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COSMID study

Surgery can control diabetes in obese Asian Indian patients

Study indicates that bariatric surgery is more effective than medical and lifestyle management in controlling type 2 diabetes in Asian Indian population

Data from an Ethicon-funded study presented at the American Diabetes Association’s annual meeting demonstrates bariatric surgery may be a better treatment option than medical therapy and lifestyle management alone for obese Asian Indian patients with inadequately controlled type 2 diabetes. The COSMID (Comparison of Surgery vs. Medicine for Indian Diabetes) Trial is the first randomized controlled study that specifically addresses the Asian Indian population, which develops type 2 diabetes at an earlier age and a lower BMI than Caucasians.

Elliott Fegelman

“There are more than 300 million people suffering from obesity in India and type 2 diabetes is growing at an alarming rate there,” said Dr Elliott Fegelman, Therapeutic Area Expert, Metabolics, Johnson & Johnson Innovations. “When compared to Caucasians, the Asian Indian population tends to get sick from diabetes at a lower BMI, but it was unclear if bariatric surgery would be as effective in this less obese population. The COSMID Trial filled that knowledge gap and the results prove that bariatric surgery is more effective at managing and controlling type 2 diabetes than medical and lifestyle management alone for this group.”

India’s population is the third most obese in the world and obesity is the number one cause of type 2 diabetes in India; over 80 percent of adult diabetics in India are clinically overweight. Asian Indians have a strong ethnic and genetic predisposition for developing diabetes at a younger age and at lower BMI than the Caucasian population. At the same weight as a Caucasian, an Asian Indian is at greater risk for obesity-related conditions such as heart disease and diabetes.

COSMID is a prospective, randomised, parallel-group, single centre clinical trial to compare the impact of Roux-en Y gastric bypass (plus medical therapy as needed) vs. optimal medical and lifestyle management among Asian Indian adults with type 2 diabetes and a BMI 25-40. The study results are from a five-year international scientific collaboration among Shah, Dr David Cummings, from the University of Washington, and Dr Keith Kim, Celebration Health, Florida.

The two-year study, following 80 subjects, found gastric bypass to be superior to medical management alone in treating patients with type 2 diabetes. COSMID is the first study to specifically address the Asian Indian population which has a different pathogenesis of type 2 diabetes than Caucasians.

Shashank Shah

“Current medical and lifestyle treatments for Asian Indians who suffer from obesity and type 2 diabetes are often inadequate to control morbidities and mortalities associated with these conditions. COSMID provides evidence that gastric bypass is a superior treatment to medical management alone, and should be an option for patients who qualify,” said Dr Shashank Shah, one of the principal investigators for the study, who presented the findings at the ADA Scientific Session. Shah is also this year’s recipient of the ADA’s prestigious Vivian Fonseca Scholar Award recognizing diabetes research focused on the South Asian, Asian American, Native Hawaiian, and Pacific Islander populations and/or research by a scientist from these areas of the world.

The results of the COSMID study are of importance not only to India, but also globally for Asian Indian populations wherever they reside - the Middle East, UK, Italy and Netherlands, as well as in North America have high concentrations of Asian Indians. Additionally, the results also could apply to other populations that tend to develop type 2 diabetes and other obesity related conditions at lower BMI’s than Caucasians.

The COSMID trial two year results, along with the recent five-year results of the STAMPEDE study, build on the existing body of evidence, demonstrating that surgery is a highly effective treatment for obesity-related diabetes for certain patients. 

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