Bariatric Surgery vs. Intensive Medical Therapy in T2D



Title: Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Taylor, Peter C. et al.


 

What You Need to Know:

Among type 2 diabetes patients with a body mass index (BMI) of 27–43, bariatric surgery plus intensive medical therapy was more effective vs. intensive medical therapy alone in lowering or resolving hyperglycemia.

Trial Design:

  • 5-year outcomes were assessed for 150 patients with type 2 diabetes and a BMI of 27–43 who were randomized to intensive medical therapy alone vs. intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy
  • At baseline, mean HbA1c was 9.2±1.5%, and mean BMI was 37±3.5
  • Primary outcome was HbA1c ≤6.0% with or without the use of diabetes medications

Key Outcomes:

  • 134 of the 149 patients (90%) completed 5 years of follow-up; 1 patient died
  • At 5 years, the primary endpoint was met by 5% (2/38) who received medical therapy alone vs. 29% (14/49) of patients who underwent gastric bypass (P=0.08) and 23% (11/47) of patients who underwent gastrectomy (P=0.17)
  • Greater mean percentage reduction from baseline HbA1c was seen in patients who had surgical procedures vs. medical therapy alone (2.1% vs. 0.3%; P=0.003)
  • Changes from baseline in body weight in the gastric-bypass and sleeve-gastrectomy groups were superior vs. changes in the medical therapy group (-23%, -19% vs. -5%, respectively)
  • Changes from baseline in levels of triglyceride (-40%, -29%, -8%) and HDL (32%, 30%, 7%), use of insulin (-35%, -34%, -13%) were greater in the gastric-bypass and sleeve-gastrectomy patients vs. medical therapy patients, respectively
  • Quality of life measures as shown by general health score increases and scores on the RAND 36-Item Health Survey were also higher in the gastric-bypass and sleeve-gastrectomy patients vs. medical therapy patients