Medical therapy

Metabolic surgery may be more effective than medical therapy for long-term control of type 2 diabetes

1. The 10-year remission rates were significantly higher for Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than for medical treatment.

2. Patients in the BPD and RYGB groups had fewer diabetes-related complications.

Level of evidence assessment: 1 (Excellent)

Overview of the study: Compared to conventional therapy, metabolic surgery results in significant short-term improvements in patients with type 2 diabetes. However, there is little evidence to study the long-term effectiveness of metabolic surgery. This single-center randomized controlled trial aimed to compare outcomes at 10 years of follow-up after Roux-en-Y Gastric Bypass (RYGB) and Biliopancreatic Diversion (BPD) surgery with medical treatment plus lifestyle interventions for treatment of type 2 Diabetes. The primary endpoint of this study was durability of diabetes remission at 10 years, while secondary endpoints included global glycemic control, change in metabolic syndrome markers, and glomerular filtration rate (GFR) . Diabetes remission was defined by fasting blood glucose 1 C

Click to read the study in The Lancet

Relevant reading: Bariatric surgery versus intensive medical therapy for diabetes – 5-year results

In depth [randomized controlled trial]: Between April 30, 2009 and October 31, 2011, 72 patients were assessed for eligibility at a single tertiary hospital in Italy. Includes people aged 30 to 60 with a BMI ≥ 35 kg/m2type 2 diabetes for at least 5 years and HbA1 C ≥7.0%. Patients with type 1 diabetes, history of bariatric surgery, pregnancy, and serious medical comorbidities were excluded. A total of 60 patients (20 in conventional medical therapy, 20 in BPD and 20 in RYGB) were enrolled in the study. 95.0% (57 of 60) of patients completed the 10-year follow-up.

Of all patients who were surgically treated, 37.5% (n=15) maintained diabetes remission throughout the study period. Specifically, in the intention-to-treat analysis, the 10-year remission rates for borderline personality disorder (50.0%, 95% confidence interval [CI] 29.9-70.1) and RYGB (25.0%, 95% CI 11.2-46.9) were significantly higher than those of medical treatment (5.5%, 95% CI 1.0 -25.7, p=0.0082). The relative risks were 9.0 (95% CI 1.3-63.5) for borderline personality disorder versus medical treatment and 4.5 (0.58-35.0) for RYGB versus medical treatment. 58.8% (20 of 34) of patients observed in remission 2 years after surgery experienced a relapse of hyperglycaemia during the follow-up period (BPD 52.6%, 95% CI 31.7-72, 7 vs. RYGB 66.7%, 95% CI 41.7-84.8). Compared to the medical treatment group (mean HbA1 C 7.6 ± 0.5%), patients in the surgery groups reported better glycemic control at 10 years of follow-up (mean DBP HbA1 C 6.4 ± 0.3% and RYGB means HbA1 C 6.7 ± 0.3%). A similar trend was reported for HbA1 C percent reduction from baseline (-0.8 ± 1.0% for medical versus -2.4 ± 1.6% for BPD versus 1.9 ± 1.6% for RYGB, p

Picture: PD

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