Bariatric surgery plus intensive medical therapy superior to intensive therapy alone.
Prior research has shown the superiority of bypass surgery on diabetes compared with other weight loss methods in the short-term.
In astudypublished in theNew England Journal of Medicine, investigators found that individuals who undergo gastric bypass surgery are more likely to achieve remission of their disease compared with individuals who received a gastric sleeve or intensive management of diet and exercise.
Included in the study were 134 patients with type 2 diabetes who were followed for 5 years. The primary endpoint was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications.
The participants were randomized to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy.
At 5 years, the results of the study showed that 2 of 38 patients who only followed intensive diet and exercise plans no longer needed insulin to manage blood glucose levels, compared with 14 of 49 patients who underwent gastric bypass and 11 of 47 patients who underwent sleeve gastrectomy.
In general, patients who haddiabetesfor less than 8 years were more likely to be cured. Additionally, even surgical patients who still needed insulin achieved greater weight loss and lower median glucose levels compared with other study participants.
Over 5 years, changes from baseline observed in the gastric bypass and sleeve gastrectomy arms were superior to the changes observed in the medical-therapy arm, accounting for body weight, high-density lipoprotein cholesterol level, use of insulin, and quality of life measures. No major late surgical complications were reported, excluding 1 reoperation, according to the study.
“Five-year outcome data showed that, among patients with type 2 diabetes and a body mass index of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia,” the authors concluded.