Diabetes treatment as effective as gastric bypass in diabetic kidney disease
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Best diabetes medical treatment was just as effective in albuminuria remission as Roux-en-Y gastric bypass for adults with diabetic kidney disease and obesity, according to study results published in eClinical Medicine.
“This is a potentially disruptive finding because, until now, bariatric surgery substantially outperformed the best medical care on all the relevant clinical outcomes,” Ricardo V. Cohen, MD, director of the Center for Obesity and Diabetes at the Oswaldo Cruz German Hospital, São Paulo, said in a related press release.
This 5-year, open-label, single-center randomized trial included 88 adults with diabetic kidney disease and class 1 obesity who completed all 5 years of follow-up. Participants were randomly assigned to Roux-en-Y gastric bypass (n = 44) or best medical treatment (n = 44), which included therapies such as metformin, insulin and medications with microvascular and microvascular benefits, such as angiotensin converting-enzyme inhibitors, angiotensin II blockers, SGLT-2 inhibitors, GLP1 receptor agonists and statins.
The primary outcome was the proportion of participants who achieved microalbuminuria remission after 5 years. Secondary outcomes included improvements in diabetic kidney disease, glycemic control, quality of life and safety.
Albuminuria remission occurred among 59.6% of participants who received best medical treatment and 69.7% of participants who underwent gastric bypass (P = .25). Participants who had gastric bypass had double the likelihood of achieving an HbA1c of 6.5% or less compared with those who received best medical treatment (60.2% vs. 25.4%; P < .001).
Regarding quality of life, participants who underwent gastric bypass had higher scores in several domains of the SF-36 questionnaire compared with participants who received best medical treatment. Researchers observed mean differences of 13.5 for general health (P = .001), 19.7 for pain (P < .001), 6.1 for social functioning (P =.27), 8.3 for emotional well-being (P = .04), 12.2 for vitality (P = .004), 16.8 for mental health (P = .06), 21.8 for physical health (P = .01) and 11.1 for physical functioning (P = .01).
Serious adverse events occurred for 15.2% of participants who received best medical treatment and 24% of those who underwent gastric bypass (P = .8).
“Although Roux-en-Y gastric bypass offered additional extra-renal benefits, the results of the best medical treatment were not statistically different from Roux-en-Y gastric bypass for efficacy and safety in remitting albuminuria in patients with diabetic kidney disease,” the researchers wrote.
Reference:
- Drugs just as good as bariatric surgery in fight against diabetic kidney disease, shows recent study led by My Best Weight director/University College Dublin’s obesity specialist. Published Nov. 15, 2022. Accessed Nov. 15, 2022.
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