Bariatric surgery ‘good therapeutic option’ for treating obesity, type 2 diabetes
Bariatric surgery is more effective than medical therapy for the long-term control of type 2 diabetes, according to an analysis of 10-year follow-up data published in The Lancet.
“Bariatric surgery is still regarded with suspicion, yet it is an incredible tool for obesity management,” Geltrude Mingrone, MD, PhD, professor of diabetes and nutrition at King’s College London and professor of internal medicine at the Catholic University of Rome, told Healio. “The results of our study, showing long-term bariatric surgery effectiveness for type 2 diabetes treatment with high-quality evidence, can help clinicians and policymakers ensure that bariatric surgery is appropriately considered in the management of people with obesity and type 2 diabetes.”
Mingrone and colleagues analyzed 10-year follow-up data from an open-label, single-center study conducted at a tertiary hospital in Rome. Participants with type 2 diabetes and a BMI of at least 35 kg/m² (n = 60) were randomly assigned to medical therapy (n = 20), Roux-en-Y gastric bypass (n = 20) or biliopancreatic diversion (n = 20). Primary endpoint was diabetes remission at 2 years, defined as an HbA1c of 6.5% or lower and a fasting glucose of 5.5 mmol/L or lower without medication for at least 1 year.
In the 10-year analysis, durability of diabetes remission was analyzed by intention to treat; 10-year follow-up rate was 95%.
Within the cohort, 15 participants, or 37.5%, maintained diabetes remission throughout the 10-year follow-up period. Ten-year remission rates in the intention to treat population were 5.5% for medical therapy (95% CI, 1-25.7; one participant went into remission after crossover to surgery), 50% for biliopancreatic diversion (95% CI, 29.9-70.1) and 25% for Roux-en-Y gastric bypass (95% CI, 11.2-46.9). Researchers observed that 20 of 34 participants who experienced diabetes remission at 2 years had a relapse of hyperglycemia during follow-up, with rates of 52.6% in the biliopancreatic diversion group and 66.7% in the Roux-en-Y gastric bypass group.
“All individuals with relapse, however, maintained adequate glycemic control at 10 years,” the researchers wrote.
Participants in the Roux-en-Y and biliopancreatic diversion groups had fewer diabetes-related complications compared with participants who received medical therapy, with an RR of 0.07 (95% CI, 0.01-0.48) for both comparisons. Serious adverse events occurred more frequently among participants in the biliopancreatic diversion and Roux-en-Y groups vs. those receiving medical therapy.
“Bariatric surgery ensures, in the long term, good glycemic control, reduction of macrovascular and microvascular complications, and net improvement of quality of life compared with standard of care treatment,” Mingrone said. “Although larger and multicenter randomized controlled trials are requested, bariatric surgery should be considered a good therapeutic option for treating people with obesity and type 2 diabetes, who have a poor glycemic control.”
In a prospective study published in The New England Journal of Medicine in August and reported by Healio, researchers assessed metabolic outcomes among a cohort of adults with obesity and type 2 diabetes who underwent Roux-en-Y gastric bypass or low-calorie diet therapy with education. In that study, researchers found that weight loss was associated with increased insulin-stimulated glucose disposal, increased beta-cell function and decreased the areas under the curve for 24-hour plasma glucose and insulin levels for the surgery and diet groups; however, there were no significant differences between the groups.
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Geltrude Mingrone, MD, PhD, can be reached at firstname.lastname@example.org.