Surgery vs Medication: Which is Better for Type 2 Diabetes?

Benefits from bariatric surgery in mildly obese patients with type 2 diabetes mellitus (T2DM) could last at least 5 years, according to a new study.

While previous research has shown that metabolic surgery can lead to short-term benefits in mildly obese patients with T2DM, little data is available on how long these effects are sustained.
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To further examine this issue, researchers conducted a retrospective cohort study of 351 mildly obese patients with T2DM, randomized between either metabolic surgery (n=51) or standard medical treatment (n=299).

The surgical group received either sleeve gastrectomy or bypass procedures, and was matched to the medical group by age, BMI, and diabetes duration.

After 5 years of follow-up, participants in the surgical group had a mean weight loss of 21%, a mean reduction in BMI from 31 to 24.5, a mean reduction in HbA1c from 9.1% to 6.3%, 36% experienced complete diabetes remission, and 28% experienced partial remission. One participant died, and 1 had end-stage renal disease.

In the medical group, 1.2% experienced complete remission, 1.6% had partial remission, 3% died, and 0.7% had end-stage renal disease. Their BMI and HbA1c levels remained similar throughout follow-up.

“For mildly obese patients with T2DM, the improvement in glycemic control from metabolic surgery lasts at least 5 years. However, the survival benefit and lifelong adverse outcomes require more than 5 years to be established,” they concluded.

—Michael Potts

Reference:
Hsu C, Almulaifi A, Chen J, et al. Effect of bariatric surgery vs. medical treatment on type 2 diabetes in patients with body mass index lower than 35. JAMA Surg. 2015 September 16 [Epub ahead of print]. doi: 10.1001/jamasurg.2015.2602.