27 Jun Diabetes: Gastric Bypass Surpassed Medical Management in Weight Loss and Metabolic Control
MedicalResearch: What are the main findings of the study?
Answer: We conducted a randomized controlled trial comparing the effectiveness of Roux-en- Y gastric bypass with an intensive diabetes and weight management program. We recruited 38 obese individuals (BMI 30-42 kg/m2) with type 2 diabetes. Participants had suboptimal glucose control and mean diabetes duration of 10 years.
Both surgical and non-surgical interventions led to patients losing a clinically significant amount of weight and keeping it off for 2 years, with average loss of approximately 57 pounds (25% of initial body weight) for the surgery group and 13 pounds (6% of initial weight) for the lifestyle and medication modification group. Other important health goals also improved more in the surgical group, including improvements in blood sugar control, blood pressure and lipid levels which together may contribute to reducing risk of developing coronary heart disease.
MedicalResearch: Were any of the findings unexpected?
Answer: Our findings of greater improvements in weight and metabolic control are consistent with other small, randomized controlled trials of short duration and with larger non-randomized cohort studies demonstrating improvements in weight and cardiometabolic outcomes in patients undergoing surgery or lifestyle and medical management.
Notably, our results demonstrating reduced 10 year risk of cardiovascular events, calculated using the well-validated UKPDS risk engine calculator, were compatible with results from the longer term observational studies, which show a superior reduction of complications from macrovascular disease and mortality in the surgical group when compared with the medically managed group. This is important as previous non-randomized studies that show lower cardiovascular event rates and improved survival must be interpreted with caution, as reasons for providers to recommend or patients to choose surgery may introduce unintended biases favoring the surgical group.
MedicalResearch: What should clinicians and patients take away from your report?
Answer: Roux-en-Y gastric bypass surgery may be an acceptable therapeutic option for obese patients with type 2 diabetes in whom surgical risk is not excessive, with weight loss and improved glucose control and cardiovascular risk reduction.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Answer: Studies with larger numbers of patients and longer duration follow up are necessary to firmly inform clinical decision making. We hope to collaborate with investigators of other randomized trials of similar design, to provide this type of data.
Additionally, it would be of high value to be able to understand the mechanisms whereby gastric bypass surgery promotes sustained weight loss and improvements in blood sugars, blood pressure, and cholesterol levels in order to develop new interventions to achieve these goals without surgery.
ICE/ENDO 2014, the joint meeting of the International Society of Endocrinology and the Endocrine Society in Chicago.