Bariatric surgery vs lifestyle intervention for diabetes treatment: 5-year outcomes from a randomized trial
Open accessAbstract
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.
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Bariatric surgery and endoscopic procedures are important therapeutic options in people with type 2 diabetes and ABCD.
“Bariatric surgery and endoscopic procedures are important therapeutic options in persons with T2D and ABCD.777–781”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [780]
The Discussion (page unavailable) concludes that bariatric surgery should be considered for treating type 2 diabetes in people with obesity. The paper does not support the additional claim that endoscopic procedures are therapeutic options; the upper endoscopy listed in its adverse-events table is not presented as a diabetes or obesity treatment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn clinical trials comparing bariatric surgery with medical treatment in people with type 2 diabetes, bariatric surgery results in greater short-term and long-term lowering of A1C, including remission of type 2 diabetes in some people.
“In clinical trials comparing bariatric surgery vs medical treatment in persons with T2D, bariatric surgery results in greater short-term and long-term lowering of A1C, including remission of T2D in some persons.777–783”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [780]
In the prospective SOS cohort study, bariatric surgery produced diabetes remission rates of 72% and 30% after 2 and 15 years, respectively, and was associated with a reduction in microvascular and macrovascular diabetes complications, including risk of cardiovascular death.
“In the prospective SOS (Swedish Obese Subjects) cohort study, bariatric surgery produced DM remission rates of 72% and 30% after 2 and 15 years, respectively, and was associated with a reduction in micro- and macrovascular DM complications, including risk of CV death.779,780”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [780]
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References 25 · Cited by 180
Research works printed but not linked: 1
- [17]17. Rubino F, Schauer P, Cummings D, Kaplan L, Cefalu W. World Conference on Interventional Therapies for Diabetes. http://www. worldconferencecalendar.com/component/option,com_conference/ page,show_ad/catid,9/adid,43817/Itemid,0/. Accessed April 20, 2019.
- Authors
- Courcoulas, A. P., Gallagher, J. W., Neiberg, R. H., Eagleton, E. B., DeLany, J. P., Lang, W., Punchai, S., Gourash, W., & Jakicic, J. M.
- Affiliations
- University of Pittsburgh (US)
- Wake Forest University Health Sciences (US)
- AdventHealth Orlando (US)
- University Hospital Zurich (CH)
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Courcoulas, Anita P
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2020-01-09
- Volume
- 105
- Issue
- 3
- Pages
- 866-876
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC7032894
- OpenAlex
- W2999398778
- Cited by
- 180
- References
- 25
- Citations by year
- 2026: 15 · 2025: 29 · 2024: 38 · 2023: 37 · 2022: 20 · 2021: 28 · 2020: 12 · 2019: 1
- FWCI
- 22.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095128)
- University of Pittsburgh Medical Center
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- bariatric surgery, type 2 diabetes, diabetes remission, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, obesity, long-term outcomes, weight loss
- MeSH terms
- Adult, Combined Modality Therapy, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Life Style, Male, Middle Aged, Remission Induction, Treatment Outcome, Risk Reduction Behavior, Bariatric Surgery, Weight Reduction Programs
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