Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Abstract

BACKGROUND Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited. METHODS We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications. RESULTS Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P = 0.01, adjusted P = 0.03, P = 0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P = 0.03, adjusted P = 0.07, P = 0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P = 0.003). At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (−23%, −19%, and −5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (−40%, −29%, and −8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (−35%, −34%, and −13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons). No major late surgical complications were reported except for one reoperation. CONCLUSIONS Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia.

7. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2018

“…However, the median disease-free period among such individuals following Roux-en-Y gastric bypass (RYGB) is 8.3 years (52,53). With or without diabetes relapse, the majority of patients who undergo surgery maintain substantial improvement of glycemic control from baseline for at least 5 (54,55) to 15 (38,39,53,(56)(57)(58) years.…”

Therapeutic fasting as a potential effective treatment for type 2 diabetes: A 4-month case study

“…These differences were achieved within only 3 months after treatment, and are durable, having been observed in both a 3-year and 5-year follow-up. 13,19 The SOS study comparing surgical and medical weight loss found that the surgical group had significantly greater weight loss and had lower overall mortality. 20 Similar to the STAMPEDE study, weight loss occurs almost immediately after treatment.…”

The Role of Bariatric Surgery in the Treatment of Type 2 Diabetes in Morbidly Obese Patients

“…There was also a significant decrease in insulin levels and fasting blood glucose postoperatively [10]. According a recent study, having bariatric surgery being done in addition to intensive medical therapy for the treatment of type 2 diabetes in patients with BMI 27-43, yielded significant results in the reduction and sometimes resolving of diabetes compared to intensive medical therapy alone [12]. Another recent study showed that the risk of microvascular complications is reduced due to improved glycemic control in pre diabetic patients who undergo bariatric surgery [13].…”