A new study led by researchers at the University of Pittsburgh and the University of Pittsburgh Medical Center recently revealed long-term benefits of bariatric surgery (weight loss surgery) in obese patients with type 2 diabetes. The study was published in the journal JAMA Surgery and is entitled “Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment A Randomized Clinical Trial.”
Obesity is considered a serious public health problem. It causes a systemic inflammatory state in the body and is associated with chronic diseases such as diabetes. Bariatric surgery is a weight loss surgery where the size of the stomach is reduced through a gastric band or through removal of part of the stomach. This surgery is highly effective in inducing long-term sustained weight loss and has been shown to contribute to health improvements and a decreased incidence of medical conditions like diabetes, heart attack, stroke and cancer. However, it remains to be determined whether bariatric surgery can be considered a durable and effective treatment strategy for type 2 diabetes over the long term.
In the study, this question is addressed by comparing remission of type 2 diabetes after surgical and nonsurgical treatments. Researchers conducted a randomized trial (NCT01047735) from October 1, 2009 to June 26, 2014 to compare surgical and medical treatments in 61 obese participants with type 2 diabetes aged 25 to 55 years. Participants were randomized to either an intensive lifestyle weight loss intervention for one year and a low-level lifestyle intervention for the following two years, or to surgical treatments (laparoscopic adjustable gastric banding [LAGB] or Roux-en-Y gastric bypass [RYGB]) followed by low-level lifestyle intervention for the next two and three years after the procedure. The team analyzed partial and complete diabetes remission, the need for diabetes medications and changes in weight three years after the intervention.
Researchers found that after 3 years, partial or complete remission of type 2 diabetes was achieved in 40% of the patients who underwent RYGB (complete remission in 15%) and 29% in those submitted to LAGB (complete remission in 5%). The use of diabetes medication was also significantly more reduced in the surgical groups in comparison to the group that underwent a lifestyle weight loss intervention only.
“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 T2DM [type 2 diabetes] treatment at 3 years,” noted the research team according to a news release.
Regarding the mean reduction in body weigh percentage after 3 years, the reduction was higher in the RYGB group (25%), followed by the LAGB group (15%) and last the lifestyle intervention group (5.7%).
The team concluded that bariatric surgery complemented with two years of low-level lifestyle intervention was superior to lifestyle intervention alone in helping obese type 2 diabetes patients to achieve disease remission. The team suggests that further studies should address the effectiveness and risks associated with bariatric surgery in a longer-term in comparison to medical management and lifestyle changes in these patients.
“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,” concluded the research team.
Dr. Michel Gagner from Florida International University, Miami who was not involved in the study added “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with T2DM and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago.”