Gastric Bypass Beats Lifestyle for Diabetes Management
Lower mean HbA1c, more diabetes remission, more weight loss versus lifestyle-medical management.
(HealthDay News) -- The addition of Roux-en-Y gastric bypass to lifestyle-medical management is associated with improved achievement of treatment goals in type 2 diabetes, according to a study published online in Diabetes Care.
Sayeed Ikramuddin, MD, from the University of Minnesota in Minneapolis, and colleagues randomized 120 adults with body mass index of 30.0 to 39.9 kg/m² and hemoglobin A1c (HbA1c) ≥8.0% to 2 treatment arms. All participants received the lifestyle-medical management intervention for 24 months, while half were randomly allocated to receive gastric bypass in addition.
The researchers found that the triple end point goal was met by 9 and 28% of lifestyle-medical management and gastric bypass patients, respectively (P = 0.01), at 36 months. At 3 years, the mean HbA1c values were 8.6 and 6.7%, respectively. At 36 months, none of the lifestyle-medical management patients had diabetes remission, while 17 and 19% of gastric bypass patients had full and partial remission, respectively. More medications were used by lifestyle-medical management patients than by gastric bypass patients (mean, 3.8 versus 1.8). Weight loss was 6.3 and 21.0%, respectively (P < 0.001). More serious or clinically significant adverse events were seen in patients with gastric bypass over 3 years (51 versus 24).
"Gastric bypass is more effective than lifestyle-medical management intervention in achieving diabetes treatment goals, mainly by improved glycemic control," the authors write.
Several authors disclosed financial ties to pharmaceutical and medical device companies, including Covidien, which funded the study.
1. Ikramuddin S, Korner J, Lee WJ, et al. Durability of Addition of Roux-en-Y Gastric Bypass to Lifestyle Intervention and Medical Management in Achieving Primary Treatment Goals for Uncontrolled Type 2 Diabetes in Mild-to-Moderate Obesity: A Randomized Control Trial, Diabetes Care. 2016 June. doi:10.2337/dc15-2481. [Epub ahead of print]