatments for [type 2 diabetes] in lower BMI individuals.”
Anita P. Courcoulas, MD, MPH, of the University of Pittsburgh Medical Center, and colleagues evaluated 61 adults aged 25 to 55 years with type 2 diabetes and obesity. They were randomly assigned to intensive lifestyle intervention for 1 year followed by low-level lifestyle intervention for 2 years or Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LABG) followed by low-level lifestyle intervention for 2 to 3 years to determine the effects of treatment over 3 years. Three-year safety and efficacy was performed for 52 participants; 18 with RYGB, 20 with LAGB and 14 with lifestyle intervention only.
Anita P. Courcoulas
Forty percent of the participants in the RYGB group and 29% in the LAGB group achieved partial or complete remission of type 2 diabetes, whereas no one in the lifestyle intervention only group achieved partial or complete remission.
The greatest change in HbA1c (–1.42%) and fasting plasma glucose (–66 mg/dL) from baseline to 3 years was found among the RYGB group compared with the LAGB group and lifestyle intervention only group. At 3 years, the LAGB group showed improved HbA1c levels, averaging –0.8%, and FPG levels of –35.2 mg/dL. Sixty-five percent of the RYGB group and 33% of the LAGB group went from using insulin or oral medication at baseline to none at 3 years, whereas none of the lifestyle intervention only group stopped using medication (P < .001).
Changes in percentage of body weight at 3 years were greatest among the RYGB group (25%), followed by LAGB (15%) and the lifestyle intervention only group (5.7%).
Compared with the lifestyle intervention only group, the RYGB group had greater improvements in triglycerides levels (P = .003) and HDL cholesterol levels (P = .0004).
“Bariatric surgical procedures and treatment show promise for durable, longer-term control of type 2 diabetes in people with obesity,” Courcoulas told Endocrine Today. “These results also extend to those with lower weight and BMI (class I obesity) than the typical weight loss surgery candidate. Bariatric surgery treatment options should be considered for people with obesity and type 2 diabetes, especially for those in whom the disease is difficult to control.”
In an accompanying editorial, Michel Gagner, MD, FRCSC, FASMBS, of Florida International University, Miami, wrote: “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with [type 2 diabetes] and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago.” – by Amber Cox
Disclosure: Courcoulas reports receiving research grants or project consultant work from Covidien, J&J Ethicon and Nutrisystem, and is a project consultant for Apollo Endosurgery and Ethicon. Gagner reports receiving honoraria for speaking engagements from Boehringer Laboratories, Covidien, Ethicon, Gore, MID and Olympus, as well as equity from Transenterix.