Weight-loss surgery edges out lifestyle changes for type 2 diabetes

To evaluate the preoperative factors associated with remission of diabetes and weight loss after laparoscopic gastric band surgery, in the study titled “Predictive Factors of Insulin Resistance Resolution With Adjustable Gastric Band Surgery,” Pablo Colsa Gutierrez from the Servicio de Cirugıa General y del Aparato Digestivo, Hospital Sierrallana, Torrelavega in Cantabria, Spain and colleagues conducted a retrospective analysis of 95 patients who underwent an adjustable gastric band procedure.

The randomized clinical trial of 61 patients offers “further important evidence that at longer-term follow-up of 3 years, surgical treatments, including Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding, are superior to lifestyle intervention alone for the remission of type 2 diabetes mellitus in obese individuals, including those with a body mass index (BMI) between 30 and 35 [kg/m”, said Dr. Anita Courcoulas at the University of Pittsburgh Medical Center and her associates.

The use of diabetes medications was reduced more in the surgical groups than the lifestyle intervention-alone group, with 65 percent of RYGB, 33 percent of LAGB, and none of the intensive lifestyle weight loss intervention participants going from using insulin or oral medication at baseline to no medication at year 3. The third had a non-surgical intensive weight loss program in year one, followed by the less-intensive lifestyle program used with the other groups.

A study published on JAMA Surgery this Wednesday has found that weight loss surgery can treat type-2 diabetes better than shifting to a healthy lifestyle.

Mean (SE) HbA1c reductions were -1.42 percentage points (SD 0.43) in the RYGB group, -0.80 point (SD 0.32) in the LAGB group, and 0.21 point (SD 0.40) for the lifestyle intervention group (P=0.001 for RYGB versus lifestyle and P=0.04 for LAGB versus lifestyle).

[The study findings are] reminiscent of the Swedish Obesity Study, a nonrandomized study of 1,658 obese patients who underwent bariatric surgery and 1,771 obese matched controls. Insurance coverage of weight-loss surgeries depends on the policy of the insurance company.

The risks associated with these procedures are similar to those of other surgeries.

The cost of weight-loss surgery varies, but the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates the cost is generally between $20,000 and $25,000.

This study reveals that the simple, safe procedure and the resulting weight loss has a net positive effect on those looking to both lose weight and control their diabetes.

When diabetes returns, it has to be treated. What’s more, he said, newer lifestyle-only interventions can be very effective.

“For these young people, I do recommend bariatric surgery and we are using it more and more”, he said.

For middle-aged and older patients, Zonszein said he prefers to control their diabetes with medications.