Bariatric Surgery Better Corrected Diabetes vs. Lifestyle Alone

July 10, 2015

T2DM patients who underwent surgery experienced decreased use of diabetes medications, if not partial or complete disease remission.

Obese patients with type 2 diabetes were able to achieve greater disease control when they underwent bariatric surgery plus low-level lifestyle changes compared with lifestyle changes alone, according to the results of a recently published study.

In fact, the study found that no participants assigned to lifestyle intervention alone were able to achieve partial or complete remission of their type 2 diabetes.

“Those who underwent a surgical procedure followed by low-level lifestyle intervention were significantly more likely to achieve and maintain glycemic control than were those who received intensive and then maintenance (low-level) lifestyle therapy alone, regardless of obesity class,” wrote researchers led by Anita P. Courcoulas, MD, MPH, of the Department of Surgery at the University of Pittsburgh Medical Center. “More than two-thirds of those in the Roux-en-Y gastric bypass (RYGB) group and nearly half of the laparoscopic adjustable gastric banding (LAGB) group did not require any medications for type 2 diabetes mellitus treatment at 3 years.”

The study included 61 participants with type 2 diabetes from the University of Pittsburgh Medical Center from 2009 to 2014 who were randomly assigned to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level intervention for 2 years (n=14), or RYGB (n=18) or LAGB (n=20) followed by low-level lifestyle intervention for two years. The mean BMI for the participants was 35.7 and 43% of participants had class I obesity.

The researchers assessed outcomes at 3 years. At that time, 40% of patients undergoing RYGB and 29% of patients undergoing LAGB achieved partial or complete remission compared with zero participants assigned to lifestyle intervention alone (P=0.004).  Complete remission was achieved in 15% of patients who underwent RYGB and 5% of those who underwent LAGB.

Patients who underwent surgical intervention were also able to achieve long-term remission. Continuous remission for at least 2 years was achieved in 45% of patients who underwent RYGB and 29% of patients who underwent LAGB.

In addition to diabetes remission, the use of diabetes medications was reduced more in the surgical groups than in the lifestyle groups: 65% of RYGB and 33% of LAGB patients went from using insulin or oral medication at baseline to no medication at year 3 compared with no participants in the lifestyle intervention alone group (P<0.001).

“This study provides further important evidence that at longer term follow-up of 3 years, surgical treatments, including RYGB and LAGB, are superior to lifestyle intervention alone for the remission of type 2 diabetes mellitus in obese individuals including those with a BMI between 30 and 35,” wrote researchers. “While this trial provides valuable insights, unanswered questions remain such as the impact of these treatments on long-term microvascular and macrovascular complications and the precise mechanisms by which bariatric surgical procedures induce their effects.”

In an editorial that accompanied the article, Michel Gagner, MD, of Florida International University, wrote, “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with type 2 diabetes mellitus and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago.”

Reference: Courcoulas AP, et al. Three-year outcomes of bariatric surgery vs. lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg.2015; Jul 1.