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Bariatric surgery superior to lifestyle, medical intervention in reducing type 2 diabetes
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Adults with mild to moderate obesity randomly assigned to Roux-en-Y gastric bypass saw a significantly greater diabetes remission rate vs. patients assigned to an intensive lifestyle and medical intervention, according to an analysis of the CROSSROADS trial.
In a parallel-group, randomized controlled trial, David E. Cummings, MD, professor of medicine in the division of metabolism, endocrinology and nutrition and a researcher at the Diabetes and Obesity Center of Excellence at the University of Washington, and colleagues analyzed data from 32 adults with type 2 diabetes and a BMI between 30 kg/m² and 45 kg/m² recruited between July 2011 and June 2012. Researchers randomly assigned participants to Roux-en-Y gastric bypass (n = 15; mean age, 52 years; 80% women; 80% white; mean BMI, 38.3 kg/m²; mean diabetes duration, 11.4 years) or intensive lifestyle and medical intervention (n = 17; mean age, 55 years; 59% women; 65% white; mean BMI, 37.1 kg/m²; mean diabetes duration, 6.8 years). The lifestyle/medical intervention was a 12-month, in-person and telephone-based program that included behavior modification skills counseling combined with diet and exercise training. Researchers followed participants for 1 year; primary outcome was the percentage of participants in each group who achieved diabetes remission (defined as an HbA1c 6%).
David E. Cummings
At 1 year, 60% of gastric bypass patients achieved diabetes remission vs. 5.9% of patients in the lifestyle/medical group (OR = 19.8; 95% CI, 2-194.6).
Mean HbA1c in the gastric bypass group fell from 7.7% to 6.4% vs. a fall from 7.3% to 6.9% in the lifestyle/medical group (P = .04); mean HbA1c values were not statistically different between groups at 6 or 12 months.
“However, the HbA1c fell progressively over time after [Roux-en-Y gastric bypass], whereas it reached a nadir at 6 months with [lifestyle/medical intervention] then tended to increase back toward baseline,” the researchers wrote.
In addition, the surgical group used fewer diabetes medications at 12 months vs. the lifestyle/medical group (mean of 0.5 vs. 1.2; P = .009).
The surgical group lost more body weight at 1 year vs. the lifestyle/medical group (mean of 25.8% vs. 6.4%; P < .001); however, lean body mass remained stable in the lifestyle/medical group and decreased by 10% in the surgical group.
Peak oxygen consumption also increased substantially in the lifestyle/medical group, whereas it remained unchanged in the surgical group. There were no deaths or serious surgical adverse events.
“Our study and others show that neither baseline BMI nor the amount of weight lost dependably predicts diabetes remission after [Roux-en-Y gastric bypass], which appears to ameliorate diabetes through mechanisms beyond just weight reduction,” the researchers wrote. “These findings call into serious question the longstanding practice of using strict BMI cut-offs as the primary criteria for selection for bariatric surgery among patients with type 2 diabetes.” – by Regina Schaffer
Disclosure: One researcher reports receiving research funding, salary support and free access to shared decision-making aids used in this study as medical editor for Informed Medical Decisions Foundation, which develops content for patient education programs, including the bariatric surgery program used by participants of this study. The foundation had an arrangement with a for-profit company, Health Dialog, to coproduce and market these programs.
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