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Gastric bypass effective in obese diabetic patients

Weight loss greater after Roux-en-Y than gastric banding or lifestyle intervention

Louise Prime

Thursday, 05 June 2014

Roux-en-Y gastric bypass surgery was more successful than either gastric banding or intensive lifestyle intervention in obese people with type 2 diabetes, a small randomised controlled trial has found. The authors behind this feasibility study*, published today in JAMA Surgery, warn that a larger trial comparing the weight-loss strategies in these patients could be both difficult and expensive; but the authors of another study in the same journal today said they had shown that a larger trial was feasible.

US researchers assessed 667 people with type 2 diabetes whose BMI was 30-40kg/m2, but they deemed only 69 suitable for inclusion in the trial. Of these, they randomly assigned 24 patients to have Roux-en-Y gastric bypass (RYGB), 22 to have laparoscopic adjustable gastric banding (LAGB), and 23 to an intensive lifestyle weight-loss intervention.

Mean weight loss was greater in the group who had had gastric bypass (27% loss) than among those who had had gastric banding (17.3% weight loss) or lifestyle intervention (10.2% loss). In addition, after a year, half (50%) of patients in the bypass group had complete remission of type 2 diabetes, and a further 17% had partial remission – compared with 27% and 23% respectively in the gastric banding group, and none at all in the lifestyle intervention group.

The study authors said: “Preliminary results show that RYGB was the most effective treatment, followed by LAGB for weight loss and T2DM outcomes at 1 year.” But they also pointed out: “This study highlights several potential challenges to successfully completing a larger RCT for treatment of T2DM and obesity in patients with a BMI of 30-40, including the difficulties associated with recruiting and randomising patients to surgical vs. nonsurgical interventions.”

In a separate study** also conducted in the US, researchers compared outcomes in 19 people with type 2 diabetes and a BMI of 30-42kg/m2 who had Roux-en-Y gastric bypass, with outcomes in another 19 who had intensive medical/weight management.

After a year, 58% of patients assigned to bypass surgery had achieved HbA1c <6.5% and fasting glucose <7.0mmol/l, compared with just 16% of those in the medical/weight management group. The bypass group also fared better in terms of other outcomes including reduction in HbA1c, weight, waist circumference, fat mass, lean mass, blood pressure and triglyceride levels, and increase in high-density lipoprotein cholesterol.

The authors said: “These differences may help inform therapeutic decisions for diabetes and weight loss strategies in obese patients with type 2 diabetes until larger randomised trials are performed.” They added that their study had “confirmed the feasibility of conducting a larger trial to compare bariatric surgery with other interventions”.

* Courcoulas A P, Goodpaster B H, Eagleton J K, et al. Surgical vs Medical Treatments for Type 2 Diabetes Mellitus. A Randomized Clinical Trial. JAMA Surg. Published online June 04, 2014. doi:10.1001/jamasurg.2014.467

** Halperin F, Ding SA, Simonson D C, at al. Roux-en-Y Gastric Bypass Surgery or Lifestyle With Intensive Medical Management in Patients With Type 2 Diabetes. Feasibility and 1-Year Results of a Randomized Clinical Trial. JAMA Surg. Published online June 04, 2014. doi:10.1001/jamasurg.2014.514

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