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Weight Loss Surgery vs Medication for Obesity and Type 2 Diabetes

A five-year clinical study of patients with type 2 diabetes and an obese level body mass index (BMI) of 27-43 suggests that weight loss surgery helps more than medication.

Bariatric surgery is weight loss surgery for people with obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band in which the stomach is divided by the band and the small intestine is rerouted.

The weight loss surgery study outline

The study population included 150 obese patients with type 2 diabetes.

They were enrolled in the study based on the following criteria: age of 20 to 60 years, a glycated hemoglobin level of seven or more, and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43.

After receiving information about the study, all the patients voluntarily signed informed consent. Patients were randomly assigned to three groups: intensive medical treatment alone, intensive medical treatment with gastric bypass, or sleeve gastrectomy.

The initial analysis, conducted three years after the randomization of patients to medical therapy or surgical intervention, demonstrated favorable results in terms of glycemic control for patients who underwent bariatric surgical therapy as compared to patients who received medical therapy only.

Both gastric bypass and sleeve gastrectomy were effective in achieving glycemic control (evaluated by glycated hemoglobin level of 6% or less), reducing cardiovascular risk, and improving patients’ quality of life.

The weight loss surgery study follow-up

An article published in the New England Journal of Medicine provides a five-year follow-up analysis for the same study population, addressing the long-term efficacy and safety of bariatric surgery for people with type 2 diabetes.

Overall, 134 of the 150 patients (89%) were included in the five-year analysis. At baseline, the average age was 49 +/- 8, the average BMI was 37+/-3.5; the average glycated hemoglobin level was 9.2 +/-1.5%, and the average duration of diabetes was 8.4+/-5.2 years, with 44% of patients requiring insulin at baseline.

The authors report encouraging results five years after surgical intervention, showing that 14 of 49 patients (29%) in the gastric-bypass group (P = 0.01) and 11 of 47 patients (23%) in the sleeve-gastrectomy group (P = 0.03) had achieved glycated hemoglobin level of 6.0% or less, as compared to only 2 of 38 patients (5%) in the medical-therapy group (P = 0.01).

In addition, surgical groups showed a significant weight reduction (−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).

No significant differences in blood pressure or low-density lipoprotein cholesterol levels were observed among the three study groups.

Weight loss surgery and medication work best

This study indicates promising outcomes for patients undergoing bariatric surgery when combined with medication.

These promising outcomes include blood sugar response control, weight loss, use of fewer diabetic medications, and improvement in overall quality of life as compared with obese patients with type 2 diabetes who received medication therapy alone.

Reference

1. Shauer PR, Bhatt DL, Kirwin JP, et al. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. The New England Journal of Medicine. February 16, 2017. doi: 10.1056/NEJMoa1600869

 

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