Weight Loss Surgery Beats Exercise, Diet For Obese Diabetics

Up to 40% of obese type 2 diabetes patients who underwent bariatric surgery were in least partial remission of diabetes at 3 years, compared to patients who followed an intensive, 1-year lifestyle intervention, reports a study from the University of Pittsburgh Medical Center.

In the single-center study, randomized obese patients with type 2 diabetes recieved either Roux-en-Y gastric bypass, or laparoscopic adjustable gastric banding surgery. Three years after the weight-loss surgery, more than two-thirds of those who had Roux-en-Y gastric bypass, and one-third of the people who had adjustable gastric banding to shrink their stomach, no longer needed any diabetes medications, the study found.

The lifestyle intervention treatment was based on the Action for Health in Diabetes (Look AHEAD) and Diabetes Prevention Program (DPP) studies. The patients went to meetings weekly for 6 months, then meetings every 2 weeks for 6 months, learning about weight loss, diet, exercise, and behavioral strategies, Dr Courcoulas said.

Lead author Anita P Courcoulas, MD, speaking to Medscape Medical News, said:

“This study provides further important evidence that at a longer-term follow-up of 3 years, surgical treatments including Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are superior to a lifestyle intervention alone for the remission of type 2 diabetes in individuals with obesity, including those with a body mass index [BMI] between 30 and 35 [class 1 obesity].”

The risks associated with weight-loss surgery are similar to those of other surgeries. They could include infection, bleeding, and blood clots which can travel to the lungs, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The cost of weight-loss surgery varies, but NIDDK estimates the cost to be generally between $20,000 and $25,000. Insurance coverage for the procedures depends on insurance company policy.

Dr Courcoulas and colleagues write that it is unclear if bariatric surgery provides durable, long-term remission from diabetes, and little has been known about bariatric-surgery outcomes in patients with class 1 obesity.

The study’s authors highlight that one key aspect of this study was the fact that more than 40 percent of the sample were people with class I obesity, meaning a BMI of 30 to <35, for whom data in the literature are largely lacking:

“Those who underwent a surgical procedure followed by low-level lifestyle intervention were significantly more likely to achieve and maintain glycemic control than were those who received intensive and then maintenance (low-level) lifestyle therapy alone, regardless of obesity class. More than two-thirds of those in the RYGB group and nearly half of the LAGB group did not require any medications for T2DM treatment at 3 years.”

Anita P. Courcoulas, MD, MPH; Steven H. Belle, PhD, MScHyg; Rebecca H. Neiberg, MS; Sheila K. Pierson, BS, BA; Jessie K Eagleton, MPH; Melissa A. Kalarchian, PhD; James P. DeLany, PhD; Wei Lang, PhD; John M. Jakicic, PhD
Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment: A Randomized Clinical Trial
JAMA Surg. Published online July 01, 2015. doi:10.1001/jamasurg.2015.153

Image: AJC1/Flickr

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