Gastric bypass surgery more beneficial than intensive lifestyle management for diabetics

Patients who underwent Roux-en-Y gastric bypass (RYGB) surgery lost more weight, reduced cardiovascular risks and improved obesity-related measures than intensive medical diabetes and weight management in obese patients with type 2 diabetes, according to a study published in the American Diabetes Association’s Diabetes Care.

“Few prospective randomized studies have compared patient-reported outcomes after randomization to bariatric surgery versus an intensive medical management program to determine whether the approach to improve metabolic health is an important determinant of changes in self-reported health status, quality of life and problems associated with managing diabetes,” wrote lead author Donald C. Simonson, MD, MPH, with Brigham and Women’s Hospital in Boston, and colleagues.

The researchers sought to compare the effects of gastric bypass surgery with intensive medical diabetes and weight management on clinical and patient-reported outcomes in obese type 2 diabetics.

Researchers randomized 38 obese type 2 diabetics equally to surgery or weight management to be overseen at Joslin Diabetes Center in Boston. The cohort had an average weight of 230 pounds and an average BMI of 36. They were also similar in age, gender, race/ethnicity, BMI and duration of diabetes. The team assessed changes in weight, HbA1c, cardiovascular risk factors and self-reported health status.

The researchers followed up with the patients after three years to gauge progress. It was noted 42 percent of the surgery group (eight patients) achieved glycemic goals and fasting plasma glucose. Of the eight patients, seven were not on anti-diabetes medication. In the weight management group, none of the patients achieved these goals.

The surgery group also had a higher percentage of patients who achieved less than 7 percent for their HbA1c. The surgery group lowered their hemoglobin by an average of 1.79 percent compared to the weight management group at 0.39 percent. Changes in HbA1c and fasting plasma glucose were more favorable for the surgery group at all time points.

Furthermore, the surgery group saw significant weight loss at an average of 55 pounds versus the weight management group which had an average decrease of 11 pounds. And the surgery group also had lower risk of coronary heart disease and stroke. The overall quality of life for the study cohort was associated more with weight loss than an improved HbA1c.

“Our study adds to a growing body of work showing metabolic and cardiovascular benefits of RYGB (surgery), even compared with an intensive multidisciplinary, multimodality medical diabetes and weight intervention,” the researchers concluded. “Our randomized trial also adds to the relatively scant existing data to support use of metabolic surgery in surgically appropriate patients with less severe grade obesity and supports the recent American Diabetes Association guidelines to consider metabolic surgery in this setting. While surgery is not without adverse events, improved patient-reported out- comes provide further evidence that serious consideration be given to RYGB for treatment of diabetes in obese patients.”