Author Insights: Gastric Bypass Surgery Plus Lifestyle-Intensive Medical Management May Improve Type 2 Diabetes Control

Sayeed Ikramuddin, MD, of the University of Minnesota in Minneapolis, and colleagues found gastric bypass surgery and adherence to intensive-lifestyle medical management (taking diabetes medication plus supervised dieting and exercise) helped patients in controlling their type 2 diabetes. (Image: University of Minnesota)

Sayeed Ikramuddin, MD, of the University of Minnesota in Minneapolis, and colleagues found gastric bypass surgery combined with medication and lifestyle modifications helped patients control their type 2 diabetes. (Image: University of Minnesota)

Shedding pounds is a key element to treating type 2 diabetes, but even with this motivation, many people who want to lose weight have difficulty doing so. Weight loss through Roux-en-Y gastric bypass surgery along with lifestyle-intensive medical management—diabetes medication plus supervised dieting and exercise—may help patients achieve lower blood pressure; lower glucose levels; and lower levels of “bad cholesterol,” low-density lipoprotein cholesterol (LDL-C). The findings appear today in JAMA.

The research involved 120 patients treated at 4 teaching hospitals in Minnesota and Taiwan who were randomly assigned to lifestyle-intensive medical management alone or coupled with Roux-en-Y gastric bypass surgery. All patients had type 2 diabetes for at least 6 months, a hemoglobin A1c (HbA1c) level of 8.0% or higher, and a body mass index (BMI) between 30.0 and 39.9. At 12 months, 49% of patients undergoing both interventions and 19% of those receiving only lifestyle-intensive medical management achieved the designated goals of an HbA1c of less than 7.0%, systolic blood pressure less than 130 mm Hg, and an LDL-C less than 100 mg/dL.

Achieving these goals was attributed to weight loss, with those who had surgery experiencing an average loss of about 26% compared with about 8% of those receiving only intensive-lifestyle medical management.

Lead author Sayeed Ikramuddin, MD, of the University of Minnesota in Minneapolis, discusses his team’s findings:

news@JAMA: Why did you do the study?

Dr Ikramuddin: Type 2 diabetes is an epidemic and difficult to treat. The first step to treatment is weight loss—and however it’s achieved is good. The question is whether weight loss surgery helps people achieve their goals. The other key component to our study was to look at bariatric surgery in patients who are generally not considered appropriate for it. Traditionally bariatric surgery is reserved for patients with morbid obesity (BMIs greater than 40), but type 2 diabetes begins at BMI levels of 31, so we looked at patients with BMIs of 30 to 40.

news@JAMA: Other studies have also hinted at the benefits of bariatric surgery for the treatment of type 2 diabetes. How does your study add to the discussion?

Dr Ikramuddin: A criticism of the other studies is that they are from single centers of excellence and it’s hard to interpret the results to other settings. Our study involved 2 hospitals in the United States and 2 in Taiwan to study surgery’s effect on Asians, and we found similar results.

news@JAMA: Should bariatric surgery be a first-line therapy for treatment of type 2 diabetes?

Dr Ikramuddin: We have to balance our results against the risk for surgical complications. Surgery is good for people who are psychologically prepared for it. And there are complications—leaks, bleeding—and not everybody should have it. What we’re looking for are patients who can make the lifestyle changes to complement the surgery, to justify the risk-benefit ratio.

Categories: Bariatric Surgery, Diabetes Mellitus, Metabolic Diseases, Obesity