02 Jul Bariatric Surgery Bests Lifestyle Interventions For Diabetes Remission In Obesity
Medical Research: What is the background for this study?
Dr. Courcoulas: This study is a randomized clinical trial that was originally funded through the American Recovery and Reinvestment Act of 2009 (ARRA) as a high priority comparative effectiveness topic; the goal of which was to better understand the role of surgical versus non-surgical treatments for Type 2 diabetes mellitus (T2DM) in people with lower Body Mass Index (BMI) between 30 and 40 kg/m2. This report highlights longer-term outcomes at 3 years following random assignment to either an intensive lifestyle weight loss intervention for 1 year followed by a low-level lifestyle intervention for 2 years or surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) followed by low-level lifestyle intervention in years 2 and 3.
Medical Research: What are the main findings?
Dr. Courcoulas: Among 61 obese participants with Type 2 diabetes who were treated, bariatric surgery with 2 years of a low-level lifestyle intervention resulted in more Type 2 diabetes disease remission than did lifestyle intervention alone. Fifty participants (82 percent) were women, and 13 (21 percent) were African American. At 3 years, any Type 2 diabetes remission (partial or complete) was achieved in 40 percent (n = 8) of RYGB, 29 percent (n = 6) of LAGB, and no intensive lifestyle weight loss intervention participants.
The use of diabetes medications was reduced more in the surgical groups than the lifestyle intervention-alone group, with 65 percent of RYGB, 33 percent of LAGB, and none of the intensive lifestyle weight loss intervention participants going from using insulin or oral medication at baseline to no medication at year 3. Average reductions in percentage of body weight at 3 years were the greatest after RYGB at 25% followed by LAGB at 15%, and lifestyle treatment at 5.7%.
The authors note that one important aspect of this study was that more than 40 percent of the people were individuals with class I obesity (BMI of 30 to <35) for whom data in the literature are largely lacking. 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. More than two-thirds of those in the RYGB group and nearly half of the LAGB group did not require any medications for Type 2 diabetes treatment at 3 years.
Dr. Courcoulas: What should clinicians and patients take away from your report?
Response: 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 in individuals with obesity including those with a BMI between 30 and 35.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Courcoulas: While this trial provides valuable insights, even larger studies are needed to definitively answer this important research question. This study has joined with 3 other similar trials that are studying the same question so that this merged and larger study will be poised to make very significant contributions to the field.
Anita P. Courcoulas M.D., M.P.H., F.A.C.S, Professor of Surgery, Director, Minimally Invasive Bariatric & General Surgery, & University of Pittsburgh Medical Center (2015). Bariatric Surgery Bests Lifestyle Interventions For Diabetes Remission In Obesity