More obese patients with type 2 diabetes achieved disease remission with bariatric surgery combined with a low-level lifestyle intervention than with lifestyle intervention alone, researchers reported in JAMA Surgery.

Nonsurgical treatments for type 2 diabetes, including lifestyle modifications and medical therapies, do not often result in complete amelioration. Bariatric surgery has been shown in several observational studies and small randomized clinical trials to significantly improve type 2 diabetes, but questions remain about the durability of this effect.

The researchers therefore sought to examine the longer-term effect of bariatric surgery, as compared with nonsurgical treatments, for type 2 diabetes.

The researchers randomly assigned 61 obese participants aged 25 to 55 years with type 2 diabetes to an intensive lifestyle weight loss intervention for 1 years followed by a low-level lifestyle intervention for 2 years or surgical treatments, including Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB), followed by a low-level lifestyle intervention in years 2 and 3.

Fifty participants (82%) were women, 13 (21%) were African American and 26 (43%) had BMI lower than 35. Mean age was 47.3 years, HbA1c was 7.8% and fasting plasma glucose level was 171.3 mg/dL.

Forty percent of patients who underwent RYGB (n=8) and 29% (n=6) who underwent LAGB achieved partial or complete remission of type 2 diabetes, respectively, as compared with none who underwent the intensive lifestyle weight loss intervention (P=.004), according to the data.

Additionally, the researchers found a greater decrease in the use of diabetes medications in the surgical groups than in the intensive lifestyle weight loss intervention alone. Sixty-five percent of RYGB participants and 33% of LAGB participants vs. none of the intensive lifestyle weight loss intervention participants went from using insulin or oral medications at baseline to no medication at 3 years (P<.001).

Moreover, at 3 years, mean reduction in percentage body weight was greatest after RYGB (25%), followed by LAGB (15%) and lifestyle intervention (5.7%; P<.01).

Importantly, the researchers noted, more than 40% of participants had BMI of 30 to 35, a population for whom data are lacking.

“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 obese individuals including those with a BMI between 30 and 35,” they wrote.

However, more research on whether these treatments affect long-term microvascular and macrovascular complications, as well as the mechanisms through which bariatric surgery induce their effects, is necessary, the researchers concluded.

In an invited commentary, Michel Gagner, MD, FRCSC, FASMBS, of Florida International University, Miami, discussed previous research in this area and placed the current findings in context.

“We should consider the use of bariatric (metabolic) surgery in all severely obese patients with [type 2 diabetes] and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago,” Gagner wrote.

References

  1. Courcoulas AP et al. JAMA Surg. 2015;doi:10.1001/jamasurg.2015.1534.
  2. Gagner M. JAMA Surg. 2015;doi:10.1001/jamasurg.2015.1542.