Results Suggest Roux-en-Y Gastric Bypass Best Treatment for Diabetes, Highlight Trial Challenges

Roux-en-YMain Points:

Roux-en-Y gastric bypass surgery resulted in the greatest average weight and appears to be the best treatment for type 2 diabetes mellitus (T2DM) compared to gastric banding and lifestyle intervention in a clinical trial that also highlights the challenges to completing a larger trial with patients with a body mass index (BMI) of 30 to 40.

Published in:

JAMA Surgery

Author:

Anita P. Courcoulas, M.D., M.P.H., of the University of Pittsburgh Medical Center, and colleagues.

Background:

Questions remain unanswered about the role of bariatric surgery in the treatment of T2DM, including the safety, efficacy and economic impact. Answers could come in a large, multicenter randomized clinical trial (RCT), but such a trial would be costly and potentially difficult to execute.

How the Study Was Conducted:

The authors report the results of an RCT examining the feasibility of a larger study and comparing the effectiveness of two types of bariatric surgery Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) and an intensive lifestyle weight-loss intervention in adults with a BMI of 30 to 40 and T2DM. While 667 adults were assessed for eligibility, the trial included 69 participants (24 assigned to receive RYGB, 22 to LAGB and 23 to the lifestyle intervention).

Results:

Patients who had RYGB had the greatest weight change (-27 percent) compared with LAGB and the lifestyle intervention (-17.3 percent and -10.2 percent, respectively). No participants in the lifestyle intervention achieved partial or complete remission of T2DM at 12 months; 50 percent of the patients in the RYGB group had partial remission and 17 percent achieved complete remission, compared with the LAGB group where 27 percent of patients had partial T2DM remission and 23 percent had complete remission.

Discussion:

“This study highlights several potential challenges to successfully completing a larger RCT for treatment of T2DM and obesity in patients with a BMI of 30 to 40, including the difficulties associated with recruiting and randomizing patients to surgical vs. nonsurgical interventions.”

Reference:

Anita P. Courcoulas MD, MPH, Bret H. Goodpaster PhD, Jessie K Eagleton MPH, Steven H. Belle PhD, MScHyg, Melissa A. Kalarchian PhD, Wei Lang PhD, Frederico G. S. Toledo MD, John M. Jakicic PhD. Surgical vs Medical Treatments for Type 2 Diabetes Mellitus: A Randomized Clinical Trial. JAMA Surg. 2014;149(7):-. doi:10.1001/jamasurg.2014.467

Editor’s Note:

Authors made conflict of interest disclosures. This study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and other sources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory:

To contact author Anita P. Courcoulas, M.D., M.P.H., call Cyndy McGrath at 412-260-4586 or email mcgrathc3@upmc.edu.

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