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RYGB decreases weight, HbA1c more than medical intervention

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NEW ORLEANS — Compared with an intensive diabetes and medical weight management intervention, Roux-en-Y gastric bypass results in greater sustained weight loss and lower HbA1c, according to a presenter here.

Donald C. Simonson, MD, MPH, ScD, member of the division of endocrinology, diabetes and hypertension at Brigham and Women’s Hospital and a lecturer on medicine at Harvard Medical School, and colleagues randomly assigned 38 adults (mean age, 52 years) with obesity and type 2 diabetes (mean BMI, 36.3 kg/m²; mean HbA1c, 8.5%) to Roux-en-Y gastric bypass (RYGB; n = 19) or an intensive diabetes and medical weight management intervention (n =19) with follow-up for 3 years.

The weight management program consisted of 12 weekly visits to a multidisciplinary program that focused on diabetes and weight management followed by monthly one-on-one sessions for 1 year.

At 12 months, maximum reductions in weight (-27.9 kg) and HbA1c (-2%) were achieved with RYGB and sustained at 3 years (weight, -24.9 kg; HbA1c, -1.8%; all P < .001 vs. baseline). At 3 months, there was a maximum weight loss of 6.9 kg and HbA1c improved by 1.5% with maintenance of weight loss in the medical intervention group; however, HbA1c was no longer improved at 3 years (-0.4%; P < .001 vs. RYGB). Triglycerides were reduced in RYGB (-39 mg/dL; P < .001) and the medical intervention group (-22 mg/dL; P < .05), and HDL cholesterol increased significantly in RYGB (+15 mg/dL; P < .001), but not in the medical intervention group (+2 mg/dL); there were no changes in LDL cholesterol.

From baseline, self-reported physical and mental health and Problem Areas in Diabetes questionnaire scores improved moderately in both groups but Impact of Weight on Quality of Life questionnaire score was improved more with RYGB compared with the medical intervention (P < .001). Improvement in quality of life was primarily driven by weight loss and not HbA1c.

“In conclusion, these sustained differences of glycemic control and cardiometabolic risk factors should be considered as valuable in surgical management of diabetes in patients with type 2 diabetes and obesity,” Simonson said during his presentation.

Reference:

Simonson DC, et al. 262-OR. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.

Disclosure: Simonson reports no relevant financial disclosures.