Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A 1c , LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study
Open accessAbstract
Importance: The Roux-en-Y gastric bypass is effective in achieving established diabetes treatment targets, but durability is unknown. Objective: To compare durability of Roux-en-Y gastric bypass added to intensive lifestyle and medical management in achieving diabetes control targets. Design, Setting, and Participants: Observational follow-up of a randomized clinical trial at 4 sites in the United States and Taiwan, involving 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0% or higher and a body mass index between 30.0 and 39.9 (enrolled between April 2008 and December 2011) were followed up for 5 years, ending in November 2016. Interventions: Lifestyle-intensive medical management intervention based on the Diabetes Prevention Program and LookAHEAD trials for 2 years, with and without (60 participants each) Roux-en-Y gastric bypass surgery followed by observation to year 5. Main Outcomes and Measures: The American Diabetes Association composite triple end point of hemoglobin A1c less than 7.0%, low-density lipoprotein cholesterol less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg at 5 years. Results: Of 120 participants who were initially randomized (mean age, 49 years [SD, 8 years], 72 women [60%]), 98 (82%) completed 5 years of follow-up. Baseline characteristics were similar between groups: mean (SD) body mass index 34.4 (3.2) for the lifestyle-medical management group and 34.9 (3.0) for the gastric bypass group and had hemoglobin A1c levels of 9.6% (1.2) and 9.6% (1.0), respectively. At 5 years, 13 participants (23%) in the gastric bypass group and 2 (4%) in the lifestyle-intensive medical management group had achieved the composite triple end point (difference, 19%; 95% CI, 4%-34%; P = .01). In the fifth year, 31 patients (55%) in the gastric bypass group vs 8 (14%) in the lifestyle-medical management group achieved an HbA1c level of less than 7.0% (difference, 41%; 95% CI, 19%-63%; P = .002). Gastric bypass had more serious adverse events than did the lifestyle-medical management intervention, 66 events vs 38 events, most frequently gastrointestinal events and surgical complications such as strictures, small bowel obstructions, and leaks. Gastric bypass had more parathyroid hormone elevation but no difference in B12 deficiency. Conclusions and Relevance: In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement. Trial Registration: clinicaltrials.gov Identifier: NCT00641251.
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In the Swedish Obesity Subjects study, after 24-year follow-up, bariatric surgery was associated with prolonged life expectancy compared with lifestyle and intensive medical management alone.
“Data from the Swedish Obesity Subjects (SOS) study revealed that after 24-year follow-up, bariatric surgery was associated with a prolonged life expectancy compared with lifestyle and intensive medical management alone.73,74”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [73]
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- Authors
- Ikramuddin, S., Korner, J., Lee, W.-J., Thomas, A. J., Connett, J. E., Bantle, J. P., Leslie, D. B., Wang, Q., Inabnet, W. B., Jeffery, R. W., Chong, K., Chuang, L.-M., Jensen, M. D., Vella, A., Ahmed, L., Belani, K., & Billington, C. J.
- Affiliations
- University of Minnesota (US)
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York
- National Taiwan University Hospital (TW)
- Mount Sinai Hospital (US)
- Min Sheng General Hospital (TW)
- Mayo Clinic (US)
- Harlem Hospital Center (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2018-01-16
- Volume
- 319
- Issue
- 3
- Pages
- 266
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5833547
- OpenAlex
- W2782960618
- Cited by
- 291
- References
- 29
- Citations by year
- 2026: 11 · 2025: 31 · 2024: 26 · 2023: 41 · 2022: 34 · 2021: 40 · 2020: 49 · 2019: 35 · 2018: 23 · 2017: 1
- FWCI
- 38.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR002494, UL1TR000040)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK050456, P30DK026687)
- National Center for Research Resources (UL1RR024156)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- Roux-en-Y gastric bypass, bariatric surgery, type 2 diabetes, lifestyle intervention, glycemic control, HbA1c, LDL cholesterol, systolic blood pressure, obesity, lookahead, Diabetes Prevention Program, long-term outcomes, body mass index, diabetes remission
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Life Style, Cholesterol, LDL, Middle Aged, Taiwan, Gastric Bypass, Treatment Outcome
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