Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial

Abstract

Context Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment. Objective Compare the remission of T2DM following surgical or nonsurgical treatments. Design, setting, and participants Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016. Interventions 61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years. Main Outcomes and Measures Diabetes remission assessed at 5 years. Results The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01). Conclusions Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.

Microbial Adaptation Due to Gastric Bypass Surgery: The Nutritional Impact

“…Bariatric surgery is currently the most effective treatment option for achieving sustained weight loss and the resolution of obesity-related comorbidities, such as T2DM, NAFLD, cardiovascular disease and reduced mortality [9][10][11][12][13]. Bariatric surgery is recommended for individuals with a BMI of ≥ 40 kg/m 2 or a BMI of > 35 kg/m 2 with obesity-related comorbidities [30].…”

“…In particular, there is a difference in the intestinal ratio of Bacteroides and Firmicutes between lean and obese individuals with a greater relative abundance of Firmicutes in obese individuals. At present, only bariatric surgery seems to induce sustained weight loss and resolution of obesity-related morbidities, such as type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), hypertension and cardiovascular disease [8][9][10][11][12][13], relatively attributable to microbial alterations.…”

Systematic review with meta‐analysis: bariatric surgery reduces the incidence of hepatocellular carcinoma

“…Bariatric surgery is an evidence‐based approach for treating obesity which offers long‐lasting weight loss 6 . Bariatric surgery has also been shown to improve diabetes, fatty liver disease and cardiovascular conditions 7‐9 . Currently, there are three main bariatric surgical procedures including gastric bypass, gastric banding and sleeve gastrectomy 10 …”

A Comprehensive insight into the effect of chromium supplementation on oxidative stress indices in diabetes mellitus: A systematic review

“…It is thought that there is a causal correlation between inflammation and oxidative stress in renal and cardiovascular complications of diabetes 18 . Diabetes is usually managed with medication, lifestyle modifications and complementary therapies such as vitamins, minerals, and herbal extract 19,20 . According to previous studies, trivalent chromium is considered to be an insulin sensitizer that inhibits developing type 2 diabetes 21 .…”