Abstract
Context
Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment.
Objective
Compare the remission of T2DM following surgical or nonsurgical treatments.
Design, setting, and participants
Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016.
Interventions
61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years.
Main Outcomes and Measures
Diabetes remission assessed at 5 years.
Results
The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01).
Conclusions
Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.
Reply to a Letter to the Editor: Bariatric Surgery in Class I Obesity. A Position Statement from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)—Obesity Surgery 2014;24:487–519