surgery

Bypass surgery leads to significantly better outcomes for type 2 diabetes, study suggests

by Barbara Hewitt on March 6, 2018

Gastric bypass surgery can give better control for diabetes and obesity than lifestyle changes, according to new research from the United States.

Scientists from the Joslin Diabetes Centre and Brigham and Women’s Hospital in Boston carried out a randomised clinical trial comparing two treatments and both groups of participants lost weight, had better diabetes management and an improved quality of life.

Gastric Bypass Surgery

(By bearsky23/Shutterstock.com)

However, those treated with a form of bariatric surgery known as Roux-en-Y gastric bypass did significantly better, after three years, than study participants provided with an intensive diabetes and weight management programme.

‘Our study demonstrates that in patients with mild-moderate obesity and type 2 diabetes, gastric bypass surgery leads to a sustained reduction in weight, improvement in glycaemic control, and decrease in cardiovascular risk compared to a medical diabetes and weight management program,’ said lead author Donald Simonson, of the BWH Division of Endocrinology, Diabetes and Hypertension.

‘Gastric bypass surgery and the medical/lifestyle intervention programme are not investigational, both are routinely available to patients at our institutions, and comparable programs exist at many other hospitals and health care facilities,’ he added.

According to Allison Goldfine, head of clinical research at Joslin and senior study author, given rapid advances in recent years in delivering both of these alternative treatments, the information from the study is very important for clinicians and patients to help them make the best decisions regarding treatment.

The study report says that after three years, patients given surgery saw dramatically greater weight loss, averaging 55 pounds compared to 11 pounds for those in the lifestyle management intervention.

The surgical group also lowered their haemoglobin A1c levels, a measure of blood sugar over several months, by an average of 1.79% compared to 0.39% for the lifestyle management group. Additionally, those given surgery showed significantly lower risk of coronary heart disease and stroke.

Although patients given the lifestyle intervention programme made encouraging initial progress in both weight loss and diabetes control, those improvements dropped noticeably over time.

‘Patients who had the gastric bypass procedure had superior ability to sustain changes both in weight and blood sugar, and they did so requiring less medication for their diabetes, their blood pressure and their lipids,’ Goldfine explained.

The two groups of trial participants generally self-reported similar improvements in quality of life overall and less distress in living with diabetes, which scientists call important positive outcomes.

Those given surgery did see a significantly higher impact of weight loss on their quality of life, and greater improvement in the domains of physical functioning, self-esteem, and work performance.

‘As a result of these findings, we expect that more physicians will consider gastric bypass surgery as a viable option for patients with type 2 diabetes and mild to moderate obesity when previous attempts to lose weight and improve glycaemic control have not been successful,’ said Simonson.

Goldfine emphasized, however, that treatment must be personalised for all patients who are struggling with obesity and diabetes, and that gastric bypass surgery is not always the best option. She pointed out that both surgical procedures and intensive lifestyle management techniques now take advantage of major medical advances achieved in the past decade or two.

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