Type 2 diabetes is one of the most challenging public health threats globally. Obesity is a risk factor, and obesity worsens the condition. Weight loss is pivotal in the management of diabetes and certainly is a goal for all type 2 diabetics. Bariatric surgery can assist in weight loss. Scientists recently did an observational study to determine if bariatric surgery (either gastric bypass or sleeve gastrectomy) along with intensive medical therapy was superior to intensive medication therapy alone in overweight or obese type 2 diabetics. What they found was encouraging.
Researchers randomized 218 overweight or obese type 2 diabetic patients into three groups: 1) medication therapy alone, 2) medication therapy plus gastric bypass surgery, and 3) medication therapy plus sleeve gastrectomy. All participants received counseling on lifestyle changes and were encouraged to participate in Weight Watchers. The goal (and predefined endpoint) of each of the three interventions was to bring the HbA1c to 6% (or lower) within 12 months (HbA1c is a measure of the average blood glucose levels over the past three months. It is more accurate than periodic home glucose testing).
Body weight, waist to hip ratio, HbA1c, and fasting blood glucose levels were measured in all of the study participants at months 3, 6, 9, and 12. Here are the results:
- 12% of the medication-only group achieved an HbA1c of 6% (or lower)
- 42% of the gastric bypass plus medication group achieved an HbA1c of 6% (or lower)
- 37% of the sleeve gastrectomy plus medication group achieved an HbA1c of 6% (or lower)
- The patients that underwent either gastric bypass surgery or sleeve gastrectomy experienced a large and rapid improvement (3 months) in HbA1c and fasting blood glucose levels.
- All of the gastric bypass patients that reached the desired HbA1c did so without medication, meaning they were eventually weaned off their initial medication regimen
- Of the successful sleeve gastrectomy patients, 28% required at least one diabetes medication
- On average medication use tended to increase in the medication-only group, and it tended to decrease in the two bariatric surgery groups
- Average weight loss in the medication-only group was 5.2%
- Average weight loss in the the gastric bypass plus medication group was 27.5%
- Average weight loss in the sleeve gastrectomy plus medication group was 24.7%
While these results are staggering and encouraging, it must pointed out that bariatric surgery is an invasive procedure. Even though it is now done laparoscopically, there is still a significant recovery period. This may not be a viable option for all obese type 2 diabetic people.