Study Argues Surgery Trumps Lifestyle Changes in Type 2 Diabetes

For those diagnosed with type-2 diabetes who were looking for a reason to explore weight loss surgery as a means of controlling their diabetes or even putting it into remission, look no further than the July 1 issue of JAMA Surgery.

There, a study by Dr. Anita P. Courcoulas, of the University of Pittsburgh Medical Center, PA, and colleagues suggests that weight-loss surgery, combined with low-level lifestyle interventions, is more effective as a treatment strategy for obese patients with type 2 diabetes than lifestyle interventions alone.

They reached this conclusion by recruiting 61 obese patients aged 25-55 diagnosed with type-2 diabetes whom they randomly assigned to receive:

• Weight-loss surgery in the first year followed by a low-level lifestyle intervention for 2 years
• Intense lifestyle intervention for 1 year followed by a low-level lifestyle intervention for 2 years.

Those who were assigned to surgery received either roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB).

These surgical interventions achieve the same ends-- limiting the amount of food that can be consumed, leading to feeling 'full' sooner-- but do it through different mechanisms. In RYGB, surgeons create a small stomach pouch from a portion of the stomach and connect it to the small intestine, bypassing the rest of the stomach and the duodenum. In LAGB, surgeons place a band around the upper part of the stomach to create a smaller stomach pouch.

The research team was looking for instances of partial or complete remission from type-2 diabetes among the entire group after three years. This was the primary endpoint, and here is what they found:

• Among participants who had RYGB, 40 percent experienced partial or complete type 2 diabetes remission. Specifically, three people had complete remission.
• Among participants who had LAGB, 29 percent experienced partial or complete type 2 diabetes remission. Specifically, one patient had complete remission.
• Among participants who had lifestyle interventions only, there were no cases of remissions, either partial or complete.

They concluded that this study "provides further important evidence that at longer-term follow-up of 3 years, surgical treatments, including RYGB and LAGB, are superior to lifestyle intervention alone for the remission of T2DM in obese individuals including those with a BMI between 30 and 35."

Note: It is important to take into consideration that the study's lead investigator, Dr Courcoulas, reported potential conflicts of interest in the following: she has received grants from Nutrisystem, J&J Ethicon (a part of Johnson and Johnson, Ehticon's purpose is to "advance innovation in surgery") and medical supplies and devices company Covidien. Covidien and Allergan, maker of the LAP-BAND(R) Adjustable Gastric Banding System, have had a long-standing agreement to jointly promote the lap-band system.

Additionally, Dr Courcoulas is a project consultant for Ethicon and Apollo Endosurgery.

Source: JAMA Surgery