Benefits of Gastric Bypass in Diabetes Control Significant But Diminish Over Time Interview with:

Charles Billington MD Chief, Section of Endocrinology and Metabolism Minneapolis VA Health Care System Professor of Medicine, University of Minnesota 

Dr. Billington

Charles Billington MD
Chief, Section of Endocrinology and Metabolism
Minneapolis VA Health Care System
Professor of Medicine, University of Minnesota What is the background for this study? What are the main findings? 

Response: We wanted to know if adding gastric bypass to intense lifestyle and medical therapy would improve overall diabetes treatment as represented by the triple endpoint of blood sugar, blood pressure and cholesterol control. We found that adding gastric bypass did provide significant benefit at five years after surgery, but that the size of the benefit declined substantially from the first to the fifth year. We also found that gastric bypass did provide significantly better blood sugar control throughout the five years, but the rate of diabetes remission at five years was low. There were many more adverse events in the gastric bypass group. What should readers take away from your report?

Response: Whether the gastric bypass surgery is an appropriate treatment for diabetes is a matter of perspective. The improvement in achievement of triple endpoint is significant but may not be large enough to warrant the adverse events. The surgery group did get better blood sugar control at the price of more adverse events. What recommendations do you have for future research as a result of this work?

Response: We need longer followup of patients after bariatric surgery to determine whether there is lasting benefit. We need to study baseline characteristics of patients that identify who is more likely to benefit.

Disclosures: I am a consultant for Novo Nordisk, Optum and ReShape. The study was supported by an unrestricted grant from Covidien (now Medtronics)


Ikramuddin S, Korner J, Lee W, Thomas AJ, Connett JE, Bantle JP, Leslie DB, Wang Q, Inabnet WB, Jeffery RW, Chong K, Chuang L, Jensen MD, Vella A, Ahmed L, Belani K, Billington CJ. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. JAMA. 2018;319(3):266–278. doi:10.1001/jama.2017.20813
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Last Updated on January 16, 2018 by Marie Benz MD FAAD