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T2DM

Bypass better banding for T2DM treatment

Partial and complete remission of T2DM were 50% and 17% in the bypass group

Roux-en-Y gastric bypass surgery resulted in the greatest average weight loss and appears to be the best treatment for T2DM compared to gastric banding and lifestyle intervention, according to a paper 'Surgical vs Medical Treatments for Type 2 Diabetes Mellitus - A Randomized Clinical Trial' published in JAMA Surgery. The outcomes from this clinical trial also highlighted several challenges of completing a larger trial with patients with a BMI>30-40.

The investigators from the University of Pittsburgh Medical Center said that many questions remain unanswered about the role of bariatric surgery for people with T2DM, and they designed a randomised clinical trial to compare initial outcomes of bariatric surgery and a structured weight loss programme for treating T2DM in participants with grades I and II obesity.

This single centre trial recruited 69 participants (aged 25-55) with a BMI>30-40, 56 (81%) were women and average haemoglobin A1c level was 7.9%. Sixty one patients were assigned to and received Roux-en-Y gastric bypass (n=20), laparoscopic adjustable gastric banding (n=21), and an intensive lifestyle weight loss intervention (n=20).

Primary outcomes in the intention-to-treat cohort were feasibility and effectiveness measured by weight loss and improvements in glycaemic control.

Outcomes

At 12 months, bypass participants had the greatest mean weight loss from baseline (27.0%; 95% CI, 30.8-23.3) compared with banding (17.3%; 95% CI, 21.1-13.5) and the lifestyle group (10.2%; 95% CI, 14.8-5.61) (p< 0.001).

Partial and complete remission of T2DM were 50% and 17%, respectively, in the bypass group and 27% and 23%, respectively, in the banding group (p<0.001 and p=0.047 between groups for partial and complete remission), with no remission in the lifestyle group.

Significant reductions in use of anti-diabetics occurred in both surgical groups. The mortality rate was zero and there were three serious adverse events included one ulcer treated medically in the bypass group and two rehospitalisations for dehydration in the banding group.

"This study highlights several potential challenges to successfully completing a larger randomised control trial for treatment of T2DM and obesity in patients with a BMI of 30 to 40, including the difficulties associated with recruiting and randomizing patients to surgical vs. nonsurgical interventions," conclude the authors from the University of Pittsburgh Medical Center. “Preliminary results show that RYGB was the most effective treatment, followed by LAGB for weight loss and T2DM outcomes at one year.”

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